Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: a large twin study

BACKGROUND

Childhood maltreatment (CM) has been associated with increased risk of attention deficit hyperactivity disorder (ADHD) in children and adults. It is, however, unclear whether this association is causal or due to familial confounding.

METHOD

Data from 18 168 adult twins, aged 20-46 years, were drawn from the population-based Swedish twin registry. Retrospective self-ratings of CM (emotional and physical neglect, physical and sexual abuse and witnessing family violence), and self-ratings for DSM-IV ADHD symptoms in adulthood were analysed. Possible familial confounding was investigated using a within twin-pair design based on monozygotic (MZ) and dizygotic (DZ) twins.

RESULTS

CM was significantly associated with increased levels of ADHD symptom scores in adults [regression coefficient: 0.40 standard deviations, 95% confidence interval (CI) 0.37-0.43]. Within twin-pair analyses showed attenuated but significant estimates within DZ (0.29, 95% CI 0.21-0.36) and MZ (0.18, 95% CI 0.10-0.25) twin pairs. Similar results emerged for hyperactive/impulsive and inattentive ADHD symptom scores separately in association with CM. We conducted sensitivity analyses for early maltreatment, before age 7, and for abuse and neglect separately, and found similarly reduced estimates in DZ and MZ pairs. Re-traumatization after age 7 did not significantly influence results.

CONCLUSIONS

CM was significantly associated with increased ADHD symptoms in adults. Associations were partly due to familial confounding, but also consistent with a causal interpretation. Our findings support cognitive neuroscience studies investigating neural pathways through which exposure to CM may influence ADHD. Clinicians treating adults with ADHD should be aware of the association with maltreatment.

ADHD in context: Young adults' reports of the impact of occupational environment on the manifestation of ADHD

Does changing context play a role in the decline in ADHD symptoms in adulthood? Insufficient research has explored the functioning of adults with ADHD. As adults, individuals with ADHD have significantly more latitude to control aspects of their day-to-day environments. Do the new contexts young adults find themselves in alter their experience of ADHD? Are there particular occupational or educational contexts in which young adults report functioning better than others? To examine this issue, we conducted semi-structured interviews at four North American sites in 2010-11 with 125 young adults, originally diagnosed with ADHD as children, regarding their work and post-secondary educational environments. Many subjects describe their symptoms as context-dependent. In some contexts, participants report feeling better able to focus; in others, their symptoms-such as high energy levels-become strengths rather than liabilities. Modal descriptions included tasks that were stressful and challenging, novel and required multitasking, busy and fast-paced, physically demanding or hands-on, and/or intrinsically interesting. Consistent with a developmental psychopathology framework, ADHD is experienced as arising from an interaction between our subjects and their environments. These findings demonstrate the need to account for the role of context in our understanding of ADHD as a psychiatric disorder, especially as it manifests in young adulthood.

Characterising resting-state functional connectivity in a large sample of adults with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood psychiatric disorder that often persists into adulthood. While several studies have identified altered functional connectivity in brain networks during rest in children with ADHD, few studies have been performed on adults with ADHD. Existing studies have generally investigated small samples. We therefore investigated aberrant functional connectivity in a large sample of adult patients with childhood-onset ADHD, using a data-driven, whole-brain approach. Adults with a clinical ADHD diagnosis (N=99) and healthy, adult comparison subjects (N=113) underwent a 9-minute resting-state fMRI session in a 1.5T MRI scanner. After elaborate preprocessing including a thorough head-motion correction procedure, group independent component analysis (ICA) was applied from which we identified six networks of interest: cerebellum, executive control, left and right frontoparietal and two default-mode networks. Participant-level network maps were obtained using dual-regression and tested for differences between patients with ADHD and controls using permutation testing. Patients showed significantly stronger connectivity in the anterior cingulate gyrus of the executive control network. Trends were also observed for stronger connectivity in the cerebellum network in ADHD patients compared to controls. However, there was considerable overlap in connectivity values between patients and controls, leading to relatively low effect sizes despite the large sample size. These effect sizes were slightly larger when testing for correlations between hyperactivity/impulsivity symptoms and connectivity strength in the executive control and cerebellum networks. This study provides important insights for studies on the neurobiology of adult ADHD; it shows that resting-state functional connectivity differences between adult patients and controls exist, but have smaller effect sizes than existing literature suggested.

Does collateral retrospective information about childhood attention-deficit/hyperactivity disorder symptoms assist in the diagnosis of attention-deficit/hyperactivity disorder in adults? Findings from a large clinical sample

OBJECTIVES

In accordance with consolidated clinical practice, Diagnostic and Statistical Manual of Mental Disorders, 5th edition suggests a key role of collateral information in the evaluation of retrospective childhood attention-deficit/hyperactivity disorder symptoms in adults despite poor evidence supporting its use. This study aims to assess the incremental value of collateral information on the presence of childhood attention-deficit/hyperactivity disorder symptoms when evaluating adults with attention-deficit/hyperactivity disorder.

METHODS

Adult patients with attention-deficit/hyperactivity disorder (n = 449) and non-attention-deficit/hyperactivity disorder subjects (n = 143) underwent an extensive clinical assessment based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria. For patients, retrospective collateral information regarding childhood attention-deficit/hyperactivity disorder was obtained and used to sort them into two groups: agreement (n = 277) and disagreement (n = 172) between self- and collateral reports. We compared demographic, clinical and response to treatment profiles among groups to test the relevance of collateral information on the specific issue of childhood attention-deficit/hyperactivity disorder symptoms.

RESULTS

Both attention-deficit/hyperactivity disorder groups had higher rates of several comorbidities (oppositional defiant, conduct, substance use and bipolar disorders; all p < 0.001) and impairments than controls. Disagreement between self- and collateral reports on childhood attention-deficit/hyperactivity disorder symptoms occurred in 38% of patients. Overall, attention-deficit/hyperactivity disorder disagreement and agreement groups had similar profiles in response to treatment and comorbidity, and the few differences detected in impairment measures were of small magnitude (Eta(2) < 0.05).

CONCLUSION

Although collateral report has an important role for diagnosing attention-deficit/hyperactivity disorder in children, it has no incremental value in the evaluation of childhood attention-deficit/hyperactivity disorder symptoms in adults with a self-reported history of attention-deficit/hyperactivity disorder assessed in clinical settings.

Association Between Adult Attention Deficit Hyperactivity Disorder and Helmet Use Among Motorcycle Riders

Background

Use of helmets plays a major role in preventing injuries or decreasing injury severity among motorcycle riders. Use of helmets may depend on personal factors such as psychological factors.

Objectives

The aim of this study was to independently assess the association between helmet use among motorcycle riders and ADHD scores, with controlling the accident history and was taken more sensitive measures if helmet use was different between motorcycle riders, according to their ADHD scores.

Patients and Methods

A cross-sectional study was done on 205 motorcycle riders referred to Kerman Referral Injury Hospital after a motorcycle traffic accident. Friends and family members possessing motorcycles who visited the patient in this facility were included in our sample. The Persian version of the Conner’s Adult ADHD Rating Scale (CAARS) self-report (screening version) was used in order to screen for adult ADHD. CAARS scores were compared between those who usually used helmets and those who did not.

Results

Univariable analysis showed the mean of the age variable was significantly higher in the helmeted group, 26.94 ± 7.72 vs. 23.08 ± 7.7.32, (P < 0.001). The majority of the non-helmeted group was single (P < 0.001). Subjects with secondary educational level were more often in the helmeted group (P = 0.007). Daily and weekly driving hours were higher in the non-helmeted group (P = 0.002 and P = 0.004). Most of the subjects in the helmeted group had a driving license in comparison with the other group (P < 0.001). There was not a significant association between SES and having hyperactive children and helmet use (P = 0.159). In all ADHD subscales, a significant association was found and scores were higher in the non-helmeted group (P < 0.05). Nevertheless, multivariable analysis did not confirm the association of the ADHD screening score with helmet use.

Conclusions

The result of this study did not find an independent association between ADHD and helmet use.

Adult Attention Deficit Hyperactivity Disorder and Parenting Styles

The aim of the present study was to compare the parenting styles in parents with and without adult attention deficit hyperactivity disorder (ADHD) who had children with ADHD. It was a case-control study with convenience sampling strategy. Participants were recruited from the parents of previously diagnosed children with ADHD referred to Imam Hossein Hospital, Tehran/ Iran. Ninety parents with adult ADHD and 120 normal parents were chosen by Conner's Adult ADHD Screening Scale (CAARS) and psychiatrist interview. Using Baumrind Parenting Styles Questionnaire and Arnold Parenting Scale, parenting styles were assessed in both the groups. Results from independent samples t-test indicated that Authoritarian parenting style (F = 0.576, p 0.022) and Over reacting style (F = 7.976, p 0.045) were significantly higher in cases. On the other hand, controls were using Permissive style (F = 0.131, p 0.044) more than cases. The results are consistent with prior studies; these findings can improve the content of parent training for children with ADHD, who have adult ADHD themselves.

Deviant white matter structure in adults with attention-deficit/hyperactivity disorder points to aberrant myelination and affects neuropsychological performance

Attention-deficit/hyperactivity disorder (ADHD) in childhood is characterized by gray and white matter abnormalities in several brain areas. Considerably less is known about white matter microstructure in adults with ADHD and its relation with clinical symptoms and cognitive performance. In 107 adult ADHD patients and 109 gender-, age- and IQ-matched controls, we used diffusion tensor imaging (DTI) with tract-based spatial statistics (TBSS) to investigate whole-skeleton changes of fractional anisotropy (FA) and mean, axial, and radial diffusivity (MD, AD, RD). Additionally, we studied the relation of FA and MD values with symptom severity and cognitive performance on tasks measuring working memory, attention, inhibition, and delay discounting. In comparison to controls, participants with ADHD showed reduced FA in corpus callosum, bilateral corona radiata, and thalamic radiation. Higher MD and RD were found in overlapping and even more widespread areas in both hemispheres, also encompassing internal and external capsule, sagittal stratum, fornix, and superior lateral fasciculus. Values of FA and MD were not associated with symptom severity. However, within some white matter clusters that distinguished patients from controls, worse inhibition performance was associated with reduced FA and more impulsive decision making was associated with increased MD. This study shows widespread differences in white matter integrity between adults with persistent ADHD and healthy individuals. Changes in RD suggest aberrant myelination as a pathophysiological factor in persistent ADHD. The microstructural differences in adult ADHD may contribute to poor inhibition and greater impulsivity but appear to be independent of disease severity.

Cognitive heterogeneity in adult attention deficit/hyperactivity disorder: A systematic analysis of neuropsychological measurements

Attention Deficit/Hyperactivity Disorder (ADHD) in childhood is associated with impaired functioning in multiple cognitive domains: executive functioning (EF), reward and timing. Similar impairments have been described for adults with persistent ADHD, but an extensive investigation of neuropsychological functioning in a large sample of adult patients is currently lacking. We systematically examined neuropsychological performance on tasks measuring EF, delay discounting, time estimation and response variability using univariate ANCOVA's comparing patients with persistent ADHD (N=133, 42% male, mean age 36) and healthy adults (N=132, 40% male, mean age 36). In addition, we tested which combination of variables provided the highest accuracy in predicting ADHD diagnosis. We also estimated for each individual the severity of neuropsychological dysfunctioning. Lastly, we investigated potential effects of stimulant medication and a history of comorbid major depressive disorder (MDD) on performance. Compared to healthy adults, patients with ADHD showed impaired EF, were more impulsive, and more variable in responding. However, effect sizes were small to moderate (range: 0.05-0.70) and 11% of patients did not show neuropsychological dysfunctioning. The best fitting model predicting ADHD included measures from distinct cognitive domains (82.1% specificity, 64.9% sensitivity). Furthermore, patients receiving stimulant medication or with a history of MDD were not distinctively impaired. To conclude, while adults with ADHD as a group are impaired on several cognitive domains, the results confirm that adult ADHD is neuropsychologically heterogeneous. This provides a starting point to investigate individual differences in terms of impaired cognitive pathways.

Demographic, developmental and psychosocial predictors of the development of anxiety in adults with ADHD

The purpose of this research was to investigate potential demographic, developmental and psychosocial predictors of anxiety in the context of ADHD. Participants included 267 adults with a diagnosis of ADHD (168 males:99 females) and an age range of 18-70 years (M = 31 years; SD = 10.03 years). A background interview, parent questionnaire and rating scales were used to gather participant information. Correlations, independent t tests and one-way analysis of variances were used to identify variables associated with anxiety, and a stepwise multiple regression was used to identify potential predictors of anxiety. Variables associated with anxiety included childhood aggression, employment status, difficulties making friends, number of children and caffeine intake. Childhood aggression and caffeine intake were the potential predictors. Clinicians should be aware of these potential predictors of anxiety in the context of ADHD in order to minimise the likelihood of the development or maintenance of comorbid anxiety. Future research is needed in order to draw any conclusions on cause and effect.

Development of graphomotor fluency in adults with ADHD: Evidence of attenuated procedural learning

PURPOSE

The present study sought to determine if adults with ADHD demonstrate reduced graphomotor learning relative to controls.

METHOD

Twenty-eight control adults (n=14) and adults with ADHD (n=14) were recruited and wrote a novel grapheme on a digitizing tablet 30 times. Participants with ADHD were counterbalanced on and off stimulant medication.

RESULTS

Control participants, F(1,13)=13.786, p=.003, ω(2)partial=.460, and participants with ADHD on medication, F(1,13)=10.462, p=.007, ω(2)partial=.387, demonstrated significant improvement in graphomotor fluency with equivalent practice whereas participants with ADHD off medication did not, F(1,12)=0.166, NS.

CONCLUSIONS

Results indicate that graphomotor program learning in adults with ADHD may occur more slowly than typically developing peers. Findings have implications for providing accommodations to adults with ADHD, potential benefits of stimulant medication, and using digitizing technology as a neuropsychological assessment instrument.

Association of adult attention deficit hyperactivity disorder subtypes and response to methylphenidate HCL treatment: A magnetic resonance spectroscopy study

The effects of methylphenidate (MPH) treatment on N-acetyl aspartate (NAA), choline and creatine are being examined in individuals with different subtypes of attention deficit hyperactivity disorder (ADHD). Sixty ADHD subjects were included into the study aging between 18 and 60 years. Levels of NAA, creatine and choline in anterior cingulate cortex, cerebellum, striatum and dorsolateral prefrontal cortex were measured with magnetic resonance spectroscopy. Then, 10mg oral MPH was given to the subjects and the same metabolite levels were measured after an interval of 30min. Distribution of the patients according to the ADHD subtypes was as follows: 21 of them (35.0%) were in the inattentive type, 11 of them (18.3%) were in the hyperactive type and 28 of them were (46.7%) in the combined type. Changes of brain metabolite levels after MPH were found not to be statistically significantly different between the subtypes. The increase of choline levels after MPH compared to the levels of choline before MPH in striatum in the combined type patients were statistically significant. No clear association was found between ADHD subtypes and changes of brain metabolites with use of MPH in adult ADHD.

Maternal psychiatric history is associated with the symptom severity of ADHD in offspring

Controversy exists about the role of parent psychopathology in persistence and severity of attention deficit hyperactivity disorder (ADHD) symptoms in their children. Here we aimed to analyse the potential association between the severity of ADHD symptoms in children and the presence of psychiatric and ADHD symptoms in their biological parents. Seventy-three triads of children and their parents who were in active treatment for their diagnosed ADHD were evaluated in our Child and Adolescent Mental Health Centers. The mental health of the parents was also assessed. The general psychopathology of the parents was evaluated using the Symptom Checklist-90-R (SCL-90-R), and symptoms of hyperactivity were examined using the Adult ADHD Self-Report Scale (ASRS v.1.1). The severity of symptoms in children was assessed using the ADHD Rating Scale-IV (ADHD-RS-IV). Variables that could have affected the clinical development of ADHD such as sex, evolution time, age, academic level and the presence of comorbidities were controlled. The severity of the symptoms in children with ADHD was significantly related to the psychiatric history of their mother, the younger age of the child and the presence of a comorbid conduct disorder in the child. We discussed the importance of screening for parental psychopathology in clinical practice.

Is age a better predictor of weight loss one year after gastric bypass than symptoms of disordered eating, depression, adult ADHD and alcohol consumption?

INTRODUCTION

Findings regarding psychological risk factors for low weight loss after bariatric surgery have been inconsistent. The association between gender and weight outcome is unclear while younger age has been consistently shown to be associated with better weight outcome. The aim of this study was to analyze the interactions between gender and age on the one hand and symptoms of disordered eating, depression, adult ADHD and alcohol consumption on the other hand in regard to weight loss after gastric bypass.

METHODS

Bariatric surgery patients were recruited and asked to fill out self-report questionnaires regarding behavioral risk factors before and twelve months after surgery. Data from one hundred and twenty-nine patients were analyzed.

RESULTS

After controlling for age, no psychological variable measured prior to surgery could predict weight loss after twelve months. After surgery, there was an interaction effect between age, gender and specific eating disorder symptoms. Specifically, loss of control over eating was a risk factor for low weight loss among older, but not among younger, female participants. Symptoms of adult ADHD were associated with elevated alcohol consumption after surgery.

DISCUSSION

These results indicate that age and gender may moderate the effects of potential risk factors for inferior weight outcome. This interaction could potentially be one of the reasons behind the mixed findings in this field. Thus, there are important gender differences in the bariatric population that should be considered. The present study is the first to show that symptoms of adult ADHD may not be a risk factor for inferior weight loss but for alcohol risk consumption after gastric bypass.

Prevalence and incidence of adult attention deficit/hyperactivity disorder in a large managed care population

OBJECTIVES

To estimate longitudinal trends in prevalence and incidence rates of adult ADHD 2006-2009.

RESEARCH DESIGN AND METHODS

Kaiser Permanente Southern California (KPSC) electronic medical records were analyzed to assess prevalence and incidence rates for adult ADHD. Trends over time were estimated and compared using three case definitions (ADHD diagnosis only [DX], ADHD DX and ≥2 FDA-approved ADHD prescriptions [DX + RX], and ADHD DX and ≥1 behavioral therapy visit [DX + BT]).

MAIN OUTCOME MEASURES

Prevalence and incidence rates of adult ADHD.

RESULTS

Prevalence ranged from 151 (DX + RX) to 312 (DX) cases per 100,000 members in 2006, increasing to 239 (DX + RX) and 415 (DX) cases in 2009. Prevalence based on DX + BT declined from 185 in 2006 to 94 cases per 100,000 in 2009. In 2006, incidence ranged from 15 (DX + BT) to 68 (DX) cases per 100,000 person-years. Incidence rates remained stable throughout the study period. Stratified analyses based on DX + RX revealed only slight variations by gender, but sharp differences by age, with younger adults demonstrating a higher prevalence overall as well as dramatic increases over the study period. Prevalence was highest among Caucasians, increasing substantially across all race groups over time.

LIMITATIONS

A limitation of this study is that incidence rates may not be representative of new cases if diagnoses existed prior to enrollment in KPSC. Similarly, prevalence rates may be affected if patients sought care outside of the health plan.

CONCLUSIONS

Adult ADHD prevalence in this managed care organization appears low, but showed increasing prevalence and incidence rates over time.

Lamotrigine for attention deficit-hyperactivity disorder comorbid with mood disorders: a case series

Attention deficit-hyperactivity disorder (ADHD) is frequently comorbid with mood disorders in both children and adults. Comorbidity is shown to have negative consequences and it needs to be treated effectively. Lamotrigine, an anticonvulsant indicated for the maintenance treatment of bipolar depression is reported to be effective in adult ADHD comorbid with bipolar II disorder. We conducted a retrospective chart review to identify patients with adult ADHD and comorbid mood disorders on lamotrigine, along with ADHD medications, and/or antidepressants and antipsychotics. We identified 40 patients (17 women, 42.5%; age range 16 - 55 yrs), 50% with bipolar II and 50% with recurrent depression. Their treatment response was evaluated by Clinical Global Impression scales. We found that 31 patients (77.5%) improved with lamotrigine, there was no change in 7 patients (17.5%) and 2 patients got worse, with a mean lamotrigine dose of 125.6 ± 47.8 mg (25 - 250 mg). To our knowledge, this is the first study to report that lamotrigine might be a safe and effective treatment option for adult ADHD comorbid with bipolar and recurrent depression.

Brain alterations in adult ADHD: effects of gender, treatment and comorbid depression

Children with attention-deficit/hyperactivity disorder (ADHD) have smaller volumes of total brain matter and subcortical regions, but it is unclear whether these represent delayed maturation or persist into adulthood. We performed a structural MRI study in 119 adult ADHD patients and 107 controls and investigated total gray and white matter and volumes of accumbens, caudate, globus pallidus, putamen, thalamus, amygdala and hippocampus. Additionally, we investigated effects of gender, stimulant treatment and history of major depression (MDD). There was no main effect of ADHD on the volumetric measures, nor was any effect observed in a secondary voxel-based morphometry (VBM) analysis of the entire brain. However, in the volumetric analysis a significant gender by diagnosis interaction was found for caudate volume. Male patients showed reduced right caudate volume compared to male controls, and caudate volume correlated with hyperactive/impulsive symptoms. Furthermore, patients using stimulant treatment had a smaller right hippocampus volume compared to medication-naïve patients and controls. ADHD patients with previous MDD showed smaller hippocampus volume compared to ADHD patients with no MDD. While these data were obtained in a cross-sectional sample and need to be replicated in a longitudinal study, the findings suggest that developmental brain differences in ADHD largely normalize in adulthood. Reduced caudate volume in male patients may point to distinct neurobiological deficits underlying ADHD in the two genders. Smaller hippocampus volume in ADHD patients with previous MDD is consistent with neurobiological alterations observed in MDD.

Stigmatization in teachers towards adults with attention deficit hyperactivity disorder

OBJECTIVES

Attention deficit hyperactivity disorder (ADHD) is understood as a developmental disorder which shares common characteristics between childhood, adolescence and adulthood. However, ADHD is widely associated with misconceptions and misbeliefs which can lead to stigmatization. Teachers have an important role for the individual development as they accompany students for a long period of time. The aim of the present study was to explore stigmatizing attitudes in teachers towards adults with ADHD, thereby focusing on the developmental trajectory of the condition. Furthermore, it was aimed to identify factors contributing to prevention and intervention of stigmatization in ADHD.

METHODS

Stigma responses of 170 teachers and 170 comparison participants were measured and compared with a recently developed tool for the assessment of stigmatization towards adults with ADHD. Furthermore, the contribution of knowledge about ADHD and the frequency of contact with adults with ADHD to stigmatization were explored.

RESULTS

Teachers showed significantly less stigmatizing attitudes than comparison participants in various dimensions, including Reliability and Social Functioning, Malingering and Misuse of Medication and the total scale. With regard to teachers, frequency of contact with adults with ADHD was not related to stigma. However, knowledge about the disorder was negatively correlated with stigma in teachers, indicating lower expressed stigma with increasing knowledge about adult ADHD.

CONCLUSIONS

Teachers demonstrated more sensitized attitudes towards stigma in adults with ADHD than comparison participants. Since the present results indicate that knowledge about ADHD increase the sensitivity towards the disorder, special education programs for the community may have the potential to reduce stigmatization towards adults with ADHD. Possibilities for intervention strategies of stigmatization in educational settings were discussed.

Lipid peroxidation markers in adult attention deficit hyperactivity disorder: new findings for oxidative stress

Malondialdehyde (MDA) is a reliable marker of lipid peroxidation where paraoxonase and arylesterase are two enzymes against it. Although increased MDA has been previously shown in adults with attention deficit/hyperactivity disorder (A-ADHD), levels of paraoxonase and arylesterase enzymes have not been studied yet. We aimed to determine the status of both MDA level and paraoxonase and arylesterase enzyme activities in A-ADHD patients. A total of 35 adults with ADHD diagnosis according to Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria and 29 healthy volunteers were included in the study. Serum MDA, paraoxonase and arylesterase levels of the participants were measured. The disease severity of the patients was determined by using Turgay's Adult Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) DSM IV Based Diagnostic Screening and Rating Scale. The serum MDA level of patients was significantly higher than that of healthy control subjects, whereas their paraoxonase and arylesterase levels were significantly lower. There was no correlation between the levels of biochemical parameters (MDA, paraoxonase and arylesterase) and the disease severity. Sub-types of A-ADHD were similar in terms of these biochemical parameters. Increased lipid peroxidation, a part of oxidative stress, in adults with ADHD appears to be unbuffered by antioxidant enzymes, namely paraoxonase and arylesterase.

Self-reported symptoms of adult attention deficit hyperactivity disorder among obese patients seeking bariatric surgery and its relation to alcohol consumption, disordered eating and gender

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Symptoms of adult attention deficit hyperactivity disorder (ADHD) are common among people with obesity. Symptoms of ADHD are associated with other impulsive behaviours. Impulsivity can manifest differently in women and men.

WHAT THIS STUDY ADDS

The prevalence of ADHD symptoms was equal in both sexes in this patient group. ADHD symptoms were associated with hazardous alcohol consumption in men but not in women. It may be important to investigate several comorbid conditions simultaneously instead of a single diagnosis. Eating disorders and adult attention deficit hyperactivity disorder (ADHD), both characterized by deficits in impulse control, are common among bariatric surgery patients. Previous studies in other groups have found gender differences in how symptoms of ADHD and eating disorders manifest as women show more disordered eating and men show more risk consumption of alcohol. In the present study, the association between symptoms of adult ADHD, eating disorders and hazardous alcohol consumption was investigated, while considering gender differences. Self-report questionnaires were obtained from 276 bariatric surgery patients 3-6 months before surgery. The prevalence rates of adult ADHD and binge eating disorder (BED) were 8.6% and 6.3%, respectively, with no evidence of gender difference in the prevalence rates. Hazardous alcohol consumption was reported by a significantly larger portion of men (16.9%) than women (8.6%). There was an association between adult ADHD and both BED and hazardous alcohol consumption. However, symptoms of adult ADHD were associated with hazardous alcohol consumption in men but not in women. Our results suggest gender differences in hazardous alcohol consumption and self-reported symptoms of disordered eating despite similar prevalence rate of BED, but no gender difference in symptoms of adult ADHD. Finally, as the associations between these variables seem to be different in women and men, future studies need to investigate potential gender-specific functional and temporal relations between these variables.

The WHO Adult ADHD Self-Report Scale: Reliability and Validity of the Korean Version

OBJECTIVE

A self-report scale of adult attention-deficit/hyperactivity disorder, the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS) was developed and demonstrated good psychometric properties. The purpose of the present study is to investigate the psychometric properties of the ASRS in Korean samples.

METHODS

The ASRS includes 18 questions regarding the frequency of recent DSM-IV Criterion A symptoms of adult ADHD. We examined the factor structure, internal consistency, and convergent validity of the ASRS in Korean samples.

RESULTS

The ASRS demonstrated good internal consistency and test-retest reliability. Correlations between the ASRS and other adult ADHD measures were high, providing evidence of convergent validity. A subsequent exploratory factor analysis indicated that a two-factor solution provided the best fit.

CONCLUSION

It is expected that this scale would be helpful in clinical settings and research in Korea.

Prevalence of ADHD among students of zahedan university of medical science in iran

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) is a common mental disorder in adults that was under-diagnosed until recently. Due to probable consequences of ADHD such as occupational and educational dysfunctions and substance use, this disorder is becoming more and more of a concern. This study aimed to investigate ADHD symptoms among students of Zahedan University of medical sciences, Iran.

METHODS

This cross-sectional study was performed in Zahedan University of Medical Sciences from 2008 to 2009. Our sample included 1500 individuals who were chosen using simple sampling method. Considering the goal of the investigation, two questionnaires were distributed among students including demographic information form and the Conners' Adult ADHD Rating Scales-Self Report (Screening Version, CAARS-S:SV). Data analysis was done using descriptive and analytical statistics in SPSS software.

RESULTS

Out of 1500 questionnaires distributed among students, 913 were completed. 589 students (64.5%) were female and 324 (35.5%) were male. The Mean age of participants was 21.7 ± 3.2 years. ADHD symptoms were defined based on the Conner's adult test. Based on CAARS-S: SV, inattention/memory, hyperactivity/restlessness, impulsiveness/emotional lability, and problems with self-concept subscale symptoms were found in 107 (11.7%), 109 (12%), 121 (13.2%), and 30 (3.3%) respondents, respectively. These findings were significantly higher than average.

CONCLUSIONS

According to our results, it seems that the prevalence of ADHD is high among students. Thus, more screening is required in this population in order to diagnose and treat the disorder earlier and prevent its consequences, such as substance abuse.

DECLARATION OF INTEREST

None.

Effect of symptoms of adult attention deficit hyperactivity disorder on symptoms of post traumatic stress disorder in Korean conscripts

OBJECTIVE

This study is conducted to investigate the effect of symptoms of Attention Deficit and Hyperactivity Disorder (ADHD) on symptoms of Posttraumatic Stress Disorder (PTSD) among 224 conscripts during 5 weeks of military basic training.

METHODS

Total number of subject is 224 conscripts. We evaluated past and present symptoms of ADHD with Korean-Wender Utah rating scale (K-WURS) and Korean adult attention -deficit/hyperactivity disorder scale (K-AADHDS) and stress and symptoms of PTSD with Brief Encounter Psychosocial Instrument-K (BEPSI-K), the Korean version of the Impact of Event Scale-Revised (IES-R-K) on 1 week and 5 weeks later of basic military training. Pearson correlation analysis and multivariate logistic regression analysis were performed to evaluate risk factors of PTSD using SPSS program and Path analysis also was used to find relationship between past and present ADHD and PTSD simultaneously using AMOS program.

RESULTS

Present symptoms of ADHD (OR=1.145, CI=1.054-1.245, p=0.001) and Past symptoms of ADHD (OR=1.049, CI=1.005-1.095, p=0.028) were significant risk factor of PTSD symptoms on 1st week of basic military training. The symptoms of PTSD on fist week was also significant risk factor of PTSD after 5weeks of basic military training (OR=1.073, CI=1.020-1.129, p=0.006). Using path analysis, we could found confirm these relations between past and present ADHD symptoms and symptoms of PTSD.

CONCLUSION

The result suggests that past and present symptoms of ADHD are the risk factor of symptoms of PTSD on first week. And the symptoms of PTSD on first week are also risk factor of PTSD symptoms on last weeks in Korean conscripts. The symptoms of ADHD might make an important role in vulnerability of the symptoms of PTSD in Korean conscripts.

Dose of Methylphenidate during Service Transition for Adults with ADHD

OBJECTIVES

We wanted to investigate how one element of the transitional process of adolescents to an adult ADHD service, namely the use of medication, fared when compared to the recommendations of national guidelines.

METHODS

We did a chart review of the dose of stimulants in a cohort of transitional patients after they were transferred to an adult ADHD service, whilst investigating if other variables such as severity of ADHD, age, gender and comorbidity played any role in determining the dose of stimulants at transition.

RESULTS

The dose of stimulants when calculated in mg/kg was almost half the recommended whist the patients were also severely symptomatic. Reported comorbidity with Autistic Spectrum Disorders was also very high.

CONCLUSIONS

A handover approach of adolescents with ADHD to an adult service, may hide gaps at least as far as prescribing is concerned. This gap may need considerable resources to address successfully. We suggest that establishing transitional processes may help minimise this problem.