Objective Measures of Behavior Manifestations in Adult ADHD and Differentiation from Participants with Bipolar II Disorder, Borderline Personality Disorder, Participants with Disconfirmed ADHD as Well as Normative Participants
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Background: The present study evaluated two psychometric instruments derived from the objective measurement of adult ADHD using the Quantified Behavior Test Plus. The instruments were examined in ADHD versus a clinical group with overlapping symptoms including borderline personality disorder and bipolar II disorder, and another clinical group with participants assessed for but disconfirmed a diagnosis of ADHD as well as adult normative participants. Methods: The Quantified Behavior Test Plus includes Continuous Performance Testing and a Motion Tracking System with parameters related to attention and activity operationalized as the cardinal symptoms of ADHD and then summarized into a Weighed Core Symptoms scale with ten cut-points ranging from 0 to 100. A categorical predictor variable called Prediction of ADHD was used to examine the levels of sensitivity and specificity for the Quantified Behavior Test Plus with regard to ADHD. Results: The Weighed Core Symptoms scale separated ADHD and normative participants from each other as well as from the two clinical reference groups. The scale reported highest levels of core symptoms in the ADHD group and the lowest level of core symptoms in the normative group. Analyses with Prediction of ADHD yielded 85 % specificity for the normative group, 87 % sensitivity for the ADHD group, 36 % sensitivity for the bipolar II and borderline group and 41 % sensitivity for the group with a disconfirmed diagnosis of ADHD. Conclusions: The Weighed Core Symptoms scale facilitated objective assessment of adult ADHD insofar that the ADHD group presented more core symptoms than the other two clinical groups and the normative group. Sensitivity for the Quantified Behavior Test Plus was lower in complex clinical groups with Bipolar II disorder, Borderline disorder and in patients with a disconfirmed diagnosis of ADHD. The psychometric instruments may be further evaluated with regard to well-documented and effective treatment programs for ADHD core symptoms.
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Sensitivity of Qb+© dropped substantially when differentiating between individuals with ADHD and other clinical groups such as bipolar II disorder (36%) or borderline personality disorder (41%).
“However, sensitivity dropped substantially when trying to differentiate between individuals with ADHD and other clinical groups such as bipolar II disorder (36%) or borderline personality disorder (41%; [35]).”
From Assessing ADHD symptoms in children and adults: evaluating the role of objective measures (2018) · cites this paper as [35]
The Discussion reports 87% sensitivity, not 36% or 41%. It identifies 36% as clinical specificity for a combined bipolar II/borderline group and 41% as clinical specificity for a disconfirmed-ADHD group; it does not assign separate percentages to bipolar II and borderline personality disorder. (LLM, conf=0.94)
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Experimental — accuracy not yet measuredStudies of Qb+© demonstrated high sensitivity (86%) and specificity (83%) when differentiating between subjects with and without ADHD.
“There are studies of the Qb+©, the version used for adolescents and adults, demonstrating high sensitivity (86%) and specificity (83%) when trying to differentiate between subjects with and without ADHD [35, 36].”
From Assessing ADHD symptoms in children and adults: evaluating the role of objective measures (2018) · cites this paper as [35]
The Methods (Instruments; page unavailable) report 86% sensitivity and 83% specificity for a QbTest-Plus-based predictor distinguishing ADHD participants from healthy normative participants. The claim says more broadly “subjects with and without ADHD”; the Discussion reports substantially lower specificity for clinical groups without ADHD, so the figures do not apply to that broader comparison. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe measure of impulsivity is the least sensitive symptom for discriminating between adults with and without ADHD and between patients with ADHD or other psychiatric disorders.
“The measure of impulsivity has been shown to be the least sensitive symptom with regard to discriminating between adults with and without ADHD as well as between patients with ADHD or other psychiatric disorders [35, 36, 39].”
From Assessing ADHD symptoms in children and adults: evaluating the role of objective measures (2018) · cites this paper as [35]
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“…for instance, the QbTest has previously demonstrated 86% and 83% sensitivity and specificity respectively, when differentiating between ADHD and neurotypical controls, yet sensitivity drops to 36% when differentiating ADHD and borderline personality disorder controls (Edebol et al., 2012, 2013).”
BackgroundÉtain, B., Lajnef, M., Loftus, J., Henry, C., Raust, A., Gard, S., Kahn, J., Leboyer, M., Scott, J. L., & Bellivier, F. (2016) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867416642021 · Cited by 13 · see citing works
“1) do not meet ADHD caseness criteria (Edebol et al., 2012; McCann and Roy-Byrne, 2004; Perroud et al., 2014; Torres et al., 2015).”
BackgroundMotor cortex dysfunction in problem gamblers
Chowdhury, N. S., Livesey, E. J., Blaszczynski, A. P., & Harris, J. A. (2020) · Addiction Biology · doi:10.1111/adb.12871 · Cited by 10 · see citing works
Perceived Feeling of Security: A Candidate for Assessing Remission in Borderline Patients?
Norlander, T., Ernestad, E., Moradiani, Z., & Nordén, T. (2015) · The Open Psychology Journal · doi:10.2174/1874350101508010146 · Cited by 9 · see citing works
Self-citationGustafsson, U., & Hansen, M. (2023) · Mental Health Science · doi:10.1002/mhs2.43 · Cited by 8 · see citing works
QbTest for Monitoring Medication Treatment Response in ADHD: A Systematic Review
Gustafsson, U., & Hansen, M. (2023) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/0117450179276630231030093814 · Cited by 6 · see citing works
ADHD in College Students - a Guide for Clinicians and Administrators
Winkler, A., Bohle-Frankel, B., White, L. A., Strauss, G. D., & Gottlieb, D. T. (2020) · Current Psychopharmacologye · doi:10.2174/2211556009999200616132427 · Cited by 6 · see citing works
Martin-Key, N. A., Stevenson, A., & Roy, P. (2021) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000001350 · Cited by 5 · see citing works
Luderer, M., Seidt, J., Gerhardt, S., Hoffmann, S., Vollstädt-Klein, S., Reif, A., & Sobanski, E. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1112843 · Cited by 5 · see citing works
The Quantified Behavioural Test Plus (QbTest+) in adult ADHD
Nylander, E., Sparding, T., Floros, O., Rydén, E., Landén, M., & Hansen, S. (2022) · Nordic Psychology · doi:10.1080/19012276.2022.2036628 · Cited by 4 · see citing works
Tomlinson, E., Ward, M., Walker, J. G., Benavente, M., Wang, H., Cooper, C., Jones, H. E., Owen‐Smith, A., Manzano, C. L., James, S., et al. (2025) · Health Technology Assessment · doi:10.3310/drdr7171 · Cited by 3 · see citing works
Contrasting expectancy effects with objective measures in adults with untreated ADHD during QbTest
Löhman, M., Domingo, B., Östlund, M., & Jansson, L. (2023) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12906 · Cited by 3 · see citing works
Fuermaier, A. B. M., Hirsch, O., Albrecht, B., Chavanon, M., & Christiansen, H. (2025) · Journal of Attention Disorders · doi:10.1177/10870547251348779 · Cited by 2 · see citing works
“This test, which gained approval from the Federal Drug Administration in 2014 (Dolgin, 2014), serves as a diagnostic tool for ADHD (Edebol et al., 2012; Lis et al., 2010; Söderström et al., 2014).”
Dai, Y.-W., & Hsu, C.-F. (2025) · Children · doi:10.3390/children12111448 · Cited by 2 · see citing works
“The Continuous Performance Test (CPT) has been proposed as an objective measure for ADHD diagnosis [62], though evidence has cast doubt on its diagnostic value [63].”
Tan, Y. L., Ma, G., McIntyre, R. S., Teopiz, K. M., Dri, C. E., Chiang, S., Zhou, D., Hao, F., Li, Z., Zhang, Z., et al. (2025) · Psychiatry International · doi:10.3390/psychiatryint7010001 · Cited by 1 · see citing works
Perspektiv på utredning och diagnos vid ADHD
Edebol, H., & Norlander, T. (2013) · Socialmedicinsk tidskrift · doi:10.62607/smt.v90i3.43298
Self-citationAsherson, P. J., Buitelaar, J. K., Faraone, S. V., Jebsen, K. G., & Rohde, L. A. (2016)
Jansson, L., Löhman, M., Östlund, M., & Domingo, B. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05231-8
“The clinical documentation is comprehensive, and results show that QbTest can differentiate between patients and healthy controls and between ADHD and other clinical groups [36, 37].”
BackgroundPark, S.-Y., An, Y., Park, S., Shin, M., & Kang, U. G. (2024) · Psychiatry Investigation · doi:10.30773/pi.2024.0066
Normative Data for Objective ADHD Smartphone Application in a General Population
Gustafsson, U., Nolen, R., Casals, N., Larsson, S., Sanyal, R. Y., & Hansen, M. (2025) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/0117450179377329250131072308
- Authors
- Edebol, H., Helldin, L., & Norlander, T.
- Affiliations
- Karlstad University (SE)
- NU Hospital Group (SE)
- Karolinska Institutet (SE)
- Corresponding author
- Edebol, Hanna
- Venue
- Clinical Practice & Epidemiology in Mental Health
- Publisher
- Bentham Science Publishers Ltd.
- Published
- 2012-11-02
- Volume
- 8
- Issue
- 1
- Pages
- 134-143
- ISSN
- 1745-0179 (ISSN-L)
- PMC
- PMC3497060
- OpenAlex
- W2115364825
- Cited by
- 40
- References
- 52
- Citations by year
- 2025: 5 · 2024: 1 · 2023: 6 · 2022: 4 · 2021: 2 · 2020: 4 · 2019: 2 · 2018: 3 · 2017: 1 · 2016: 4 · 2015: 3 · 2014: 3 · 2013: 1 · 2012: 1
- FWCI
- 1.83
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Clinical Practice and Epidemiology in Mental Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Landstinget i Värmland
- Cilag
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- adult ADHD, bipolar II disorder, borderline personality disorder, continuous performance test, motion tracking, attention, sensitivity and specificity, differential diagnosis
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