Previous use and development (24DR)

Attachment 2. Previous use and development

The Attention-Deficit/Hyperactivity Disorder (ADHD) questions to be evaluated were derived from several sources. The overarching topics covered in the question set are those related to ADHD diagnosis, symptoms, treatment, telehealth, functional impairment, and misuse in adults. The questions are intended for use on the 2025 National Health Interview Survey (NHIS). ADHD is a serious public health problem affecting many children and adults. These questions are important to evaluate because they would complement existing questions on the NHIS as well as other surveys which focus on children’s health. And, they would expand understanding about adult ADHD diagnosis and treatment, as well as how ADHD may affect daily functioning.

The sources for the ADHD questions (Attachment 1) are as follows:

Questions on Diagnosis (Qs 1-9)

These diagnosis questions include new items adapted from the National Longitudinal Study of Adolescent to Adult Health (Add Health),¹ The National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NS–DATA),² The National Survey of Children’s Health (NSCH),³ and the Rapid Survey System-2 (RSS-2).⁴ Adaptations were made to explore barriers to diagnosis, to explore potential sources of a diagnosis, to change questions from proxy- to self-complete. Adaptions were also made to an NS-DATA question about age of onset, shifting from asking about diagnosis to asking about symptoms. In addition to these newly adapted questions, the question set includes a diagnosis question from the National Health Interview Survey (NHIS) 2007 and 2012. A version of this diagnosis question was previously evaluated by the CCQDER in a different context.⁵ The NHIS question was included here to evaluate the updated response option terminology for ADHD and ADD.

Questions on Symptoms and Severity (Qs 10-12)

These questions on symptoms and severity of ADHD include new items adapted from the NS-DATA, NSCH, the NHIS and the National Comorbidity Survey Replication (NCSR).⁶ The adaptations were made to adjust from asking for proxy- to self-complete, and to modify the NHIS anxiety/depression question to emphasize attention, hyperactivity, and impulsivity.

Questions on Treatment (Qs 13-14)

Question 13, which asks about prescription medication, is modified from the NHIS, NSCH, and RSS-2. The question on treatments that have helped with symptoms, Question 14, is a new item adapted from European guidelines for ADHD treatment in adults⁷ and informed by treatment descriptions for adult ADHD⁸.

Questions on Telehealth (Qs 15-17)

These three telehealth questions explore if a respondent has ever used telehealth services for their ADHD, if they currently use telehealth for ADHD treatment, and if they were diagnosed via telehealth for their ADHD condition. These questions were derived from the RSS-2 and NHIS 2023.

Questions on Health-related Functional Impairment (Qs 18-24)

These questions were adapted from the Behavioral Risk Factors Surveillance System (BRFSS)⁹ “Healthy Days” questions. These questions seek to address how much ADHD affects respondents’ overall quality of life.

Questions on Misuse and Diversion (Qs 25-27)

These questions were adapted from the Youth Risk Behaviors Survey (YRBS),¹⁰ specifically the opioid and former combined opioid and stimulant question, The National Survey on Drug Use and Health (NSDUH),¹¹ and the NS-DATA. These questions examine misuse as it pertains to ADHD medications.

1 Add Health (unc.edu)

2 SLAITS - National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (cdc.gov)

3 National Survey of Children's Health (NSCH) (census.gov)

4 NCHS Rapid Surveys System (cdc.gov)

5 Willson, S., 2006, Cognitive Interviewing Evaluation of the 2007 Complementary and Alternative Medicine Module for the National Health Interview Survey, Hyattsville, MD: National Center for Health Statistics. https://wwwn.cdc.gov/QBank/Report.aspx?1012

6 National Comorbidity Survey (harvard.edu)

7 Kooij JJS, Bijlenga D, Salerno L, et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry. 2019;56(1):14-34. doi:10.1016/j.eurpsy.2018.11.001

8 Attention-Deficit/Hyperactivity Disorder in Adults: What You Need to Know - National Institute of Mental Health (NIMH) (nih.gov)

9 CDC - BRFSS

10 Youth Risk Behavior Surveillance System (YRBSS) | CDC

11 National Survey on Drug Use and Health (samhsa.gov)