An Evaluation of the Relationship Between Objective and Subjective Measures of Attention

Objective: The use of neuropsychological measures for the diagnosis of attention-deficit hyperactivity disorder (ADHD) has been questioned due to concerns about inadequate specificity and sensitivity. The use of self-report measures in a comprehensive ADHD assessment is considered by some to be the "gold standard," as they can evaluate symptoms outside of the artificial testing environment. However, research evaluating correlations between objective neuropsychological tests and subjective self-report measures of attention has produced mixed results. The aim of this study was to evaluate the convergence (or lack thereof) between commonly used measures in the assessment of ADHD. Method: Veterans (N = 504) with ADHD (n = 279; 60.13%) and without ADHD were comprehensively evaluated using objective neuropsychological tests (Trail Making Tests, Conners Continuous Performance Test 3, and the Integrated Visual and Auditory Continuous Performance Test 2), as well as self-report measures of ADHD (Barkley's Adult ADHD Rating Scale-IV, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, ADHD Diagnostic Interview, the Minnesota Multiphasic Personality Inventory 2-Restructured Form, and the Minnesota Multiphasic Personality Inventory 3). Results: No significant differences were found between veterans with and without ADHD on any objective tests of cognitive functioning. Most correlations between the self-reported ADHD symptoms and neuropsychological tests were not significant. Hierarchical regressions showed that neuropsychological measures were generally not able to predict self-reported symptoms of ADHD, except for commission errors on the Conners Continuous Performance Test 3, which were significantly associated with self-reported symptoms of impulsivity. Conclusion: Overall, objective cognitive tests may have a limited diagnostic utility in the diagnosis of ADHD. Public Significance Statement This study emphasizes the importance of utilizing self-report measures in the assessment of attention-deficit hyperactivity disorder (ADHD), as relying on objective neuropsychological tests may lead to an inaccurate diagnosis. Objective measures of cognitive functioning were not significantly related to self-reported ADHD symptoms and may have a limited diagnostic utility in the diagnosis of ADHD. A comprehensive approach to ADHD assessment should consider the limitations of objective measures and the clinical utility of self-report measures in the evaluatio