Diagnosis Threat in Adults with Attention Deficit Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex neurological condition currently defined by the American Psychological Association as a persistent pattern of inattention and/or hyperactivity/impulsivity (APA, 2000, p. 85). Currently, there is no DSM-IV diagnosis for ADHD in adults, although some researchers estimate that approximately 50-80% of childhood cases of ADHD carry on into adolescence and adulthood (Barkley, Fischer, Smallish, & Fletcher, 2002). Obtaining an accurate estimation is prevented by several factors, including a lack of an objective diagnostic test for ADHD (Stefanatos & Baron, 2007). One construct that has not been well studied in ADHD populations is the effect of negative expectations on neuropsychological test performance, which researchers have called diagnosis threat (Suhr & Gunstad, 2002). This phenomenon has been examined in individuals with mild traumatic brain injury (mTBI); however, there is reason to believe that it can occur with other diagnoses as well. The current study aimed to identify the degree to which diagnosis threat influenced test performance in an adult ADHD population. Seventy participants with a diagnosis of ADHD were randomly assigned to either a control group or a diagnosis threat group. All participants were given then given a test battery. Participants in the diagnosis threat group were told that they were selected to participate on the basis of their ADHD diagnosis, whereas controls were told simply to perform to the best of their ability. As hypothesized, participants who were in the diagnosis threat group performed worse on tests of simple attention, memory, and intelligence when compared to controls. This demonstrates the potential for diagnosis threat to occur in populations other than mTBI and has direct implications for the way clinicians work with patients diagnosed with ADHD