اعتباریابی و رواسازی مقیاس خودگزارشی ADHD بزرگسالان کانرز (CAARS–S:SV) در جمعیت ایرانی

نویسندگان

1 دانشگاه خوارزمی

2 دانشگاه علوم پزشکی شهید بهشتی

چکیده

مقدمه: اختلال کمبود توجه و بیش‌فعالی اغلب تا دوران بزرگسالی ادامه می‌یابد. ابزارهای تشخیص این اختلال در کودکی، روایی و اعتبار مناسبی دارد، اما تشخیص آن در بزرگسالان کماکان با مشکلاتی همراه است. بنابراین اقداماتی در جهت ایجاد ملاک‌های اختصاصی برای تشخیص اختلال کمبود توجه و بیش‌فعالی بزرگسالان نیاز است. در حال حاضر نسخه‌های متنوع مقیاس‌های درجه‌بندی اختلال کمبود توجه -بیش‌فعالی بزرگسالان کانرز،  استاندارد بین‌المللی برای ارزیابی این اختلال دارد.
روش: این مطالعه به اعتباریابی، رواسازی و بررسی ویژگی‌های روان‌سنجی فرم فارسی نسخه خودگزارش‌دهی مقیاس درجه‌بندی اختلال کمبود‌ توجهی - بیش‌فعالی بزرگسالان کانرز  می‌پردازد. روش مطالعه تحلیلی - توصیفی از نوع مطالعات همبستگی – روان‌سنجی است. به‌منظور بررسی ویژگی‌های روان‌سنجی پرسشنامه در جمعیت بهنجار نمونه‌ای شامل 1021 آزمودنی نسخه خودگزارش‌دهی مقیاس درجه‌بندی اختلال کمبود توجه - بیش‌فعالی بزرگسالان کانرز و متغیرهای دموگرافیک را تکمیل کردند. برای تعیین همسانی درونی و ثبات آزمون از ضریب آلفای کرونباخ و همبستگی بین دو اجرا با فاصله‌ی 4 هفته‌ی آزمون استفاده شد. برای بررسی ساختار عاملی مدل فارسی و تأیید ساختار عاملی فرم اصلی آمریکایی، تحلیل عاملی اکتشافی و تأییدی انجام شد. همچنین، به‌منظور بررسی روایی ملاک یا روایی تفکیکی پرسشنامه، نمونه‌ای شامل 77 بزرگسال مبتلا به اختلال کمبود توجه و بیش‌فعالی و 79 آزمودنی سالم به‌عنوان گروه کنترل انتخاب شدند. تشخیص اختلال کمبود توجه و بیش‌فعالی از طریق مصاحبه‌ی بالینی ساختاریافته بر اساس «دی. اس. ام.» انجام گرفت.
نتایج: تحلیل عاملی اکتشافی از طریق روش محورهای اصلی، با توجه به چرخش متمایل ابلیمین، انجام شد. آزمون کیزر – میر - اکلین، برای بررسی کیفیت نمونه‌گیری برابر با 0.912 و مقدار کرویت بارتلت با درجه آزادی 435 برابر با 2011.36 (0.0001>p)، به‌دست آمد، که هر دو مقدار نشان دهنده‌ی مناسب بودن انجام تحلیل عاملی اکتشافی است. لازم به ذکر است که مدل سه عاملی، 68 درصد از واریانس متغیرها را تبیین کرد. همچنین، نتایج بدست آمده حاکی از همسانی درونی یا ضریب آلفای کرونباخ بسیار بالا برای خرده‌مقیاس‌های پرسشنامه است. مقدار ضریب آلفای کرونباخ برای سه عامل به ترتیب برابر با 0.802، 0.758 و 0.869 به‌دست آمد. نسخه‌ی فارسی مقیاس درجه‌بندی اختلال کمبود توجه - بیش‌فعالی بزرگسالان کانرز: نسخه غربال‌گری خودگزارشی آن پرسشنامه روایی برای تشخیص‌گذاری بین بزرگسالان مبتلا به اختلال کمبود توجه و بیش‌فعالی و سالم است. نتایج تحلیل عاملی تأییدی بر اساس 30 سئوال مقیاس، با مدل اصلی آمریکایی برازش بالایی را نشان داد. به‌عبارت‌دیگر، شاخص‌های برازش تحلیل عاملی تأییدی برازش بالایی را نشان دادند. نتایج بازآزمایی در دو اجرای پرسشنامه حاکی از ثبات این تست در جمعیت ایرانی است.
بحث و نتیجه‌گیری: بر اساس یافته‌های به‌دست آمده می‌توان نتیجه گرفت که مقیاس درجه‌بندی اختلال کمبود توجه - بیش‌فعالی بزرگسالان کانرز: نسخه غربال‌گری خودگزارشی دارای اعتبار و روایی بالا و همچنین، ویژگی‌های روان‌سنجی مناسبی است و نشان می‌دهد استفاده از این پرسشنامه در جمعیت ایرانی مناسب است.

کلیدواژه‌ها


References 1. Edition F. Diagnostic and statistical manual of mental disorders: Am Psychiatric Assoc; 2013. 2. Ramsay JR, Rostain AL. Adult ADHD research: Current status and future directions. Sage Publications Sage CA: Los Angeles, CA; 2008. 3. Weiss G, Hechtman LT. Hyperactive children grown up: ADHD in children, adolescents, and adults: Guilford Press; 1993. 4. Klein RG, Mannuzza S. Long-term outcome of hyperactive children: A review. Journal of the American Academy of Child & Adolescent Psychiatry. 1991;30(3):383-7. 5. Biederman J, Petty CR, Evans M, Small J, Faraone SV. How persistent is ADHD? A controlled 10-year follow-up study of boys with ADHD. Psychiatry research. 2010;177(3):299-304. 6. Barkley RA, Murphy KR, Fischer M. ADHD in adults: What the science says: Guilford Press; 2010. 7. Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, et al. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: Continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of consulting and clinical psychology. 2012;80(6):1041. 8. McGough JJ, McCracken JT. Adult attention deficit hyperactivity disorder: moving beyond DSM-IV. Am Psychiatric Assoc; 2006. 9. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of psychiatry. 2006;163(4):716-23. 10. Polanczyk G, De Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American journal of psychiatry. 2007;164(6):942-8. 11. Visser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, Ghandour RM, et al. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry. 2014;53(1):34-46. e2. 12. Kooij SJ, Bejerot S, Blackwell A, Caci H, Casas-Brugué M, Carpentier PJ, et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC psychiatry. 2010;10(1):67. 13. Asherson P, Buitelaar J, Faraone SV, Rohde LA. Adult attention-deficit hyperactivity disorder: key conceptual issues. The Lancet Psychiatry. 2016;3(6):568-78. 14. Barkley RA. Challenges in diagnosing adults with ADHD. The Journal of clinical psychiatry. 2008;69(12):e36-e. 15. Davidson MA. Literature review: ADHD in adults: A review of the literature. Journal of attention disorders. 2008;11(6):628-41. 16. Brown TE. Brown Attention-Deficit Disorder Scales (Brown ADD Scales): For Adolescents and Adults: Psychological Corporation; 1996. 17. Conners CK, Erhardt D, Sparrow EP, editors. Conners' adult ADHD rating scales (CAARS): technical manual1999: MHS North Tonawanda. 18. Wender PH. Attention-deficit hyperactivity disorder in adults. Psychiatric Clinics of North America. 1998;21(4):761-74. 19. Adler L, Kessler R, Spencer T. Adult self report scale, ASRS-V1. 1 screener. World Health Organization, New York. 2003. 20. Adler L, Spencer T, Biederman J. Adult ADHD Investigator Symptom Rating Scale. New York: New York University School of Medicine. 2003. 21. Adler L, Spencer T, Biederman J. Adult ADHD investigator symptom rating scale-AISRS. Massachusetts General Hospital and New York University School of Medicine. 2003. 22. Adler LA, Chua HC. Management of ADHD in adults. Journal of Clinical Psychiatry. 2002;63:29-35. 23. Weiss M, Murray C. Assessment and management of attention-deficit hyperactivity disorder in adults. Canadian Medical Association Journal. 2003;168(6):715-22. 24. Conners CK, Jett JL. Attention deficit hyperactivity disorder (in adults and children): The latest assessment and treatment strategies: Compact Clinicals; 1999. 25. Erhardt D, Epstein J, Conners C, Parker J, Sitarenios G. Self-ratings of ADHD symptomas in auts II: Reliability, validity, and diagnostic sensitivity. Journal of Attention Disorders. 1999;3(3):153-8. 26. Huss M, Hölling H, Kurth B-M, Schlack R. How often are German children and adolescents diagnosed with ADHD? Prevalence based on the judgment of health care professionals: results of the German health and examination survey (KiGGS). European child & adolescent psychiatry. 2008;17(1):52-8. 27. Huss M, Iseler A, Lehmkuhl U. Interkultureller vergleich der conners-skalen: lässt sich die US-amerikanische faktorenstruktur an einer deutschen klinikstichprobe replizieren. Z Kinder Jugendpsychiatr Psychother. 2001;29(1):16-24. 28. Christiansen H, Kis B, Hirsch O, Philipsen A, Henneck M, Panczuk A, et al. German validation of the Conners Adult ADHD Rating Scales–self-report (CAARS-S) I: Factor structure and normative data. European Psychiatry. 2011;26(2):100-7. 29. Kooij JS, Conners CK, Goto T, Tanaka Y, Williams D, Allen AJ, et al. Validity of Conners' adult attention-deficit/hyperactivity disorder rating scale-investigator rated: Screening version in patients from within and outside of Europe. Psychiatry research. 2013;208(1):94-6. 30. MOGHADASIN M, FALSAFINEJAD M. APPLICATION OF STRUCTURAL EQUATION MODELS TO ESTIMATE RELIABILITY AND VALIDITY OF PSYCHOLOGICAL TESTS AND ASSESS THE RELIABILITY AND VALIDITY OF ADULT ADHD DIAGNOSTIC SCALE (CAARS-S: SV). 2013. 31. Bock RD, Bargmann RE. Analysis of covariance structures. Psychometrika. 1966;31(4):507-34. 32. Cramer EM, Bock RD. Chapter VIII: Multivariate Analysis. Review of Educational Research. 1966;36(5):604-17. 33. Long J. Covariance structure models: an introduction to LISREL. 1983. 34. Dwyer JH. Statistical models for the social and behavioral sciences: Oxford University Press, USA; 1983. 35. Long JS. Confirmatory factor analysis: A preface to LISREL: Sage Publications; 1983. 36. Hayduk LA. Structural equation modeling with LISREL: Essentials and advances: Jhu Press; 1987. 37. Hayduk LA. LISREL issues, debates and strategies: JHU Press; 1996. 38. Bollen KA. A new incremental fit index for general structural equation models. Sociological Methods & Research. 1989;17(3):303-16. 39. Bielby WT, Hauser RM. Structural equation models. Annual review of sociology. 1977;3(1):137-61. 40. Aigner DJ, Goldberger AS. Latent variables in socioeconomic models. 1977. 41. Duncan OD. Notes on social measurement: Historical and critical: Russell Sage Foundation; 1984. 42. Goldberg A, Duncan O, editors. Structural equation models in the social sciences. New York: Seminar; 1973. 43. Anderson JC, Gerbing DW. Structural equation modeling in practice: A review and recommended two-step approach. Psychological bulletin. 1988;103(3):411. 44. Bagozzi RP, Edwards JR. A general approach for representing constructs in organizational research. Organizational research methods. 1998;1(1):45-87. 45. Edwards JR, Bagozzi RP. On the nature and direction of relationships between constructs and measures. Psychological methods. 2000;5(2):155. 46. Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. Journal of marketing research. 1981:39-50. 47. Fornell C. Issues in the application of covariance structure analysis: A comment. Journal of Consumer Research. 1983;9(4):443-8. 48. McQuitty S. Statistical power and structural equation models in business research. Journal of Business Research. 2004;57(2):175-83. 49. Hoelter JW. The analysis of covariance structures: Goodness-of-fit indices. Sociological Methods & Research. 1983;11(3):325-44. 50. Sivo SA, Fan X, Witta EL, Willse JT. The search for" optimal" cutoff properties: Fit index criteria in structural equation modeling. The Journal of Experimental Education. 2006;74(3):267-88. 51. Hoe SL. Issues and procedures in adopting structural equation modeling technique. Journal of applied quantitative methods. 2008;3(1):76-83. 52. Tabachnick BG, Fidell LS, Ullman JB. Using multivariate statistics: Pearson Boston, MA; 2007. 53. Kline RB. Principles and practice of structural equation modeling: Guilford publications; 2015. 54. Jackson DL. Revisiting sample size and number of parameter estimates: Some support for the N: q hypothesis. Structural equation modeling. 2003;10(1):128-41. 55. Shah R, Goldstein SM. Use of structural equation modeling in operations management research: Looking back and forward. Journal of Operations management. 2006;24(2):148-69. 56. Tabachnick BG, Fidell LS. Experimental designs using ANOVA: Thomson/Brooks/Cole; 2007. 57. Christensen LB, Waraczynski MA. Experimental methodology: Allyn and Bacon Boston; 1988. 58. Conners C, Erhardt D, Epstein J, Parker J, Sitarenios G, Sparrow E. Self-ratings of ADHD symptoms in adults I: Factor structure and normative data. Journal of Attention Disorders. 1999;3(3):141-51. 59. Conners CK. Attention-deficit/hyperactivity disorder—historical development and overview. Journal of Attention Disorders. 2000. 60. Conners CK, Wells KC, Parker JD, Sitarenios G, Diamond JM, Powell JW. A new self-report scale for assessment of adolescent psychopathology: factor structure, reliability, validity, and diagnostic sensitivity. Journal of abnormal child psychology. 1997;25(6):487-97. 61. Macey KD. Review of Conners' Adult ADHD Rating Scales (CAARS). 2003. 62. Antony MM, Barlow DH. Handbook of assessment and treatment planning for psychological disorders: Guilford press; 2011. 63. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy. 1995;33(3):335-43. 64. ASGHARI MM, Saed F, Dibajnia P, Zangeneh J. A preliminary validation of the depression, anxiety and stress scales (dass) in non-clinical sample. 2008. 65. Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological assessment. 1998;10(2):176. 66. Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ. Evaluating the use of exploratory factor analysis in psychological research. Psychological methods. 1999;4(3):272. 67. Guttman L. Some necessary and sufficient conditions for common factor analysis. Psychometrica, 19, 149-161. 1954. 68. Kaiser HF. A note on Guttman's lower bound for the number of common factors 1. British Journal of Statistical Psychology. 1961;14(1):1-2. 69. Cattell RB. The scree test for the number of factors. Multivariate behavioral research. 1966;1(2):245-76. 70. Hoyle RH, Duvall JL. Determining the number of factors in exploratory and confirmatory factor analysis. Handbook of quantitative methodology for the social sciences. 2004:301-15. 71. Ding J, Das K, Moereels H, Koymans L, Andries K, Janssen PA, et al. Structure of HIV-1 RT/TIBO R 86183 complex reveals similarity in the binding of diverse nonnucleoside inhibitors. Nature Structural and Molecular Biology. 1995;2(5):407. 72. Schinka JA, Velicer WF, Weiner IB. Handbook of psychology, Volume 2: Research methods in psychology. John Wilay & Sons, Inc; 2003. 73. Joreskog KG, Sorbom D. LISREL VII: A guide to the program and applications. Chicago: SPSS. 1988. 74. Olsson U, Drasgow F, Dorans NJ. The polyserial correlation coefficient. Psychometrika. 1982;47(3):337-47. 75. Byrne BM. The Maslach Burnout Inventory: Validating factorial structure and invariance across intermediate, secondary, and university educators. Multivariate Behavioral Research. 1991;26(4):583-605. 76. Byrne BM. Structural equation modeling with AMOS: Basic concepts, applications, and programming: Routledge; 2016. 77. Blunch N. Introduction to structural equation modelling using SPSS and AMOS: Sage; 2008. 78. Browne MW, Cudeck R. Alternative ways of assessing model fit. Sage focus editions. 1993;154:136-. 79. Raykov T, Marcoulides GA. On multilevel model reliability estimation from the perspective of structural equation modeling. Structural Equation Modeling. 2006;13(1):130-41. 80. Kline RB. Principles and practice of structural equation modeling: Methodology in the social sciences. 2005. 81. Richarte V, Corrales M, Pozuelo M, Serra-Pla J, Ibáñez P, Calvo E, et al. Validación al español de la ADHD Rating Scale (ADHD-RS) en adultos: relevancia de los subtipos clínicos. Revista de Psiquiatría y Salud Mental. 2017;10(4):185-91. 82. Kooij J, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J, et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European psychiatry. 2019;56:14-34. 83. La Malfa G, Lassi S, Bertelli M, Pallanti S, Albertini G. Detecting attention-deficit/hyperactivity disorder (ADHD) in adults with intellectual disability: The use of Conners’ Adult ADHD Rating Scales (CAARS). Research in developmental disabilities. 2008;29(2):158-64. 84. Conners C, Erhardt D, Sparrow E, Staff M. Conner's Adult ADHD Rating Scales: CAARS: Multi-Health Systems. Inc, New York. 1999. 85. Adler LA, Faraone SV, Spencer TJ, Michelson D, Reimherr FW, Glatt SJ, et al. The reliability and validity of self-and investigator ratings of ADHD in adults. Journal of Attention Disorders. 2008;11(6):711-9. 86. Kooij J, Boonstra AM, Swinkels S, Bekker EM, de Noord I, Buitelaar JK. Reliability, validity, and utility of instruments for self-report and informant report concerning symptoms of ADHD in adult patients. Journal of Attention Disorders. 2008. 87. Skirrow C, Asherson P. Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. Journal of affective disorders. 2013;147(1-3):80-6. 88. Skirrow C, Ebner-Priemer U, Reinhard I, Malliaris Y, Kuntsi J, Asherson P. Everyday emotional experience of adults with attention deficit hyperactivity disorder: evidence for reactive and endogenous emotional lability. Psychological medicine. 2014;44(16):3571-83. 89. Skirrow C, Hosang GM, Farmer AE, Asherson P. An update on the debated association between ADHD and bipolar disorder across the lifespan. Journal of Affective Disorders. 2012;141(2-3):143-59. 90. Vidal R, Valero S, Nogueira M, Palomar G, Corrales M, Richarte V, et al. Emotional lability: the discriminative value in the diagnosis of attention deficit/hyperactivity disorder in adults. Comprehensive psychiatry. 2014;55(7):1712-9. 91. Biederman J, Ball SW, Monuteaux MC, Mick E, Spencer TJ, McCREARY M, et al. New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. Journal of the American Academy of Child & Adolescent Psychiatry. 2008;47(4):426-34. 92. Biederman J, Faraone SV, Spencer T, Wilens T, Norman D, Lapey KA, et al. Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. The American journal of psychiatry. 1993. 93. Fischer AG, Bau CH, Grevet EH, Salgado CA, Victor MM, Kalil KL, et al. The role of comorbid major depressive disorder in the clinical presentation of adult ADHD. Journal of psychiatric research. 2007;41(12):991-6. 94. McIntosh D, Kutcher S, Binder C, Levitt A, Fallu A, Rosenbluth M. Adult ADHD and comorbid depression: A consensus-derived diagnostic algorithm for ADHD. Neuropsychiatric disease and treatment. 2009;5:137. 95. Sobanski E, Brüggemann D, Alm B, Kern S, Deschner M, Schubert T, et al. Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). European archives of psychiatry and clinical neuroscience. 2007;257(7):371-7. 96. Bron T, Bijlenga D, Kooij J, Vogel S, Wynchank D, Beekman A, et al. Attention-deficit hyperactivity disorder symptoms add risk to circadian rhythm sleep problems in depression and anxiety. Journal of affective disorders. 2016;200:74-81. 97. Matthies S, Philipsen A, Svaldi J. Risky decision making in adults with ADHD. Journal of behavior therapy and experimental psychiatry. 2012;43(3):938-46. 98. Matza LS, Van Brunt DL, Cates C, Murray LT. Test–retest reliability of two patient-report measures for use in adults with ADHD. Journal of Attention Disorders. 2011;15(7):557-63. 99. Van de Glind G, van den Brink W, Koeter MW, Carpentier P-J, van Emmerik-van Oortmerssen K, Kaye S, et al. Validity of the Adult ADHD Self-Report Scale (ASRS) as a screener for adult ADHD in treatment seeking substance use disorder patients. Drug and alcohol dependence. 2013;132(3):587-96.