Factor structure and clinical correlates of the 61-item Wender Utah Rating Scale (WURS)

Effects of one single-dose methylphenidate compared to one single-dose placebo on QbTest performance in adults with untreated ADHD: a randomized controlled trial

BACKGROUND

Treatment of adults with attention-deficit/hyperactivity disorder (ADHD) primary involves methylphenidate (MPH). Earlier studies have identified placebo responders to increase toward the end of the treatment periods. However, little is known about the immediate effects of placebo on the core symptoms of ADHD in adults. The present study aimed to examine the effects of one single-dose MPH compared to one single-dose placebo during clinical assessments with continuous performance tests (CPT).

METHODS

In a randomized study with cross-over design, 40 adults between 19 and 64 years (72.5% women) with untreated ADHD were consecutively enrolled. The study comprised two trial days with four days in between. The QbTest was performed twice on the same day, before and 80 min after intake of one single-dose 20 mg immediate release methylphenidate (IR-MPH) and with one single-dose placebo, in randomized order.

RESULTS

Performance improved in QbInattention, F (3, 117) = 38.25, p < 0.001, after given IR-MPH (mean diff = 1.14) and after placebo (mean diff = 0.60) with the effect sizes 1.17 and 0.63 respectively. IR-MPH improved performance in QbActivity (mean diff = 0.81, p < 0.001) and QbImpulsivity (mean diff = 0.46, p < 0.04). The proportion of improvements (a decrease by ≥ 0.5 Qb-score) in the parameters QbInattention, QbActivity and QbImpulsivity were 90%, 60% and 52.5%, respectively. After given placebo, corresponding proportions were 60%, 30% and 35%, respectively.

CONCLUSIONS

There seems to be an immediate placebo response in the core symptom inattention. The effect of placebo cannot be ruled out and must be taken in consideration during drug trials with continuous performance tests (CPTs).

TRIAL REGISTRATION

ClinicalTrials.gov; Identifier: NCT02473185.

Contrasting expectancy effects with objective measures in adults with untreated ADHD during QbTest

Expectancy has been associated with neuropsychological assessments and cognitive performance. However, little is known about the effects of expectations in clinical assessments during drug trials with continuous performance tests (CPTs). In a randomized, double-blind study with cross-over design, we examined if the participants' self-reported expectations changed after one-single dose immediate release methylphenidate (MPH) and after one-single dose placebo during the QbTest. Forty adults between 19 and 64 years (72.5% women) with un treated ADHD were consecutively enrolled in the study and their assessments of expected performance, mental effort, perceived performance and help from the pill were analyzed. The study comprised two trial days with four days in between. The QbTest was performed twice on the same day, before and 80 minutes after a pill. Our study demonstrates that there were expectancy effects during CPTs. Participants reported lower mental effort and improved their performance in the coronary parameter QbInattention both after MPH and after placebo. No significant differences in expected performance were reported. The participants seemed to show some uncertainty when assessing their expected performance, however, they could evaluate their performance afterwards. In clinical practice, the focus should be on reinforcing patients' expectations in order to increase treatment effects.

Association of Wender Utah Rating Scale (WURS)-61 items with clinical psychiatric diagnosis in adulthood

BACKGROUND

The Wender Utah Rating Scale (WURS) is a widely used retrospective scale in adults presenting for ADHD evaluations which features items relating to childhood symptoms.

AIMS

The aim of this study is to establish if certain childhood symptoms (including ADHD) as identified by the WURS-61 are associated with specific mental health disorders in adulthood.

METHODS

Case-control study of N=630 attending Adult Mental Health Services (AMHS) and a control group without mental disorders (N=96).

RESULTS

The mean age of the participants was 39.81 (SD 12.94) of which 387 (53.3%) were females. There were no significant differences between cases and controls in terms of age (t= 1.829, df 724, p=.068) and gender (x²=1.123, df 1, p=.289). Exploratory factor analysis of WURS-61 reveals 5 factors. Using factor scores and after cross-tabulation, we found that: The presence of childhood impulsivity, emotional lability and distress in addition to inattention/disorganisation were significantly associated with adult ADHD diagnosis (F90). WURS items which suggests childhood conduct problems were associated with a number of adult diagnoses, when present either on its own (psychoactive substance use, or when present in combination with childhood impulsivity, emotional lability and distress (personality disorders).

CONCLUSION

There is an association between certain childhood behaviours and risk for later development of personality disorders, and psychoactive substance use. There is overlap of childhood symptoms to those who later diagnosed in adulthood with ADHD, personality disorders, and substance abuse.

Wender Utah Rating Scale: Psychometrics, clinical utility and implications regarding the elements of ADHD

The Wender Utah Rating Scale (WURS) is a self-report instrument completed by adults assessing a range of childhood symptoms and behaviors consistent with ADHD persisting into adulthood. Many items reflect emotional dysregulation. Although over 30 publications have examined its psychometric properties, reliance on non-clinical samples has limited conclusions from these reports, as have sub-optimal statistical approaches in most previous publications. None compared the full WURS to the abbreviated WURS-25. We evaluated both versions with adults presenting for treatment: 137 with ADHD and 230 with GAD or MDD, along with 120 normal controls. Factor analysis was performed on the full WURS using the clinical cohorts. The WURS versions were compared using ANOVA, logistic regression, ROC and confusion matrices. Consistent with two previous reports, the full WURS generated five factors: Disruptive mood & behavior, ADHD, Anxiety/dysphoria, Social and Academic. The ADHD factor correlated r > 0.8 with the Disruptive mood/behavior and the Academic factor. ADHD patients scored higher than GAD/MDD subjects (p < .001) on the Disruptive mood & behavior, ADHD, and Academic factors. The WURS-25 produced good separation of ADHD subjects from normal controls with ROC (AUC = 0.974) and logistic regression (Sensitivity = 91%, Specificity = 92%). Conversely, the full WURS better separated ADHD subjects from psychiatric controls with both ROC (AUC = 0.995) and logistic regression (Sensitivity = 84%, Specificity = 94%). Use of the full WURS with its five factors proved more successful at distinguishing ADHD from MDD and GAD than did the WURS-25. Its factors identify symptoms, including those of emotional dysregulation, critical to understanding ADHD.

"Like parent, like child": Attention deficit hyperactivity disorder-like characteristics in parents of ADHD cases

The objective of this study was to characterize an attention deficit hyperactivity disorder (ADHD) endophenotype in non-affected parents of adolescents with a history of ADHD, based on the relationship between performance on a sustained attention test (continuous performance task, or CPT) and polymorphisms of the DRD4 gene. In a sample of 25 non-affected parents of adolescents with ADHD history obtained from a longitudinal study of a nonclinical population, and 25 non-affected parents of adolescents with no ADHD history, four groups were evaluated with respect to the presence or absence of the long allele polymorphism of the DRD4 gene (i.e., over seven repeats). Comparisons of CPT performance among the four study groups included the number of commission errors, the number of omission errors, mean reaction time on correct responses (MRT), and reaction time (RT) variability (mean standard deviation of RT in each block [SDRT, as variability], and the sigma and tau components of the ex-Gaussian approach). The group of non-affected parents of adolescents with ADHD history and at least one long allele of the DRD4 gene showed greater RT variability (measured by SDRT), which is best explained by the greater frequency of abnormally slow responses (measured by tau). An association between the presence of the long allele of the DRD4 gene polymorphism and ADHD-like failure in CPT performance was evident in the non-affected parents of adolescents with ADHD in childhood. These findings suggest that certain traits of CPT performance could be considered an ADHD endophenotype.