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Mattos P, Moraes CEFD, Sichieri R, Hay P, Faraone SV, Appolinario JC. Adult ADHD Symptoms in a Large Metropolitan Area From Brazil: Prevalence and Associations with Psychiatric Comorbidity, Bullying, Sexual Abuse, and Quality of Life. J Atten Disord 2024; 28:1082-1091. [PMID: 38380531 DOI: 10.1177/10870547241229097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence and psychiatric correlates of symptomatic ADHD in a large metropolitan area of a middle-income country. METHODS An in-person household survey with randomly selected 2,297 adults aged 19 to 60 from Rio de Janeiro, Brazil, assessed by trained lay interviewers. The Adult Self-Rating Scale Screener (ASRS-6) was used. Chi-square and logistic regression were conducted. RESULTS ADHD prevalence was 4.59 (95% CI [3.56, 5.44]). Those with ADHD were younger and more often unemployed; they displayed more psychiatric symptoms (depression, anxiety, and alcohol abuse) and a history of bullying and sexual abuse. They also had worse physical health indicators. Findings remained significant when controlling for socioeconomic variables. CONCLUSION Adults with symptomatic ADHD from a large metropolitan area in Brazil show a pattern of findings consistent with what has been observed in higher-income countries.
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Affiliation(s)
- Paulo Mattos
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Carlos Eduardo Ferreira de Moraes
- Obesity and Eating Disorders Group, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
| | - Rosely Sichieri
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
- Mental Health Services, SWSLHD, Campbelltown, Sydney, Australia
| | - Stephen V Faraone
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jose Carlos Appolinario
- Obesity and Eating Disorders Group, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Stein J, Jorge BC, Nagaoka LT, Reis ACC, Manoel BDM, Godoi AR, Fioravante VC, Martinez FE, Pinheiro PFF, Pupo AS, Arena AC. Can exposure to lisdexamfetamine dimesylate from juvenile period to peripubertal compromise male reproductive parameters in adult rats? Toxicol Appl Pharmacol 2024; 484:116867. [PMID: 38378049 DOI: 10.1016/j.taap.2024.116867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/22/2024]
Abstract
Lisdexamfetamine (LDX) is a d-amphetamine prodrug used to treat attention deficit and hyperactivity disorder, a common neurodevelopmental disorder in children and adolescents. Due to its action mediated by elevated levels of catecholamines, mainly dopamine and noradrenaline, which influence hormonal regulation and directly affect the gonads, this drug may potentially disrupt reproductive performance. This study evaluated the effects of exposure to LDX from the juvenile to peripubertal period (critical stages of development) on systemic and reproductive toxicity parameters in male rats. Male Wistar rats (23 days old) were treated with 0; 5.2; 8.6 or 12.1 mg/kg/day of LDX from post-natal day (PND) 23 to 53, by gavage. LDX treatment led to reduced daily food and water consumption, as well as a decrease in social behaviors. The day of preputial separation remained unaltered, although the treated animals exhibited reduced weight. At PND 54, the treated animals presented signs of systemic toxicity, evidenced by a reduction in body weight gain, increase in the relative weight of the liver, spleen, and seminal gland, reduction in erythrocyte and leukocyte counts, reduced total protein levels, and disruptions in oxidative parameters. In adulthood, there was an increase in immobile sperm, reduced sperm count, morphometric changes in the testis, and altered oxidative parameters, without compromising male sexual behavior and fertility. These findings showed that LDX-treatment during the juvenile and peripubertal periods induced immediate systemic toxicity and adversely influenced reproductive function in adult life, indicating that caution is necessary when prescribing this drug during the peripubertal phase.
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Affiliation(s)
- Julia Stein
- Department of Structural and Functional Biology, Morphology sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Bárbara Campos Jorge
- Department of Structural and Functional Biology, Morphology sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Lívia Trippe Nagaoka
- Department of Structural and Functional Biology, Morphology sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Ana Carolina Casali Reis
- Department of Structural and Functional Biology, Morphology sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Beatriz de Matos Manoel
- Department of Structural and Functional Biology, Morphology sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Alana Rezende Godoi
- Department of Structural and Functional Biology, Anatomy sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Vanessa Caroline Fioravante
- Department of Structural and Functional Biology, Anatomy sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Francisco Eduardo Martinez
- Department of Structural and Functional Biology, Anatomy sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Patrícia Fernanda Felipe Pinheiro
- Department of Structural and Functional Biology, Anatomy sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - André Sampaio Pupo
- Department of Biophysics and Pharmacology, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Arielle Cristina Arena
- Department of Structural and Functional Biology, Morphology sector, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; Center of Information and Toxicological Assistance (CIATOX), Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.
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3
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Lewczuk K, Marcowski P, Wizła M, Gola M, Nagy L, Koós M, Kraus SW, Demetrovics Z, Potenza MN, Ballester-Arnal R, Batthyány D, Bergeron S, Billieux J, Briken P, Burkauskas J, Cárdenas-López G, Carvalho J, Castro-Calvo J, Chen L, Ciocca G, Corazza O, Csako RI, Fernandez DP, Fujiwara H, Fernandez EF, Fuss J, Gabrhelík R, Gewirtz-Meydan A, Gjoneska B, Grubbs JB, Hashim HT, Islam MS, Ismail M, Jiménez-Martínez MC, Jurin T, Kalina O, Klein V, Költő A, Lee SK, Lin CY, Lin YC, Lochner C, López-Alvarado S, Lukavská K, Mayta-Tristán P, Miller DJ, Orosová O, Orosz G, Ponce FP, Quintana GR, Quintero Garzola GC, Ramos-Diaz J, Rigaud K, Rousseau A, Tubino Scanavino MD, Schulmeyer MK, Sharan P, Shibata M, Shoib S, Sigre-Leirós V, Sniewski L, Spasovski O, Steibliene V, Stein DJ, Ünsal BC, Vaillancourt-Morel MP, Claire Van Hout M, Bőthe B. Cross-Cultural Adult ADHD Assessment in 42 Countries Using the Adult ADHD Self-Report Scale Screener. J Atten Disord 2024; 28:512-530. [PMID: 38180045 DOI: 10.1177/10870547231215518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVE We analyzed adult ADHD symptoms in a cross-cultural context, including investigating the occurrence and potential correlates of adult ADHD and psychometric examination of the Adult ADHD Self-Report Scale (ASRS) Screener. METHOD Our analysis is based on a large-scale research project involving 42 countries (International Sex Survey, N=72,627, 57% women, Mage=32.84; SDage=12.57). RESULTS The ASRS Screener demonstrated good reliability and validity, along with partial invariance across different languages, countries, and genders. The occurrence of being at risk for adult ADHD was relatively high (21.4% for women, 18.1% for men). The highest scores were obtained in the US, Canada, and other English-speaking Western countries, with significantly lower scores among East Asian and non-English-speaking European countries. Moreover, ADHD symptom severity and occurrence were especially high among gender-diverse individuals. Significant associations between adult ADHD symptoms and age, mental and sexual health, and socioeconomic status were observed. CONCLUSIONS Present results show significant cross-cultural variability in adult ADHD occurrence as well as highlight important factors related to adult ADHD. Moreover, the importance of further research on adult ADHD in previously understudied populations (non-Western countries) and minority groups (gender-diverse individuals) is stressed. Lastly, the present analysis is consistent with previous evidence showing low specificity of adult ADHD screening instruments and contributes to the current discussion on accurate adult ADHD screening and diagnosis.
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Affiliation(s)
- Karol Lewczuk
- Cardinal Stefan Wyszynski University, Warsaw, Poland
| | | | | | - Mateusz Gola
- University of California, San Diego, USA
- Institute of Psychology, Polish Academy of Sciences, Poland
| | - Léna Nagy
- ELTE Eötvös Loránd University, Budapest, Hungary
| | - Mónika Koós
- ELTE Eötvös Loránd University, Budapest, Hungary
| | | | - Zsolt Demetrovics
- ELTE Eötvös Loránd University, Budapest, Hungary
- University of Gibraltar, Gibraltar
| | - Marc N Potenza
- Yale University School of Medicine, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | | | | | - Sophie Bergeron
- Université de Montréal, Canada
- Centre de Recherche Interdisciplinaire sur les Problèmes Conjugaux et les Agressions Sexuelles (CRIPCAS), Canada
| | - Joël Billieux
- University of Lausanne, Switzerland
- Lausanne University Hospitals, Switzerland
| | - Peer Briken
- University Medical Centre Hamburg-Eppendorf, Germany
| | - Julius Burkauskas
- Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania
| | | | | | | | | | | | | | | | | | - Hironobu Fujiwara
- Kyoto University, Kyoto, Japan
- RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
- The General Research Division, Osaka University Research Center on Ethical, Legal and Social Issues, Osaka, Japan
| | | | | | - Roman Gabrhelík
- Charles University, Prague, Czech Republic
- General University Hospital in Prague, Czech Republic
| | | | - Biljana Gjoneska
- Macedonian Academy of Sciences and Arts, Republic of North Macedonia
| | | | | | - Md Saiful Islam
- Jahangirnagar University, Savar, Dhaka, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Savar, Dhaka, Bangladesh
| | | | - Martha C Jiménez-Martínez
- Universidad Pedagógica y Tecnológica de Colombia, Colombia
- Grupo de Investigación Biomédica y de Patología, Colombia
| | | | | | | | | | - Sang-Kyu Lee
- Hallym University Chuncheon Sacred Heart Hospital, South Korea
- Chuncheon Addiction Management Center, South Korea
| | - Chung-Ying Lin
- National Cheng Kung University, Tainan
- University of Religions and Denominations, Qom, Iran
| | | | | | | | | | | | | | - Oľga Orosová
- Pavol Jozef Safarik University in Kosice, Slovakia
| | | | | | | | | | | | | | | | - Marco De Tubino Scanavino
- Western University, St. Joseph's Health Care London and London Health Sciences Centre, London, Canada
- Lawson Health Research Institute, London, Canada
- Universidade de São Paulo, Brazil
| | | | - Pratap Sharan
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sheikh Shoib
- Department of Health Services, Srinagar, India
- Sharda University, Greater Noida, India
- Psychosis Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | | | | | - Vesta Steibliene
- Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania
| | - Dan J Stein
- University of Cape Town, Rondebosch, South Africa
- South African Medical Research Council, South Africa
| | - Berk C Ünsal
- ELTE Eötvös Loránd University, Budapest, Hungary
| | - Marie-Pier Vaillancourt-Morel
- Centre de Recherche Interdisciplinaire sur les Problèmes Conjugaux et les Agressions Sexuelles (CRIPCAS), Canada
- Université du Québec à Trois-Rivières, Canada
| | | | - Beáta Bőthe
- Université de Montréal, Canada
- Centre de Recherche Interdisciplinaire sur les Problèmes Conjugaux et les Agressions Sexuelles (CRIPCAS), Canada
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Heriseanu AI, Spirou D, Moraes CEF, Hay P, Sichieri R, Appolinario JC. Grazing Is Associated with ADHD Symptoms, Substance Use, and Impulsivity in a Representative Sample of a Large Metropolitan Area in Brazil. Nutrients 2023; 15:2987. [PMID: 37447311 DOI: 10.3390/nu15132987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Grazing is a clinically relevant eating behaviour, especially when it presents with a sense of loss of control (compulsive grazing). There is evidence that other disordered eating patterns are associated with problematic substance use and impulsivity-related conditions, such as attention-deficit/hyperactivity disorder (ADHD). This overlap contributes to higher psychopathology and treatment complications. Less is known about grazing, and most information originates in high-income countries. Hence, we sought to investigate relationships between grazing, tobacco and alcohol use, ADHD, and impulsivity in a large representative sample from Brazil. Data were collected by trained interviewers from adults (N = 2297) through an in-person household survey based on a stratified and clustered probability sample. We found significant associations between compulsive grazing and problematic alcohol use (OR = 3.02, 95% CI: 1.65, 5.53), ADHD (OR = 8.94, 95% CI: 5.11, 15.63), and smoking (OR = 1.67, 95% CI: 1.12, 2.47), with impulsivity contributing to the first two relationships. The substantial association with ADHD suggests that other executive functions may promote disordered eating, possibly expressed through difficulties in adhering to regular meals. Clinically, these findings highlight the importance of assessing problematic eating patterns, such as compulsive grazing, in those presenting with difficulties with substance use or impulsivity, and vice versa.
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Affiliation(s)
- Andreea I Heriseanu
- eCentreClinic, School of Psychological Sciences, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Dean Spirou
- School of Medicine, Western Sydney University, Sydney, NSW 2214, Australia
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Carlos E F Moraes
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia
- Obesity and Eating Disorders Group, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Sydney, NSW 2214, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia
- Mental Health Service, South West Sydney Local Health District, Campbelltown, NSW 2560, Australia
| | - Rosely Sichieri
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Jose C Appolinario
- Obesity and Eating Disorders Group, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
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Fatori D, Fonseca Zuccolo P, Shephard E, Brentani H, Matijasevich A, Archanjo Ferraro A, Aparecida Fracolli L, Chiesa AM, Leckman J, Constantino Miguel E, V Polanczyk G. A randomized controlled trial testing the efficacy of a Nurse Home Visiting Program for Pregnant Adolescents. Sci Rep 2021; 11:14432. [PMID: 34257407 PMCID: PMC8277870 DOI: 10.1038/s41598-021-93938-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
To test the efficacy of a nurse home visiting program (HVP) on child development, maternal and environmental outcomes in the first years of life. We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse HVP for adolescent mothers living in a poor urban area of São Paulo, Brazil. Eighty adolescent mothers were included and randomized to receive either Primeiros Laços (intervention group, n = 40) or healthcare as usual (control group, n = 40). Primeiros Laços is a home visiting intervention delivered by trained nurses that starts during the first 16 weeks of pregnancy and continues to the child's age of 24 months. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and 3, 6, 12, and 24 months of child's age. We assessed oscillatory power in the mid-range alpha frequency via electroencephalography when the children were aged 6 months. Child development was measured by the Bayley Scales of Infant Development Third Edition (BSID-III). Weight and length were measured by trained professionals and anthropometric indexes were calculated. The home environment and maternal interaction with the child was measured by the Home Observation and Measurement of the Environment. Generalized estimating equation models were used to examine intervention effects on the trajectories of outcomes. Standardized effect sizes (Cohen's d) were calculated using marginal means from endpoint assessments of all outcomes. The trial was registered at clinicaltrial.gov: NCT02807818. Our analyses showed significant positive effects of the intervention on child expressive language development (coefficient = 0.89, 95% CI [0.18, 1.61], p = 0.014), maternal emotional/verbal responsivity (coefficient = 0.97, 95% CI [0.37, 1.58], p = 0.002), and opportunities for variety in daily stimulation (coefficient = 0.37, 95% CI [0.09, 0.66], p = 0.009). Standardized effect sizes of the intervention were small to moderate. Primeiros Laços is a promising intervention to promote child development and to improve the home environment of low-income adolescent mothers. However, considering the limitations of our study, future studies should be conducted to assess Primeiros Laços potential to benefit this population.Clinical Trial Registration: The study was registered at clinicaltrial.gov (Registration date: 21/06/2016 and Registration number: NCT02807818).
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Affiliation(s)
- Daniel Fatori
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, R Dr Ovídio Pires de Campos, 785, São Paulo, SP, CEP 05403-903, Brazil.
| | - Pedro Fonseca Zuccolo
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, R Dr Ovídio Pires de Campos, 785, São Paulo, SP, CEP 05403-903, Brazil
| | - Elizabeth Shephard
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, R Dr Ovídio Pires de Campos, 785, São Paulo, SP, CEP 05403-903, Brazil
| | - Helena Brentani
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, R Dr Ovídio Pires de Campos, 785, São Paulo, SP, CEP 05403-903, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alexandre Archanjo Ferraro
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Lislaine Aparecida Fracolli
- Departamento de Enfermagem Em Saúde Coletiva da Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Anna Maria Chiesa
- Departamento de Enfermagem Em Saúde Coletiva da Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
| | - James Leckman
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Euripedes Constantino Miguel
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, R Dr Ovídio Pires de Campos, 785, São Paulo, SP, CEP 05403-903, Brazil
| | - Guilherme V Polanczyk
- Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, R Dr Ovídio Pires de Campos, 785, São Paulo, SP, CEP 05403-903, Brazil.
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Zhang KA, Markon KE. Age and Gender Measurement Noninvariance of the Adult ADHD Self-Report Scale Screener. J Atten Disord 2021; 25:403-413. [PMID: 30449230 DOI: 10.1177/1087054718808059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The nature and form of demographics-related differences in ADHD self-reported symptoms across adulthood is currently poorly understood. This study explored the psychometrics of the Adult ADHD Self-Report Scale Screener (ASRS-6), including its age- and gender-related measurement invariance. Method: Structural equation models were used to analyze adult data-aged 16 to 95 years-from the 2007 British Adult Psychiatric Morbidity Survey. Results: The three-factor model (disorganization, inattention, hyperactivity) outperformed one- and two-factor models. Self-reported attentional deficits may be more pathognomonic of overall self-reported ADHD in adults than other symptoms. All items exhibited age measurement noninvariance while only a subset exhibited gender measurement noninvariance. Individuals who are male and younger tend to have lower thresholds for endorsement for ASRS-6 items than individuals who are female and older. Conclusion: The ASRS-6 does not appear to be unidimensional, and self-reported ASRS-6 symptomatology changes in meaning with age.
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Affiliation(s)
- K Anne Zhang
- The University of Iowa, Iowa City, USA.,Indiana University, Bloomington, USA
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Prevalence of attention-deficit/hyperactivity disorder in older adults: A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 118:282-289. [DOI: 10.1016/j.neubiorev.2020.07.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022]
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8
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da Silva FGS, e Vairo FP, de Souza CFM, Schwartz IVD. Attention-deficit hyperactivity disorder in Brazilian patients with phenylketonuria. Acta Neurol Belg 2020; 120:893-899. [PMID: 29981005 DOI: 10.1007/s13760-018-0972-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
Recent studies have shown that patients with phenylketonuria (PKU), even with the early diagnosis and continuous treatment, may have symptoms of attention-deficit hyperactivity disorder (ADHD) and that the prevalence of ADHD in this population would be higher than in the general population. This study aims to determine the prevalence of ADHD in a sample of PKU patients from Southern Brazil. Patients were prospectively assessed by clinical interviews, neurological examination, and application of the MTA-SNAP-IV scales for patients aged 5-17 years and the Adult Self-Report Scale for patients over 17 years. Thirty-one patients (mean age = 17.4; early diagnosis = 27) were followed. Patients with ADHD and younger than 17 years had a median Phe in the last 6 months of life higher than those without the diagnosis of ADHD (ADHD patients = 617.1 µmol/L, no-ADHD patients 393.2 µmol/L, and p = 0.03). There was a predominantly hyperactive/impulsivity clinical presentation of ADHD (n = 4/5 patients), which differs from that reported elsewhere in the literature. Future studies are essential to better define the clinical presentation of ADHD in these patients and further elucidate its pathophysiology.
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Temizsoy H, Özlü-Erkilic Z, Ohmann S, Sackl-Pammer P, Popow C, Akkaya-Kalayci T. Influence of Psychopharmacotherapy on the Quality of Life of Children with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2019; 29:419-425. [PMID: 30925091 DOI: 10.1089/cap.2018.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Attention-deficit/hyperactivity disorder (ADHD) may have a lasting effect on the quality of life (QoL) of children and their parents. Children with ADHD as well as their parents report a lower QoL compared with healthy children and children with chronic diseases such as bronchial asthma. The primary objective of this study was to investigate the changes of QoL of children with ADHD and their parents' subjective well-being before and after starting pharmacotherapy. We used the appropriate KINDL questionnaire for assessing the children's QoL and the World Health Organization (WHO) Big Five Questionnaire for assessing parental well-being. Methods: We assessed the QoL and the parental well-being in 60 children and adolescents with ADHD between the ages of 6 and 12 years [mean age 8.7 years, (standard deviation = 1.8)], treated at the Department of Child and Adolescent Psychiatry of the Medical University of Vienna. QoL was rated using the KINDL questionnaires, and parental well-being was assessed using the WHO Big Five Questionnaire (WHO-5) before and after starting pharmacotherapy. We used t-tests and three-way GLM-ANOVA (SPSS, version 22; IBM Corp.) for evaluating the statistical significance of pre-post differences. Results: The QoL of the children with ADHD and the subjective well-being of the parents improved significantly after introducing pharmacotherapy. Conclusions: Pharmacotherapy is recommended in children with clinically significant ADHD not only because it helps to improve the symptoms of ADHD, but also their QoL and the well-being of their parents.
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Affiliation(s)
- Hanife Temizsoy
- 1Outpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,2Department of Orthopaedic Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| | - Zeliha Özlü-Erkilic
- 1Outpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Susanne Ohmann
- 3Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Petra Sackl-Pammer
- 3Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Christian Popow
- 3Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Türkan Akkaya-Kalayci
- 1Outpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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10
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Cotton J, Baker ST. A data mining and item response mixture modeling method to retrospectively measure Diagnostic and Statistical Manual of Mental Disorders-5 attention deficit hyperactivity disorder in the 1970 British Cohort Study. Int J Methods Psychiatr Res 2019; 28:e1753. [PMID: 30402897 PMCID: PMC6877163 DOI: 10.1002/mpr.1753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 09/21/2018] [Accepted: 10/06/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To facilitate future outcome studies, we aimed to develop a robust and replicable method for estimating a categorical and dimensional measure of Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) attention deficit hyperactivity disorder (ADHD) in the 1970 British Cohort Study (BCS70). METHOD Following a data mining framework, we mapped DSM-5 ADHD symptoms to age 10 BCS70 data (N = 11,426) and derived a 16-item scale (α = 0.85). Mapping was validated by an expert panel. A categorical subgroup was derived (n = 594, 5.2%), and a zero-inflated item response theory (IRT) mixture model fitted to estimate a dimensional measure. RESULTS Subgroup composition was comparable with other ADHD samples. Relative risk ratios (ADHD/not ADHD) included boys = 1.38, unemployed fathers = 2.07, below average reading = 2.58, and depressed parent = 3.73. Our estimated measures correlated with two derived reference scales: Strengths and Difficulties Questionnaire hyperactivity (r = 0.74) and a Rutter/Conners-based scale (r = 0.81), supporting construct validity. IRT model items (symptoms) had moderate to high discrimination (0.90-2.81) and provided maximum information at average to moderate theta levels of ADHD (0.5-1.75). CONCLUSION We extended previous work to identify ADHD in BCS70, derived scales from existing data, modeled ADHD items with IRT, and adjusted for a zero-inflated distribution. Psychometric properties were promising, and this work will enable future studies of causal mechanisms in ADHD.
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Affiliation(s)
- Joanne Cotton
- Faculty of EducationUniversity of CambridgeCambridgeUK
| | - Sara T. Baker
- Faculty of EducationUniversity of CambridgeCambridgeUK
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Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry 2018; 56:14-34. [DOI: 10.1016/j.eurpsy.2018.11.001] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/02/2018] [Accepted: 11/03/2018] [Indexed: 12/17/2022] Open
Abstract
AbstractBackground Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.
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Vogel SWN, Ten Have M, Bijlenga D, de Graaf R, Beekman ATF, Kooij JJS. Distribution of ADHD symptoms, and associated comorbidity, exposure to risk factors and disability: Results from a general population study. Psychiatry Res 2018; 267:256-265. [PMID: 29940457 DOI: 10.1016/j.psychres.2018.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 05/25/2018] [Accepted: 06/07/2018] [Indexed: 12/28/2022]
Abstract
The aim of this study was to examine whether ADHD is a dimensional trait in the adult general population. We studied whether an increased number of ADHD symptoms was associated with higher comorbidity, exposure to risk factors (childhood abuse and parental psychopathology), and disability. We ascertained whether even low numbers of ADHD symptoms were associated with an increased burden of disease. Data were used from the second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2, N = 5303). NEMESIS-2 is a nationally representative face-to-face survey on mental health of the Dutch general population. ADHD symptoms, mental comorbidity, and disability were assessed using the Adult ADHD Self-Report Scale Screener, the Composite International Diagnostic Interview version 3.0, and the Medical Outcomes Study Short Form Health Survey, respectively. Dose-response relationships were found between the number of ADHD symptoms and Axis I and II mental disorders; exposure to risk factors; and mental and physical disability. Our study supports the notion that ADHD is a dimensional trait in the adult general population. Even low numbers of symptoms were associated with an increased burden of disease, and therefore these should be identified and treated.
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Affiliation(s)
- Suzan W N Vogel
- PsyQ Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, The Hague 2593 HR, The Netherlands.
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Da Costakade 45, Utrecht 3521 VS, The Netherlands
| | - Denise Bijlenga
- PsyQ Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, The Hague 2593 HR, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Da Costakade 45, Utrecht 3521 VS, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, A.J. Ernststraat 1187, Amsterdam 1081 HL, The Netherlands
| | - J J Sandra Kooij
- PsyQ Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, The Hague 2593 HR, The Netherlands; Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, A.J. Ernststraat 1187, Amsterdam 1081 HL, The Netherlands
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Arias VB, Esnaola I, Rodríguez-Medina J. Identifying potentially marker symptoms of attention-deficit/hyperactivity disorder. PeerJ 2018; 6:e4820. [PMID: 29844973 PMCID: PMC5969048 DOI: 10.7717/peerj.4820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/02/2018] [Indexed: 11/20/2022] Open
Abstract
Background For the diagnosis of attention-deficit/hyperactivity disorder (ADHD), the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) proposes that adherence to six symptoms in either group (inattention and hyperactivity/impulsivity) will lead to the diagnosis of one of three presentations of the disorder. Underlying this diagnostic algorithm is the assumption that the 18 symptoms have equal relevance for the diagnosis of ADHD, all are equally severe, and all have the same power to detect the presence of the disorder in all its degrees of severity, without considering the possibility of using marker symptoms. However, several studies have suggested that ADHD symptoms differ in both their power to discriminate the presence of the disorder and the degree of severity they represent. The aim of the present study was to replicate the results of previous research by evaluating the discriminative capacity and relative severity of ADHD symptoms, as well as to extend the investigation of this topic to Spanish-speaking Latin American samples. Methods The properties of ADHD symptoms rated by the parents of 474 Chilean children were analyzed. Symptom parameters were estimated using the graded response model. Results The results suggest that symptoms of ADHD differ substantially in both the accuracy with which they reflect the presence of the disorder, and their relative severity. Symptoms “easily distracted by extraneous stimuli” and “have difficulty sustaining attention in tasks” (inattention) and “is on the go, acting as if driven by motor” (hyperactivity/impulsivity) were the most informative, and those with relatively lower severity thresholds. Discussion The fact that symptoms differ substantially in the probability of being observed conditionally to the trait level suggests the need to refine the diagnostic process by weighting the severity of the symptom, and even to assess the possibility of defining ADHD marker symptoms, as has been done in other disorders.
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Affiliation(s)
- Víctor B Arias
- Department of Personality, Assessment and Psychological Treatment, University of Salamanca, Salamanca, Spain.,Institute on Community Integration (INICO), University of Salamanca, Spain
| | - Igor Esnaola
- Department of Developmental and Educational Psychology, University of the Basque Country, San Sebastian, Basque Country, Spain
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14
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Takeda T, Tsuji Y, Kurita H. Psychometric properties of the Japanese version of the Adult Attention-deficit hyperactivity disorder (ADHD) Self-Report Scale (ASRS-J) and its short scale in accordance with DSM-5 diagnostic criteria. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 63:59-66. [PMID: 28260624 DOI: 10.1016/j.ridd.2017.02.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 06/06/2023]
Abstract
We developed the Japanese version of the Adult ADHD Self-Report Scale (ASRS-J) and report its psychometric properties. The ASRS-J and other questionnaires were administered to 48 adults with ADHD, 46 adults with non-ADHD psychiatric disorders, 96 non-clinical adults, and 894 university students. ADHD diagnoses were made using the Japanese semi-structured diagnostic interview for adult ADHD, which is compatible with the DSM-5. The ASRS-J, its subscales, and the short form, all had Cronbach's α values of around 0.80. Total scores on the ASRS-J and the ASRS-J-6 were highly correlated with readministration after a two-week interval. The total and 18 individual item scores in the ASRS-J were significantly higher in the ADHD group than the other three groups. ASRS-J scores were correlated with scores on the Japanese version of Conners' Adult ADHD Rating Scales-Self Report subscales (0.59≤r≤0.77), with one exception. ASRS-J scores were also correlated (albeit more weakly; r=0.38) with Beck Depression Inventory-II total scores. Employing optimal cut-offs, sensitivity, specificity, and positive and negative predictive values of the ASRS-J and ASRS-J-6 are all above 0.69. The ASRS-J and ASRS-J-6 showed acceptable psychometric properties, although further study is necessary.
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Affiliation(s)
- Toshinobu Takeda
- Department of Clinical Psychology, Ryukoku University, Kyoto, Japan.
| | - Yui Tsuji
- Graduate School of Psychological Science, Health Sciences University of Hokkaido, Sapporo, Japan
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15
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Fayyad J, Sampson NA, Hwang I, Adamowski T, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LHSG, Borges G, de Girolamo G, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Lee S, Navarro-Mateu F, O'Neill S, Pennell BE, Piazza M, Posada-Villa J, Ten Have M, Torres Y, Xavier M, Zaslavsky AM, Kessler RC. The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys. ACTA ACUST UNITED AC 2016; 9:47-65. [PMID: 27866355 DOI: 10.1007/s12402-016-0208-3] [Citation(s) in RCA: 410] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
Abstract
We previously reported on the cross-national epidemiology of ADHD from the first 10 countries in the WHO World Mental Health (WMH) Surveys. The current report expands those previous findings to the 20 nationally or regionally representative WMH surveys that have now collected data on adult ADHD. The Composite International Diagnostic Interview (CIDI) was administered to 26,744 respondents in these surveys in high-, upper-middle-, and low-/lower-middle-income countries (68.5% mean response rate). Current DSM-IV/CIDI adult ADHD prevalence averaged 2.8% across surveys and was higher in high (3.6%)- and upper-middle (3.0%)- than low-/lower-middle (1.4%)-income countries. Conditional prevalence of current ADHD averaged 57.0% among childhood cases and 41.1% among childhood subthreshold cases. Adult ADHD was significantly related to being male, previously married, and low education. Adult ADHD was highly comorbid with DSM-IV/CIDI anxiety, mood, behavior, and substance disorders and significantly associated with role impairments (days out of role, impaired cognition, and social interactions) when controlling for comorbidities. Treatment seeking was low in all countries and targeted largely to comorbid conditions rather than to ADHD. These results show that adult ADHD is prevalent, seriously impairing, and highly comorbid but vastly under-recognized and undertreated across countries and cultures.
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Affiliation(s)
- John Fayyad
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Tomasz Adamowski
- Department of Nervous System Diseases, Faculty of Health Science, Medical University of Wroclaw, Wroclaw, Poland
| | | | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq
| | - Laura H S G Andrade
- Section of Psychiatric Epidemiology-LIM 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Guilherme Borges
- Instituto Nacional de Psiquiatria Ramon de la Fuente Muñiz, Mexico, DF, Mexico
| | - Giovanni de Girolamo
- IRCCS St John of God Clinical Research Centre/IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Chiyi Hu
- Shenzhen Institute of Mental Health, Shenzhen, China.,Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.,Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon.,Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Fernando Navarro-Mateu
- IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain
| | | | - Beth-Ellen Pennell
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Marina Piazza
- National Institute of Health, Lima, Peru.,Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Margreet Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Miguel Xavier
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Hierarchy and Psychometric Properties of ADHD Symptoms in Spanish Children: An Application of the Graded Response Model. PLoS One 2016; 11:e0164474. [PMID: 27736911 PMCID: PMC5063325 DOI: 10.1371/journal.pone.0164474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/26/2016] [Indexed: 11/19/2022] Open
Abstract
The Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria assume that the 18 symptoms carry the same weight in an Attention Deficit with Hyperactivity Disorder (ADHD) diagnosis and bear the same discriminatory capacity. However, it is reasonable to think that symptoms may differ in terms of severity and even in the reliability with they represent the disorder. To test this hypothesis, the aim of this study was to calibrate in a sample of Spanish children (age 4–7; n = 784) a scale for assessing the symptoms of ADHD proposed by Diagnostic and Statistical Manual of Mental Disorders, IV-TR within the framework of Item Response Theory. Samejima’s Graded Response Model was used as a method for estimating the item difficulty and discrimination parameters. The results showed that ADHD subscales (Attention Deficit and Hyperactivity / Impulsivity) had good psychometric properties and had also a good fit to the model. However, relevant differences between symptoms were observed at the level of severity, informativeness and reliability for the assessment of ADHD. This finding suggests that it would be useful to identify the symptoms that are more important than the others with regard to diagnosing ADHD.
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Groß-Lesch S, Dempfle A, Reichert S, Jans T, Geissler J, Kittel-Schneider S, Nguyen TT, Reif A, Lesch KP, Jacob CP. Sex- and Subtype-Related Differences in the Comorbidity of Adult ADHDs. J Atten Disord 2016; 20:855-66. [PMID: 24196345 DOI: 10.1177/1087054713510353] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Comorbidity in adult ADHD (aADHD) has been investigated in a large number of studies using varying research approaches with divergent results. In contrast, there is limited information about sex- or subtype-related differences from studies with small sample size. METHOD A large sample of 910 individuals (458 males, 452 females) affected with aADHD was recruited at a tertiary referral center. All probands underwent a four-step procedure for diagnosing aADHD, including the Structured Clinical Interview of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Axis I disorders to assess comorbidity. This study will provide additional information regarding the co-morbidity of Axis I disorders in the currently largest clinical referral sample. However, the main objective of this study is to gain information about sex- or subtype-related differences. RESULTS Affected females show higher rates of mood (61% vs. 49%), anxiety (32% vs. 22%), and eating disorders (16% vs. 1%) than affected males, while substance use disorders were more frequent in affected males (45% vs. 29%), which mirrors sex differences in prevalence in the general population. There were hardly any relevant differences in comorbidities between subtypes, with the exception of the inattentive subtype having an especially low prevalence of panic disorder. Comorbidity in general and substance use disorders in particular, but not sex or subtype, were highly predictive of lower psychosocial status. CONCLUSION Sex-related differences in the comorbidity of aADHD are more pronounced than subtype-related differences.
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Minahim D, Rohde LA. Attention deficit hyperactivity disorder and intellectual giftedness: a study of symptom frequency and minor physical anomalies. BRAZILIAN JOURNAL OF PSYCHIATRY 2016; 37:289-95. [PMID: 26692428 DOI: 10.1590/1516-4446-2014-1489] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 12/30/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the presence of symptoms of attention deficit and hyperactivity disorder (ADHD) in intellectually gifted adults and children. METHODS Two cross-sectional studies were performed in children and adults whose intelligence quotient (IQ) had been previously evaluated using Raven's Progressive Matrices (RPM) test. Seventy-seven adults displaying IQ scores above the 98th percentile were assessed using the Adult Self-Report Scale (ASRS-18) for signs of ADHD and a modified Waldrop scale for minor physical anomalies (MPAs). Thirty-nine children (grades 1-5) exhibiting IQ scores above the 99th percentile, as well as an equally matched control group, were assessed for ADHD by teachers using the Swanson, Nolan and Pelham IV Rating Scale (SNAP-IV) as used in the NIMH Collaborative Multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA-SNAP-IV). RESULTS In gifted adults, the frequency of ADHD-positive cases was 37.8%, and the total MPA score was significantly associated with ADHD (p < 0.001). In children, the ADHD-positive case frequency was 15.38% in the gifted group and 7.69% in the control group (odds ratio [OR] = 2.18, p = 0.288). CONCLUSIONS The high frequency of ADHD symptoms observed, both in gifted adults and in gifted (and non-gifted) children, further supports the validity of this diagnosis in this population. Furthermore, the significant association between MPAs and ADHD suggests that a neurodevelopmental condition underlies these symptoms.
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Affiliation(s)
- Daniel Minahim
- Graduate Program in Psychiatry, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luis A Rohde
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Maciel ROH, Ferreira GA, Akemy B, Cardoso F. Executive dysfunction, obsessive-compulsive symptoms, and attention deficit and hyperactivity disorder in Systemic Lupus Erythematosus: Evidence for basal ganglia dysfunction? J Neurol Sci 2015; 360:94-7. [PMID: 26723981 DOI: 10.1016/j.jns.2015.11.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/20/2015] [Accepted: 11/26/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Chorea is well described in a group of patients with Systemic Lupus Erythematosus (SLE). There is less information, however, on other movement disorders as well as non-motor neuropsychiatric features such as obsessive-compulsive symptoms (OCS), executive dysfunction and attention deficit and hyperactivity disorder (ADHD) in subjects with SLE. METHODS Fifty-four subjects with SLE underwent a battery of neuropsychiatric tests that included the Mini Mental State Examination, the Montreal Cognitive Assessment, the Frontal Assessment Battery (FAB), the FAS verbal and the categorical (animals) semantic fluency tests, the Obsessive and Compulsive Inventory - Revised, the Yale-Brown Obsessive and Compulsive Scale and Beck's Anxiety and Depression Scales. ADHD was diagnosed according to DSM-IV criteria. SLE disease activity and cumulative damage were evaluated according to the modified SLE Disease Activity Index 2000 (mSLEDAI-2K) and the SLICC/ACR, respectively. RESULTS Six (11.1%) and 33 (61.1%) patients had cognitive impairment according to the MMSE and MoCA, respectively. Eleven (20.4%) had abnormal FAB scores, and 5 (9.3%) had lower semantic fluency scores than expected. The overall frequency of cognitive dysfunction was 72.2% (39 patients) and of neuropsychiatric SLE was 77.8% (42 patients). Two patients (3.7%) had movement disorders. Fifteen (27.8%) had OCS and 17 (31.5%) met diagnostic criteria for ADHD. ADHD and OCS correlated with higher disease activity, p=0.003 and 0.006, respectively. Higher cumulative damage correlated with lower FAB scores (p 0.026). CONCLUSIONS Executive dysfunction, ADHD, OCS, and movement disorders are common in SLE. Our finding suggests that there is frequent basal ganglia dysfunction in SLE.
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Affiliation(s)
| | - Gilda Aparecida Ferreira
- Rheumatology Clinic, Department of Locomotor System, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bárbara Akemy
- Rheumatology Clinic, Department of Locomotor System, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Francisco Cardoso
- Movement Disorders Clinic, Department of Neurology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Storebø OJ, Ramstad E, Krogh HB, Nilausen TD, Skoog M, Holmskov M, Rosendal S, Groth C, Magnusson FL, Moreira‐Maia CR, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Forsbøl B, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2015; 2015:CD009885. [PMID: 26599576 PMCID: PMC8763351 DOI: 10.1002/14651858.cd009885.pub2] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children with ADHD find it difficult to pay attention, they are hyperactive and impulsive.Methylphenidate is the drug most often prescribed to treat children and adolescents with ADHD but, despite its widespread use, this is the first comprehensive systematic review of its benefits and harms. OBJECTIVES To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. SEARCH METHODS In February 2015 we searched six databases (CENTRAL, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, Conference Proceedings Citations Index), and two trials registers. We checked for additional trials in the reference lists of relevant reviews and included trials. We contacted the pharmaceutical companies that manufacture methylphenidate to request published and unpublished data. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. At least 75% of participants needed to have an intellectual quotient of at least 70 (i.e. normal intellectual functioning). Outcomes assessed included ADHD symptoms, serious adverse events, non-serious adverse events, general behaviour and quality of life. DATA COLLECTION AND ANALYSIS Seventeen review authors participated in data extraction and risk of bias assessment, and two review authors independently performed all tasks. We used standard methodological procedures expected within Cochrane. Data from parallel-group trials and first period data from cross-over trials formed the basis of our primary analyses; separate analyses were undertaken using post-cross-over data from cross-over trials. We used Trial Sequential Analyses to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach for high risk of bias, imprecision, indirectness, heterogeneity and publication bias. MAIN RESULTS The studies.We included 38 parallel-group trials (5111 participants randomised) and 147 cross-over trials (7134 participants randomised). Participants included individuals of both sexes, at a boys-to-girls ratio of 5:1, and participants' ages ranged from 3 to 18 years across most studies (in two studies ages ranged from 3 to 21 years). The average age across all studies was 9.7 years. Most participants were from high-income countries.The duration of methylphenidate treatment ranged from 1 to 425 days, with an average duration of 75 days. Methylphenidate was compared to placebo (175 trials) or no intervention (10 trials). Risk of Bias.All 185 trials were assessed to be at high risk of bias. Primary outcomes. Methylphenidate may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.77, 95% confidence interval (CI) -0.90 to -0.64; 19 trials, 1698 participants; very low-quality evidence). This corresponds to a mean difference (MD) of -9.6 points (95% CI -13.75 to -6.38) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points; DuPaul 1991a). A change of 6.6 points on the ADHD-RS is considered clinically to represent the minimal relevant difference. There was no evidence that methylphenidate was associated with an increase in serious (e.g. life threatening) adverse events (risk ratio (RR) 0.98, 95% CI 0.44 to 2.22; 9 trials, 1532 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 0.91 (CI 0.02 to 33.2). SECONDARY OUTCOMES Among those prescribed methylphenidate, 526 per 1000 (range 448 to 615) experienced non-serious adverse events, compared with 408 per 1000 in the control group. This equates to a 29% increase in the overall risk of any non-serious adverse events (RR 1.29, 95% CI 1.10 to 1.51; 21 trials, 3132 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 1.29 (CI 1.06 to 1.56). The most common non-serious adverse events were sleep problems and decreased appetite. Children in the methylphenidate group were at 60% greater risk for trouble sleeping/sleep problems (RR 1.60, 95% CI 1.15 to 2.23; 13 trials, 2416 participants), and 266% greater risk for decreased appetite (RR 3.66, 95% CI 2.56 to 5.23; 16 trials, 2962 participants) than children in the control group.Teacher-rated general behaviour seemed to improve with methylphenidate (SMD -0.87, 95% CI -1.04 to -0.71; 5 trials, 668 participants; very low-quality evidence).A change of seven points on the Child Health Questionnaire (CHQ; range 0 to 100 points; Landgraf 1998) has been deemed a minimal clinically relevant difference. The change reported in a meta-analysis of three trials corresponds to a MD of 8.0 points (95% CI 5.49 to 10.46) on the CHQ, which suggests that methylphenidate may improve parent-reported quality of life (SMD 0.61, 95% CI 0.42 to 0.80; 3 trials, 514 participants; very low-quality evidence). AUTHORS' CONCLUSIONS The results of meta-analyses suggest that methylphenidate may improve teacher-reported ADHD symptoms, teacher-reported general behaviour, and parent-reported quality of life among children and adolescents diagnosed with ADHD. However, the low quality of the underpinning evidence means that we cannot be certain of the magnitude of the effects. Within the short follow-up periods typical of the included trials, there is some evidence that methylphenidate is associated with increased risk of non-serious adverse events, such as sleep problems and decreased appetite, but no evidence that it increases risk of serious adverse events.Better designed trials are needed to assess the benefits of methylphenidate. Given the frequency of non-serious adverse events associated with methylphenidate, the particular difficulties for blinding of participants and outcome assessors point to the advantage of large, 'nocebo tablet' controlled trials. These use a placebo-like substance that causes adverse events in the control arm that are comparable to those associated with methylphenidate. However, for ethical reasons, such trials should first be conducted with adults, who can give their informed consent.Future trials should publish depersonalised individual participant data and report all outcomes, including adverse events. This will enable researchers conducting systematic reviews to assess differences between intervention effects according to age, sex, comorbidity, type of ADHD and dose. Finally, the findings highlight the urgent need for large RCTs of non-pharmacological treatments.
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Affiliation(s)
- Ole Jakob Storebø
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- University of Southern DenmarkDepartment of Psychology, Faculty of Health ScienceCampusvej 55OdenseDenmark5230
| | - Erica Ramstad
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Helle B. Krogh
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | | | | | | | - Susanne Rosendal
- Psychiatric Centre North ZealandThe Capital Region of DenmarkDenmark
| | - Camilla Groth
- Herlev University HospitalPediatric DepartmentCapital RegionHerlevDenmark
| | | | - Carlos R Moreira‐Maia
- Federal University of Rio Grande do SulDepartment of PsychiatryRua Ramiro Barcelos, 2350‐2201APorto AlegreRSBrazil90035‐003
| | - Donna Gillies
- Western Sydney Local Health District ‐ Mental HealthCumberland HospitalLocked Bag 7118ParramattaNSWAustralia2124
| | | | - Dorothy Gauci
- Department of HealthDirectorate for Health Information and Research95 G'Mangia HillG'MangiaMaltaPTA 1313
| | - Morris Zwi
- Whittington HealthIslington Child and Adolescent Mental Health Service580 Holloway RoadLondonLondonUKN7 6LB
| | - Richard Kirubakaran
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Center for Evidence‐Informed Health Care and Health PolicyCarman Block II FloorCMC Campus, BagayamVelloreTamil NaduIndia632002
| | - Bente Forsbøl
- Psychiatric Department, Region ZealandChild and Adolescent Psychiatric ClinicHolbaekDenmark
| | - Erik Simonsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- Copenhagen UniversityInstitute of Clinical Medicine, Faculty of Health and Medical SciencesCopenhagenDenmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
- Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchCopenhagenDenmark
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21
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Garcia Rosales A, Vitoratou S, Banaschewski T, Asherson P, Buitelaar J, Oades RD, Rothenberger A, Steinhausen HC, Faraone SV, Chen W. Are all the 18 DSM-IV and DSM-5 criteria equally useful for diagnosing ADHD and predicting comorbid conduct problems? Eur Child Adolesc Psychiatry 2015; 24:1325-37. [PMID: 25743746 DOI: 10.1007/s00787-015-0683-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 01/21/2015] [Indexed: 11/26/2022]
Abstract
In view of ICD-11 revision, we evaluate whether the 18 DSM-IV diagnostic items retained by DSM-5 could be further improved (i) in predicting ADHD 'caseness' and 'impairment' and (ii) discriminating ADHD without CD (ADHD - CD) cases from ADHD with CD (ADHD + CD) cases. In a multi-centre study sample consisting of 1497 ADHD probands and 291 unaffected subjects, 18 diagnostic items were examined for redundancy; then each item was evaluated for association with caseness, impairment and CD status using Classical Test Theory, Item-Response Theory and logistic regression methods. First, all 18 DSM-IV items contributed significantly and independently to the clinical diagnosis of ADHD. Second, not all the DSM-IV items carried equal weighting. "Often loses things", "forgetfulness" and "difficulty sustaining attention" mark severity for Inattentiveness (IA) items and "often unduly noisy", "exhibits a persistent pattern of restlessness", "leaves seat in class" and "often blurts out answers" for Hyperactivity/Impulsivity (HI) items. "Easily distracted", "inattentive to careless mistakes", "often interrupts" and "often fidgets" are associated with milder presentations. In the IA domain, "distracted" yields most information in the low-severity range of the latent trait, "careless" in the mid-severity range and "loses" in the high-severity range. In the HI domains, "interrupts" yields most information in the low-severity range and "motor" in the high-severity range. Third, all 18 items predicted impairment. Fourth, specific ADHD items are associated with ADHD + CD status. The DSM-IV diagnostic items were valid and not redundant; however, some carried more weight than others. All items were associated with impairment.
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Affiliation(s)
- Alexandra Garcia Rosales
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.
- Barnet, Enfield and Haringey Mental Health Trust, London, UK.
| | - Silia Vitoratou
- Department of Biostatistics, Institute of Psychiatry, King's College London, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Child and Adolescent Psychiatry, University of Göttingen, Göttingen, Germany
| | - Philip Asherson
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert D Oades
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry, University of Göttingen, Göttingen, Germany
| | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
- Research Unit of Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
- Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Wai Chen
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
- Division of Clinical Neuroscience, School of Medicine, University of Southampton, Southampton, UK
- Complex ADHD Service (CAHDS), Department of Health, Perth, WA, Australia
- Department of Child and Adolescent Psychiatry, School of Paediatrics and Child Health and School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, WA, 6840, Australia
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22
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Young JT, Carruthers S, Kaye S, Allsop S, Gilsenan J, Degenhardt L, van de Glind G, van den Brink W, Preen D. Comorbid attention deficit hyperactivity disorder and substance use disorder complexity and chronicity in treatment-seeking adults. Drug Alcohol Rev 2015; 34:683-93. [PMID: 25790353 DOI: 10.1111/dar.12249] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 01/08/2015] [Indexed: 01/29/2023]
Abstract
INTRODUCTION AND AIMS Attention deficit hyperactivity disorder (ADHD) is a known risk factor for substance use disorder (SUD); however, the potential additive contribution of comorbid ADHD to drug-specific dependence in SUD populations is largely unknown. The current study aimed to assess this association between ADHD symptoms and drug-specific SUD complexity and chronicity. DESIGN AND METHODS A cross-sectional survey was administered to a convenience sample of 489 adults receiving SUD treatment at 16 Australian drug and alcohol treatment centres between September 2010 and August 2011. Participants were screened for adult ADHD symptoms using the Adult ADHD Self-Report Scale. Associations between ADHD screening status and drug-specific SUD complexity and chronicity were assessed using multivariate logistic and modified Poisson regression analysis, controlling for a range of potential confounders. RESULTS Overall, 215 (44%) patients screened positive for concurrent adult ADHD and SUD. After Simes' correction, a significant positive association was observed between ADHD screening status and current amphetamine SUD (odds ratio (OR) = 1.85; 95% confidence interval (CI): 1.19-2.36). Patients who screened positive for ADHD were significantly more likely to report SUD history for heavy alcohol use (OR = 2.05; 95% CI: 1.21-3.45) and amphetamine (OR = 1.96; 95% CI: 1.26-3.06) as well as significantly increased risk of moderate (3-4 years) duration for benzodiazepine and amphetamine SUDs and long (≥5 years) duration for alcohol, opiates other than heroin or methadone, and amphetamine SUDs. DISCUSSION AND CONCLUSIONS The findings provide evidence that there is increased drug dependence complexity and chronicity in treatment-seeking SUD patients who screen positively for ADHD, specifically for amphetamine, alcohol, opiates other than heroin or methadone, and benzodiazepines.
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Affiliation(s)
- Jesse Tyler Young
- National Drug Research Institute, Curtin University, Perth, Australia.,Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Parkville, Parkville, Australia
| | - Susan Carruthers
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Steve Allsop
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Joanne Gilsenan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Parkville, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Geurt van de Glind
- Trimbos-Instituut, ICASA Foundation, Utrecht, The Netherlands.,Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim van den Brink
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - David Preen
- Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Australia
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23
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Chaim TM, Zhang T, Zanetti MV, da Silva MA, Louzã MR, Doshi J, Serpa MH, Duran FLS, Caetano SC, Davatzikos C, Busatto GF. Multimodal magnetic resonance imaging study of treatment-naïve adults with attention-deficit/hyperactivity disorder. PLoS One 2014; 9:e110199. [PMID: 25310815 PMCID: PMC4195718 DOI: 10.1371/journal.pone.0110199] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/18/2014] [Indexed: 01/08/2023] Open
Abstract
Background Attention-Deficit/Hiperactivity Disorder (ADHD) is a prevalent disorder, but its neuroanatomical circuitry is still relatively understudied, especially in the adult population. The few morphometric magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) studies available to date have found heterogeneous results. This may be at least partly attributable to some well-known technical limitations of the conventional voxel-based methods usually employed to analyze such neuroimaging data. Moreover, there is a great paucity of imaging studies of adult ADHD to date that have excluded patients with history of use of stimulant medication. Methods A newly validated method named optimally-discriminative voxel-based analysis (ODVBA) was applied to multimodal (structural and DTI) MRI data acquired from 22 treatment-naïve ADHD adults and 19 age- and gender-matched healthy controls (HC). Results Regarding DTI data, we found higher fractional anisotropy in ADHD relative to HC encompassing the white matter (WM) of the bilateral superior frontal gyrus, right middle frontal left gyrus, left postcentral gyrus, bilateral cingulate gyrus, bilateral middle temporal gyrus and right superior temporal gyrus; reductions in trace (a measure of diffusivity) in ADHD relative to HC were also found in fronto-striatal-parieto-occipital circuits, including the right superior frontal gyrus and bilateral middle frontal gyrus, right precentral gyrus, left middle occipital gyrus and bilateral cingulate gyrus, as well as the left body and right splenium of the corpus callosum, right superior corona radiata, and right superior longitudinal and fronto-occipital fasciculi. Volumetric abnormalities in ADHD subjects were found only at a trend level of significance, including reduced gray matter (GM) in the right angular gyrus, and increased GM in the right supplementary motor area and superior frontal gyrus. Conclusions Our results suggest that adult ADHD is associated with neuroanatomical abnormalities mainly affecting the WM microstructure in fronto-parieto-temporal circuits that have been implicated in cognitive, emotional and visuomotor processes.
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Affiliation(s)
- Tiffany M. Chaim
- Laboratory of Psychiatric Neuroimaging, Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo, Sao Paulo, Brazil
- Center for Interdisciplinary Research on Applied Neurosciences, University of São Paulo, Sao Paulo, São Paulo, Brazil
- Program for Attention Deficit Hyperactivity Disorder, Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo, Sao Paulo, Brazil
- * E-mail:
| | - Tianhao Zhang
- Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, Unites States of America
| | - Marcus V. Zanetti
- Laboratory of Psychiatric Neuroimaging, Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo, Sao Paulo, Brazil
- Center for Interdisciplinary Research on Applied Neurosciences, University of São Paulo, Sao Paulo, São Paulo, Brazil
| | - Maria Aparecida da Silva
- Program for Attention Deficit Hyperactivity Disorder, Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Mário R. Louzã
- Program for Attention Deficit Hyperactivity Disorder, Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Jimit Doshi
- Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, Unites States of America
| | - Mauricio H. Serpa
- Laboratory of Psychiatric Neuroimaging, Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo, Sao Paulo, Brazil
- Center for Interdisciplinary Research on Applied Neurosciences, University of São Paulo, Sao Paulo, São Paulo, Brazil
| | - Fabio L. S. Duran
- Laboratory of Psychiatric Neuroimaging, Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo, Sao Paulo, Brazil
- Center for Interdisciplinary Research on Applied Neurosciences, University of São Paulo, Sao Paulo, São Paulo, Brazil
| | - Sheila C. Caetano
- Laboratory of Psychiatric Neuroimaging, Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo, Sao Paulo, Brazil
- Center for Interdisciplinary Research on Applied Neurosciences, University of São Paulo, Sao Paulo, São Paulo, Brazil
| | - Christos Davatzikos
- Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, Unites States of America
| | - Geraldo F. Busatto
- Laboratory of Psychiatric Neuroimaging, Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo, Sao Paulo, Brazil
- Center for Interdisciplinary Research on Applied Neurosciences, University of São Paulo, Sao Paulo, São Paulo, Brazil
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24
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Conrad P, Bergey MR. The impending globalization of ADHD: notes on the expansion and growth of a medicalized disorder. Soc Sci Med 2014; 122:31-43. [PMID: 25441315 DOI: 10.1016/j.socscimed.2014.10.019] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 10/06/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) has been medicalized in the United States since the 1960s. Primarily used in North America until the 1990s, ADHD diagnosis and treatment have increasingly been applied internationally. After documenting the expansion of ADHD in a global context, this paper presents five brief international examples examining ADHD usage and expansion: the United Kingdom, Germany, France, Italy and Brazil. We then identify and describe several vehicles that facilitate the migration of the ADHD diagnosis: the transnational pharmaceutical industry; the influence of western psychiatry; moving from ICD to DSM diagnostic criteria; the role of the Internet including the related advent of easily accessible online screening checklists; and advocacy groups. Finally, we discuss what this globalization of a diagnosis reflects about the potential global medicalization of other conditions.
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Affiliation(s)
- Peter Conrad
- Department of Sociology, MS-71, Brandeis University, Waltham, MA 02454-9110, USA.
| | - Meredith R Bergey
- Department of Sociology, MS-71, Brandeis University, Waltham, MA 02454-9110, USA.
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25
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Asherson P, Bushe C, Saylor K, Tanaka Y, Deberdt W, Upadhyaya H. Efficacy of atomoxetine in adults with attention deficit hyperactivity disorder: an integrated analysis of the complete database of multicenter placebo-controlled trials. J Psychopharmacol 2014; 28:837-46. [PMID: 25035246 PMCID: PMC4230847 DOI: 10.1177/0269881114542453] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Persistence of attention deficit hyperactivity disorder (ADHD) into adulthood can be disabling or lead to substantial impairment. Several clinical trials of atomoxetine (ATX) in adults with ADHD have been reported following the National Institute for Health and Clinical Excellence (NICE) guidelines issued in 2008. We performed an integrated analysis of all Eli Lilly-sponsored, randomized, double-blind, placebo-controlled studies of ATX in adults with ADHD completed as of May 2012. Individual patient data were pooled from six short-term (10-16 week) studies (1961 patients) and three longer-term (six-month) studies (1413 patients). In the short-term analysis, ATX patients achieved a significantly greater mean reduction in ADHD symptoms than placebo patients (-12.2 vs -8.1; Conners' Adult ADHD Rating Scale-Investigator-Rated: Screening Version (CAARS-Inv: SV); p<0.001). In the longer-term analysis, respective improvements after six months were -13.2 vs -9.7 (p<0.001). Response rates at study endpoints for ATX vs placebo, based on CAARS-Inv: SV improvement ≥ 30% and Clinical Global Impressions of ADHD-Severity (CGI-ADHD-S) ≤ 3 were 34.8% vs 22.3% in the short-term and 43.4% vs 28.0% after six months, and CAARS-Inv: SV improvements ≥ 40% were 41.3% vs 25.3% in the short-term and 44.0% vs 31.4% after six months (all p<0.001). Overall, ATX had a clinically significant effect in adults with ADHD, with reductions in core symptoms and clinically meaningful responder rates.
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Affiliation(s)
- Philip Asherson
- MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
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26
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Kaye S, Darke S, Torok M. Attention deficit hyperactivity disorder (ADHD) among illicit psychostimulant users: a hidden disorder? Addiction 2013; 108:923-31. [PMID: 23227816 DOI: 10.1111/add.12086] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 03/28/2012] [Accepted: 12/03/2012] [Indexed: 01/08/2023]
Abstract
AIMS To estimate the prevalence, nature and correlates of symptomatology consistent with adult attention deficit hyperactivity disorder (ADHD) among illicit psychostimulant users. DESIGN Cross-section survey. SETTING Sydney, Australia. PARTICIPANTS 269 regular illicit psychostimulant users. MEASUREMENTS Structured interview assessing demographics, drug use and treatment history, psychostimulant dependence and self-reported symptoms consistent with adult ADHD. FINDINGS Almost half (45%) screened positive for adult ADHD (ADHD+). Symptoms of inattention (90%) were more prevalent than symptoms of hyperactivity/impulsivity (57%). Of those who screened positive for adult ADHD, only 17% had received a prior diagnosis of ADHD. The ADHD+ group differed from other participants in several respects: an earlier initiation of substance use and injecting drug use; more extensive polydrug use; a higher frequency of recent stimulant use and injecting drug use; a greater likelihood of stimulant dependence; and a greater likelihood of having received treatment for drug dependence. After controlling for other factors, screening positive for ADHD was associated independently with fewer years of education, earlier initiation of regular tobacco use and more extensive life-time polydrug use. CONCLUSIONS Clinicians should be aware of the potential for patients of drug and alcohol treatment services to have undiagnosed and/or untreated ADHD that may impact on their compliance with, and retention in, treatment.
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Affiliation(s)
- Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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27
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Carlsson V, Hakeberg M, Blomkvist K, Wide Boman U. Attention deficit hyperactivity disorder and dental anxiety in adults: relationship with oral health. Eur J Oral Sci 2013; 121:258-63. [PMID: 23659259 DOI: 10.1111/eos.12016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2012] [Indexed: 12/26/2022]
Abstract
The aim of the present study was to investigate the presence of attention deficit hyperactivity disorder (ADHD) in adult patients with severe dental anxiety. Specifically, we analysed the relationship among ADHD, oral health, and dental anxiety. The World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener was administered to a consecutive sample of patients referred to a dental fear research and treatment clinic. Patients completed questionnaires measuring dental anxiety (Dental Fear Survey) and self-rated oral health, and underwent a full radiographic examination. Of the total sample (n = 110), 16% scored above the established ASRS cut-off point, which is indicative of having ADHD. The ADHD group showed a higher level of dental anxiety and poorer self-rated oral health. There were also indications of poorer clinical oral health in the ADHD group, but these results did not reach statistical significance. In conclusion, the results of this study indicate an increased prevalence of ADHD in highly dentally anxious adults and the need to pay special attention to these patients because of greater treatment needs and increased dental anxiety.
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Affiliation(s)
- Viktor Carlsson
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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28
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Genro JP, Roman T, Rohde LA, Hutz MH. The Brazilian contribution to Attention-Deficit/Hyperactivity Disorder molecular genetics in children and adolescents. Genet Mol Biol 2012; 35:932-8. [PMID: 23411749 PMCID: PMC3571428 DOI: 10.1590/s1415-47572012000600007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is a common psychiatric condition of children worldwide. This disorder is defined by a combination of symptoms of inattention and hyperactivity/impulsivity. Diagnosis is based on a sufficient number of symptoms causing impairment in these two domains determining several problems in personal and academic life. Although genetic and environmental factors are important in ADHD etiology, how these factors influence the brain and consequently behavior is still under debate. It seems to be consensus that a frontosubcortical dysfunction is responsible, at least in part, for the ADHD phenotype spectrum. The main results from association and pharmacogenetic studies performed in Brazil are discussed. The investigations performed so far on ADHD genetics in Brazil and elsewhere are far from conclusive. New plausible biological hypotheses linked to neurotransmission and neurodevelopment, as well as new analytic approaches are needed to fully disclose the genetic component of the disorder.
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Affiliation(s)
- Júlia Pasqualini Genro
- Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
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29
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Rapoport JL, Giedd JN, Gogtay N. Neurodevelopmental model of schizophrenia: update 2012. Mol Psychiatry 2012; 17:1228-38. [PMID: 22488257 PMCID: PMC3504171 DOI: 10.1038/mp.2012.23] [Citation(s) in RCA: 546] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 02/13/2012] [Indexed: 02/06/2023]
Abstract
The neurodevelopmental model of schizophrenia, which posits that the illness is the end state of abnormal neurodevelopmental processes that started years before the illness onset, is widely accepted, and has long been dominant for childhood-onset neuropsychiatric disorders. This selective review updates our 2005 review of recent studies that have impacted, or have the greatest potential to modify or extend, the neurodevelopmental model of schizophrenia. Longitudinal whole-population studies support a dimensional, rather than categorical, concept of psychosis. New studies suggest that placental pathology could be a key measure in future prenatal high-risk studies. Both common and rare genetic variants have proved surprisingly diagnostically nonspecific, and copy number variants (CNVs) associated with schizophrenia are often also associated with autism, epilepsy and intellectual deficiency. Large post-mortem gene expression studies and prospective developmental multi-modal brain imaging studies are providing critical data for future clinical and high-risk developmental brain studies. Whether there can be greater molecular specificity for phenotypic characterization is a subject of current intense study and debate, as is the possibility of neuronal phenotyping using human pluripotent-inducible stem cells. Biological nonspecificity, such as in timing or nature of early brain development, carries the possibility of new targets for broad preventive treatments.
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Affiliation(s)
- J L Rapoport
- Child Psychiatry Branch, NIH, NIMH, Bethesda, MD 20892, USA.
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