The effect of medication and question wording on self-reported symptoms and their accuracy in young adults with attention-deficit/hyperactivity disorder

Objectives This study examined the effect of whether participants were on or off their medications and the effect of questionnaire wording on self-reported symptoms in young adults with ADHD. Additionally, this research evaluated the relationships between these self-reported symptoms and objective performance on measures of working memory. Design This experimental study utilized a mixed factorial design with one between-subjects factor (whether participants were unmedicated or medicated at the time they completed their assessment) and one within-subjects factor (whether participants reported their on-medication or off-medication symptoms when describing their ADHD subjective symptomatology). Methods Forty-five young adults with ADHD (ages 18-23) completed a brief neuropsychological evaluation and several self-report questionnaires. Results Although being medicated or unmedicated while completing the questionnaires did not directly affect self-reported symptoms or their accuracy, questionnaire wording exerted a statistically significant effect on subjective symptomatology; participants described themselves as substantially more symptomatic at times when they are off than at times when they are on their medications. More importantly, their general self-perceptions (symptoms when medication state was not specified) of their Inattention/Memory Problems and their Hyperactivity/Restlessness aligned with their descriptions of their off-medication symptoms, whereas their general self-perceptions of their Impulsivity/Emotional Lability and Problems with Self-Concept related to both their self-reported off-medication and on-medication symptoms. Conclusions These results highlight the necessity of specifying medication state when asking patients to report their current symptomatology. Failing to do so risks an over-reporting of symptoms from patients who are typically on medications as they may describe the extent of their unmedicated, rather than medicated, symptomatology. Practitioner points Being medicated or unmedicated while completing questionnaires about subjective symptomatology did not directly affect self-reported symptoms of young adults with ADHD or the accuracy of these self-reports. When medication state was not specified on a questionnaire, young adults with ADHD reported symptoms similar to those they experience when they are not medicated. These results highlight the importance of specifying medication state when asking young adults with ADHD to report their current symptomatology. Failing to do so risks an over-reporting of symptoms from patients who are typically on medications. These findings open the door for further research with larger and more diverse and representative samples of adults with ADHD to evaluate the accuracy of their subjective symptomatology relative to their objective abilities. Future studies should also examine whether gender affects subjective symptoms, their accuracy, or the influence of question wording and medications on self-reported symptomatology of adults with ADHD, as the current study was unable to address this important issue.