Interpreting ADHD Rating Scale Scores: Linking ADHD Rating Scale Scores and CGI Levels in Two Randomized Controlled Trials of Lisdexamfetamine Dimesylate in ADHD

Objective: To provide additional understanding of the clinical significance of Attention-Deficit/Hyperactivity Disorder Rating Scale, Version IV (ADHD-RS-IV) total and change scores in relation to Clinical Global Impressions-Severity or -Improvement (CGI-S/-I) levels. Methods: Using two similarly designed pivotal trials of lisdexamfetamine dimesylate (Vyvanse, Shire US Inc), equipercentile linking was used to identify scores on the ADHD-RS-IV and CGI that have the same percentile rank. Results: As assessed by CGI-S levels, moderately, markedly, severely, and extremely ill adults had mean (SD) baseline ADHD-RS-IV scores of 36.2 (4.9), 42.1 (6.1), 45.4 (5.1), and 53.0, respectively. A similar relationship was observed in children. At endpoint, children categorized as minimally, much, or very much improved by CGI-I demonstrated mean (SD) ADHD-RS-IV changes from baseline of -9.9 (6.8), -25.5 (7.2), and -33.2 (9.3), respectively. Adults demonstrated a similar relationship between ADHD-RS-IV change scores and CGI-I ratings. Based on equipercentile link function, a change from baseline in ADHD-RS-IV total score of ~10–15 points or 25% to 30% corresponded to a change of 1 level in CGI-I score. Conclusion: This analysis makes possible the establishment of a clinical impression of severity of illness from total ADHD-RS-IV scores and may facilitate the clinical interpretation of improvement of ADHD-RS-IV change scores. FOCUS POINTS • Linking the Clinical Global Impressions-Severity (CGI-S) ratings with Attention-Deficit/Hyperactivity Disorder Rating Scale, Version IV (ADHD-RS-IV) scores at baseline, two trials of lisdexamfetamine dimesylate demonstrated that a difference of ~8–10 points in baseline ADHD-RS-IV score is appreciated clinically as a 1-point difference in CGI-S score. • An improvement in ADHD-RS-IV score of ~50% to 60% is needed to achieve a rating of much improved (2-level improvement) on the CGI-Improvement scale. • For all three pairs of linkages, the relationship between ADHD-RS-IV scores and CGI levels was consistent across the age groups. ORIGINAL RESEARCH Primary Psychiatry. 2010;17(3):44-52