Potential Symptoms of ADHD for Emerging Adults

Emotional Dysregulation in Emerging Adult ADHD: A Key Consideration in Explaining and Classifying Impairment and Co-Occurring Internalizing Problems

OBJECTIVE

The current study sought to clarify and harness the incremental validity of emotional dysregulation and unawareness (EDU) in emerging adulthood, beyond ADHD symptoms and with respect to concurrent classification of impairment and co-occurring problems, using machine learning techniques.

METHOD

Participants were 1,539 college students (Mage = 19.5, 69% female) with self-reported ADHD diagnoses from a multisite study who completed questionnaires assessing ADHD symptoms, EDU, and co-occurring problems.

RESULTS

Random forest analyses suggested EDU dimensions significantly improved model performance (ps < .001) in classifying participants with impairment and internalizing problems versus those without, with the resulting ADHD + EDU classification model demonstrating acceptable to excellent performance (except in classification of Work Impairment) in a distinct sample. Variable importance analyses suggested inattention sum scores and the Limited Access to Emotional Regulation Strategies EDU dimension as the most important features for facilitating model classification.

CONCLUSION

Results provided support for EDU as a key deficit in those with ADHD that, when present, helps explain ADHD's co-occurrence with impairment and internalizing problems. Continued application of machine learning techniques may facilitate actuarial classification of ADHD-related outcomes while also incorporating multiple measures.

Cognitive emotion regulation and learning effectiveness in college students with ADHD symptoms

BACKGROUND

College students with ADHD have difficulties with emotion regulation and have poorer academic skills than peers without ADHD; however, less is known regarding the relation between ADHD symptoms, maladaptive cognitive emotion regulation strategies (CERS), and learning effectiveness.

OBJECTIVES

We examined whether maladaptive CERS predicted learning effectiveness, and whether this relation was moderated by ADHD symptoms.

DESIGN

A cross-sectional online survey.

METHODS

College students (N = 4,183; Mage = 19.24; 70.1% female) at eight universities completed a battery as part of a larger study.

RESULTS

College students in our elevated ADHD group used significantly more maladaptive CERS and performed worse in three domains of learning effectiveness (i.e., Academic Self-Efficacy [ASE], Organization and Attention to Study [OAS], Stress and Time Press [STP]) than college students in our non-ADHD group. Further, ADHD symptoms moderated the relation between maladaptive CERS and OAS, such that individuals with the highest levels of ADHD symptoms were less impacted by maladaptive CERS.

CONCLUSION

Increased use of maladaptive CERS is unique to ADHD rather than lack of adaptive CERS. Also, maladaptive CERS and low ADHD symptoms interact to predict poor OAS. Interventions for college students, regardless of ADHD status, should incorporate emotion regulation components to improve learning effectiveness.

Short form Conners' Adult ADHD Rating Scales: Factor structure and measurement invariance by sex in emerging adults

INTRODUCTION

The short version of the Conners' Adult ADHD Rating Scales (CAARS-S:S) is a self-report measure used to identify symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) during adulthood. However, its psychometric properties specifically in emerging adults, or the transitional age group between adolescence and adulthood, remain understudied. This study aimed to validate the factor structure of the CAARS-S:S in a sample of emerging adults.

METHOD

The CAARS-S:S measure was completed by adults (n = 591) aged 18 to 29 located in English-speaking countries, including Australia, Canada and the United States. Confirmatory factor analysis was used to test a four-factor model of Inattention/Memory Problems, Hyperactivity/Restlessness, Impulsivity/Emotional Lability and Problems with Self-Concept, as well as the model's invariance by sex. Sex was also included as a covariate in the model to examine differences in males' and females' scores on each factor.

RESULTS

Overall, the four-factor structure fit the data and was invariant across males and females. All factors demonstrated high internal reliability (average ωt and α = .86). It was observed that males tended to score higher on Inattention/Memory Problems while females scored higher on Problems with Self-Concept.

CONCLUSION

This research establishes the psychometric properties of the CAARS-S:S, placing greater confidence in using it to screen for ADHD symptoms in emerging adults living in a Westernized cultural context. The detailed findings of this research, implications for the use of the CAARS-S:S in this age group and potential future directions for examining the properties of the measure are discussed.

Questionnaire-based computational screening of adult ADHD

BACKGROUND

ADHD is classically seen as a childhood disease, although it persists in one out of two cases in adults. The diagnosis is based on a long and multidisciplinary process, involving different health professionals, leading to an under-diagnosis of adult ADHD individuals. We therefore present a psychometric screening scale for the identification of adult ADHD which could be used both in clinical and experimental settings.

METHOD

We designed the scale from the DSM-5 and administered it to n = 110 control individuals and n = 110 ADHD individuals. The number of items was reduced using multiple regression procedures. We then performed factorial analyses and a machine learning assessment of the predictive power of the scale in comparison with other clinical scales measuring common ADHD comorbidities.

RESULTS

Internal consistency coefficients were calculated satisfactorily for TRAQ10, with Cronbach's alpha measured at .9. The 2-factor model tested was confirmed, a high correlation between the items and their belonging factor. Finally, a machine-learning analysis showed that classification algorithms could identify subjects' group membership with high accuracy, statistically superior to the performances obtained using comorbidity scales.

CONCLUSIONS

The scale showed sufficient performance for its use in clinical and experimental settings for hypothesis testing or screening purpose, although its generalizability is limited by the age and gender biases present in the data analyzed.

Feasibility, Acceptability, and Effectiveness of a New Cognitive-Behavioral Intervention for College Students with ADHD

OBJECTIVE

This purpose of this study was to assess the feasibility, acceptability, and effectiveness of a new group cognitive-behavioral treatment (CBT) to enhance executive function (EF) in college students with ADHD.

METHODS

Eighteen students meeting rigorous DSM-5 criteria for ADHD were enrolled in two nine-member groups. The treatment targeted time-awareness, distractibility, procrastination, and failure to plan, and included strategies to facilitate academic EF skills.

RESULTS

Eighty-four percent of students attended nine or more of the 12 weekly sessions. Repeated measures analyses of change from pre- to posttreatment yielded improvement in clinician- and self-ratings of DSM-5 ADHD inattentive symptoms, with robust effect sizes. Also improved were scores on standardized scales of time-management, concentration, and total EF.

DISCUSSION

Results provide support for the feasibility, acceptability, and effectiveness of a CBT program in reducing inattentive symptoms and enhancing EF in college students with ADHD, and warrant investigation on a larger scale.

Unique considerations in the assessment of ADHD in college students

Evidence-based practice in psychology (EBPP) has long focused on treatment, but evidence-based psychological assessment (EBPA) is also crucial given the important role of accurate and reliable diagnostic practices in treatment planning. In terms of the diagnosis of attention-deficit/hyperactivity disorder (ADHD), EBPA practices are well-established for children, and more recently for adults, but for college students in particular there are special considerations that warrant attention. College students with symptoms of ADHD have some challenges that are unique, and thus the assessment and diagnosis of ADHD in these students is unique. The aim of this review is not to cover all EBPA strategies for diagnosing ADHD in emerging adult college students; rather, we will focus on the unique considerations at play in college ADHD assessment. These include (a) conceptual matters such as the appropriateness of the DSM-5 criteria for college students, the limitations of our understanding of ADHD this population because of a lack of diversity in research studies, and the issue of late-identified ADHD; and (b) practical matters, such as specific documentation needs, how to gather and interpret self- and other-report of symptoms, how to assess impairment, and alternate explanations for ADHD-like symptoms in college students.

Psychometric Properties of the Weiss Functional Impairment Rating Scale: Evidence for Utility in Research, Assessment, and Treatment of ADHD in Emerging Adults

Objective: The current study examines psychometric properties of the Weiss Functional Impairment Rating Scale (WFIRS), a measure of adult ADHD-related impairment. It is a self-report questionnaire that provides a metric of overall life impairment and domain-specific dysfunction. Method: Using data from a large (N = 2,093), multi-institution sample of college students and including a subsample of collateral informants (n = 262), a series of analyses were conducted. Results: The WFIRS demonstrated robust internal reliability, cross-informant agreement on par or superior to other measures of ADHD symptomatology and impairment, and concurrent validity. The WFIRS was not shown to be uniquely associated with ADHD, as internalizing symptoms also associated with the total and domain scores. Conclusion: The use of the WFIRS in identifying ADHD-related impairment in emerging adults appears to be psychometrically supported, and will prove useful to clinicians and researchers.

Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in young adults: A qualitative review of the utility of assessment measures and recommendations for improving the diagnostic process

Objective: Identify assessment measures that augment the clinical interview and improve the diagnostic accuracy of adult ADHD assessment.Method: The sometimes limited research literatures concerning the diagnostic efficacies of the clinical interview, standard and novel ADHD behavior rating scales, performance and symptom validity testing, and cognitive tests are critically reviewed.Results: Based on this qualitative review, both clinical interviews alone and ADHD behavior rating scales alone have adequate sensitivity but poor specificity in diagnosing ADHD. Response validity and symptom validity tests have reasonably good sensitivity and very good specificity in detecting invalid symptom presentation. Cognitive test batteries have inadequate sensitivity and specificity in identifying ADHD. Using cognitive tests in conjunction with behavior rating scales significantly improves the specificity of an assessment battery. Executive function behavior rating scales and functional impairment rating scales are unlikely to improve the diagnostic accuracy of ADHD assessment.Conclusions: Based on this review, key clinical interview questions, behavior rating scales, symptom validity tests, and cognitive tests that have promise to enhance current assessment practices are recommended. These are the authors' personal opinions, not consensus standards, or guidelines promulgated by any organization. These measures are incorporated in a practical, somewhat abbreviated, battery that has the potential to improve clinicians' ability to diagnose adult ADHD.

Smoking abstinence effects on emotion dysregulation in adult cigarette smokers with and without attention-deficit/hyperactivity disorder

BACKGROUND

Cigarette smoking is robustly associated with attention-deficit/hyperactivity disorder (ADHD), but little is known about psychological mechanisms accounting for this comorbid relationship. This study examined difficulties in emotion regulation, or emotion dysregulation, among adult cigarette smokers with and without ADHD. Emotion dysregulation was predicted to be higher in an ADHD group at screening and after 24 -h smoking abstinence compared to a non-ADHD group.

METHODS

Cigarette smokers with (n = 19) and without (n = 20) ADHD completed a screening visit, baseline visit, and two experimental visits: smoking as usual (i.e., smoking satiated) and after biochemically-verified 24 -h smoking abstinence (i.e., smoking abstinent). Three emotion dysregulation rating scales (two self-report and one clinician rated) were administered at the screening visit and experimental sessions. Experimental sessions also included two emotion dysregulation behavioral tasks.

RESULTS

The ADHD group scored higher on all three rating scales at screening (p's < .001). For experimental sessions, group (ADHD, non-ADHD) x condition (smoking satiated, smoking abstinence) interactions were not significant across measures. However, group main effects emerged indicating higher emotion dysregulation in the ADHD group across all measures (p's < .001). Main effects also emerged for experimental condition, but were more mixed across emotion dysregulation measures.

CONCLUSIONS

Emotion dysregulation was higher among adult smokers with ADHD and during smoking abstinence across diagnostic groups, suggesting that this malleable psychological mechanism plays a role in smoking both for those with and without ADHD-such findings can inform treatment and prevention efforts.

DSM-5 and Other Symptom Thresholds for ADHD: Which Is the Best Predictor of Impairment in College Students?

OBJECTIVE

Approximately 5% of adults have ADHD. Despite recommendations regarding the diagnosis of emerging adults, there is not a strong consensus regarding the ideal method for diagnosing ADHD in both emerging and mature adults. We were interested in determining whether a threshold of four, five, or six ADHD symptoms would be associated with significantly different levels of functional impairment and be more or less indicative of a potential ADHD diagnosis.

METHOD

We examined the relation between functional impairment and these ADHD symptom thresholds in 2,577 college students.

RESULTS

Our findings suggest that none of these symptom thresholds are differentially better at predicting functional impairment.

CONCLUSION

The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) threshold of five symptoms for ages 17 years and older is not necessarily predictive of ADHD-related impairment in college students and may not be preferable to other thresholds. Options for resolving this diagnostic dilemma are discussed.

The Impact of DSM-5 A-Criteria Changes on Parent Ratings of ADHD in Adolescents

OBJECTIVE

Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) A-criteria for ADHD were expanded to include new descriptors referencing adolescent and adult symptom manifestations. This study examines the effect of these changes on symptom endorsement in a sample of adolescents with ADHD (N = 259; age range = 10.72-16.70).

METHOD

Parent ratings were collected and Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) and DSM-5 endorsement of ADHD symptoms were compared.

RESULTS

Under the DSM-5, there were significant increases in reported inattention, but not hyperactivity/impulsivity (H/I) symptoms, with specific elevations for certain symptoms. The average adolescent met criteria for less than one additional symptom under the DSM-5, but the correlation between ADHD symptoms and impairment was attenuated when using the DSM-5 items. Impulsivity items appeared to represent adolescent deficits better than hyperactivity items. Results were not moderated by demographic factors.

CONCLUSION

In a sample of adolescents with well-diagnosed DSM-IV-TR ADHD, developmental symptom descriptors led parents to endorse slightly more symptoms of inattention, but this elevation is unlikely to be clinically meaningful.

A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation

OBJECTIVE

Mindfulness meditation training is garnering increasing empirical interest as an intervention for ADHD in adulthood, although no studies of mindfulness as a standalone treatment have included a sample composed entirely of adults with ADHD or a comparison group. The aim of this study was to assess the feasibility, acceptability, and preliminary efficacy of mindfulness meditation for ADHD, executive functioning (EF), and emotion dysregulation symptoms in an adult ADHD sample.

METHOD

Adults with ADHD were stratified by ADHD medication status and otherwise randomized into an 8-week group-based mindfulness treatment ( n = 11) or waitlist group ( n = 9).

RESULTS

Treatment feasibility and acceptability were positive. In addition, self-reported ADHD and EF symptoms (assessed in the laboratory and ecological momentary assessment), clinician ratings of ADHD and EF symptoms, and self-reported emotion dysregulation improved for the treatment group relative to the waitlist group over time with large effect sizes. Improvement was not observed for EF tasks.

CONCLUSION

Findings support preliminary treatment efficacy, though require larger trials.

Perceived stress and ADHD symptoms in adults

OBJECTIVE

Given that ADHD has been linked to dysfunction across development and in many life domains, it is likely that individuals experiencing these symptoms are at increased risk for experiencing stress. The current study examines the association between ADHD and other psychiatric symptoms and perceived stress in a community sample of adults.

METHOD

Perceived stress data collected from 983 participants (M(age) = 45.6 years) were analyzed primarily via hierarchical multiple regression using ADHD symptom clusters, demographic variables, and anxiety and depression scale variables as predictors.

RESULTS AND CONCLUSION

ADHD symptoms positively associated with perceived stress. Inattention and sluggish cognitive tempo (SCT), as opposed to hyperactivity-impulsivity and newly proposed executive dysfunction symptoms, were the most consistent predictors. These findings reinforce that the experience of ADHD symptoms in adulthood is associated with stress and suggest that SCT could play an important role in assessing risk for negative adult outcomes.

Young adult romantic couples' conflict resolution and satisfaction varies with partner's attention-deficit/hyperactivity disorder type

Attention-deficit/hyperactivity disorder (ADHD) has previously been associated with less satisfaction and success in romantic relationships. This study compares conflict resolution and problem-solving behaviors in young adult romantic couples either having one partner with ADHD combined type (C-couples), having one partner identified with ADHD inattentive type (IA-couples), or in which neither partner has an ADHD diagnosis (nondiagnosed [ND] couples). Self-reports of current and childhood ADHD symptoms corroborated diagnostic status and speaker and listener behaviors, coded via the Rapid Couples Interaction Scoring System (Gottman, 1996), were the primary dependent variables. Analyses revealed greater negativity and less positivity in C-couples' behavior during a conflict resolution task, relative to IA and ND couples, and this corresponded with couples' relational satisfaction. IA-couples emitted relational behavior that was largely similar to ND couples. Findings support that relational impairment exists in C-couples, and to some degree, contrast with previous research suggesting that individuals with predominant inattention experience greater social impairment in adulthood than those with other types of ADHD.

Does executive functioning (EF) predict depression in clinic-referred adults? EF tests vs. rating scales

BACKGROUND

Deficits in executive functioning (EF) are implicated in neurobiological and cognitive-processing theories of depression. EF deficits are also associated with Attention-deficit/hyperactivity disorder (ADHD) in adults, who are also at increased risk for depressive disorders. Given debate about the ecological validity of laboratory measures of EF, we investigated the relationship between depression diagnoses and symptoms and EF as measured by both rating scales and tests in a sample of adults referred for evaluation of adult ADHD.

METHOD

Data from two groups of adults recruited from an ADHD specialty clinic were analyzed together: Adults diagnosed with ADHD (N=146) and a clinical control group of adults referred for adult ADHD assessment but not diagnosed with the disorder ADHD (N=97). EF was assessed using a rating scale of EF deficits in daily life and a battery of tests tapping various EF constructs. Depression was assessed using current and lifetime SCID diagnoses (major depression, dysthymia) and self-report symptom ratings.

RESULTS

EF as assessed via rating scale predicted depression across measures even when controlling for current anxiety and impairment. Self-Management to Time and Self-Organization and Problem-Solving showed the most robust relationships. EF tests were weakly and inconsistently related to depression measures.

LIMITATIONS

Prospective studies are needed to rigorously evaluate EF problems as true risk factors for depressive onset.

CONCLUSIONS

EF problems in everyday life were important predictors of depression. Researchers and clinicians should consistently assess for the ADHD-depression comorbidity. Clinicians should consider incorporating strategies to address EF deficits when treating people with depression.