Cited by 17Attention Deficit Hyperactivity DisorderPsychometric Methodologies and TestingAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Are We Measuring ADHD or Anxiety? Examining the Factor Structure and Discriminant Validity of the Adult ADHD Self-Report Scale in an Adult Anxiety Disorder Population

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Alarachi, Arij, Merrifield, Colleen, Rowa, Karen, McCabe, Randi E.·2024·Assessment

Abstract

Adults with clinical anxiety have significant symptom overlap and above average rates of attention-deficit/hyperactivity disorder (ADHD). Despite this, ADHD remains a vastly under-detected disorder among this population, indicating the need for a screener with well-understood symptom dimensions and good discriminant validity. The current study compared competing models of ADHD as well as discriminant properties of self-reported ADHD symptoms as measured by the Adult ADHD Self-Report Scale (ASRS-v1.1) in 618 adults with clinical anxiety. A three-factor correlated model of Inattention, Impulsivity, and Hyperactivity, with the movement of one item, talks excessively, to a factor of Impulsivity from Hyperactivity fit better than the one-factor, two-factor, and traditional three-factor models of ADHD. Discriminant properties of the screener were fair to good against measures of clinical anxiety and distress; however, some items within the Hyperactivity factor (e.g., difficulty relaxing; feeling driven by a motor) loaded more strongly onto factors of clinical anxiety than ADHD when measures were pooled together. These results suggest that clinicians making differential diagnoses between adult ADHD and anxiety or related disorders should look for evidence of ADHD beyond the overlapping symptoms, particularly for those within the Hyperactivity factor.

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Crossref · 10.1177/10731911231225190

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  • Many individuals treated exclusively for depression or anxiety continue to experience disabling attentional symptoms, delaying recovery.

    “many individuals treated exclusively for depression or anxiety continue to experience disabling attentional symptoms, delaying recovery [106,112]”

    From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [112]

    The paper’s discussion of undetected ADHD in adults with anxiety disorders (section labeled Abstract; page unavailable) links it to concentration difficulties and poor clinical outcomes, including poor treatment adherence. It does not establish that people treated exclusively for depression or anxiety continue to have disabling attentional symptoms that delay recovery; depression treatment is not addressed in the cited passages. (LLM, conf=0.84)

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Research works printed but not linked: 3

  1. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.).
  2. Dray S. Campbell M. Gilmore L. (2006). Why are girls with ADHD invisible? Connections, 23(2), 2– 7.
  3. World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: Diagnostic criteria for research (Vol. 2).

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Authors
Alarachi, A., Merrifield, C., Rowa, K., & McCabe, R. E.
Affiliations
St. Joseph’s Healthcare Hamilton (CA)
Corresponding author
Alarachi, Arij
Venue
Assessment
Published
2024-01-30
Volume
31
Issue
7
Pages
1508-1524
ISSN
  • 1073-1911 (ISSN-L)
  • 1552-3489
OpenAlex
W4391360113
Cited by
17
References
93
Citations by year
2026: 6 · 2025: 8 · 2024: 3
FWCI
5.00
Type
journal article
Language
en
Open access
Locations
  • Assessment (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
adult ADHD, anxiety disorders, Adult ADHD Self-Report Scale, factor structure, discriminant validity, symptom overlap, inattention, impulsivity, hyperactivity, differential diagnosis, ADHD screening
MeSH terms
Adult, Anxiety, Anxiety Disorders, Attention Deficit Disorder with Hyperactivity, Diagnosis, Differential, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Psychometrics, Reproducibility of Results, Young Adult, Self Report

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