A Q&A with Psychologist and ADHD Expert, Russell Barkley
Russell Barkley, Ph.D., a Clinical Professor of Psychiatry at the Medical University of South Carolina, has recently published three new rating scales for evaluating adults for ADHD, deficits in executive functioning and psychosocial impairment in major life activities. Dr. Barkley is also the author of nine books, including his most recent Taking Charge of Adult ADHD. Dr. Barkley agreed to answer a few of ADDA E-News’ questions about these new scales.
Can you describe your new rating scales briefly for our readers?
The Barkley Deficits in Executive Functioning Scale (BDEFS) assesses how lags and gaps in executive functions show up in adults' daily activities. Theoretically based and empirically developed, the BDEFS evaluates self-management relative to time, self-organization and problem solving, self-restraint, self-motivation, and self-regulation of emotion. These have been associated with higher risks for impairment in various major life activities including educational and occupational functioning, social relationships, driving, credit and money management, marital satisfaction, parenting stress, general psychological adjustment, and even risk of psychological morbidity in offspring (or children inheriting a similar disorder).
The Barkley Adult ADHD Rating Scale IV (BAARS-4) assesses adult ADHD symptoms based on the DSM-IV, as well as recollections of childhood ADHD symptoms. The scale surveys the domains of impairment essential to making a diagnosis of ADHD, but it’s the first scale that identifies Inattentive Only adults who have Sluggish Cognitive Tempo (SCT). SCT is a newly recognized attention disorder that, while distinct from ADHD, may overlap in as many as 50% of cases.
I developed the Barkley Functional Impairment Scale (BFIS) for two important reasons. First, in nearly every case, a patient must show clear signs of functional impairment to be diagnosed with a major mental disorder, and therefore qualify for disability. Second, there were very few tools for evaluating functional impairment in adult life activities such as work, education, relationships, home responsibilities, driving, managing money, etc., and none of the existing tools had established norms or acceptable evidence for reliability and validity.
Why did we need new scales for ADHD?
There are several very good rating scales for evaluating ADHD in adults, but none of them contain items for evaluating the newly discovered disorder of attention that researchers call SCT and that clinicians have been calling ADD. Research shows that this attention disorder is more often characterized by staring, daydreaming, spaciness, mental confusion and fogginess, sluggish behavior, a proneness to make mistakes in processing information, lethargy, and hypo-activity among other symptoms. My own recent research indicates this is not a subtype of ADHD but a separate disorder affecting a different aspect of attention. Some researchers are speculating that it may be a form of pathological mind-wandering that interferes with attending to important external tasks, goals, or other activities. A scale is essential to help identify this type of inattention along with that of adult ADHD.
Does this means that adults who think they have ADHD now might not?
It’s possibile. Some adults with SCT may have been diagnosed with the Inattentive Type of ADHD because there was no other diagnosis to give them. The DSM-IV contains just one disorder of attention—ADHD. It's possible that as many as half of adults labeled as having this inattentive type of ADHD in fact have SCT. If SCT is a different disorder of attention, as research is coming to suggest, then it may not respond the same way to treatments being used to treat ADHD, and might respond better to other treatments that do not necessarily help ADHD. But to be able to study this further, we needed to develop a means of identifying adults with SCT.
Why are there three scales, and in what situation would an adult with ADHD (or a professional who works with them) need the BDEFS or the BFIS?
Each of the three scales evaluates different sets of symptoms. The ADHD scale (BAARS-4) is specifically for identifying adults with ADHD or with SCT. The BDEFS evaluates deficits in executive functioning in daily life activities for adults with ADHD, SCT or in adults with other mental and neurological disorders, making it useful on a much broader scale. The BFIS, as noted above, was created to provide, for the first time, a means for screening for impairment in 15 domains of psychosocial functioning (work, relationships, money management, etc.).
In what case might people already diagnosed with ADHD want to get these tests?
If they are well-diagnosed, there is little or no reason for them to ask to complete the BAARS-4 as it is a measure of ADHD severity and that has already been determined by a professional. But if they are curious about how impaired they may be in executive functioning or in psychosocial domains of life, then completing the BDEFS and BFIS might be informative.
Can I, as an adult with ADHD, test myself using these scales, or should I ask my professional to get them, and where can one purchase them?
The scales were developed to be used only by professionals. They are not for self-diagnosis as they require professional training in assessing mental disorders and an in-depth understanding of the contents of the scale manuals.
Professionals can use the scales in clinical practice with patients concerned about EF deficits, ADHD, or psychosocial impairment. They can also be used in research settings, in treatment trials as a measure of response to intervention or in industrial-organizational settings where screening adults for possible ADHD, deficits in EF, or psychosocial impairment is an important objective.