Can Adults Provide Accurate Ratings of the ADHD Symptoms They Displayed During Childhood?

by Dr. David Rabiner

Most experts would agree that evaluating an adult for possible ADHD is a more complicated procedure than it is with a child. In addition to determining whether an adult currently shows a sufficient number of ADHD symptoms to possibly warrant the diagnosis, one also needs to determine whether there was some evidence of impairment from these symptoms during childhood. This can be difficult to do for several reasons. First, the adult's parents may not be available to provide their recollection of symptoms their child displayed many years ago. Even if they are, the adult may not wish to have his or her parents involved in this way. Obtaining information directly from an elementary school teacher from 20 years ago or more is even more problematic.

Because of these problems, it is important to determine whether an adult’s account of ADHD symptoms that he or she displayed during childhood provides reliable and valid information. Can such reports be trusted, or is the accuracy of one's recall for problems that occurred in the distant past hopelessly confounded by a variety of factors? What about the accuracy of current reports of ADHD symptoms from adults? With children, clinicians typically rely on the reports of parents and teachers because a child is often not a very reliable reporter of his or her own symptoms of ADHD. Is there good reason to believe that these same reports from adults are more reliable sources of information?

In a study published in the American Journal of Psychiatry, an interesting attempt to answer these fundamental questions pertaining to the assessment of ADHD in adults was made (Murphy, P., and Schachar, R. 2000). This was a two-part study that employed a simple and straightforward design.

In the first portion of the study, 50 adults ranging in age from 20 to 50 were asked to complete a questionnaire assessing the degree of ADHD symptoms that they displayed during childhood. The parents of these adults, who ranged in age from 45 to 93, were asked to complete the same questionnaire rating the symptoms of ADHD that their now adult child had display during childhood. The questionnaire was simply a list of the 18 symptoms of ADHD specified in the current diagnostic manual that participants rated on a 1 to 4 scale indicating how often they displayed each symptom as a child.

The participants in this study included a relatively equal numbers of males and females, who were drawn from the general population. These individuals had not been diagnosed as having ADHD, and the vast majority would not be expected to have this condition. The authors were simply interested in whether the retrospective reports of the adults would correspond with the retrospective reports of their parents. That is, do adults and their parents agree on the severity of ADHD symptoms that were displayed by the adult as a child? A positive answer to this question would suggest that the retrospective reports of an adult be used in the diagnostic process in lieu of obtaining this information directly from the adult's parent. If little or no relation were found, however, it would argue that any information provided by the adult client about his or her functioning during childhood really needs to be supplemented with information gleaned directly from other sources.

In the second portion of the study the question addressed was whether an adult’s self-report of current ADHD symptoms coincide with the reports provided by those in a very good position to observe them, such as their spouse or partner. As noted above, when evaluating a child for ADHD, clinicians typically depend on the reports provided by parents and teachers, as the reports of these informants are believed to be more reliable than what most children provide themselves. With adults, however, it is far more common to rely solely on what they say about themselves. Is this reliance on self-report of ADHD symptoms justified or must the reports of other informants (spouses) be obtained? The authors reasoned that if the ratings that adults and their spouses provide independently showed high agreement; the use of adult self-reports would be supported. If, however, these ratings diverged substantially, reliance only on self-reports would be called into question. Participants in this portion of the study included 100 adults between the ages of 25 and 65. Once again, relatively equal numbers of males and females were included.

Results from the first portion of the study indicate that highly significant correlations were found between adults' ratings of the ADHD symptoms they displayed during childhood and the ratings of these same symptoms provided by their parents. For inattentive symptoms, the correlation between adult and parent ratings was 0.76; for ratings of hyperactive-impulsive symptoms the correlation was 0.69. In both cases, the magnitude of these correlations indicates that there is a very strong relationship between adult and parent reports. In regards to the magnitude of the symptoms reported, the adults recalled that they had displayed a greater number of symptoms than their parents did.

Recall that the ages of adults in this study ranged from 20 to 50. Because of this wide age range, the authors wondered whether the relationship between adult and parent reports of symptoms displayed by the adult during childhood might diminish as people got older. In other words, would the relationship be stronger for the younger adults in the study than for the older adults. When the authors examined this question they found that the relationship did seem somewhat stronger among the younger adults (those younger than 34). Even among the older adults, however, the correlation between adult and parent ratings was still substantial.

Similar results were obtained for the second study as once again, the ratings provided by adults and their spouses/partners for ADHD symptoms currently displayed were highly correlated. In this case, the correlation for inattentive symptoms was 0.70 and the correlation for hyperactive-impulsive symptoms was 0.59.

In this study, the authors attempt to investigate two issues that create difficulty when assessing an adult for ADHD. The first issue is that for the diagnosis to be made, symptoms must have been clearly evident and causing impairment during childhood, and obtaining information about this from sources besides the adult can be difficult. The second issue deals with concerns about whether information provided by the adult about his or her current symptoms would typically agree with what others who are in a good position to observe the adult would report.

The first part of the study clearly demonstrates that when asked about ADHD symptoms displayed during childhood, the ratings most adults provide will be in substantial agreement with ratings that would be provided by their parents. This suggests that most adults will be able to provide a true account of their childhood behavior. Results from the second portion of the study indicate the ratings for current ADHD symptoms provided by most adults will be quite consistent with what others who know them well are likely to say. Thus, accounts of current behavior with respect to ADHD would be accurate as well.

These findings are important because they imply that the evaluation of adults for ADHD may not need to include the use of information obtained from other sources. If clinicians can rely on the retrospective and current accounts of ADHD symptoms that an adult client provides, it simplifies the process considerably in many cases.

Of course, it is important to note that a limitation of these studies is that very few of the adults included actually had ADHD themselves. Thus, all we really know is that most adults in the general population are likely to provide accounts of current and former behavior that would agree with the accounts provided by their significant others. It is quite possible, however, that this high degree of correspondence would not necessarily be found among the population of adults who would actually be likely to seek out an evaluation for ADHD. Thus, the next stage of this research would be to obtain a sample of adults with ADHD and determine if similar results were obtained to those reported here. If such results were obtained, it would lend considerable support to the practice of relying only on personal reports when evaluating an adult client for ADHD.

About The Author

Dr. David Rabiner is a Senior Research Scientist conducting research on ADHD and children's social development at Duke University.

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