Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Psychology Dissertations Student Dissertations, Theses and Papers 2019 Assessing the Validity of the Quotient Adhd System and Its Value in a Comprehensive Diagnostic Assessment Battery for Adult ADHD Hillary Ammon Scharf Philadelphia College of Osteopathic Medicine Follow this and additional works at: https://digitalcommons.pcom.edu/psychology_dissertations Part of the Clinical Psychology Commons Recommended Citation Ammon Scharf, Hillary, "Assessing the Validity of the Quotient Adhd System and Its Value in a Comprehensive Diagnostic Assessment Battery for Adult ADHD" (2019). PCOM Psychology Dissertations. 519. https://digitalcommons.pcom.edu/psychology_dissertations/519 This Dissertation is brought to you for free and open access by the Student Dissertations, Theses and Papers at DigitalCommons@PCOM. It has been accepted for inclusion in PCOM Psychology Dissertations by an authorized administrator of DigitalCommons@PCOM. For more information, please contact [email protected]. Philadelphia College of Osteopathic Medicine School of Professional and Applied Psychology ASSESSING THE VALIDITY OF THE QUOTIENT ADHD SYSTEM AND ITS VALUE IN A COMPREHENSIVE DIAGNOSTIC ASSESSMENT BATTERY FOR ADULT ADHD By Hillary Ammon Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Psychology June 2019 PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE DEPARTMENT OF PSYCHOLOGY - Dissertation Approval This is to certify that the thesis presented to us by ______________________________ on the ______ day of __________________, 20___, in partial fulfillment of the requirements for the degree of Doctor of Psychology, has been examined and is acceptable in both scholarship and literary quality. Committee Members’ Signatures: ______________________________, Chairperson ______________________________ ______________________________ ______________________________, Chair, Department of Psychology iii Acknowledgements I would to thank my committee members, Drs. Brad Rosenfield, Russ Ramsay, and Susan Mindel, for their support and flexibility throughout this process. In particular, Dr. Rosenfield aided in identifying this research question and was prompt in addressing all questions and concerns throughout the process. Throughout all the research courses, Dr. Mindel provided support and guidance, particularly related to the statistics required for this dissertation. Second, I would like to thank Drs. Ramsay and Anthony Rostain for allowing me to administer the assessment measures, as it allowed a better understanding of my research questions. Also, for permitting the use of their archival data, for their suggestions and support, and for inviting me to the clinic’s ADHD research meetings. I would also like to thank my family for their unconditional support, love, patience, and encouragement throughout my master’s program, this doctoral program and dissertation, and my life. Thank you for always believing in me. I would not have been able to achieve the goal of obtaining a doctorate without your support. Mom- thank you for being my unofficial editor throughout my entire academic career. Dad- thank you for encouraging me to follow in your footsteps by becoming a psychology major in undergrad. Finally, I would like to thank my husband, Ethan. Thank you for enduring this journey with me. You provided unconditional support. You helped celebrate the milestones and provided support during the challenging moments. You took on extra responsibilities in the household when I needed to focus on schoolwork and supported our family financially. I am so lucky to have you in my life. iv Abstract The purpose of this study was to determine the validity and reliability of the Quotient ADHD System (the Quotient) as a tool for the assessment of adult ADHD. At the time of this study, the Quotient was a widely accepted measure, yet there was a paucity of empirical evidence for its use with adults. This study reviewed the relationship between adult participants’ (N = 151) scores on two self-reported measures, the Barkley Deficits in Executive Functioning Scale (BDEFS) and the Barkley Adult ADHD Rating Scale – IV (BAARS-IV), and the Quotient at a university-based ADHD-specialty outpatient clinic in a large city in the Northeastern U.S. It was predicted that participants’ scores on the self-report measures would correlate with and predict the behavioral correlates of ADHD, the latter as measured by the Quotient. The present study determined that the Global Scaled Score metric of the Quotient correlates with the Total Executive Functioning (EF) Summary Score of the BDEFS and the ADHD Total Score of the BAARS-IV. Furthermore, this study found a significant, positive correlation between the Motion Scaled Scores of the Quotient and the ADHD Hyperactivity scale on the BAARS-IV. Additionally, through a post-hoc analysis, a correlation was found between the Inattention Scaled Scores of the Quotient and the Self-Restraint scale on the BDEFs. These findings may lend support that some of the core characteristics of ADHD, such as inattention and impulsivity, are less accurately measured by continuous performance tests (CPTs), while the behavioral traits of hyperactivity are more accurately captured by CPTs. Keywords: adult attention-deficit/hyperactivity disorder, adult ADHD, symptoms, executive functions, assessment of ADHD v Table of Contents List of Tables .............................................................................................................................. viii Chapter 1: Introduction ................................................................................................................... 1 Statement of the Problem ..................................................................................................... 1 Purpose of the Study ............................................................................................................ 4 Chapter 2: Literature Review .......................................................................................................... 6 History of the Diagnosis ...................................................................................................... 6 ADHD Subtypes .................................................................................................................. 9 Inattention ................................................................................................................. 9 Hyperactivity/impulsivity ....................................................................................... 12 Combined presentation ........................................................................................... 14 Inattentive (restrictive): A proposed, but rejected category .................................... 15 Sluggish cognitive tempo/concentration deficit disorder: A proposed category .... 15 Executive Functioning ....................................................................................................... 16 Genetics ............................................................................................................................. 20 Neurobiology ..................................................................................................................... 22 Gender ................................................................................................................................ 22 Age and Symptom Progression .......................................................................................... 23 Childhood presentation ........................................................................................... 24 Adult presentation ................................................................................................... 25 Functional Impairment ....................................................................................................... 26 Education ................................................................................................................ 26 Occupational functioning ........................................................................................ 27 Social impairment ................................................................................................... 28 Impairments in other important life activities ......................................................... 29 vi ADHD and Psychiatric Comorbidities ............................................................................... 30 Internalizing disorders............................................................................................. 31 Externalizing disorders ........................................................................................... 35 Assessment of ADHD ............................................................................................................ 37 Rating scales ........................................................................................................... 40 Continuous performance tests ................................................................................. 43 Summary ................................................................................................................................ 48 Chapter 3: Hypotheses .................................................................................................................. 50 Hypothesis 1 .........................................................................................................................