Diagnostic accuracy of a brief screening tool forAttention Deficit/Hyperactivity Disorder in UK prison inmates
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background: Attention Deficit/Hyperactivity Disorder (ADHD) is overrepresented in prison, making
it imperative to identify a screening tool that can be quickly applied to efficiently detect the disorder.
We explored the discrimination ability of a widely used ADHD screen, the Barkley Adult ADHD
Rating Scale (BAARS-IV), against a clinical diagnostic interview. A brief version of the screen was
then developed in order to simplify its use in the prison context, and maximise its diagnostic
properties. Methods: A cross-sectional study of 390 male prison inmates performed in the United
Kingdom, who were all screened and interviewed via the Diagnostic Interview for ADHD in Adults
2.0 (DIVA-2). Results: A total of 47 (12.1%) inmates screened positive for ADHD using the full
BAARS-IV, and 96 were clinically diagnosed (24.6%), for a sensitivity of 37.9 and specificity of
96.3. Our models identified the six items that most predicted ADHD diagnosis, with adjusted Odds
Ratios (OR) ranging from 2.66 to 4.58. Sensitivity, specificity and accuracy were 0.82, 0.84 and 0.84
for the developed brief scale, and 0.71, 0.85 and 0.81 for its validation, with weighted probability
scores producing AUC of 0.89 and 0.82, respectively. Conclusions: The original BAARS-IV
performed poorly at identifying prison inmates with ADHD. Our developed brief scale substantially
improved diagnostic accuracy. The brief screening instrument has great potential to be used as an
accurate and resource effective tool to screen young people and adults for likely ADHD in the
criminal justice system.
it imperative to identify a screening tool that can be quickly applied to efficiently detect the disorder.
We explored the discrimination ability of a widely used ADHD screen, the Barkley Adult ADHD
Rating Scale (BAARS-IV), against a clinical diagnostic interview. A brief version of the screen was
then developed in order to simplify its use in the prison context, and maximise its diagnostic
properties. Methods: A cross-sectional study of 390 male prison inmates performed in the United
Kingdom, who were all screened and interviewed via the Diagnostic Interview for ADHD in Adults
2.0 (DIVA-2). Results: A total of 47 (12.1%) inmates screened positive for ADHD using the full
BAARS-IV, and 96 were clinically diagnosed (24.6%), for a sensitivity of 37.9 and specificity of
96.3. Our models identified the six items that most predicted ADHD diagnosis, with adjusted Odds
Ratios (OR) ranging from 2.66 to 4.58. Sensitivity, specificity and accuracy were 0.82, 0.84 and 0.84
for the developed brief scale, and 0.71, 0.85 and 0.81 for its validation, with weighted probability
scores producing AUC of 0.89 and 0.82, respectively. Conclusions: The original BAARS-IV
performed poorly at identifying prison inmates with ADHD. Our developed brief scale substantially
improved diagnostic accuracy. The brief screening instrument has great potential to be used as an
accurate and resource effective tool to screen young people and adults for likely ADHD in the
criminal justice system.
Date Issued
2016-02-12
Date Acceptance
2016-01-12
Citation
Psychological Medicine, 2016, 46 (7), pp.1449-1458
ISSN
1469-8978
Publisher
Cambridge University Press
Start Page
1449
End Page
1458
Journal / Book Title
Psychological Medicine
Volume
46
Issue
7
Copyright Statement
© Cambridge University Press 2016. The final publication is available via Cambridge Journals Online at http://dx.doi.org/10.1017/S0033291716000039
Sponsor
Shire Pharmaceuticals Development Ltd
Grant Number
n/a
Subjects
Psychiatry
1701 Psychology
1117 Public Health And Health Services
1109 Neurosciences
Publication Status
Published