Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Feuerlein Center of Translational Addiction Medicine, Germany.
Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; MEDIAN Klinik Wilhelmsheim, Oppenweiler, Germany.
Drug Alcohol Depend. 2019 Feb 1;195:52-58. doi: 10.1016/j.drugalcdep.2018.11.020. Epub 2018 Dec 10.
Attention-deficit/hyperactivity disorder (ADHD) is a common comorbid disorder that is frequently overlooked in adults with alcohol use disorder (AUD). Moreover, identifying ADHD in AUD patients is time-consuming and difficult. The aim of this study was to assess the clinical utility of two self-report screening instruments for adult ADHD in AUD patients.
404 adults seeking residential treatment for AUD were screened using the Conners' Adult ADHD Rating Scale Screening Self-Rating (CAARS-S-SR) and the Adult ADHD Rating Scale (ASRS). Results were compared with ADHD diagnosis obtained from a stepped approach: first, a structured interview (Diagnostic Interview for ADHD in adults 2.0.; DIVA) was applied; second, probable ADHD diagnoses had to be confirmed by two expert clinicians.
At the previously reported cut-off values, ASRS and CAARS-S-SR showed low sensitivities of 57.1 and 70.6%. A high number of false negative results (NPV ASRS: 89.5%; CAARS-S-SR: 92.3%) indicates underreporting of ADHD symptoms. Sensitivity improved at lower cut-off (ASRS ≥ 11; CAARS-S-SR ≥60) or with a combination of both instruments at lower cut-offs. Area Under the Curve (AUC) for the combination of ASRS and CAARS-S-SR was superior to the AUCs of the single questionnaires.
Underreporting of ADHD symptoms in ASRS and CAARS-S-SR of AUD patients requires lower cut-off values to detect the majority of ADHD, albeit at the expense of an increased rate of false-positive results. Cut-off values should be adjusted to the clinical setting. Clinicians should take into consideration that a negative screening result does not necessarily imply absence of ADHD.
注意力缺陷/多动障碍（ADHD）是一种常见的共病障碍，在患有酒精使用障碍（AUD）的成年人中经常被忽视。此外，识别 AUD 患者中的 ADHD 既费时又困难。本研究旨在评估两种用于 AUD 患者成人 ADHD 的自我报告筛查工具的临床实用性。
对 404 名寻求酒精使用障碍住院治疗的成年人使用康纳斯成人 ADHD 评定量表筛查自评（CAARS-S-SR）和成人 ADHD 评定量表（ASRS）进行筛查。结果与通过递进方法获得的 ADHD 诊断进行比较：首先，应用结构化访谈（成人 ADHD 诊断访谈 2.0；DIVA）；其次，必须由两名专家临床医生确认可能的 ADHD 诊断。
在之前报道的截断值下，ASRS 和 CAARS-S-SR 的敏感性分别为 57.1%和 70.6%，较低。大量假阴性结果（NPV ASRS：89.5%；CAARS-S-SR：92.3%）表明 ADHD 症状报告不足。敏感性在较低截断值（ASRS≥11；CAARS-S-SR≥60）或使用两个仪器的组合在较低截断值下提高。ASRS 和 CAARS-S-SR 组合的曲线下面积（AUC）优于单个问卷的 AUC。
AUD 患者的 ASRS 和 CAARS-S-SR 中 ADHD 症状报告不足，需要较低的截断值来检测大多数 ADHD，但代价是假阳性结果的增加。截断值应根据临床情况进行调整。临床医生应考虑到阴性筛查结果不一定意味着不存在 ADHD。
