• Demographic Characteristics of the ADHD Reference Sample
• Treatment Status of the ADHD Reference Sample

Demographic Characteristics of the ADHD Reference Sample

The following section describes features of the individuals with ADHD being rated as part of the ADHD Reference Sample (i.e., those completing the Self-Report form and those being rated by Observers). Information about observers providing ratings about these individuals with ADHD can be found in appendix J.

A total of 425 individuals were included in the ADHD Combined Gender Reference Sample (N = 255 for Self-Report and N = 170 for Observer¹). Whereas the purpose of the Normative Sample is to enable interpretation of an individual’s results relative to what is typical in the general population, the purpose of the ADHD Reference Sample is to facilitate clinical decision-making by enabling comparisons to results that are typical of individuals diagnosed with ADHD (see Clinical Group Differences in chapter 9, Validity, for details on distinct score profiles within the ADHD Reference Sample). The ADHD Reference Sample consists of individuals from a clinical population who had been previously diagnosed with one of the three DSM ADHD presentations (i.e., Predominantly Inattentive, Predominantly Hyperactive/Impulsive, or Combined; note however that the sample for Predominantly Hyperactive/Impulsive is relatively small, which reflects the rarity of this diagnosis in practice for adults). Table 7.11 displays the distribution of gender by age group within the Combined Gender ADHD Reference Sample and Table 7.12 summarizes key demographic characteristics of the Combined Gender ADHD Reference Sample. Though the sample sizes are modest when divided by age group, continuous norming methodology was applied to allow for the conversion of raw scores to T-scores (see Standardization Procedures in this chapter).

The majority of rated individuals in the ADHD Reference Sample were married (51.0% Self-Report, 55.3% Observer), followed by individuals who were single (38.0% Self-Report, 36.5% Observer); the remaining individuals were separated, divorced, or widowed. A substantial portion of the rated individuals were employed full-time (47.1% Self-Report, 47.1% Observer); the rest were employed part-time (24.3% Self-Report, 23.5% Observer), were unemployed (20.4% Self-Report, 23.5% Observer), were retired (3.1% Self-Report, 3.5% Observer), or indicated some other employment status. Nearly one quarter of rated individuals were currently enrolled as students (24.0% Self-Report, 24.7% Observer). A large percentage of the rated individuals spoke only English (79.6% Self-Report, 83.5% Observer); the remaining individuals were multilingual (i.e., they spoke English and other language[s]).

Treatment Status of the ADHD Reference Sample

Raters in the ADHD Reference Sample were asked to report the mental health treatment status of the person being rated (including medication and/or psychosocial treatments). The majority of those rated were receiving at least one form of treatment (83.1% for Self-Report, 77.5% for Observer).

For the Self-Report sample, 79.3% reported taking medication for psychological/psychiatric conditions; 75.3% of the Observer sample reported that the individual being rated was taking medication (see Table 7.13 and 7.14). Medications included those often prescribed for ADHD (both stimulant and non-stimulant varieties), as well as medications indicated for treating various co-occurring diagnoses (such as mood stabilizers and anti-anxiety medications). Over half of the individuals rated in the ADHD Reference Sample indicated medication only (i.e., no other current treatment; 57.2% Self-Report; 58.1% Observer). For those receiving non-pharmacological treatment, the most common treatment reported was individual psychological therapy (31.4% Self-Report 27.9% Observer), followed by “Other” (8.7% Self-Report; 10.6% Observer). Other forms of treatment that were specified included mindfulness training or meditation, trauma therapy, and couples’ therapy. See Table 7.13 and Table 7.14 for a summary of the forms of treatments that were reported in the Combined Gender and Gender Specific ADHD Reference Samples, respectively.

All respondents who indicated that the individual being rated was taking medication were instructed to complete the CAARS 2 based on the person’s functioning when not taking medication or when the medication has worn off. At the end of the assessment, these respondents were asked to confirm that they followed the instructions by answering items while thinking about the off-medication status of the individual being rated. The majority of raters (82.4% Self-Report; 70.3% Observer) describing someone taking medication were consistent in their mindset, reporting at the end of the rating scale that they answered the questions as instructed (i.e., while thinking about the individual being rated when “off their medication”).

Effect sizes (as measured by Cliff’s d; Cliff, 1993) were used to consider whether medication use impacted ratings and scores for the CAARS; however, no meaningful differences were observed. First, results for the medicated group were examined. Specifically, scores were compared between those who reported following the instructions to think about the person being rated when not taking medication versus those who reported that they rated the individual as if they were taking medication or combined observations across on/off medication status (i.e., contrary to instructions). No meaningful differences were found between these two groups (effects were negligible to small; see Table 7.15). Next, results were compared between those not taking medication and those taking medication. Scale-level differences ranged from trivial to small effect sizes across all groupings for Self-Report and Observer (see Table 7.15). Considering the absence of meaningful group differences, all subsequent analyses were conducted on the full ADHD Reference Sample.