Validación al español de la ADHD Rating Scale (ADHD-RS) en adultos: relevancia de los subtipos clínicos / Spanish validation of the adult Attention Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS): relevance of clinical subtypes

Introducción. El trastorno por déficit de atención e hiperactividad (TDAH) tiene una prevalencia de entre el 2,5 y el 4% de la población general adulta. La Attention Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS) es una escala autoinformada de 18 ítems para la evaluación de los síntomas del TDAH en adultos. El objetivo del presente estudio es realizar la validación de la versión española de la ADHD-RS. Material y método. Se incluyó una muestra de 304 adultos con TDAH y 94 controles sanos sin TDAH. El diagnóstico de TDAH se evaluó con la Entrevista Clínica Estructurada para el DSM-IV (SCID-I) y la Entrevista Diagnóstica para TDAH en Adultos de Conners para el DSM-IV (CAADID-II). Para determinar la validez interna de la estructura de 2 dimensiones de la ADHD-RS se realizó un análisis factorial exploratorio. Los coeficientes α se realizaron como medida de la consistencia interna de las dimensiones consideradas. Mediante un estudio de regresión logística se evaluó el modelo en términos de especificidad, sensibilidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Resultados. La media de edad de los participantes fue de 33,29 años (DE=10,50), con un 66% de hombres (sin diferencias entre los 2 grupos). El análisis factorial se realizó con un análisis de componentes principales seguido de una normalización por la rotación varimax. La medida de Kaiser-Meyer-Olkin para el test de adecuación de muestras fue de 0,868 (notable) y el test de esfericidad de Bartlett fue 2 (153)=1.835,76, p<0,0005, indicando que el análisis factorial es adecuado. Este modelo de 2 factores explica el 37,8% de la varianza. El coeficiente α de los 2 factores es 0,84 y 0,82. La estrategia original proponía un punto de corte de 24: sensibilidad (81,9%), especificidad (74,7%), VPP (50,0%), VPN (93,0%), coeficiente kappa 0,78 y área bajo la curva (AUC) 0,89. La nueva estrategia de puntuación sugerida por nuestro grupo propone diferentes puntos de corte según las diferentes presentaciones clínicas de TDAH. El punto de corte para la presentación combinada de TDAH es 24: sensibilidad (81,9%), especificidad (87,3%), VPP (78,6%), VPN (89,4%), coeficiente kappa 0,88 y AUC 0,94, mientras que el punto de corte para la presentación predominante con falta de atención sería 21: sensibilidad (70,2%), especificidad (76,1%), VPP (71,7%), VPN (74,8%), coeficiente kappa 0,88 y AUC 0,94. Conclusiones. La versión española de la ADHD-RS es una escala válida para discriminar correctamente adultos con TDAH de personas sin TDAH. La nueva propuesta de puntuación sugiere la relevancia de las presentaciones clínicas en los diferentes puntos de corte seleccionados (AU)

Introduction. Adult attention deficit hyperactivity disorder (ADHD) has a prevalence between 2.5% and 4% of the general adult population. Over the past few decades, self-report measures have been developed for the current evaluation of adult ADHD. The ADHD-RS is a 18-items scale self-report version for assessing symptoms for ADHD DSM-IV. A validation of Spanish version of the ADHD-RS was performed. Material and method. The sample consisted of 304 adult with ADHD and 94 controls. A case control study was carried out (adult ADHD vs. non ADHD). The diagnosis of ADHD was evaluated with the Structured Clinical Interview for DSM-IV (SCID-I) and the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID-II). To determinate the internal validity of the two dimensions structure of ADHD-RS an exploratory factor analysis was performed. The α-coefficients were taken as a measure of the internal consistency of the dimensions considered. A logistic regression study was carried out to evaluate the model in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV). Results. Average age was 33.29 (SD=10.50) and 66% of subjects were men (there were no significant differences between the two groups). Factor analysis was done with a principal component analysis followed by a normalized varimax rotation. The Kaiser-Meyer-Olkin measure of sampling adequacy tests was .868 (remarkable) and the Bartlett's test of sphericity was 2 (153)=1,835.76, P<.0005, indicating the appropriateness of the factor analysis. This two-factor model accounted for 37.81% of the explained variance. The α-coefficient of the two factors was .84 and .82. The original strategy proposed 24 point for cut-off: sensitivity (81.9%), specificity (74.7%), PPV (50.0%), NPV (93.0%), kappa coefficient .78 and area under the curve (AUC) .89. The new score strategy proposed by our group suggests different cut-off for different clinical presentations. The 24 point is the best cut-off for ADHD combined presentation: sensitivity (81.9%), specificity (87.3%), PPV (78.6%), NPV (89.4%), kappa coefficient .88 and AUC .94, and 21 point is the best cut-off for ADHD predominantly inattentive presentation: sensitivity (70.2%), specificity (76.1%), PPV (71.7%), NPV (74.8%), kappa coefficient .88 and AUC .94. Conclusions. In this study, the Spanish version of the ADHD-RS is a valid scale to discriminate between ADHD adults and controls. The new proposed score strategy suggests the relevance of clinical presentations in the different cut-offs selected (AU)

Spanish validation of the adult Attention Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS): relevance of clinical subtypes. / Validación al español de la ADHD Rating Scale (ADHD-RS) en adultos: relevancia de los subtipos clínicos.

INTRODUCTION: Adult attention deficit hyperactivity disorder (ADHD) has a prevalence between 2.5% and 4% of the general adult population. Over the past few decades, self-report measures have been developed for the current evaluation of adult ADHD. The ADHD-RS is a 18-items scale self-report version for assessing symptoms for ADHD DSM-IV. A validation of Spanish version of the ADHD-RS was performed. MATERIAL AND METHOD: The sample consisted of 304 adult with ADHD and 94 controls. A case control study was carried out (adult ADHD vs. non ADHD). The diagnosis of ADHD was evaluated with the Structured Clinical Interview for DSM-IV (SCID-I) and the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID-II). To determinate the internal validity of the two dimensions structure of ADHD-RS an exploratory factor analysis was performed. The α-coefficients were taken as a measure of the internal consistency of the dimensions considered. A logistic regression study was carried out to evaluate the model in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV). RESULTS: Average age was 33.29 (SD=10.50) and 66% of subjects were men (there were no significant differences between the two groups). Factor analysis was done with a principal component analysis followed by a normalized varimax rotation. The Kaiser-Meyer-Olkin measure of sampling adequacy tests was .868 (remarkable) and the Bartlett's test of sphericity was 2 (153)=1,835.76, P<.0005, indicating the appropriateness of the factor analysis. This two-factor model accounted for 37.81% of the explained variance. The α-coefficient of the two factors was .84 and .82. The original strategy proposed 24 point for cut-off: sensitivity (81.9%), specificity (74.7%), PPV (50.0%), NPV (93.0%), kappa coefficient .78 and area under the curve (AUC) .89. The new score strategy proposed by our group suggests different cut-off for different clinical presentations. The 24 point is the best cut-off for ADHD combined presentation: sensitivity (81.9%), specificity (87.3%), PPV (78.6%), NPV (89.4%), kappa coefficient .88 and AUC .94, and 21 point is the best cut-off for ADHD predominantly inattentive presentation: sensitivity (70.2%), specificity (76.1%), PPV (71.7%), NPV (74.8%), kappa coefficient .88 and AUC .94. CONCLUSIONS: In this study, the Spanish version of the ADHD-RS is a valid scale to discriminate between ADHD adults and controls. The new proposed score strategy suggests the relevance of clinical presentations in the different cut-offs selected.

Tratamiento del trastorno por déficit de atención/ hiperactividad en la edad adulta a través de la realidad virtual mediante un programa de mindfulness / Treatment of attention deficit hyperactivity disorder in adults using virtual reality through a mindfulness programme

Introducción. El trastorno por déficit de atención/hiperactividad (TDAH) es un trastorno del neurodesarrollo altamente prevalente, presenta una elevada comorbilidad con sintomatología afectiva y ansiosa, afecta a la funcionalidad de la persona que lo padece, tienen una baja adhesión terapéutica y genera unos costes sociales y personales elevados. El mindfulness es un tratamiento psicológico que ha demostrado ser eficaz para el TDAH. La realidad virtual es un tratamiento altamente utilizado en fobias y extendido a otras patologías con resultados positivos. Objetivo. Desarrollar el primer tratamiento con realidad virtual y mindfulness para el TDAH en la edad adulta, que suponga un aumento en la adhesión terapéutica y reduzca costes. Pacientes y métodos. Estudio piloto de 25 pacientes tratados con realidad virtual, mediante cuatro sesiones de 30 minutos, y 25 mediante psicoestimulantes. Se tomarán medidas de evaluación pretratamiento, postratamiento y postratamiento a los 3 y 12 meses, tanto de TDAH como de depresión, ansiedad, funcionalidad y calidad de vida. Se analizarán posteriormente con el programa SPSS v. 20 y se realizará un ANOVA de grupos independientes para ver las diferencias entre tratamientos y un test-retest para detectar el mantenimiento de los cambios. Resultados y conclusiones. Es necesaria la utilización de tratamientos que sean efectivos, supongan una reducción en los costes y un aumento en la adhesión terapéutica. El tratamiento con realidad virtual se plantea como una alternativa a los tratamientos clásicos, que sea más breve y atractiva para los pacientes (AU)

Introduction. Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder, which presents a high comorbidity with anxiety and affective signs and symptoms. It has repercussions on the functioning of those suffering from it, who also have low therapy compliance and generate a significant cost both at a personal level and for society. Mindfulness is a psychological treatment that has proved to be effective for ADHD. Virtual reality is widely used as treatment in cases of phobias and other pathologies, with positive results. Aims. To develop the first treatment for ADHD in adults based on virtual reality and mindfulness, while also resulting in increased treatment adherence and reduced costs. Patients and methods. We conducted a pilot study with 25 patients treated by means of virtual reality, in four 30-minute sessions, and 25 treated with psychostimulants. Measures will be taken pre-treatment, post-treatment and at 3 and 12 months post-treatment, to evaluate both ADHD and also depression, anxiety, functionality and quality of life. Data will be later analysed with the SPSS v. 20 statistical program. An ANOVA of independent groups will be performed to see the differences between treatments and also a test-retest to detect whether the changes will be maintained. Results and conclusions. It is necessary to use treatments that are effective, reduce costs and increase therapy adherence. Treatment with virtual reality is an interesting alternative to the classical treatments, and is shorter and more attractive for patients (AU)