Prevalence of ADHD symptom malingering, nonmedical use, and drug diversion among college-enrolled adults with a prescription for stimulant medications

Further validation of the Parent-Reported ADHD Symptom Infrequency Scale (PRASIS) in parents of children with oppositional defiant disorder and anxiety

This study aimed to validate a novel parent-report measure of ADHD symptom inflation, the Parent-Reported ADHD Symptom Infrequency Scale (PRASIS), in a clinical sample. The PRASIS is composed of an Infrequency subscale and an ADHD subscale. Online participants were assigned to one of three groups: mothers of children with diagnosed ADHD (n = 110), mothers of children with diagnosed ODD and/or anxiety (n = 116), and mothers of children without ADHD, ODD, or anxiety. The third group was then randomized to either receive instructions to complete the questionnaire honestly (controls, n = 164) or to complete the questionnaire as if they were trying to convince a provider that their child has ADHD (simulators, n = 141). Results indicated good to excellent internal consistency (INF α = .83, ADHD Total α = .93); strong convergent validity of the PRASIS ADHD scale with the ADHD Rating Scale-5 (r(529) = .85, p < .001); excellent group discrimination of the PRASIS Infrequency scale and the PRASIS ADHD scale (η2 = 0.38-0.42); and specificity of 86.7, sensitivity of 67.4%, and an AUC of .86 for the Infrequency scale. Overall, these outcomes supported the utility of the PRASIS in samples including mothers of children with psychiatric diagnoses of ODD and/or anxiety.

Overcoming defensive responding in the estimation of prevalence of non-medical use of prescription stimulants

BACKGROUND

Prevalence of Non-Medical Use of Prescription Stimulants (NMUPS) is estimated to be high among young adults enrolled in college. However, precise estimation of the prevalence of NMUPS is challenging owing to biases affecting self-report of sensitive and potentially illegal behaviors.

OBJECTIVE

This study aimed to estimate the prevalence and risk factors of NMUPS using the crosswise randomized response technique (CRRT) and compare findings to the traditionally-used direct self-report (DSR) method.

METHODS

This study utilized a cross-sectional, randomized experimental design to survey adult undergraduate students at a major southeastern university in the United States. Eligible respondents were randomly assigned to a DSR group or a CRRT group. Those in the DSR group were presented a direct question about NMUPS, but those in the CRRT group were asked to indicate whether their response to the NMUPS question was the 'same' or 'different' compared to a random non-sensitive question.

RESULTS

Prevalence of NMUPS was found to be 18.6% (95% CI:18.5%-18.7%) in the DSR group and 32.5% (95% CI:32.1%-32.9%; p = 0.003) in the CRRT group. Logistic regression analysis predicting NMUPS in the DSR group showed that it was significantly associated with positive expectancies (OR:3.50; 95% CI:2.44-5.02), negative expectancies (OR:0.49; 95% CI:0.35-0.68), perceived norms (OR:1.71; 95% CI:1.27-2.29), and religious beliefs (OR:0.69; 95% CI:0.52-0.92).

CONCLUSIONS

The setting and mechanism of the survey is likely closely related to the validity of prevalence estimation of sensitive behaviors. This study found that prevalence of sensitive behaviors such as NMUPS is significantly higher when respondents are provided increased anonymity.

Attention deficit/hyperactivity disorder in adults: A case study

Attention-Deficit/Hyperactivity Disorder (ADHD) is often misdiagnosed or mistreated in adults because it is often thought of as a childhood problem. If a child is diagnosed and treated for the disorder, it often persists into adulthood. In adult ADHD, the symptoms may be comorbid or mimic other conditions making diagnosis and treatment difficult. Adults with ADHD require an in-depth assessment for proper diagnosis and treatment. The presentation and treatment of adults with ADHD can be complex and often requires interdisciplinary care. Mental health and non-mental health providers often overlook the disorder or feel uncomfortable treating adults with ADHD. The purpose of this manuscript is to discuss the diagnosis and management of adults with ADHD.

Upstream Approaches to Addressing Prescription Stimulant Misuse and Diversion: Exploring Perspectives of College Students Who Misuse and Divert

Background

We interviewed college students who engage in prescription stimulant misuse and diversion to better understand perspectives on prevention and intervention strategies.

Methods

Trained student researchers at one southern California university completed 32 face-to-face interviews with students who had a history of misuse and/or diversion. Participants provided insights on programs, policies, and practices that have the potential to deter behavior. Data were analyzed inductively via thematic analysis.

Results

Students were often misinformed or unaware of existing programs, policies and practices. Additionally, some students felt their behaviors would not be detected, whereas other students felt the fear of being detected would lead them to change their behaviors. Harm reduction and treatment-based approaches to address misuse were also recommended.

Conclusions

Our findings emphasize the importance of better educating students about, and enforcing, existing policies. In addition, the need to better inform students of existing campus programs is warranted.

Empirically-informed guidelines for first-time adult ADHD diagnosis

INTRODUCTION

Adult Attention Deficit/Hyperactivity Disorder (ADHD) is prone to misdiagnosis because its symptoms are subjective, share features with a broad range of mental, behavioral and physical disorders, and express themselves heterogeneously. Furthermore, Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for adult ADHD diagnosis remain underdeveloped, prompting a need for systematic and empirically-informed guidelines.

METHOD

This article presents a brief history of research on adult ADHD and reviews common sources of false positive and false negative diagnoses. A systematic, stepped diagnostic procedure is described that adheres to DSM guidelines and integrates the latest science on adult ADHD assessment and diagnosis.

RESULTS

Seven steps are recommended: a structured diagnostic interview with the patient, collection of informant ratings, casting a wide net on symptoms using "or rule" to integrate informant reports, providing checks and balances on the "or rule" by enforcing the impairment criterion, chronicling a symptom timeline, ruling out alternative explanations for symptoms, and finalizing the diagnosis.

CONCLUSIONS

Based on the extant research, it is expected that the stepped diagnostic procedure will increase detection of malingering, improve diagnostic accuracy, and detect non-ADHD cases with subclinical difficulties or non-ADHD pathologies.