Advertisement

Quality of Life Research

, Volume 16, Issue 9, pp 1511–1520 | Cite as

Responsiveness of the Adult Attention-Deficit/Hyperactivity Disorder Quality of Life Scale (AAQoL)

  • Louis S. MatzaEmail author
  • Joseph A. Johnston
  • Douglas E. Faries
  • Karen G. Malley
  • Meryl Brod
Article

Abstract

Aims

This study examined responsiveness of the Adult Attention-Deficit/Hyperactivity Disorder Quality of Life Scale (AAQoL), which was developed to assess health-related quality of life (HRQL) among adults with attention-deficit/hyperactivity disorder (ADHD).

Methods

Adults with ADHD completed the AAQoL, Conners’ Adult ADHD Rating Scale (CAARS), SF-36, and Endicott Work Productivity Scale (EWPS) at baseline and week 8 of a randomized, placebo-controlled trial of atomoxetine. Clinicians rated symptom severity and improvement (CGI-ADHD-S, CGI-ADHD-I). Responsiveness was examined through effect sizes and association with change in the measures listed previously (Spearman correlations, GLMs).

Results

Analyses included 328 patients (58.8% male; mean age = 36.9 years). All AAQoL scales reflected significant improvement from baseline to week 8 (P < 0.0001). AAQoL change scores were significantly correlated with change in the CGI-ADHD-S (r = −0.37 to −0.50), EWPS (r = −0.43 to −0.63), and CAARS (r = −0.35 to −0.62) (all P < 0.001). AAQoL change scores significantly discriminated among patients with various levels of symptom improvement. AAQoL effect sizes (−0.67 to −1.11) were larger than effect sizes for the SF-36 (0.15 to −0.39).

Conclusions

The AAQoL was responsive to change in symptoms of ADHD, and it appears to be a useful outcome measure for treatments of ADHD in adults.

Keywords

AAQoL ADHD Attention-deficit hyperactivity disorder Health-related quality of life Responsiveness 

Abbreviations

AAQoL

Adult ADHD Quality of Life Measure

ADHD

Attention-deficit hyperactivity disorder

CGI-ADHD-I

Clinical Global Impressions-ADHD Improvement

CGI-ADHD-S

Clinical Global Impressions-ADHD Severity

CAADID

Conners’ Adult ADHD Diagnostic Interview for DSM-IV

CAARS-Self

Conners’ Adult Attention-Deficit/Hyperactivity Disorder Rating Scale-Self Report: Screening Version

DSM-IV-TR

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision

EWPS

Endicott Work Productivity Scale

GLMs

General linear models

HRQL

Health-related quality of life

SF-36

Medical Outcomes Study 36-Item Short Form Health Survey

MID

Minimally important difference

SEM

Standard error of measurement

Notes

Acknowledgments

The authors thank Karin Coyne for psychometric consultation as well as Jodi Shorr and Julie Meilak for production assistance. This study was funded by Eli Lilly and Company.

References

  1. 1.
    American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Press.Google Scholar
  2. 2.
    Biederman, J., Monuteaux, M. C., Mick, E., et al. (2006b). Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychological Medicine, 36(2), 167–179.PubMedCrossRefGoogle Scholar
  3. 3.
    Faraone, S. V., & Biederman, J. (2005). What is the prevalence of adult ADHD? Results of a population screen of 966 adults. Journal of Attention Disorders, 9(2), 384–391.PubMedCrossRefGoogle Scholar
  4. 4.
    Kessler, R. C., Adler, L. A., Barkley, R., et al. (2005a). Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: Results from the national comorbidity survey replication. Biological Psychiatry, 57(11), 1442–1451.PubMedCrossRefGoogle Scholar
  5. 5.
    Mannuzza, S., Klein, R. G., & Moulton, J. L., 3rd (2003). Persistence of Attention-Deficit/Hyperactivity Disorder into adulthood: What have we learned from the prospective follow-up studies? Journal of Attention Disorders, 7(2), 93–100.PubMedCrossRefGoogle Scholar
  6. 6.
    Safren, S. A., Sprich, S., Chulvick, S., & Otto, M. W. (2004). Psychosocial treatments for adults with attention-deficit/hyperactivity disorder. The Psychiatric Clinics of North America, 27(2), 349–360.PubMedCrossRefGoogle Scholar
  7. 7.
    Simpson, D., & Plosker, G. L. (2004). Atomoxetine: a review of its use in adults with attention-deficit hyperactivity disorder. Drugs, 64(2), 205–222.PubMedCrossRefGoogle Scholar
  8. 8.
    Spencer, T., Biederman, J., & Wilens, T. (2004a). Nonstimulant treatment of adult attention-deficit/hyperactivity disorder. The Psychiatric Clinics of North America, 27(2), 373–383.PubMedCrossRefGoogle Scholar
  9. 9.
    Spencer, T., Biederman, J., & Wilens, T. (2004b). Stimulant treatment of adult attention-deficit/hyperactivity disorder. The Psychiatric Clinics of North America, 27(2), 361–372.PubMedCrossRefGoogle Scholar
  10. 10.
    Kessler, R. C., Adler, L., Ames, M., et al. (2005c). The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256.PubMedCrossRefGoogle Scholar
  11. 11.
    Magnusson, P., Smari, J., Sigurdardottir, D., et al. (2006). Validity of self-report and informant rating scales of adult ADHD symptoms in comparison with a semistructured diagnostic interview. Journal of Attention Disorders, 9(3), 494–503.PubMedCrossRefGoogle Scholar
  12. 12.
    Mehringer, A. M., Downey, K. K., Schuh, L. M., et al. (2002). The Assessment of Hyperactivity and Attention (AHA): development and preliminary validation of a brief self-assessment of adult ADHD. Journal of Attention Disorders, 5(4), 223–231.PubMedCrossRefGoogle Scholar
  13. 13.
    Murphy, K. R., & Adler, L. A. (2004). Assessing attention-deficit/hyperactivity disorder in adults: focus on rating scales. The Journal of Clinical Psychiatry, 65(Suppl 3), 12–17.PubMedGoogle Scholar
  14. 14.
    Guyatt, G. H., Feeny, D. H., & Patrick, D. L. (1993). Measuring health-related quality of life. Annals of Internal Medicine, 118(8), 622–629.PubMedGoogle Scholar
  15. 15.
    Leidy, N. K., Revicki, D. A., & Geneste, B. (1999). Recommendations for evaluating the validity of quality of life claims for labeling and promotion. Value in Health, 2(2), 113–127.PubMedCrossRefGoogle Scholar
  16. 16.
    Biederman, J., Faraone, S. V., Spencer, T. J., et al. (2006a). Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community. Journal of Clinical Psychiatry, 67(4), 524–540.PubMedCrossRefGoogle Scholar
  17. 17.
    Eakin, L., Minde, K., Hechtman, L., et al. (2004). The marital and family functioning of adults with ADHD and their spouses. Journal of Attention Disorders, 8(1), 1–10.PubMedCrossRefGoogle Scholar
  18. 18.
    Friedman, S. R., Rapport, L. J., Lumley, M., et al. (2003). Aspects of social and emotional competence in adult attention-deficit/hyperactivity disorder. Neuropsychology, 17(1), 50–58.PubMedCrossRefGoogle Scholar
  19. 19.
    Kessler, R. C., Adler, L., Ames, M., et al. (2005b). The prevalence and effects of adult attention deficit/hyperactivity disorder on work performance in a nationally representative sample of workers. Journal of Occupational and Environmental Medicine, 47(6), 565–572.PubMedCrossRefGoogle Scholar
  20. 20.
    Brod, M., Perwien, A., Adler, L., Spencer, T., & Johnston, J. (2005). Conceptualization and assessment of Quality of Life for adults with Attention-Deficit/Hyperactivity Disorder. Primary Psychiatry, 12(6), 58–64.Google Scholar
  21. 21.
    Brod, M., Johnston, J., Able, S., & Swindle, R. (2006). Validation of a quality-of-life measure for Adult Attention-Deficit/Hyperactivity Disorder. Quality Life Research, 15, 117–129.CrossRefGoogle Scholar
  22. 22.
    Revicki, D. A., Osoba, D., Fairclough, D., et al. (2000). Recommendations on health-related quality of life research to support labeling and promotional claims in the United States. Quality Life Research, 9(8), 887–900.CrossRefGoogle Scholar
  23. 23.
    Guyatt, G. H., Walter, S., & Norman, G. (1987). Measuring change over time: assessing the usefulness of evaluative instruments. Journal of Chronic Diseases, 40(2), 171–178.PubMedCrossRefGoogle Scholar
  24. 24.
    Deyo, R. A., & Centor, R. M. (1986). Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance. Journal of Chronic Diseases, 39(11), 897–906.PubMedCrossRefGoogle Scholar
  25. 25.
    Conners, C. K., Erhart, D., & Sparrow, E. (1999). Conners’ Adult ADHD Rating Scales, technical manual. New York: Multi-Health Systems.Google Scholar
  26. 26.
    Endicott, J., & Nee, J. (1997). Endicott Work Productivity Scale (EWPS): a new measure to assess treatment effects. Psychopharmacology Bulletin, 33(1), 13–16.PubMedGoogle Scholar
  27. 27.
    Ware, J. E., Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.PubMedCrossRefGoogle Scholar
  28. 28.
    Ware, J. E., Snow, K. K., Kosinski, M. K., & Gandek, B. (1993). SF-36 health survey: manual and interpretation guide. Boston: The Health Institute, New England Medical Center.Google Scholar
  29. 29.
    Guy, E., (Ed.). (1976). ECDEU assessment manual for psychopharmacology. Rockville, MD: National Institute of Mental Health.Google Scholar
  30. 30.
    Husted, J. A., Cook, R. J., Farewell, V. T., & Gladman, D. D. (2000). Methods for assessing responsiveness: a critical review and recommendations. Journal of Clinical Epidemiology, 53(5), 459–468.PubMedCrossRefGoogle Scholar
  31. 31.
    Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  32. 32.
    Kazis, L. E., Anderson, J. J., & Meenan, R. F. (1989). Effect sizes for interpreting changes in health status. Medical Care, 27(Suppl 3), S178–S189.PubMedCrossRefGoogle Scholar
  33. 33.
    Matza, L. S., Stoeckl, M. N., Shorr, J. M., & Johnston, J. A. (2006). Impact of atomoxetine treatment on health-related quality of life and functional status among patients with ADHD. Expert Review Pharmacoeconomics Outcomes Research, 6(4), 379–390.CrossRefGoogle Scholar
  34. 34.
    Wiebe, S., Guyatt, G., Weaver, B., Matijevic, S., & Sidwell, C. (2003). Comparative responsiveness of generic and specific quality-of-life instruments. Journal of Clinical Epidemiology, 56(1), 52–60.PubMedCrossRefGoogle Scholar
  35. 35.
    Kalpaklioglu, A. F., Kara, T., Kurtipek, E., et al. (2005). Evaluation and impact of chronic cough: comparison of specific vs generic quality-of-life questionnaires. Annals of Allergy, Asthma and Immunology, 94(5), 581–585.CrossRefGoogle Scholar
  36. 36.
    Leong, K. P., Yeak, S. C., Saurajen, A. S., et al. (2005). Why generic and disease-specific quality-of-life instruments should be used together for the evaluation of patients with persistent allergic rhinitis. Clinical and Experimental Allergy, 35(3), 288–298.PubMedCrossRefGoogle Scholar
  37. 37.
    Jaeschke, R., Singer, J., & Guyatt, G. H. (1989). Measurement of health status. Ascertaining the minimal clinically important difference. Controlled Clinical Trials, 10(4), 407–415.PubMedCrossRefGoogle Scholar
  38. 38.
    Crosby, R. D., Kolotkin, R. L., & Williams, G. R. (2003). Defining clinically meaningful change in health-related quality of life. Journal of Clinical Epidemiology, 56(5), 395–407.PubMedCrossRefGoogle Scholar
  39. 39.
    Lydick, E., & Epstein, R. S. (1993). Interpretation of quality of life changes. Quality of Life Research, 2(3), 221–226.PubMedCrossRefGoogle Scholar
  40. 40.
    Farivar, S. S., Lio, H., & Hays, R. D. (2004). Half standard deviation estimate of the minimally important difference in HRQOL scores. Expert Review Pharmacoeconomics Outcomes Research, 4(5), 515–523.CrossRefGoogle Scholar
  41. 41.
    Guyatt, G. H., Osoba, D., Wu, A. W., Wyrwich, K. W., & Norman, G. R. (2002). Methods to explain the clinical significance of health status measures. Mayo Clinic Proceedings, 77(4), 371–383.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Louis S. Matza
    • 1
    Email author
  • Joseph A. Johnston
    • 2
  • Douglas E. Faries
    • 2
  • Karen G. Malley
    • 3
  • Meryl Brod
    • 4
  1. 1.Center for Health Outcomes Research at UBCBethesdaUSA
  2. 2.Eli Lilly & CompanyIndianapolisUSA
  3. 3.Malley Research Programming, Inc.RockvilleUSA
  4. 4.The Brod GroupMill ValleyUSA

Personalised recommendations