A New Subscale for the Personality Assessment Inventory (PAI) to Screen Adults for Attention-Deficit/Hyperactivity Disorder (ADHD) Page: 58
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because ADHD symptomatology must be present before the age of twelve (American Psychiatric
Association, 2013). Unfortunately, when individuals are asked to give retrospective reports about
themselves as children, accounts tend to be vague and have poor predictive power for current
impairment (Suhr, Zimak, Buelow & Fox, 2009). Even the minimum age at which onset of
ADHD symptoms occur seems arbitrary. For decades, the DSM criteria for onset of symptoms
and impairments was before the age of 7. Only the most recent DSM changed this criterion to be
for age 12. This change was instituted because many individuals with ADHD only experience
significant impairment once expectations for self-management increase (Epstein & Loren, 2013).
For children in families who have parents with ADHD, their impairment may seem normal. For
children who grow up in a highly structured environment, have high intelligence, or have
predominantly inattentive symptoms, their impairments may go unnoticed by their families and
teachers. The change of onset was an attempt to reduce these diagnostic issues (American
Psychiatric Association, 2013; Epstein & Loren, 2013).
ADHD Comorbidities
ADHD has a high association with a number of psychiatric conditions and social
problems. Adults with ADHD are more likely to be diagnosed with an internalizing disorder and
have low self-esteem (Blase, Gilbert, Anastopoulos, Costello, Hoyle & Swartzwelder, 2008).
Major depressive disorder is the most commonly diagnosed comorbid psychiatric disorder with
ADHD; anxiety is the second most common (Fischer et al., 2007). Regardless of the ADHD
subtype an adult has, internalizing disorders are equally likely (Nelson & Gregg, 2012).
According to the National Comorbidity Survey Replication (NCS-R), an epidemiological survey
that evaluation American adults with ADHD for comorbid disorders, 38.3% of adults with
ADHD also have a mood disorder (Adler et al., 2008; Kessler et al., 2006). Among adults with58
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Calmenson, Nina E. A New Subscale for the Personality Assessment Inventory (PAI) to Screen Adults for Attention-Deficit/Hyperactivity Disorder (ADHD), dissertation, August 2021; Denton, Texas. (https://digital.library.unt.edu/ark:/67531/metadc1833444/m1/66/: accessed July 17, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; .