Attention-deficit/hyperactivity disorder: a neuropsychological perspective towards DSM-V

Women with ADHD: it is an explanation, not the excuse du jour

PURPOSE

To call attention to attention deficit hyperactivity disorder (ADHD) as a psychiatric disorder that can limit women's potential and overall well-being.

CONCLUSION

ADHD, a legitimate neurobiological disorder that is often hidden, ignored, or misdiagnosed among women, causes them to struggle in silence. Proper interventions for women with ADHD that provide significant attention to context mitigate challenges across psychological, academic, occupational, and social domains. This should amend the diagnosis du jour concept, thereby supporting mechanisms to improve early intervention and positive outcomes.

PRACTICE IMPLICATIONS

Primary care practitioners play a central role in recognition, intervention, and recovery of women with ADHD.

What have birth cohort studies asked about genetic, pre- and perinatal exposures and child and adolescent onset mental health outcomes? A systematic review

Increased understanding of early neurobehavioural development is needed to prevent, identify, and treat childhood psychopathology most effectively at the earliest possible stage. Prospective birth cohorts can elucidate the association of genes, environment, and their interactions with neurobehavioural development. We conducted a systematic review of the birth cohort literature. On the basis of internet searches and 6,248 peer-reviewed references, 105 longitudinal epidemiological studies were identified. Twenty studies met inclusion criteria (prospectively recruited, population-based cohort studies, including at least one assessment before the end of the perinatal period and at least one assessment of behaviour, temperament/personality, neuropsychiatric or psychiatric status before 19 years of age), and their methodologies were reviewed in full. Whilst the birth cohort studies did examine some aspects of behaviour and neurodevelopment, observations in the early months and years were rare. Furthermore, aspects of sampling method, sample size, data collection, design, and breadth and depth of measurement in some studies made research questions about neurodevelopment difficult to answer. Existing birth cohort studies have yielded limited information on how pre- and perinatal factors and early neurodevelopment relate to child psychopathology. Further epidemiological research is required with a specific focus on early neurodevelopment. Studies are needed which include the measures of early childhood psychopathology and involve long-term follow-up.

ADHS im Jugendalter

Ausgehend von der Betrachtung der ADHS als Lebensspannenerkrankung geht die vorliegende Studie der Frage nach, inwieweit Symptome einer adulten Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) bereits im Jugendalter auftreten und Folgen für die klinische Praxis haben. Auf der Basis einer Repräsentativdatenerhebung wurde eine Stichprobe von N = 140 Jungen und Mädchen im Alter zwischen 14 und 19 Jahren erhoben. Mittels der eingesetzten Verfahren ADHS-E, SF-12, SWLS und PHQ-15 und PHQ-9 wurden Zusammenhänge zwischen den ADHS-Symptomen im Erwachsenenalter und Lebenszufriedenheit bzw. Lebensqualität über psychische und körperliche Symptome bei Heranwachsenden untersucht. Dabei konnte die ADHS als ein wesentlicher Faktor für die Beeinträchtigung der Lebenszufriedenheit und Begünstigung von Depressivität in der Adoleszenz ausgemacht werden. Für die klinische Praxis ergibt sich daraus ein veränderter Blickwinkel auf die Lebenszufriedenheit von Jugendlichen im Allgemeinen und auf zusätzliche psychische Belastungen im Rahmen einer adoleszenten Form der ADHS im Besonderen.

Sensitivity of the test of memory and learning to attention and memory deficits in children with ADHD

Children with attention deficit hyperactivity disorder (ADHD) exhibit a number of cognitive deficits. The current study compared patterns of attention, learning, and memory impairment on the Test of Memory and Learning (TOMAL) between 80 children with ADHD and 80 normal comparisons who were matched for age and gender. Results demonstrated that children with ADHD performed significantly worse than matched controls on the Attention/Concentration Index and the Sequential Recall Index. ROC analysis indicated that these two indexes had good classification accuracy with AUCs of.76 and.77 respectively. There were also group differences on the other index scores except the Associative Recall Index. Factor analysis of the ADHD sample extracted five factors, including an Attention factor that significantly correlated with performance on nonverbal memory tasks. Significant correlations between the TOMAL Index scores and tests of intelligence and visuomotor integration supported the convergent and discriminant validity of the test. These results provide support for the criterion validity of the TOMAL in assessing neurocognitive deficits in children with ADHD.

Unveiling the mystery about adult ADHD: one woman's journey

Attention deficit hyperactivity disorder (ADHD), a neurobiological disorder, affects millions of individuals and can significantly impact an individual's life course. Research guidelines used in assessment, diagnosis, and treatment have focused primarily on Caucasian males generating, in part, the need to redress how gender and other contextual factors are considered. Consequently many women and persons from diverse cultural groups can be ignored or misdiagnosed. Undiagnosed and untreated women with ADHD are therefore limited in their potential to flourish socially, academically, interpersonally, and in their family roles. This case example of a 38-year-old African American woman illustrates how her life journey was affected by undiagnosed ADHD.

Genetic interaction analysis for DRD4 and DAT1 genes in a group of Mexican ADHD patients

Attention-deficit hyperactivity disorder (ADHD) is a clinically complex and multifactorial psychiatric disorder of inattention, hyperactivity and impulsivity. Family, twin and adoption studies suggest a genetic influence in the etiology of ADHD. Two variable number of tandem repeats (VNTR) polymorphic systems have been frequently associated with this disorder: the 7 repeat (R) allele in exon 3 of the dopamine receptor D4 (DRD4) and the 10R allele located in the 3' untranslated region (UTR) of the dopamine transporter (DAT1). We conducted a case-control association study between ADHD and these polymorphisms in a group of adolescent inhabitants of the metropolitan area of Mexico City. In addition, we evaluated the interaction between these genes, the disorder and its associated psychiatric comorbidities. No positive association between ADHD and the 7R allele of DRD4 or the 10R allele of DAT1 was observed; however, compared to controls, patients with internalized comorbidities had a lesser frequency of genotypes with the 7R allele of DRD4 and the 10/10 genotype of DAT1. A logistic regression analysis showed that the simultaneous absence of the 10/10 DAT1 and 7/7 DRD4 genotypes predicts membership to the group of ADHD patients with internalized comorbidities (e.g. anxiety, depression). Our results highlight the importance of cross-ethnic research and the possibility of a distinct genetic basis that underlies the type of comorbidities associated with ADHD. This result should be considered in terms of the study design, and further replication is necessary in an independent sample.

What grabs his attention but not hers? Estrogen correlates with neurophysiological measures of vocal change detection

Prior research revealed sex differences in the processing of unattended changes in speaker prosody. The present study aimed at investigating the role of estrogen in mediating these effects. To this end, the electroencephalogram (EEG) was recorded while participants watched a silent movie with subtitles and passively listened to a syllable sequence that contained occasional changes in speaker prosody. In one block, these changes were neutral, whereas in another block they were emotional. Estrogen values were obtained for each participant and correlated with the mismatch negativity (MMN) amplitude elicited in the EEG. As predicted, female listeners had higher estrogen values than male listeners and showed reduced MMN amplitudes to neutral as compared to emotional change in speaker prosody. Moreover, in both, male and female listeners, MMN amplitudes were negatively correlated with estrogen when the change in speaker prosody was neutral, but not when it was emotional. This suggests that estrogen is associated with reduced distractibility by neutral, but not emotional, events. Emotional events are spared from this reduction in distractibility and more likely to penetrate voluntary attention directed elsewhere. Taken together, the present findings provide evidence for a role of estrogen in human cognition and emotion.

Executive dysfunction and delay aversion in attention deficit hyperactivity disorder: nosologic and diagnostic implications

In this article the authors reflect on the role of executive function (EF) deficits and delay aversion (DAv) in the diagnosis of attention deficit hyperactivity disorder (ADHD). The authors, empirical review shows clearly that EF deficits and DAv are implicated in ADHD, although neither is necessary for ADHD nor specific to it. The constructs are somewhat dissociable from one another so that each may represent a distinctive feature associated with an ADHD subsample. The authors argue that neither EF deficits nor DAv add much value to the diagnosis of ADHD as it is currently conceptualized, but may be crucial in helping to partition heterogeneity in the condition, leading to the refinement of ADHD nosology.

The shifting subtypes of ADHD: classification depends on how symptom reports are combined

Research on the correlates of ADHD subtypes has yielded inconsistent findings, perhaps because the procedures used to define subtypes vary across studies. We examined this possibility by investigating whether the ADHD subtype distribution in a community sample was sensitive to different methods for combining informant data. We conducted a study to screen all children in grades 1-5 (N = 7847) in a North Carolina County for ADHD. Teachers completed a DSM-IV behavior rating scale and parents completed a structured telephone interview. We found substantial differences in the distribution of ADHD subtypes depending on whether one or both sources were used to define the subtypes. When parent and teacher data were combined, the procedures used substantially influenced subtype distribution. We conclude the ADHD subtype distribution is sensitive to how symptom information is combined and that standardization of the subtyping process is required to advance our understanding of the correlates of different ADHD subtypes.