Research paperScreening for attention-deficit/hyperactivity disorder in borderline personality disorder

•We studied a large sample of patients with borderline personality disorder.•Using structured interviews, we found a prevalence of adult ADHD of 32.4%.•The most largely used questionnaire for ADHD screening, the ASRS showed low positive and negative predictive values.•ASRS should be used with caution in this population, or possibly associated with the WURS scale.

BackgroundA valid screening instrument is needed to detect attention-deficit/hyperactivity disorder (ADHD) in treatment-seeking borderline personality disorder (BPD) patients.We aimed to test the performance of the widely-used Adult ADHD Self-Report Scale v1.1 screener (ASRS-v1.1).Methods317 BPD subjects were systematically assessed for comorbid ADHD and completed the ASRS-v1.1. 79 BPD patients also completed the Wender Utah Rating Scale (WURS-25).ResultsThe prevalence of adult ADHD was of 32.4%. The overall positive predictive value of the ASRS-v1.1 was of 38.5%, the negative predictive value 77.0%, the sensitivity 72.8%, and the specificity 43.9%. Combining WURS-25 and ASRS-v1.1 improved sensitivity to 81.8% and specificity to 59.6%.LimitationsCross-sectional study on treatment-seeking patients.ConclusionsWe found a high prevalence of ADHD using structured interviews. The ASRS-v1.1 was not a sensitive screener for identifying possible ADHD cases in a BPD population, with a high number of false positives. When combined with the WURS-25, it offered improved screening.