aceoptimal CAARS-S:SV cutoff scores for adult ADHD screening in Iranian male taxi drivers
Source article: Establishing diagnostic thresholds for adult ADHD screening in taxi drivers: validation of the CAARS-S via Item Response Theory and Machine Learning
Background Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is under-recognized in professional drivers, yet it poses significant safety risks. The Conners' Adult ADHD Rating Scale Short Version (CAARS-S:SV) lacks empirically validated cutoff scores for occupational screening in Iran. This study aimed to assess the psychometric properties of the Persian CAARS-S:SV in taxi drivers and to determine optimal ADHD diagnostic thresholds using both traditional and machine-learning methods. Methods A sample of 298…
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A 2026 peer-reviewed study validated the Persian Conners' Adult ADHD Rating Scale Short Version in 298 male taxi drivers in Iran, mean age 36.8, to establish occupational screening thresholds. Using a 198/100 train-test split, the authors compared ROC, item response theory, logistic regression and Random Forest approaches for cutoff selection.
The work matters because adult ADHD is under-recognized in professional drivers yet poses significant safety risks, and empirically derived cutoffs could improve early identification. Uncertainty remains about generalizability beyond Iranian male drivers, the failure of IRT for the total score due to unidimensionality violation, and poor performance of logistic regression, indicating method choice critically affects screening accuracy.
- Study enrolled 298 male taxi drivers mean age 36.8 7 8.9 years in Iran, with ADHD prevalence 20.8% (n = 62).
- Persian CAARS-S:SV showed Cronbach's b1 0.72 to 0.89 and CFA fit c72/df = 2.40, RMSEA = 0.07; CFI = 0.91 supporting three-factor structure.
- Dataset split into training n = 198 and test n = 100 to compute sensitivity, specificity, PPV and NPV for thresholds derived via ROC, IRT, logistic regression and Random Forest.
In 298 Iranian male taxi drivers, ROC and Random Forest analysis of the Persian CAARS-S:SV identified total-score cutoffs with 88% sensitivity and 86.7% specificity for adult ADHD screening.
Item Response Theory produced an unacceptably low 68% sensitivity for the total score at threshold 24, and logistic regression yielded only 16%-60% sensitivity for ADHD status in the same driver sample.
The rundown
Researchers administered the Persian CAARS-S:SV to 298 male taxi drivers and split data into training (198) and test (100) sets to compare threshold-setting methods including ROC analysis, Terluin et al. IRT method, logistic regression and Random Forest.
On the test set, Subscale D showed ROC sensitivity 96% specificity 76% versus RF sensitivity 92% specificity 85.3%, while RF resulted in lower error value to diagnose the status of ADHD in the participants, supporting data-driven screening protocols in occupational health settings.
Findings limited to male Iranian taxi drivers and IRT total-score threshold failed due to violated assumptions, with logistic regression also performing poorly.
Sources
- Peer-reviewedJournal of injury & violence research2026-08-01
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