756198

research-article2018
JADXXX10.1177/1087054718756198Journal of Attention DisordersSilverstein et al.

Article
Journal of Attention Disorders

Validation of the Expanded Versions of

2019, Vol. 23(10) 1101­–1110
© The Author(s) 2018
Article reuse guidelines:
the Adult ADHD Self-Report Scale v1.1 sagepub.com/journals-permissions
DOI: 10.1177/1087054718756198
https://doi.org/10.1177/1087054718756198

Symptom Checklist and the Adult ADHD journals.sagepub.com/home/jad

Investigator Symptom Rating Scale

Michael J. Silverstein1,2 , Stephen V. Faraone3, Samuel Alperin2,4, Terry L. Leon2,

Joseph Biederman5, Thomas J. Spencer5, and Lenard A. Adler2

Abstract
Objective: The aim of this study is to validate the Adult ADHD Self-Report Scale (ASRS) and Adult ADHD Investigator
Symptom Rating Scale (AISRS) expanded versions, including executive function deficits (EFDs) and emotional dyscontrol
(EC) items, and to present ASRS and AISRS pilot normative data. Method: Two patient samples (referred and primary
care physician [PCP] controls) were pooled together for these analyses. Results: Final analysis included 297 respondents,
171 with adult ADHD. Cronbach’s alphas were high for all sections of the scales. Examining histograms of ASRS 31-item
and AISRS 18-item total scores for ADHD controls, 95% cutoff scores were 70 and 23, respectively; histograms for pilot
normative sample suggest cutoffs of 82 and 26, respectively. Conclusion: (a) ASRS- and AISRS-expanded versions have
high validity in assessment of core 18 adult ADHD Diagnostic and Statistical Manual of Mental Disorders (DSM) symptoms
and EFD and EC symptoms. (b) ASRS (31-item) scores 70 to 82 and AISRS (18-item) scores from 23 to 26 suggest a high
likelihood of adult ADHD. (J. of Att. Dis. 2019; 23(10) 1101-1110)

Keywords
ADHD, ASRS, AISRS, scale psychometrics, executive function, emotional control

Introduction symptoms in adult context and rated on a frequency basis. It

Currently, it is presumed that ADHD affects approximately
4.4% of U.S. adults (Kessler et al., 2006). Those with adult
ADHD have increased rates of psychiatric comorbidities,
workplace issues, and accidents with injuries (Biederman,
Faraone, et al., 2006; de Graaf et al., 2008; Kupper et al.,
2012; London & Landes, 2016). The Adult ADHD
Investigator Symptom Rating Scale (AISRS) is a clinician-
administered semistructured interview methodology devel-
oped to evaluate treatment responses (Spencer et al., 2010).
The measure contains prompts and stem questions designed
to capture the Diagnostic and Statistical Manual of Mental
Disorders (DSM) symptoms of the disorder ADHD as they
present in adulthood. Based on the responses from the
patient, the administering clinicians rate the symptom
severity as 0 = none, 1 = mild, 2 = moderate, or 3 = severe.
The scale has been used and validated many times in a vari-
ety of clinical drug trials (Adler & Gorny, 2015; Adler et al.,
2006; Adler, Zimmerman, Starr, Silber, Palumbo, Orman &
Spencer 2009; Arnold, Feifel, Earl, Yang, & Adler, 2014;
Goodman et al., 2017; Spencer et al., 2010).
The Adult ADHD Self-Report Scale (ASRS) Symptom
Checklist is a self-report that presents the 18 DSM ADHD
was developed by the World Health Organization (WHO)
work group on adult ADHD, and comprises an 18-item
Symptom Checklist (corresponding to the 18 symptoms
found in the DSM) and a six-item screener (items extracted
from the symptom checklist) to help identify adults at risk of
ADHD (Kessler et al., 2005; Ustun et al., 2017). The
Screener and the Symptom Checklist use a 5-point Likert-
type scale to rate ADHD symptoms (0 = never, 1 = rarely, 2
= sometimes, 3 = often, and 4 = very often). Depending on
the question, “sometimes,” “often,” or “very often” suggests
clinical impairment for that specific item. The ASRS v1.1
Symptom Checklist is designed to provide clinicians with an
1
Drexel University, Philadelphia, PA, USA
2
New York University School of Medicine, USA
3
State University of New York Upstate Medical University, Syracuse,
USA
4
Cincinnati Children’s Hospital Medical Center, OH, USA
5
Massachusetts General Hospital, Boston, USA
Corresponding Author:
Lenard A. Adler, Department of Psychiatry and Child and Adolescent
Psychiatry, New York University School of Medicine, One Park Avenue,
8th Floor, New York, NY 10016, USA.
Email: Lenard.adler@nyumc.org
1102 Journal of Attention Disorders 23(10)
inventory of adult ADHD symptoms as the first part of a
diagnostic evaluation or to be used in monitoring treatment
response (Adler, Shaw, & Alperin, 2015; Adler et al., 2006).
The ASRS and AISRS have both been expanded to include
additional symptoms intended to assess executive function
deficits (EFDs; nine items) and emotional dyscontrol (EC; four
items). EFDs are deficiencies of high order cognitive pro-
cesses, such as self-control, self-regulation, and ability to pri-
oritize and to plan multiple tasks. EC includes symptoms of
mood lability, irritability, and emotional overreactivity. These
additional items were developed by the WHO adult ADHD
work group by examining other scales that measure ADHD
non-DSM symptoms, including the Brown Attention Deficit
Disorder Scale, the Conners’ Adult ADHD Rating Scale
(CAARS)–Self-Report: Long Version (Brown, 1996; Conners,
Erhardt, & Sparrow, 1998), and the Utah Criteria (Wender,
1998). As with the Diagnostic and Statistical Manual of
Mental Disorders (5th ed.; DSM-5; American Psychiatric
Association [APA], 2013) items, specific prompts have been
written for the AISRS to help guide the rater to explore the full
manifestations of symptoms in an adult with ADHD.
There is much disagreement in the literature if EFD/EC
should be viewed as core symptoms of adult ADHD, associ-
ated features, or merely the result of co-traveling symptoms
(Adler et al., 2017; Barkley & Murphy, 2010; Biederman
et al., 2015; Biederman, Petty, et al., 2006; Brown, 2007;
Corbisiero, Morstedt, Bitto, & Stieglitz, 2017; Faraone,
2000; Kessler et al., 2010). Nevertheless, as both EFD and
EC are associated with adult ADHD, these symptoms are
often measured in adult ADHD treatment studies. The
effects of medication treatment in adults with ADHD in
addressing symptoms of EFDs and EC have been examined
using a variety of measures (Adler et al., 2013; Biederman
et al., 2017; Brown et al., 2011; Marchant, Reimherr, Halls,
Williams, & Strong, 2010; Reimherr et al., 2007; Rosler
et al., 2010). We now present data as to the psychometrics
of the expanded EFDs and EC portions of the AISRS and
ASRS v1.1 Symptom Checklist as prior validations focused
on the DSM portions of the scales (Adler et al., 2006;
Spencer et al., 2010). We also present pilot normative data
for both scales, which could be quite useful in classifying
patient and participant scores when examining treatment
response and in diagnosing adult ADHD.
Method
The present article presents secondary analysis of data from
a larger study to update and validate the ASRS Screener for
DSM-5 (Ustun et al., 2017).
Participants
Two samples were pooled together: (a) a referred sample of
adults recruited as part of the New York University Adult
ADHD Program and (b) patients screened for ADHD at a
primary care physician (PCP) practice in the New York
area.
Referred sample. The referred sample was composed of
adults (aged 18-54, inclusive) recruited as part of the New
York University Adult ADHD Program (Adler et al., 2017;
Ustun et al., 2017). These participants were administered
the Structured Clinical Interview for DSM-IV-TR Axis I
Disorders (SCID), the ASRS Symptom Checklist–Expanded
Version to measure self-reported ADHD symptoms, and the
Adult ADHD Clinical Diagnostic Scale (ACDS) v1.2 to
assess DSM-5 adult ADHD. A subset of participants (n =
85) were also administered the AISRS-expanded version.
Participants self-reported medical history, psychiatric his-
tory, and demographics.
PCP practice sample.  This sample was composed of adults
(18-60 years, inclusive) who were screened negative ADHD
at a PCP practice in the New York area affiliated with New
York University Langone Medical Center (see Silverstein,
Alperin, Faraone, Kessler, & Adler, 2017, for a full descrip-
tion of recruitment and assessment methods).
After the initial screening at the PCP waiting room,
ADHD screen negative participants were contacted by
trained research staff between 0 and 21 days after initial
screening. These phone assessments included the Mini
International Neuropsychiatric Interview 7.0 (MINI) to
screen for DSM-5 psychiatric comorbidities, the ASRS
Symptom Checklist–Expanded Version to measure self-
reported ADHD symptoms, and the ACDS v1.2 to confirm
lack of current DSM-5 adult ADHD diagnosis.
Demographics, medical, and psychiatric histories were also
collected.
All conduct of both studies was approved by the
Institutional Review Board Associates (IRBA) of New York
University School of Medicine.
Rating Scales
In this study, adult ADHD was evaluated with ACDS v1.2
(Adler & Cohen, 2004; Adler et al., 2015), a semistructured
diagnostic interview that is widely used in adult ADHD
studies (Fayyad et al., 2017; Houston et al., 2011; Spencer
et al., 2001; Spencer et al., 1998; Spencer et al., 1995; Ustun
et al., 2017). The ACDS v1.2 interview begins with a retro-
spective assessment of childhood symptoms of ADHD and
then an expanded set of recent (past year, following DSM-5)
symptoms, including all DSM-5 Criterion A1 and A2
symptoms.
The AISRS is described above. The adult portion of the
ACDS v1.2 and the AISRS has the same prompts and struc-
ture, except that the AISRS asks for a retrospective report-
ing of the 2 weeks and the ACDS v1.2 past year.
Silverstein et al. 1103
The ACDS v1.2, AISRS, and ASRS all have expanded
versions (with prompts for the ACDS v1.2 and AISRS) that
consist of 13 non-DSM symptoms of EFDs and EC noted
above. For both samples, raters for the clinical assessment
were trained per standard rater training procedures prior to
initiation of study (Adler et al., 2005).
Psychiatric comorbidities for the referred sample were
evaluated using the SCID and with the MINI for the PCP
sample (First, Spitzer, Gibbon, & Williams, 2002; Sheehan
et al., 1998). The SCID is a widely used clinical interview
used to measure psychiatric comorbidities and has been
used for many adult ADHD studies (e.g., Adler et al., 2008;
Kessler et al., 2004; Oddo, Knouse, Surman, & Safren,
2016). The MINI is a short-structured clinical interview
used to screen for DSM-5 psychiatric comorbidities. It has
been well validated and is widely used to evaluate for psy-
chiatric comorbidities in research studies, including adult
ADHD studies (Bradley et al., 2017; Spencer et al., 2006;
Yoshimasu et al., 2016).
All of the evaluations for the referred sample were con-
ducted in person; all the assessments for the PCP sample that
are relevant for the present analysis PCP sample were con-
ducted via telephone. Referred sample interviews were con-
ducted by two clinical psychology trainees (a PhD candidate
with an MA and an MA candidate with a BA), and the PCP
sample interviews were administered by two research coordi-
nators with experience in adult ADHD (one with a BA and
one with a BS). The clinical interviewers for both samples
were trained by one of the investigators (L.A.A.). Validity of
the referred sample interviews was established by regular
direct observation of interviews. To prevent rater drift, cali-
bration meetings were held between the coordinators, and
consistent ratings and validity of these interviews were estab-
lished by meetings with one of the investigators (L.A.A.).
Data Analysis
All statistical analyses were conducted using SPSS (Version
22). For participants who only had an ACDS v1.2 and did
not have an AISRS (n = 214), AISRS scores were extracted
from the ACDS ratings. The AISRS and ACDS v1.2 have
the same prompts and 4-point rating scale (“none/never,”
“mild,” “moderate,” and “severe,” with the latter two being
the threshold for clinical impairment for each item for both
scales). Therefore, no transformations of the ACDS v1.2
ratings to extract AISRS scores for each participant were
required. Past analysis on the present data set has demon-
strated the statistical rationalization (Silverstein, Faraone,
et al., 2017), and Cohen’s Kappa’s examination of item-by-
item agreement demonstrates high agreement between
AISRS and ACDS scores. All subsequent discussion of
AISRS data will refer to the combination of the AISRS
scores obtained from the actual scale and the extracted
scores from the ACDS v1.2.
Internal consistencies for the ASRS and AISRS were
calculated with Cronbach’s alpha. To further evaluate the
psychometrics of the additional EFDs and EC items, item-
total correlations were also calculated for the items of the
ASRS and AISRS EFDs and EC subscales. Item-total cor-
relations refer to the correlation between that item and the
other items of the scale when that item is excluded.
To create normative data for this sample, histograms of
ADHD controls for ASRS 31-item score (nine inattentive
[IA], nine hyperactive–impulsive [H-I], four EC, and nine
EFD items) and AISRS total DSM 18-item (nine IA and nine
H-I) score were plotted. In addition, to create a normative
data representative of the adult population with and without
adult ADHD (~4.4%), six adult ADHD cases were randomly
selected (three males and three females). Histograms of this
pilot nationally representative sample of ASRS 31-item
scores and AISRS 18-item scores were plotted.
All tests were two-tailed and used a significance level of
p < .05, unless indicated.
Results
Demographic Characteristics of the Samples
Data from 297 participants were analyzed for this study.
The mean age of the total sample was 32.0 ± SD 10.5 years,
44.5% (n = 133) male and 55.5% (n = 166) female; 57.2%
(n = 171) of the sample met criteria for current adult ADHD,
11.7% met criteria for current Generalized Anxiety Disorder,
and 35.8% met criteria for past Major Depressive Disorder
(see Silverstein, Faraone, et al., 2017, for full presentation
of demographics of the sample).
Internal Consistency
Cronbach’s alpha for the ASRS and AISRS DSM 18-item
scales and individual subscales ranged from .84 to .96 and
.85 to .97, respectively (Table 1). These remained high con-
trolling for age and gender (Table 1). Item-total correlations
for both scales’ EFD items ranged from .62 to .89 (Table 2),
for EC from .63 to .72 (Table 2).
ASRS and AISRS Pilot Normative Data
ASRS and AISRS cutoff score.  Examining the histograms of
ASRS and AISRS scores for ADHD controls, 95% cutoff
scores were 70 and 23, respectively (Figures 1 and 2). When
randomly selecting six ADHD+ cases (three males and
three females) to create a pilot sample of adult ADHD in the
general population (~5% ADHD prevalence rate in our
sample), ASRS 95% cutoff score was 82. Using this pilot
sample method, AISRS cutoff score was between 25 and 27
(between 94.8 and 95.5 cumulative %), and therefore pre-
sumed to be 26 (Figures 3 and 4).
1104 Journal of Attention Disorders 23(10)

Table 1.  Internal Consistency of ASRS and AISRS Total 18- Table 2.  Item-Total Correlations for the EC and EFD items of
Item Scale and Subscale. the ASRS and AISRS.

Cronbach’s alpha Item-total

correlation
Scales/subscale ASRS AISRS
ASRS/AISRS symptom domaina ASRS AISRS
Total 18-item DSM-5 Symptom .95 .97
b
Scale (IA + H-I items) Mood changes frequently .722 .721
  IA subscale .94 .96 Easily hassled or frequently feels .692 .700
  H-I subscale .91 .94 overwhelmedb
  EF subscale .94 .96 Difficulty expressing anger appropriately at .630 .637
  EC subscale .84 .85 others; doesn’t stand up for selfb
Sensitive to criticismb .640 .690
Note. ASRS = Adult ADHD Self-Report Scale; AISRS = Adult ADHD Wastes or mismanages timec .847 .861
Investigator Symptom Rating Scale; DSM-5 = Diagnostic and Statistical
Has trouble planning ahead or preparing for .864 .869
Manual of Mental Disorders (5th ed.; American Psychiatric Association,
2013); IA = inattentive; H-I = hyperactive–impulsive; EFDs= executive
upcoming eventsc
function deficits; EC = emotional dyscontrol. Has difficulty arranging work by its priority .853 .891
or importance; can’t prioritize wellc
Depends on others to keep life in order and .624 .677
Adult ADHD controls with high AISRS scores. Seven adult attend to detailsc
ADHD controls, determined by the ACDS v1.2 to be ADHD Can’t get things done unless there is an .820 .899
negative, had AISRS scores ≥23 (range = 23-30). Of note, absolute deadlinec
two patients (both of whom had AISRS score = 23) had insuf- Unable to complete tasks in the allotted .811 .881
ficient levels of impairment due to their adult ADHD symp- time; needs extra time to finish
satisfactorilyc
toms noted on their ACDS v1.2 evaluation, and therefore
Remembers some ideas of the details in .647 .751
failed to meet criteria for adult ADHD. Six of the patients had
required reading but has difficulty grasping
psychiatric conditions (depression or Generalized Anxiety the main ideac
Disorder) that could explain their impairment, and four failed Lacks self-disciplinec .648 .871
to meet childhood onset of significant symptoms criterion Bores easilyc .778 .762
(therefore failing to meet DSM-5 Criterion A1).
Note. ASRS = Adult ADHD Self-Report Scale; AISRS = Adult ADHD
Investigator Symptom Rating Scale. EC = emotional dyscontrol; EFDs=
Discussion and Conclusion executive function deficits.
a
The ASRS and AISRS have the same symptom domains. The symptom
Our analyses demonstrate that the ASRS and AISRS domains, and not the actual questions or prompts, have been printed
31-item expanded versions have high validity in their above.
b
assessment of 18 core DSM-5 adult ADHD symptoms, Indicates EC item.
c
Indicates EFD item.
EFD, and EC symptoms. In addition, the expanded versions
have good psychometric properties in the assessment of
EFDs and EC. Pilot data suggest that AISRS 18-item DSM ADHD criteria it is possible for an adult with ADHD who
IA and H-I scores ranging from 23 to 26 have a high likeli- only meets criteria for 5 IA or H-I symptoms of moderate
hood of adult ADHD. The AISRS cutoff score finding is severity to have a score of 10. It is possible that symptom
consistent with clinical trials generally requiring an AISRS loading with few moderate symptoms is not sufficient to
18-item total score of at least 24 to 26 (Adler et al., 2011; create enough impairment (DSM-5 Criterion D) to make the
Biederman, Mick, Spencer, Surman, & Faraone, 2012; diagnosis. This may be a result of 97% of the ADHD+ sam-
Goodman et al., 2017). Our pilot data also show that patients ple presenting with at least seven IA or H-I symptoms of at
with an ASRS 31-item total score ranging from 70 to 82 least moderate severity. Or, it is possible that most adults
have a high likelihood of adult ADHD. with ADHD do not have only five or six IA or H-I symp-
The Cronbach’s alpha for EC items was lower than EFD toms of moderate severity. Nevertheless, the present find-
items, which suggests that EC is a less homogeneous and, ings underscore the importance of considering general
perhaps, less reliable construct than EFD. The lower alpha impairment due to ADHD (Criterion D) beyond merely
for EC items is consistent with previous findings of EC looking at individual impairing symptoms when evaluating
symptoms having less robust factor loadings, and that EC for adult ADHD.
may be a somewhat less robust core feature of adult ADHD, Recently, there has been an increased demand and
as compared with EFDs (Adler et al., 2017). subsequent attempts in the literature to refine diagnostic
It is interesting that the AISRS cutoff score for high like- evidence-based procedures for adult ADHD (Martel, Nigg,
lihood of adult ADHD is 24 because using DSM-5 adult & Schimmack, 2017; Sibley, Mitchell, & Becker, 2016). The
Silverstein et al. 1105

Figure 1.  Frequency of ASRS 31-item total score for ADHD(–) controls.
Note. ASRS = Adult ADHD Self-Report Scale.

Figure 2.  Frequency of AISRS 18-item total score for ADHD(–) controls.
Note. AISRS = Adult ADHD Investigator Symptom Rating Scale.

Figure 3.  Frequency of ASRS 31-item total score for nationally representative sample.
Note. ASRS = Adult ADHD Self-Report Scale.
1106 Journal of Attention Disorders 23(10)
Figure 4.  Frequency of AISRS 18-item total score for nationally representative sample.
Note. AISRS = Adult ADHD Investigator Symptom Rating Scale.
design of clear and simple methods for diagnosis (e.g., cut-
off scores on a scale) is especially important considering that
many providers, especially those in primary care, lack confi-
dence in evaluation and diagnosis of the disorder (Adler,
Shaw, Sitt, Maya, & Morrill, 2009; Faraone, Spencer,
Montano, & Biederman, 2004; Goodman, Surman, Scherer,
Salinas, & Brown, 2012). The ASRS cutoff score can be par-
ticularly useful for those less confident in their clinical eval-
uation or clinical ratings of their patient’s symptoms.
Nonetheless, there are numerous methodological con-
cerns to consider when both establishing cutoffs and using
self-report or clinician-rated scales for adult ADHD. It is
extremely important to note that using cutoff scores does not
mean that the patient meets DSM-5 criteria for adult ADHD,
as neither the ASRS nor AISRS evaluate the DSM require-
ment impairment criteria. In addition, including only a
referred sample (which generally serves as the source of
many patients when evaluating scale psychometrics) as the
sample set to establish the psychometric validity reduces the
generalizability of findings as it may result in a biased sam-
ple. For example, referred samples are unlikely to include
those who are less aware of their symptoms or less classic
ADHD presentations that other providers do not identify (see
Sibley et al., 2016). Many studies do not include randomly
selected participants (and not just referred sample). The pres-
ent analysis is less likely to be fraught with the issue of miss-
ing those who are unaware that they have adult ADHD as the
analysis included a large randomly selected PCP sample of
ADHD negatives recruited from a PCP practice.
An additional limit of selecting a cutoff score is that it
does not consider the influence of overlapping symptoms.
For example, there may be overlap between the symptoms
of inattention and EFD as evaluated by the AISRS (e.g.,
conflation of DSM symptom of losing things and EFD
symptoms of organization). Using a cutoff score may give
more weight to these symptoms. This may be particularly
concerning when evaluating atypical cases of adult ADHD.
These concerns are why we have suggested elsewhere (e.g.,
Adler et al., 2008; Faraone, 2000; Kessler et al., 2005) that
clinical evaluations of adult ADHD should consider multi-
ple sources of information when establishing a diagnosis.
We therefore believe that the present study evidences that
cutoff scores can be an additional source of information to
increase clinician confidence and diagnostic accuracy, but
stress that cutoff scores should not be solely used as a single
factor in making the diagnosis.
Limitations
Although the sample was robust, investigator symptom rat-
ings were, as noted above, obtained from a combination of
AISRS and ACDS v1.2 ratings, which was psychometri-
cally valid. The noted ASRS 31-item expanded cutoff
range predictive of adult ADHD of 70 to 82 was somewhat
large; the noted variability in EC ratings may have contrib-
uted to this larger range. In addition, the clinical interviews
did not include informant reports, which could have
improved diagnostic accuracy (Adler et al., 2006; Martel
et al., 2017; Molina & Sibley, 2014; Sibley et al., 2016;
Zucker, Morris, Ingram, Morris, & Bakeman, 2002).
Finally, the psychometrics of the expanded scales to evalu-
ate EFD and EC symptoms did not include neuropsycho-
logical tests to validate findings. Nevertheless, data support
higher yield of symptom recognition via EFD symptom
scales in ADHD than neuropsychological test (Biederman
et al., 2008).
Silverstein et al. 1107

Declaration of Conflicting Interests (NARSAD); NIDA; New River; National Institute of Child Health
and Human Development (NICHD); National Institute of Mental
The author(s) declared the following potential conflicts of interest
Health (NIMH); Novartis; Noven; Neurosearch; Organon; Otsuka;
with respect to the research, authorship, and/or publication of this
Pfizer; Pharmacia; Phase V Communications; Physicians
article: Dr. Samuel Alperin, Ms. Terry Leon, and Mr. Michael
Academy; The Prechter Foundation; Quantia Communications;
Silverstein have no conflicts to disclose. In the past 5 years, Dr.
Reed Exhibitions; Shionogi Pharma, Inc.; Shire; the Spanish Child
Faraone received income, potential income, travel expenses, con-
Psychiatry Association; The Stanley Foundation; UCB Pharma,
tinuing education support, and/or research support from Otsuka,
Inc.; Veritas; and Wyeth. Dr. Thomas Spencer received research
Lundbeck, Rhodes, Arbor, KenPharm, Ironshore, Shire, Akili
support or was a consultant from the following sources: Alcobra;
Interactive Labs, CogCubed, Alcobra, VAYA, Sunovion,
Avekshan; Cephalon; Eli Lilly & Company; Enzymotec Ltd.;
Genomind, Neurolifesciences, Neurovance, Alcobra, Otsuka, and
Heptares; Impax; Ironshore; Janssen; Lundbeck; McNeil
Pfizer. Dr. Joseph Biederman is currently receiving research sup-
Pharmaceutical; Novartis; Shire Laboratories, Inc.; Sunovion;
port from the following sources: American Academy of Child and
VayaPharma; the Food and Drug Administration (FDA), and the
Adolescent Psychiatry (AACAP); The Department of Defense;
Department of Defense. Consultant fees are paid to the MGH
Food & Drug Administration; Headspace; Lundbeck; Neurocentria,
Clinical Trials Network and not directly to Dr. Spencer. Dr.
Inc.; National Institute on Drug Abuse (NIDA); PamLab; Pfizer;
Thomas Spencer has been on an advisory board for the following
Shire Pharmaceuticals, Inc.; Sunovion; and National Institutes of
pharmaceutical companies: Alcobra. Dr. Spencer received
Health (NIH). Dr. Biederman has a financial interest in Avekshan
research support from Royalties and Licensing fees on copy-
LLC, a company that develops treatments for ADHD. His interests
righted ADHD scales through MGH Corporate Sponsored
were reviewed and are managed by Massachusetts General
Research and Licensing. Through MGH corporate licensing, Dr.
Hospital (MGH) and Partners HealthCare in accordance with their
Spencer has a U.S. Patent (#14/027,676) for a nonstimulant treat-
conflict of interest policies. Dr. Biederman’s program has received
ment for ADHD and a patent pending (#61/233,686) for a method
departmental royalties from a copyrighted rating scale used for
to prevent stimulant abuse. In the past 3 years, Dr. Lenard Adler
ADHD diagnoses, paid by Ingenix, Prophase, Shire, Bracket
has received income, potential income, travel expenses, support
Global, Sunovion, and Theravance; these royalties were paid to
for serving on the advisory board on ADHD, consulting support,
the Department of Psychiatry at MGH. In 2017, Dr. Biederman is
payment for development of educational presentations, grant sup-
a consultant for Aevi Genomics, Akili, Guidepoint, Ironshore,
port, and/or research support from Cortex/Respire Pharmaceuticals,
Medgenics, and Piper Jaffray. He is on the scientific advisory
Sunovion Pharmaceuticals, Enzymotec, Shire Pharmaceuticals,
board for Alcobra and Shire. He received honoraria from the MGH
National Football League, Major League Baseball, Shire
Psychiatry Academy for tuition-funded Continuing medical edu-
Pharmaceuticals, Alcobra Pharmaceuticals, Lundbeck, The State
cation (CME) courses. Through MGH corporate licensing, he has
University of New York Upstate, APSARD, and Purdue. He also
a U.S. Patent (#14/027,676) for a nonstimulant treatment for
has received royalty payments (as inventor) from New York
ADHD and a patent pending (#61/233,686) on a method to pre-
University for the license of adult ADHD scales and training mate-
vent stimulant abuse. In 2016, Dr. Biederman received honoraria
rials since 2004.
from the MGH Psychiatry Academy for tuition-funded CME
courses, and from Alcobra and The American Professional Society
of ADHD and Related Disorders (APSARD). He was on the scien- Funding
tific advisory board for Arbor Pharmaceuticals. He was a consul- The author(s) disclosed receipt of the following financial support
tant for Akili and Medgenics. He received research support from for the research, authorship, and/or publication of this article:
Merck and Sertraline Pediatric Registry for the Evaluation of Funding for the current analyses from DataStat, Inc., Ann Arbor,
Safety (SPRITES). In 2015, Dr. Biederman received honoraria MI and New York University School of Medicine Office of
from the MGH Psychiatry Academy for tuition-funded CME Industrial Liaison.
courses and from Avekshan. He received research support from
Ironshore; Magceutics, Inc.; and Vaya Pharma/Enzymotec. In ORCID iD
2014, Dr. Biederman received honoraria from the MGH Psychiatry
Academy for tuition-funded CME courses. He received research Michael J. Silverstein https://orcid.org/0000-0002-8697-6631
support from AACAP, Alcobra, Forest Research Institute, and
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Author Biographies
Michael J. Silverstein is a first-year PhD student in clinical psy-
chology at Drexel University. He received his BA from Yeshiva
University, where he majored in psychology and biology. He has
worked with the New York University ADHD Program for the
past 3+ years, conducting psychometric analyses on adult ADHD
scales to assess Diagnostic and Statistical Manual of Mental
Disorders (DSM)–defined and associated symptoms. His research
interests are pediatric traumatic stress and at-risk youth, the devel-
opment of preventive and intervention programs for these youth,
and adult ADHD.
Stephen V. Faraone, PhD, is a distinguished professor in the
Department of Psychiatry and Neuroscience and Department of
Physiology at State University of New York (SUNY) Upstate
Medical University. He is also senior scientific advisor to the
Research Program Pediatric Psychopharmacology at the
Massachusetts General Hospital and a lecturer at Harvard Medical
School. He studies the nature and causes of mental disorders in child-
hood and has made contributions to research in psychiatric genetics,
psychopharmacology, diagnostic issues, and methodology.
Samuel Alperin, MD, is a pediatric neurology intern at the
Cincinnati Children’s Hospital. He recently received an MD from
Hofstra Northwell School of Medicine. He has published on the
noradrenergic and cholinergic effects on olfactory memory in rats;
genetics, and neuropsychology of schizophrenia and bipolar disor-
der; and psychometrics and pharmacology in adult ADHD. He is
interested in memory and learning and neurodevelopmental
disorders.
Terry L. Leon, RN, MS, is a senior research coordinator program
manager for the New York University Adult ADHD Program. She
has more than 20 years of experience working in coordinating and
managing clinical trials for adult ADHD and other disorders, and
is on the executive board of NYU’s Association of Clinical
Coordination and Research Management (ACCRM).
Joseph Biederman, MD, is the chief of the clinical and research
programs in pediatric psychopharmacology and adult ADHD at
the Massachusetts General Hospital, director of the Alan and
Lorraine Bressler Clinical and Research Program for autism spec-
trum disorders at the Massachusetts General Hospital, and profes-
sor of psychiatry at the Harvard Medical School. He is board certi-
fied in general and child psychiatry.
Thomas J. Spencer, MD, is an associate professor of Psychiatry
at Harvard Medical School, Chief Medical Director Home Base
and associate chief of the Clinical and Research Program in
Pediatric Psychopharmacology at Massachusetts General Hospital.
Dr. Spencer’s research and clinical interests have focused on the
effectiveness and safety of standard and novel pharmacologic
treatments throughout the lifecycle.
Lenard A. Adler, MD, is the director of the Adult ADHD Program
in the Department of Psychiatry and professor of psychiatry and
child and adolescent psychiatry at the NYU New York University
(NYU) School of Medicine. He obtained a BA in economics from
the College of Arts and Sciences at Cornell University in 1978, his
MD from Emory University School of Medicine in 1982 and com-
pleted his residency in psychiatry in 1986 at NYU School of
Medicine. He is an active investigator and frequent lecturer, who
has authored and coauthored more than 130 peer-reviewed articles
and book chapters, along with the popular book on adult ADHD,
Scattered Minds (G. P. Putnam’s Sons, 2006), and the textbook
(co-editor), Attention-Deficit Hyperactivity Disorder in Children
and Adults (Cambridge University Press, 2015).