ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Psychol Med. 2020 Apr;50(5):857-866. doi: 10.1017/S003329171900076X. Epub 2019 Apr 10.
ADHD diagnosis requires the presence of symptoms before the age of twelve. In clinical assessment of adults, the most frequent strategy to check this criterion is investigating self-report recall of symptoms, despite little evidence on the validity of this approach. We aim to evaluate the recall accuracy and factors associated with its reliability in a large population-based sample of adults.
Individuals from the 1993 Pelotas Birth Cohort were followed-up from childhood to adulthood. At the age of 22, 3810 individuals were assessed through structured interviews by trained psychologists regarding mental health outcomes, including ADHD diagnosis and ADHD symptoms in childhood. The retrospective recall was compared with available information on ADHD childhood symptoms at the age of eleven. We also assessed factors related to recall accuracy through multiple regression analyses.
Self-reported recall of childhood symptoms at 22 years of age had an accuracy of only 55.4%, with sensitivity of 32.8% and positive predictive value of 40.7%. Current inattention symptoms were associated with lower risk and social phobia with higher risk for false-positive endorsement, while higher levels of schooling correlated with lower risk and male gender with higher risk for false-negative endorsement.
Clinicians treating male patients with social phobia and ADHD symptoms should assess even more carefully retrospective recall of ADHD childhood symptoms. Moreover, characteristics associated with recall improvement do not impact accuracy robustly. In this context, the recall of childhood ADHD symptoms seems an unreliable method to characterize the neurodevelopmental trajectory in adults with currently-impairing ADHD symptomatology.
ADHD 的诊断需要在 12 岁之前出现症状。在对成年人进行临床评估时，检查这一标准的最常见策略是调查症状的自我报告回忆，尽管这种方法的有效性证据很少。我们的目的是在一个基于大人群样本的成年人中评估回忆的准确性及其可靠性相关因素。
1993 年佩洛塔斯出生队列的个体从儿童期一直随访到成年期。在 22 岁时，通过接受过培训的心理学家对 3810 名个体进行了结构化访谈，以评估心理健康结果，包括 ADHD 诊断和儿童时期的 ADHD 症状。回顾性回忆与 11 岁时 ADHD 儿童症状的可用信息进行了比较。我们还通过多元回归分析评估了与回忆准确性相关的因素。
22 岁时自我报告的儿童期症状回忆准确性仅为 55.4%，敏感性为 32.8%，阳性预测值为 40.7%。当前的注意力不集中症状与较低的风险相关，社交恐惧症与较高的假阳性风险相关，而较高的教育水平与较低的风险相关，男性与较高的假阴性风险相关。
治疗有社交恐惧症和 ADHD 症状的男性患者的临床医生应更仔细地评估 ADHD 儿童时期症状的回顾性回忆。此外，与回忆改善相关的特征并不能稳定地影响准确性。在这种情况下，回忆儿童时期的 ADHD 症状似乎是一种不可靠的方法，无法准确描述目前存在 ADHD 症状的成年人的神经发育轨迹。
