Hong, Minha
(Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine)
,
Lee, Young Sik
(Department of Psychiatry, Chung-Ang University College of Medicine)
,
Kim, Bongseog
(Department of Psychiatry, Inje University College of Medicine)
,
Joung, Yoo Sook
(Department of Psychiatry, Sungkyunkwan University College of Medicine)
,
Yoo, Hanik K
(Seoul Brain Research Institute)
,
Kim, Eui-Jung
(Department of Psychiatry, College of Medicine, Ewha Womans University)
,
Lee, Soyoung Irene
(Department of Psychiatry, Soonchunhyang University College of Medicine)
,
Bhang, Soo Young
(Department of Psychiatry, Eulji University School of Medicine)
,
Lee, Seung Yup
(Department of Psychiatry, Kyung Hee University School of Medicine)
,
Han, Doughyun
(Department of Psychiatry, Chung-Ang University College of Medicine)
,
Bahn, Geon Ho
(Department of Psychiatry, Kyung Hee University School of Medicine)
Objectives: This study was conducted to re-validate the clinical efficacy of the Korean Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale (K-AARS), which is a self-report scale for ADHD in adults, and to determine the clinical utility and cut-off scores of K-AARS. Methods: The parti...
Objectives: This study was conducted to re-validate the clinical efficacy of the Korean Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale (K-AARS), which is a self-report scale for ADHD in adults, and to determine the clinical utility and cut-off scores of K-AARS. Methods: The participants were 135 drug naïve adults with ADHD and 144 healthy controls. To diagnose ADHD based on the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, two board-certified pediatric psychiatrists interviewed the participants and completed the Mini International Neuropsychiatric Interview. K-AARS was applied to all participants. K-AARS comprises six clinical subscales, one impairment subscale, and one driving behavior subscale. The receiver operating characteristic analysis was conducted to calculate the cut-off scores of K-AARS. Results: All subscale scores, including six clinical subscale, impairment subscale, and driving behavior subscale scores, were found to be significant in distinguishing adults with ADHD from healthy controls. The sensitivity and specificity of the six clinical subscales were 63.0-77.0% and 66.7-79.9%, respectively. The combined total score of the six clinical subscales, had a sensitivity of 80.0% and specificity of 79.9%. Conclusion: The discriminative power of K-AARS for the diagnosis of ADHD in adults was excellent, and K-AARS and the empirical diagnosis of adults can be useful in diagnosing ADHD in adulthood.
Objectives: This study was conducted to re-validate the clinical efficacy of the Korean Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale (K-AARS), which is a self-report scale for ADHD in adults, and to determine the clinical utility and cut-off scores of K-AARS. Methods: The participants were 135 drug naïve adults with ADHD and 144 healthy controls. To diagnose ADHD based on the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, two board-certified pediatric psychiatrists interviewed the participants and completed the Mini International Neuropsychiatric Interview. K-AARS was applied to all participants. K-AARS comprises six clinical subscales, one impairment subscale, and one driving behavior subscale. The receiver operating characteristic analysis was conducted to calculate the cut-off scores of K-AARS. Results: All subscale scores, including six clinical subscale, impairment subscale, and driving behavior subscale scores, were found to be significant in distinguishing adults with ADHD from healthy controls. The sensitivity and specificity of the six clinical subscales were 63.0-77.0% and 66.7-79.9%, respectively. The combined total score of the six clinical subscales, had a sensitivity of 80.0% and specificity of 79.9%. Conclusion: The discriminative power of K-AARS for the diagnosis of ADHD in adults was excellent, and K-AARS and the empirical diagnosis of adults can be useful in diagnosing ADHD in adulthood.
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제안 방법
Thus, a practice parameter targeting ADHD in adults must be developed. This study was conducted to determine the cut-off scores for the clinical application of K-AARS as a follow-up to the previous study [1] and as a part of the preparation for the publication of the practice parameters.
To overcome these obstacles, the Korean Academy of Child and Adolescent Psychiatry (KACAP) had organized a task force team to develop the Korean Adult ADHD Rating Scale (K-AARS) in 2009, and professor Jae Won Kim was appointed as the principal investigator [1]. Through discussions on whether the new scale will be a self-report form or a physician rate form and whether it can be used as a screening or diagnostic tool, the team members developed a self-report scale to diagnose ADHD in adults. The initial draft of the scale included 86 questions, and the scale was used on 136 adults with ADHD and 408 healthy controls.
The initial draft of the scale included 86 questions, and the scale was used on 136 adults with ADHD and 408 healthy controls. Via a validity and reliability analysis, the final draft included 73 questions and comprised eight subscales: six clinical subscales, one impairment subscale (IMP), and one subscale for driving behavior (DR) [1]. K-AARS was highly reliable in terms of internal consistency (Cronbach’s alpha: 0.
대상 데이터
A total of 135 adults with ADHD were included in the clinical group and 144 healthy adults in the control group. In the clinical group, 92 (68.
Meanwhile, two psychiatrists diagnosed the participants with ADHD only when a consensus is made, and this is considered the strength of the study. Another limitation is that this study was conducted at eight university hospitals located in metropolitan areas, including Seoul. These limitations should be considered when generalizing results.
Through discussions on whether the new scale will be a self-report form or a physician rate form and whether it can be used as a screening or diagnostic tool, the team members developed a self-report scale to diagnose ADHD in adults. The initial draft of the scale included 86 questions, and the scale was used on 136 adults with ADHD and 408 healthy controls. Via a validity and reliability analysis, the final draft included 73 questions and comprised eight subscales: six clinical subscales, one impairment subscale (IMP), and one subscale for driving behavior (DR) [1].
In the current study, the target age was expanded from 19 to 65 years. The participants were recruited from March 2017 to February 2019 at eight university hospitals in Seoul and other metropolitan areas.
The study protocol was approved by the Institutional Review Board of the eight university hospitals, including Kyung Hee University Hospital (KMC IRB 2017-02-054), of which the principal investigator was Geon Ho Bahn. Informed consent was obtained from all participants.
The theme of this article was presented at the spring meeting of the Korean Academy of child and Adolescent Psychiatry on 10 May 2019, Seoul, Korea.
데이터처리
, Armonk, NY, USA) was used for analysis. Moreover, receiver operating characteristic (ROC) analysis was conducted to calculate the cut-off points of K-AARS. Via the ROC curve analysis, the sensitivity and specificity of all subscales and the total score of the clinical subscales were obtained.
성능/효과
According to the ROC analysis, the sensitivity and specificity of the six clinical subscales (IA, HYP, IM, ACO, ED, and DO) were 63.0–77.0% and 66.7–79.9%, respectively (Table 3, Fig. 1).
As presented in this study, each subscale score and the sum of the six clinical subscale scores of K-AARS could be used as a diagnostic cut-off for adult patients in clinical practice. Based on this study, a total score greater than or equal to 132 for the six clinical subscales will be considered the cut-off score for diagnosing ADHD with the use of K-AARS: the true positive rate (sensitivity) of diagnosis was 80.0%, and the false positive rate (1-specificity) was less than 20.1%. Meanwhile, Kessler et al.
K-AARS differs from the existing adult ADHD scales due its subscales (ACO, ED, and DO), and a follow-up evaluation of the utilization of these subscales in the future must be carried out. Since this study showed that K-AARS had high sensitivity and specificity in the clinical group with ADHD, the cut-off scores presented were found to be a reasonable self-reporting measure in adults with ADHD.
후속연구
These limitations should be considered when generalizing results. In the future, further studies must be conducted to collect and analyze clinical data about the use of K-AARS according to region and type of psychiatric clinics. In addition, K-AARS is a self-report scale; thus, a clinical interview with physicians and other adjunctive tests, such as computerized comprehensive attention test [22] and Diagnostic Interview for ADHD in adults [23], must be conducted to diagnose adults with ADHD in clinical practice.
The subscales of K-AARS were designed by pediatric psychiatrists to assess the clinical symptoms of ADHD in adults and to suit the culture in Korea. K-AARS differs from the existing adult ADHD scales due its subscales (ACO, ED, and DO), and a follow-up evaluation of the utilization of these subscales in the future must be carried out. Since this study showed that K-AARS had high sensitivity and specificity in the clinical group with ADHD, the cut-off scores presented were found to be a reasonable self-reporting measure in adults with ADHD.
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