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Cited by 128Attention Deficit Hyperactivity DisorderMental Health Research TopicsDevelopmental and Educational Neuropsychology

The structure of adult ADHD.

Open access
Adler, Lenard A., Faraone, Stephen V., Spencer, Thomas J., Berglund, Patricia, Alperin, Samuel, Kessler, Ronald C.·2017·International Journal of Methods in Psychiatric Research
DOI 10.1002/mpr.1555PMC PMC5405726
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Abstract

Psychometric analysis of an expanded set of adult ADHD symptoms in three pooled US samples.

AI snapshot

Written from the paper’s full text.

TL;DR

In pooled U.S. samples, an expanded set of adult ADHD symptoms formed four factors: executive dysfunction/inattention, hyperactivity, impulsivity, and emotional dyscontrol. Cluster-derived profiles broadly matched DSM-5 presentations, but elevated emotional dyscontrol alone was rarely associated with an ADHD diagnosis, suggesting it may be more comorbid than core.

Key findings

  • Exploratory factor analysis of 32 ACDS symptoms found four factors: executive dysfunction/inattention, hyperactivity, impulsivity, and emotional dyscontrol. The first unrotated factor had an eigenvalue of 15.3, with 29 of 32 items loading above .40; non-DSM items had loadings comparable to DSM items (.32–.84 vs. .30–.86).
  • Factor 1 included all 9 DSM-5 inattention symptoms and 11 of 14 non-DSM items; Factor 2 had 5 hyperactivity items (.63–.84); Factor 3 had 4 impulsivity symptoms (.62–.86); Factor 4 had 3 emotional dyscontrol symptoms (.77–.81). Factor correlations ranged from .22 to .49.
  • K-means cluster analysis produced 6 clusters (R² = .55–.80; each 12.5–28.4% of respondents): high only on executive dysfunction/inattention (12.4%), hyperactivity (15.9%), emotional dyscontrol (28.5%), all factors (17.6%), all but emotional dyscontrol (12.6%), and none (13.0%).
  • DSM-5/ACDS adult ADHD prevalence was 23.3% in NCS-R, 39.7% in the health plan sample, and 94.2% in NYU Langone. The emotional-dyscontrol-only cluster had 0.5% meeting ADHD criteria, versus 60.6% in the low-on-all cluster; combined presentation was more common in NYU Langone (63.4%) than NCS-R (29.0%) or health plan (16.4%).

Methods

  • Pooled three U.S. samples: NYU Langone adult ADHD program/referred sample (191 respondents with at least one DSM-5 A1/A2 symptom), NCS-R national household validation subsample (108), and health plan telephone survey subsample (161); total 460. NCS-R and health plan interviews were weighted for oversampling screened positives.
  • Adult ADHD was assessed with ACDS v1.2, a semi-structured interview covering all 18 DSM-5 inattention and hyperactivity-impulsivity symptoms plus 14 non-DSM symptoms of executive dysfunction and emotional dyscontrol.
  • Analyses used tetrachoric correlations, pooled exploratory factor analysis, parallel analysis to determine factor number, promax rotation, regression-based factor scores, and k-means cluster analysis of standardized factor scores.

Limitations

  • Paper-stated: the ACDS emotional dyscontrol assessment was less differentiated than in other studies; no performance-based neurocognitive measures were included; and comorbid disorders were not assessed uniformly across samples, preventing tests of specificity to adult ADHD.
  • Evident from the text: individual samples were too small for stable factor recovery, so the main analysis pooled them; the NYU Langone sample was younger, had a higher proportion of men, and had much higher ADHD prevalence, suggesting self-selection or help-seeking bias; cluster profiles used standardized factor scores normed to the sample distribution and equal weighting, not DSM thresholds.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/mpr.1555

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

7 of 29 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

  • Study design and conductcitation

    The main analysis combined all samples because the individual samples were too small for a stable factor solution.

    “Our main focus is on pooled analysis that combines data across all the samples due to the fact that simulations described in the introduction show that the numbers of respondents in the individual samples are too small to recover a stable factor structure involving the anticipated number of factors with their anticipated number of per factor (Pearson and Mundfrom, 2010).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Pearson and Mundfrom, 2010 source
  • Interpretationcitation

    A 4-factor solution with 9-12 items per factor needs 320-500 respondents.

    “For a 4-factor solution of the sort hypothesized to exist by many experts in ADHD (i.e., inattention/executive dysfunction, hyperactivity, impulsivity, emotional dyscontrol), a stable factor structure based on scales with between 9 (the number of DSM-5 symptoms of inattention and the number for hyperactivity/impulsivity) and 12 items the minimum required sample size would be 320–500 respondents (”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Pearson and Mundfrom, 2010 source

      The Results and Tables 1–3 give minimum sample sizes for four-factor models with 9–12 variables per factor, but the recommendations depend on communality, item distribution, and whether good or excellent agreement is required. The stated 320–500 respondents is not a general minimum for those models: Table 1 reports some lower requirements, while the Conclusion says low-communality models often require thousands. The paper does not assess the proposed ADHD factor structure specifically. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
  • Premisecitation

    Published exploratory factor analyses of expanded adult ADHD symptom sets have reported discrepant factor structures, ranging from 2 to 6 factors.

    “These studies have found a 2-factor structure in studies of the clinician-administered Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) (Marchant et al., 2013) and the self-report version of that scale (Marchant et al., 2015) compared to 3-factor (Kessler et al., 2010), 4-factor (Amador-Campos et al., 2014; Conners et al., 1999), or 6-factor (Christiansen et al., 2011) solutions in”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Marchant et al., 2013 source
    • cites Kessler et al., 2010 source
    • cites Christiansen et al., 2011 source
  • Findingnone given

    The health plan sample was a more limited sample of the general population (people with health insurance) without age restriction.

    “The health plan sample was a more limited sample of the general population (i.e., of people with health insurance) without age restriction.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    The health plan sample had a much higher proportion of Non-Hispanic Whites (83.8%) than either the NCS-R (66.1%) or NYU Langone (62.8%) samples.

    “The health plan sample had a much higher proportion of Non-Hispanic Whites (83.8%) than either the NCS-R (66.1%) or the NYU Langone (62.8%) samples”
    Quote in the paperNot a substantial claim
  • May combine two claims. 48
  • Classified as probably not a substantial claim. 21

  • May combine two claims.

    Premisecitation

    Factor analyses need larger samples when symptoms are binary and when their prevalence varies.

    “In addition, sample size requirements are higher when the symptoms are dichotomies, as they typically are in factor analyses of psychiatric symptoms, and when symptom prevalence is variable (Pearson and Mundfrom, 2010).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Pearson and Mundfrom, 2010 source

      The Conclusion states that dichotomous data require larger samples than continuous data. In Coefficient of Congruence (page unavailable), the uniform 50/50 distribution generally requires the smallest sample, but the paper finds no consistent difference between mixed-prevalence and uniform 80/20 conditions. Thus, it does not establish that variable symptom prevalence itself always raises the sample-size requirement. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premiseown data

    The authors' earlier pooled analysis of 345 respondents yielded three factors among expanded ADHD symptoms: inattentive/executive dysfunction, hyperactivity, and impulsivity, with emotional dyscontrol items loading on impulsivity.

    “Our own previous work, based on a pooled analysis of 345 respondents in a national household sample and a health plan sample, found a 3-factor structure among symptoms in an expanded symptom assessment that included all 18 DSM symptoms of AD and HD in addition to 14 additional symptom questions designed to assess executive dysfunction and emotional dyscontrol (Kessler et al., 2010).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Kessler et al., 2010 source

      The Methods (The samples and Measures; page unavailable) describe 131 household-survey respondents and 214 health-plan respondents, totaling 345, and an assessment with 18 DSM-IV symptoms plus 14 additional symptoms. The Results (Prevalence, structure, and bivariate associations; page unavailable) report three factors and place mood changes and sensitivity to criticism on the impulsivity factor. But the second factor is explicitly inattention-hyperactivity, not hyperactivity alone; the proposed factor labels therefore misstate part of the finding. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    K-means cluster analysis produces clusters with lower within-cluster variation and higher between-cluster variation than latent class analysis.

    “K-means cluster analysis was used rather than latent class analysis based on evidence that cluster analysis produces clusters with lower within-cluster variation and higher between-cluster variation than latent class analysis (Eshghi et al., 2011).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Eshghi et al., 2011 source

      The Discussion reports that traditional cluster analysis produced the most homogeneous and best-differentiated clusters in the authors’ comparison, and the Methodology and analysis section says its cluster solution used k-means. But this result concerns one dataset, and the authors caution that their performance measures may favor traditional cluster analysis. The citation does not establish the claim as a general advantage over latent class analysis. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Other research suggests that emotional dyscontrol is common in adult ADHD, shows familial association with ADHD, and predicts the longitudinal course of ADHD.

    “Other research suggests that emotional dyscontrol is common in adult ADHD (Surman et al., 2013; Vidal et al., 2014), shows familial association with ADHD (Surman et al., 2013), and predicts the longitudinal course of ADHD (Biederman et al., 2012).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Surman et al., 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Vidal et al., 2014 source
    • cites Biederman et al., 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The NCS-R sample was a subset of respondents from a national household sampled ages 18-44.

    “The NCS-R sample was a subset of respondents from a national household sampled ages 18–44.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The NYU Langone patient sample was the youngest, with 66.5% of respondents ages 18-30, followed by NCS-R (46.6%) and health plan (26.6%).

    “The NYU Langone patient sample was the youngest (66.5% of respondents ages 18–30) followed by the NCS-R (46.6% ages 18–30) and health plan (26.6% ages 18–30) samples.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The executive dysfunction/inattention factor included all DSM-5 inattentive symptoms, and the non-DSM symptoms had factor loadings comparable to the DSM symptoms.

    “Exploratory factor analysis found 4 factors representing executive dysfunction/inattention (including, but not limited to, all the DSM-5 inattentive symptoms, with non-DSM symptoms having factor loadings comparable to those of DSM symptoms), hyperactivity, impulsivity, and emotional dyscontrol.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Empirically derived multivariate symptom profiles were broadly consistent with DSM-5 inattentive-only, hyperactive/impulsive-only, and combined presentations, except that inattention included executive dysfunction/inattention and hyperactivity-only was limited to hyperactivity without high impulsivity.

    “Empirically-derived multivariate symptom profiles were broadly consistent with the DSM-5 inattentive-only, hyperactive/impulsive-only, and combined presentations, but with inattention including executive dysfunction/inattention and hyperactivity-only limited to hyperactivity without high symptoms of impulsivity.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The ratio of respondents ages 18-30 versus 31-40 in the health plan sample (54.8%) was similar to the NCS-R (46.6%), but much higher in the NYU sample (66.5%).

    “The ratio of respondents in the age range 18–30 versus 31–40 (54.8%) in the health plan sample was similar to the NCS-R (46.6%), but the proportion was much higher in the NYU sample (66.5%)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The remaining cluster (C3, high only on emotional dyscontrol), while having the highest prevalence in the sample, had by far the lowest proportion of cluster members with DSM-5 adult ADHD (0.5%).

    “The remaining cluster (C3, high only on emotional dyscontrol), while having the highest prevalence in the sample, had by far the lowest proportion of cluster members with DSM-5 adult ADHD (0.5%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the health plan sample, cluster 2 (high only on hyperactivity) was the most common symptom profile among HD-only cases followed by cluster 2 (34.3%).

    “In the health plan sample, in comparison, cluster 2 (high only on hyperactivity) was the most common symptom profile among HD-only cases followed by cluster 2 (34.3%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    We found evidence for the traditional distinctions among AD-only (C1), HD-only (C2), and combined (C4-C6) presentations, but the HD-only presentation was specific to hyperactivity rather than also including high impulsivity.

    “We found evidence for the traditional distinctions among AD-only (C1), HD-only (C2), and combined (C4–C6) presentations, but the HD-only presentation was specific to hyperactivity rather than also including high impulsivity.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    A 6-cluster solution was optimal in increasing explained variance in factor scores without producing small splinter clusters, with R2 values in the range .55-.80 across factors and each cluster containing between 12.5% and 28.4% of respondents.

    “A 6-cluster solution was optimal in increasing explained variance in factor scores without producing small splinter clusters, with R2 values in the range .55–.80 across factors and each cluster containing between 12.5% and 28.4% of respondents.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The 2 mood lability symptoms, but none of the planning-organization symptoms, had meaningful loadings on other factors.

    “The 2 mood lability symptoms, but none of the planning-organization symptoms, had meaningful loadings on other factors”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The three combined presentations differed in that one (C4) was characterized by high scores on all four factors, another (C5) by high scores on all factors other than emotional dyscontrol, and the last (C6) by below-average scores on all factors.

    “The three combined presentations differed in that one (C4) was characterized by high scores on all four factors, another (C5) by high scores on all factors other than emotional dyscontrol (C5), and the last (C6) by below-average scores on all factors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Three of the clusters featured respondents who were high on only one factor: executive dysfunction/inattention (C1; 12.4%), hyperactivity (C2; 15.9%), or emotional dyscontrol (C3; 28.5%), while the other 3 clusters included respondents either high on all factors (C4; 17.6%), on all but emotional dyscontrol (C5; 12.6%), or high on no factor (C6; 13.0%).

    “Three of the clusters featured respondents who were high on only one factor: executive dysfunction/inattention (C1; 12.4% of respondents), hyperactivity (C2; 15.9%), or emotional dyscontrol (C3; 28.5%), while the other 3 clusters included respondents either high on all factors (C4; 17.6%), on all but emotional dyscontrol (C5; 12.6%), or high on no factor (C6; 13.0%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The majority of NYU Langone cases had the combined presentation (63.4%), with almost all remaining cases having the AD-only presentation (35.0%).

    “The majority of the NYU Langone cases, in comparison, had the combined presentation (63.4%), with almost all the remaining cases having the AD-only presentation (35.0%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    One of these factors shows that DSM-5 AD symptoms are part of a larger executive dysfunction/inattention factor, while others show that hyperactivity and impulsivity can be distinguished in adult ADHD and that emotional dyscontrol is a distinct component of adult ADHD.

    “One of these factors shows that DSM-5 AD symptoms are part of a larger executive dysfunction/inattention factor, while others show that hyperactivity and impulsivity can be distinguished in adult ADHD and that emotional dyscontrol is a distinct component of adult ADHD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The DSM-5 AD-only presentation was as common as the HD-only presentation in the community samples (NCS-R and health plan), but much less common than the AD-only presentation in the treatment sample (NYU Langone).

    “An important reason for this discrepancy can be seen in Table 2, where we showed that the DSM-5 AD-only presentation was as common as the HD-only presentation in the community samples (i.e., the NCS-R and health plan samples), but much less common than the AD-only presentation in the treatment sample (i.e., the NYU Langone sample)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The 51.0% of respondents in C2 (high only on hyperactivity) who met diagnostic criteria consisted mostly of AD-only cases, with smaller numbers of HD-only cases, and very few cases with the combined presentation (0.7%).

    “The 51.0% of respondents in C2 (high only on hyperactivity) who met diagnostic criteria consisted mostly of AD-only cases, with smaller numbers of HD-only cases, and very few cases with the combined presentation (0.7%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Virtually all respondents with the AD-only presentation and with the combined presentations featuring high factor scores met DSM-5/ACDS criteria for adult ADHD.

    “Virtually all respondents with the AD-only presentation and with the combined presentations featuring high factor scores met DSM-5/ACDS criteria for adult ADHD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Roughly half (47.6%) of NCS-R cases had the HD-only presentation, with the others divided roughly equally between AD-only (23.2%) and combined (29.2%) presentations.

    “Roughly half (47.6%) of the NCS-R cases had the HD-only presentation, with the others divided roughly equally between AD-only (23.2% of cases) and combined (29.2%) presentations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Only one other symptom loaded on Factor 2: the non-DSM-5 symptom being easily bored, with a higher loading on Factor 2 (.56) than Factor 1 (.40).

    “Only one other symptom loaded on Factor 2: the non-DSM-5 symptom being easily bored, with a higher loading on Factor 2 (.56) than Factor 1 (.40).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The most striking difference, and the only one that was statistically significant, was that the majority of NYU Langone cases had a DSM-5 combined presentation (63.3%), while that presentation was considerably less common in the NCS-R (29.0%; t=2.9, p=.002) and health plan (16.3%; t=4.8, p<.001) samples.

    “The most striking difference, and the only one that was statistically significant, was that the majority of NYU Langone cases had a DSM-5 combined presentation (63.3%), while that presentation was considerably less common in the NCS-R (29.0%; t=2.9, p=.002) and health plan (16.3%; t=4.8, p<.001) samples.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Correlations among factors were all positive and in the range between .22 (Factors 2 and 4) and .49 (Factors 1 and 2).

    “Correlations among factors were all positive and in the range between .22 (Factors 2 and 4) and .49 (Factors 1 and 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Empirically derived symptom profiles based on cluster analysis are broadly consistent with the DSM-5 distinctions among AD-only, HD-only, and combined presentation, but a considerably higher proportion of cases are characterized in this empirically-derived scheme as having the combined presentation than in the DSM-5 scheme.

    “Finally, we found that empirically derived symptom profiles based on cluster analysis are broadly consistent with the DSM-5 distinctions among AD-only, HD-only, and combined presentation, but that a considerably higher proportion of cases are characterized in this empirically-derived scheme as having the combined presentation than in the DSM-5 scheme.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The 60.6% of respondents meeting diagnostic criteria in C6 (low on all factors) were primarily non-restrictive AD-only (24.4%) or non-restrictive HD-only (27.8%), with far fewer restrictive (0.0% AD-only; 2.2% HD-only) or combined (6.1%) cases.

    “The 60.6% of respondents meeting diagnostic criteria in C6 (low on all factors), in comparison, were primarily non-restrictive AD-only (24.4%) or non-restrictive HD-only (27.8%), with far fewer restrictive (0.0% AD-only; 2.2% HD-only) or combined (6.1%) cases.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The DSM-5 AD-only profile was the most common one in the health plan sample (51.1%), with insignificantly lower proportions of cases having this profile in the NCS-R (23.3%) and NYU Langone (35.2%) samples (t=0.3-1.7; p = .09-.79).

    “The DSM-5 AD-only profile was the most common one in the health plan sample (51.1%), with insignificantly lower proportions of cases having this profile in the NCS-R (23.3%) and NYU Langone (35.2%) samples (t=0.3–1.7; p = .09–.79).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A somewhat lower proportion of cases had the HD-only profile in the health plan sample (32.6%) while this profile was very rare in the NYU Langone sample (1.7%).

    “A somewhat lower proportion of cases had the HD-only profile in the health plan sample (32.6%) while this profile was very rare in the NYU Langone sample (1.7%)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The majority of health plan cases had the AD-only presentation (51.1%), followed by HD-only (32.7%) and combined (16.4%).

    “The majority of health plan cases, in comparison, had the AD-only presentation (51.1%), followed by HD-only (32.7%) and combined (16.4%) presentations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The single DSM-5 symptom with a loading lower than .40 (talks excessively) was 1 of 3 DSM-5 symptoms with lower loadings on the first (.30) than second (.54) unrotated principal factor, the others being fidgeting (.41, .44) and difficulty remaining seated (.50, .54).

    “The single DSM-5 symptom with a loading lower than .40 (talks excessively) was 1 of 3 DSM-5 symptoms with lower loadings on the first (.30) than second (.54) un-rotated principal factor, the others being fidgeting (.41, .44) and difficulty remaining seated (.50, .54).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The higher proportion of Non-Hispanic Whites in the health plan sample presumably reflects the higher rate of health insurance coverage among Non-Hispanic Whites than racial-ethnic minorities.

    “presumably reflecting the higher rate of health insurance coverage among Non-Hispanic Whites than racial-ethnic minorities (Artiga, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Artiga, 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The ACDS includes separate childhood and adult prompts to ensure thorough assessment of symptom severity and breadth.

    “The ACDS uses childhood and adult specific prompts to ensure adequate exploration of the severity and breadth of DSM ADHD symptoms and additional symptoms of executive dysfunction and emotional dyscontrol.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The self-report WRAADDS factor analysis used 120 community controls and 122 patients, a sample several times smaller than the smallest required size.

    “Even the smallest of these required sample sizes is several times larger than the sample size used in the factor analysis of the self-report version of the WRAADDS.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Marchant et al., 2015 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The 14 non-DSM symptom items played no role in diagnostic decisions.

    “None of the 14 non-DSM symptom items was used in making diagnoses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study did not operationalize the DSM-5 requirement for impairment before age 12.

    “The DSM-5 requirement of impairment before age 12 was not operationalized.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    NCS-R ACDS interviewers received 40 hours of training and had to pass five practice interviews by matching trainers' symptom ratings before starting.

    “The ACDS was administered in the NCS-R by 4 experienced PhD-level clinical interviewers who received 40 hours of training from 2 board certified psychiatrists specializing in adult ADHD research (LA, TS). Each interviewer had to complete 5 practice interviews with symptom ratings matching those of the trainers prior to beginning interviews.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    A supervising psychiatrist reviewed a random 20% of NCS-R and health plan interviews, and agreement exceeded 95% in each sample.

    “A random 20% of NCS-R and health plan interviews were reviewed by a supervising psychiatrist and agreement was over 95% in each of these samples.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    NYU Langone participants received face-to-face semi-structured diagnostic interviews under blinded conditions.

    “Blinded semi-structured diagnostic interviews described below were administered face-to-face to these patients and controls as part of their intake evaluation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The 717 respondents in the clinician-administered WRAADDS factor analysis would have sufficed for a 4-factor model but not for a 7-factor model.

    “However, the sample size used in an earlier factor analysis of the clinician-administered version of the WRAADDS that combined data across 3 clinical trial samples (with a combined sample of 717) would have been large enough to evaluate a 4-factor model, although not a 7-factor model (Marchant et al., 2015).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Marchant et al., 2015 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study did not operationalize Criterion E and did not diagnose ADHD not otherwise specified.

    “Criterion E (that the symptoms do not occur exclusively during the course of a pervasive developmental disorder or psychotic disorder and are not better accounted for by another mental disorder) was not operationalized and ADHD not otherwise specified was not diagnosed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    The ACDS includes 14 non-DSM symptoms considered relevant to adult ADHD from clinical experience and prior literature.

    “The interview began with a retrospective assessment of all symptoms of childhood ADHD and then assessed an expanded set of recent (past 6 months) symptoms including all 9 DSM-5 Criterion A1 (AD) symptoms, all 9 A2 (HD) symptoms, and 14 non-DSM symptoms believed relevant to adult ADHD based on clinical experience and the research literature, including deficits in higher-level executive function and”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Both the NCS-R and health plan samples used weekly calibration meetings and tape reviews to prevent rater drift.

    “Weekly calibration meetings and reviews of tapes were used in both studies to prevent drift.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Men or people with symptom profiles more characteristic of men were more likely than others with adult ADHD to self-select into the NYU Langone sample.

    “suggesting either that men or people with symptom profiles more characteristic of men were more likely than others with adult ADHD to self-select into the NYU Langone sample.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The original CAARS factor analysis and a confirmatory replication produced four factors: three matched inattentive/executive dysfunction, hyperactivity, and impulsivity, and a fourth reflected self-concept problems.

    “The original CAARS factor analysis (Conners et al., 1999) and a confirmatory factor analysis replication (Amador-Campos et al., 2014) found a 4-factor solution, with 3 of the factors the same as the inattentive/executive dysfunction, hyperactivity, and impulsivity factors in our earlier study, and the 4th factor representing problems with self-concept.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Conners et al., 1999

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Amador-Campos et al., 2014

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Completed interviews in the NCS-R and health plan samples were weighted to correct for over-sampling of screened positives.

    “The completed interviews were weighted to adjust for over-sampling of screened positives.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Investigators at Massachusetts General Hospital and NYU School of Medicine established and validated the non-DSM symptoms using mechanisms similar to those for the basic ACDS v1.2.

    “These non-DSM symptoms were established and validated by similar mechanisms as the basic ACDS v1.2 by investigators at Massachusetts General Hospital and NYU School of Medicine.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    The 7×7 correlation matrix among the rational WRAADDS subscales contains only 21 correlations, which makes it impossible to identify a factor model with more than 2 correlated factors.

    “Critically, the resulting 7×7 correlation matrix among the rational WRAADDS subscales contains only 21 correlations (i.e., 7×6/2 = 21), making it impossible to identify a factor model with more than 2 correlated factors, as a 3-factor model would contain 21 factor loadings (7 for each of 3 factors) and 3 correlations among factors, which would exceed the number of degrees of freedom in the”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Emotional dyscontrol is more distinct but prominent in the combined presentation of adult ADHD.

    “These results show that executive dysfunction is as central as DSM-5 symptoms to adult ADHD, while emotional dyscontrol is more distinct but prominent resent in the combined presentation of adult ADHD.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Cluster analysis is designed to minimize distance between cluster centroids and observed cases within clusters.

    “These desirable features are due to cluster analysis being designed to minimize distance between cluster centroids and observed cases within clusters (Chaturvedi et al., 2001)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chaturvedi et al., 2001 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We gave equal weight to the symptoms in each of the 4 observed factors.

    “In addition, we gave equal weight to the symptoms in each of the 4 observed factors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    High inattention/executive dysfunction and high impulsivity are specific to adult ADHD.

    “This suggests that high inattention/executive dysfunction and high impulsivity (which, as noted above, occurred only in the combined presentations) are specific to adult ADHD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationown data

    The characterization of C6 as not being high on any dimension is a comparative statement, as 60.6% of C6 respondents met DSM-5 criteria.

    “It is important to note in this regard that the characterization of C6 as not being high on any dimension is a comparative statement, as 60.6% of C6 respondents met DSM-5 criteria.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The ACDS assessment of emotional dyscontrol was less differentiated than the assessments in other recent studies.

    “First, as noted above, the ACDS assessment of emotional dyscontrol was less differentiated than the assessments in other recent studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    We did not assess comorbid disorders in a uniform fashion across samples, making it impossible to investigate the extent to which the factors and clusters documented here are specific to adult ADHD.

    “Third, we did not assess comorbid disorders in a uniform fashion across samples, making it impossible to carry out an investigation of the extent to which the factors and clusters documented here are specific to adult ADHD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A somewhat different 4-factor solution than ours was found in the original exploratory factor analysis of the Conners' Adult ADHD Rating Scale as well as in a subsequently confirmatory factor analysis of that solution in a Spanish sample.

    “A somewhat different 4-factor solution than ours was found in the original exploratory factor analysis of the Conners’ Adult ADHD Rating Scale (Conners et al., 1999) as well as ina subsequently confirmatory factor analysis of that solution in a Spanish sample (Amador-Campos et al., 2014).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Conners et al., 1999

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Amador-Campos et al., 2014

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Our analysis had strengths including a large sample size, diverse sample composition, and assessments based on semi-structured clinical interviews rather than self-report scales.

    “Although our analysis had a number of strengths, including a large sample size, diverse sample composition, and assessments based on semi-structured clinical interviews rather than self-report scales”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The concept of "executive dysfunction" is heterogeneous and different behavioral and neurocognitive measures are often only weakly correlated with each other.

    “It is important to note in this regard that the concept of “executive dysfunction” is heterogeneous and that different behavioral and neurocognitive measures are often only weakly correlated with each other (Biederman et al., 2008).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Biederman et al., 2008 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Our assessment did not include any of the performance-based measures of neurocognitive functioning used in a number of other recent studies of adult ADHD.

    “Second, our assessment did not include any of the performance-based measures of neurocognitive functioning used in a number of other recent studies of adult ADHD (e.g., Dehili et al., 2013; Micoulaud-Franchi et al., 2016; Surman et al., 2015).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    It was impossible to find more than 2 factors in those studies because only 7 underlying subscales were used as the basis of the factor analyses.

    “That is, it was impossible to find more than 2 factors in those studies because only 7 underlying subscales were used as the basis of the factor analyses.”
    Quote in the paperSubstantial claim
60 of 60

  • The paper relies on this without support.

    No published data confirm the empirical validity of the seven WRAADDS subscales.

    “To our knowledge, no empirical data have ever been reported confirming the empirical validity of these 7 subscales.”

  • The paper relies on this without support.

    No prior study has examined whether person-level analysis would reveal presentations with elevated emotional dyscontrol.

    “We are aware of no previous study that investigated this possibility.”

  • The paper relies on this without support.

    The ACDS provides a valid assessment of adult ADHD symptoms.

    “Exploratory factor analysis in the pooled sample found one very large unrotated first principal factor (Eigenvalue = 15.3) for which 29 of the 32 ACDS items had factor loadings above .40.”

  • The paper relies on this without support.

    The DSM-5/ACDS diagnostic criteria are a valid standard for identifying adult ADHD cases.

    “DSM-5/ACDS adult ADHD prevalence was considerably lower in the NCS-R (23.3%) and health plan (39.7%) samples than the NYU Langone sample (94.2%)”

  • The paper relies on this without support.

    The three samples are sufficiently comparable to pool for factor analysis.

    “Exploratory factor analysis in the pooled sample found one very large unrotated first principal factor (Eigenvalue = 15.3) for which 29 of the 32 ACDS items had factor loadings above .40.”

  • The paper relies on this without support.

    The factor scores derived from the ACDS items adequately capture the underlying symptom dimensions.

    “Respondents were assigned standardized factor-weighted scores on each of the 4 factors.”

  • The paper relies on this without support.

    The k-means cluster analysis on factor scores yields meaningful symptom profiles.

    “K-means cluster analysis was used to examine the multivariate associations among these 4 factor scores.”

  • The paper relies on this without support.

    The DSM-5 presentations are the correct reference for validating clusters.

    “Cross-classification of cluster membership with DSM-5/ACDS diagnoses showed that virtually all respondents in 3 of the clusters (C1 high only on executive dysfunction/inattention; and C4- C5 (high either on all factors or on all but emotional dyscontrol) met DSM-5 criteria for adult ADHD”
8 of 8

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • ADHD in adults can be associated with different challenges than in children and adolescents, such as higher prevalence of psychiatric comorbidities and functional impairment, potentially because of increasing life responsibilities and stressors.

    “However, ADHD in adults can be associated with different challenges than those in children and adolescents, such as higher prevalence of psychiatric comorbidities2,17 and functional impairment,7,18 potentially because of increasing life responsibilities and stressors.6,19”

    From Health care resource utilization and costs associated with psychiatric comorbidities in adult patients with attention-deficit/ hyperactivity disorder (2024) · cites this paper as [18]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • The same cluster is ranked first and second

    Minor

    For health-plan HD-only cases, cluster 2 is named both the most common profile and the profile that follows it.

  • C6's diagnostic rate exceeds the stated range

    Minor

    C6 is included among the two clusters said to have diagnostic rates of 40.6%-51.9%, but its rate is subsequently given as 60.6%.

  • Cluster sizes fall outside the stated range

    Minor

    The stated range is 12.5%-28.4%, but C1 is reported as 12.4% and C3 as 28.5%.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Artiga S., 2013, Health coverage by race and ethnicity: the potential impact of the Affordable Care Act
  2. Conners C. K., 1999, Conners’ Adult ADHD Rating Scales (CAARS)
  3. Faraone S. V., 2010, Diagnostic efficiency of symptom items for identifying adult ADHD, Journal of ADHD and Related Disorders, 1, 38
  4. Gorsuch R. L., 1983, Factor Analysis
  5. NYU School of Medicine, 2015, Adult ADHD Program

Cited by

Sorted by citations

Related

Authors
Adler, L. A., Faraone, S. V., Spencer, T. J., Berglund, P., Alperin, S., & Kessler, R. C.
Affiliations
  • NYU Langone Health (US)
  • SUNY Upstate Medical University (US)
  • Harvard University (US)
  • University of Michigan (US)
  • Hofstra University (US)
ORCID
Venue
International Journal of Methods in Psychiatric Research
Publisher
Wiley
Published
2017-02-17
Volume
26
Issue
1
ISSN
  • 1049-8931 (ISSN-L)
  • 1557-0657
DOI
10.1002/mpr.1555
PMC
PMC5405726
OpenAlex
W2589097179
Cited by
128
References
47
Citations by year
2026: 13 · 2025: 14 · 2024: 13 · 2023: 20 · 2022: 14 · 2021: 17 · 2020: 9 · 2019: 5 · 2018: 15 · 2017: 8
FWCI
8.30
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • International Journal of Methods in Psychiatric Research (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
Funders
  • John D. and Catherine T. MacArthur Foundation (R01 DA016558, R13-MH066849)
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • Pfizer
  • GlaxoSmithKline
  • World Health Organization
  • Massachusetts General Hospital
  • York University
  • European Commission (602805)
  • Universitetet i Bergen
  • National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
  • Pfizer Foundation (R01‐MH069864, R01-DA016558, R13-MH066849)
  • Pan American Health Organization
  • National Institute of Mental Health (R13-MH-066849, R01‐MH070884, MH070884, R01MH094469, U13MH066849, R01‐MH069864)
  • National Institute on Drug Abuse (K05DA015799, R01DA016558)
  • Fogarty International Center (FIRCA R01-TW006481, R01-TW006481, R03TW006481)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
  • Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
Keywords
adult ADHD, executive dysfunction, emotional dysregulation, inattention, hyperactivity, impulsivity, symptom profiles, factor structure, combined presentation, inattentive presentation
MeSH terms
Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Female, Humans, Impulsive Behavior, Male, Middle Aged, Young Adult, Executive Function

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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