We know a great deal about identifying, measuring, and treating the core symptoms of ADHD. We need to know more about measuring and treating how these symptoms are related to functional impairment, and how successful treatment of symptoms has been in remediating the patient’s complaints of difficulty functioning.
Individuals with ADHD seek help for a “problem”
That might be difficulty in school, problems with friends, accidents or other life challenges. The clinician may interpret these difficulties, or functional impairments, as driven by ADHD symptoms and will collect information about the 18 core symptoms of attention, hyperactivity and impulsivity.
Treatment with stimulant medication is often very effective and improving symptoms, and this in turn is moderately effective at improving functioning. Some functional impairments may require treatment, even when symptoms are better. For example,
- A child may need an IEP to manage the classroom.
- An adult may need coaching to improve organization or time management.
Identification of the functional impairments that concern you, and whether or not they have improved, is the ultimate measure of whether or not treatment has been helpful.
It is just as important to ‘measure’ functioning using a standardized scale such as the Weiss Functional Impairment Rating Scale (WFIRS Parent or WFIRS Self Report) as it is to precisely measure improvement in symptoms.
About the Author
Margaret D. Weiss, MD, PhD, FRCP(C), is the Director of Neurodevelopmental Services at Cambridge Health Alliance and an Associate Professor at Harvard University. She has specialized in diagnosis, treatment, and research in neurodevelopmental disorders through the life cycle. She received her MD and Fellowship in Psychiatry from McGill University and her PhD in the History of Science from Harvard University. Dr. Weiss has published over 160 articles, co-authored the current chapter on ADHD in the Comprehensive Textbook of Psychiatry and the book ADHD in Adulthood: A Guide to Current Theory, Diagnosis, and Treatment. Dr. Weiss is known for her research on melatonin and sleep hygiene treatment in ADHD. She is the author of the Weiss Functional Impairment Rating Scale, a widely used measure translated into fourteen languages. She has lectured in more than twenty-three countries.
References
1. Weiss MD. A Paradigm for Targeting Functional Impairment as an Outcome in Attention-Deficit/Hyperactivity Disorder. Brain Sci. 2022;12(8). Epub 20220731. doi: 10.3390/brainsci12081014. PubMed PMID: 36009077; PMCID: PMC9405930.
2. Weiss MD, Stein MA. Measurement Informed Care in Attention-Deficit/Hyperactivity Disorder (ADHD). Child Adolesc Psychiatr Clin N Am. 2022;31(3):363-72. Epub 20220511. doi: 10.1016/j.chc.2022.03.010. PubMed PMID: 35697390.
3. Weiss M, Childress A, Mattingly G, Nordbrock E, Kupper RJ, Adjei AL. Relationship Between Symptomatic and Functional Improvement and Remission in a Treatment Response to Stimulant Trial. J Child Adolesc Psychopharmacol. 2018;28(8):521-9. Epub 20180723. doi: 10.1089/cap.2017.0166. PubMed PMID: 30036076; PMCID: PMC6201781.
4. Weiss MD, McBride NM, Craig S, Jensen P. Conceptual review of measuring functional impairment: findings from the Weiss Functional Impairment Rating Scale. Evid Based Ment Health. 2018;21(4):155-64. Epub 20181012. doi: 10.1136/ebmental-2018-300025. PubMed PMID: 30314990; PMCID: PMC6241626.