The present work studies the Attention Deficit Hyperactivity Disorder (ADHD) in adults, a condition characterized by deficits in attention capacity and high hyperactivity and impulsivity behaviours. This disorder, which has an estimated prevalence of 3-4% in the general population, causes a significant impact in academic, work, social and family areas. One of the main difficulties arising from ADHD assessment in adults is the change that occurs in the clinical expression of the disorder in adulthood comparing to childhood. Given the need for valid and reliable instruments for its diagnose, we carried out the validation of the Spanish version of the Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID) (Epstein et al., 1999), a widely used instrument in both clinical and research settings. The analysis of criterion and concurrent validity showed that the Spanish version of CAADID is a valid instrument to ADHD diagnose in adults. Most studies on personality and ADHD focus on personality disorders more than in normal trait personality models. Similarly, the literature on personality characteristics in adults with ADHD is scarce and results vary according to the theoretical approach from which personality is evaluated. The second study of the present work aimed to assess the discriminant and criterion validity of the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ) (Zuckerman, 2002), an instrument used to assess normal personality traits. The results of this study demonstrated that this instrument adequately discriminate subjects with ADHD compared to subjects from the general population, and allows establishing a personality profile in adults with ADHD. One of the most common comorbid disorders in ADHD adults is the Substance Use Disorder (SUD). Likewise, about 20-30% of patients with ADHD have a comorbid SUD. Comorbidity is, in fact, one of the causes contributing to the complexity of adult ADHD diagnosis, and this difficulty increases when SUD is present. The Psychiatry Research Interview for Substance and Mental Disorders (PRISM) (Torrens et al., 2004) allows to simultaneously assess abuse and substance dependence disorders, both current and lifetime, as well as other Axis I and Axis II diagnostic categories (Antisocial and Borderline Personality Disorder). The third study of this work assessed the criterion and concurrent validity of the "Adult ADHD section" of the PRISM. The results showed an adequate ability to classify ADHD subjects and a satisfactory correlation with other instruments valid for assessment of this disorder. As in most psychiatric disorders, the cause of comorbidity with TUS in ADHD patients appears to be caused by the combination of multiple clinical factors, including the severity of the disorder in childhood and the persistence in adulthood, as well as comorbidity with other externalizing conduct disorders (Biederman et al., 2008; Fergusson et al., 2007; Wilens et al., 2011). The last study of the present research analysed together for the first time a large number of childhood and adolescence variables associated with the presence of TUS in ADHD adults. Specifically, externalizing conduct disorders comorbidity, temperament traits, academic and environmental factors and family history. Also, comparing to a clinical sample without ADHD, a greater prevalence of SUD and functional impairment was found in subjects with ADHD. In summary, the main objective of this doctoral thesis is to contribute to the development of assessment and diagnostic measures of ADHD in adults. Moreover, also intended to assess the usefulness of these instruments in daily clinical practice, providing a better definition of the disorder, associated clinical characteristics and comorbidity, and further investigate its association with substance use disorders.
Instrumentos de evaluación y diagnóstico del trastorno por déficit de atención con hiperactividad (TDAH) en adultos: Clínica y estudio de la comorbilidad con los trastornos por uso de sustancias (TUS)
Mariana Isabel, M. N. (Author). 23 Apr 2014
Student thesis: Doctoral thesis
Student thesis: Doctoral thesis