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Adamis D, West S, Singh J, Hanley L, Coada I, McCarthy G, Langan N, Gavin B, McNicholas F. Functional impairment and quality of life in newly diagnosed adults attending a tertiary ADHD clinic in Ireland. Ir J Med Sci 2024:10.1007/s11845-024-03713-6. [PMID: 38755511 DOI: 10.1007/s11845-024-03713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/11/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Attention Deficit-Hyperactive Disorder (ADHD) is a neurodevelopmental disorder, often persisting into adulthood. AIMS To investigate the levels of functionality and quality of life (QoL) in adult patients newly diagnosed with ADHD and to compare with those without an ADHD diagnosis. METHODS Consecutive patients who were referred to and assessed in a tertiary adult ADHD clinic enrolled in the study. Diagnosis of ADHD was based on DSM-5 criteria. Functionality was measured using the Weiss Functional Impairment Rating Scale (WFIRS) and the Global Assessment of Functioning Scale (GAF). QoL was assessed with the Adult ADHD Quality of Life Questionnaire (AAQoL). RESULTS Three-hundred and forty participants were recruited, 177 (52.1%) females. Of them 293 (86.2%) were newly diagnosed with ADHD. Those with ADHD had significant lower functionality as it was measured with the WFIRS and GAF, and worse QoL (AAQoL) compared to those without. In addition, a significant correlation between GAF and WFIRS was found. CONCLUSIONS The results show that adults with ADHD have decreased functionality and worse QoL when compared against those presenting with a similar symptomatology, but no ADHD diagnosis. ADHD is not just a behavioural disorder in childhood, but a lifelong condition with accumulating problems that can lead to lower QoL and impaired functioning throughout adulthood.
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Affiliation(s)
- Dimitrios Adamis
- Sligo Mental Health Services, Clarion Rd, Sligo, Ireland.
- University of Galway, Galway, Ireland.
- University College Dublin, Dublin, Ireland.
- University of Limerick, Limerick, Ireland.
| | - Sam West
- Sligo Mental Health Services, Clarion Rd, Sligo, Ireland
- University of Galway, Galway, Ireland
| | - Jasmin Singh
- Sligo Mental Health Services, Clarion Rd, Sligo, Ireland
| | - Liadan Hanley
- Sligo Mental Health Services, Clarion Rd, Sligo, Ireland
- University of Galway, Galway, Ireland
| | - Iulian Coada
- Sligo Mental Health Services, Clarion Rd, Sligo, Ireland
| | - Geraldine McCarthy
- Sligo Mental Health Services, Clarion Rd, Sligo, Ireland
- University of Galway, Galway, Ireland
| | - Natasha Langan
- Sligo Mental Health Services, Clarion Rd, Sligo, Ireland
| | | | - Fiona McNicholas
- University College Dublin, Lucena CAMHS Rathgar, CHI Crumlin Dublin 12, Dublin 7, Dublin, Ireland
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Caroline S SS, Sudhir PM, Mehta UM, Kandasamy A, Thennarasu K, Benegal V. Assessing Adult ADHD: An Updated Review of Rating Scales for Adult Attention Deficit Hyperactivity Disorder (ADHD). J Atten Disord 2024; 28:1045-1062. [PMID: 38369740 DOI: 10.1177/10870547241226654] [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: 02/20/2024]
Abstract
METHOD Scholarly articles on adult ADHD between 1996 and 2022 were reviewed using the PRISMA guidelines. ADHD rating scales with multiple citations were selected and their psychometric properties and symptom coverage were analyzed. RESULTS Ten rating scales, with sound psychometric properties, were identified. Out of those reviewed two (BADDS and BAARS-IV) load on the inattentive domain of ADHD, while the rest focus on a comprehensive assessment of ADHD. Only one scale (BARRS-IV) incorporates an assessment of functional impairment. Some scales though widely utilized have not been adequately examined for their sensitivity. CONCLUSIONS Rating scales are reliable and valid, in the assessment of adult ADHD. We present a review of recent scales, with an expanded focus, to help clinicians make informed decisions on diagnosis, identifying targets and planning interventions accordingly.
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Affiliation(s)
- Sharon Suganthi Caroline S
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Paulomi M Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Arun Kandasamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - K Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Nordby ES, Guribye F, Schønning V, Andersen SL, Kuntsi J, Lundervold AJ. A Blended Intervention Targeting Emotion Dysregulation in Adults With Attention-Deficit/Hyperactivity Disorder: Development and Feasibility Study. JMIR Form Res 2024; 8:e53931. [PMID: 38231536 PMCID: PMC10831671 DOI: 10.2196/53931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Many adults with attention-deficit/hyperactivity disorder (ADHD) experience difficulties related to emotion regulation. Such difficulties are known to substantially impact quality of life and overall functioning. Yet, there is a lack of treatment interventions specifically designed to address these challenges. OBJECTIVE This study aimed to describe the development and assess the feasibility, along with the initial clinical outcomes, of a novel blended intervention for adults with ADHD. The blended intervention combines both face-to-face and digital components and is specifically designed to address emotion dysregulation in ADHD. METHODS This intervention was an 8-week blended intervention combining weekly face-to-face group sessions with a supplementary digital companion app. The intervention is based on elements from dialectic behavioral therapy skills training and positive psychology. To evaluate its feasibility, we performed a 10-week feasibility study with an uncontrolled pre-post study design, including 16 adults with ADHD and co-occurring emotion dysregulation. The feasibility measures encompassed adherence, satisfaction, and perceived credibility of the intervention. Clinical outcomes were evaluated by self-reported symptoms of emotion dysregulation, inattention, hyperactivity-impulsivity, executive function, depression, anxiety, and a measure of quality of life. Paired sample 2-tailed t tests were used to analyze clinical outcomes with a Bonferroni-corrected significance level. RESULTS Both treatment credibility and treatment satisfaction were rated favorably by the majority of the participants. In particular, the participants emphasized meeting others with ADHD as beneficial. In terms of adherence, 3 participants withdrew before initiating the intervention, while another 4 participants did not complete the intervention. On average, the participants who enrolled in the intervention attended 6.2 of the 8 group sessions and completed 6.7 of the 8 skills training modules in the companion app. In terms of clinical outcomes, there was a reduction in symptoms of emotion dysregulation from before to after the intervention (d=2.0). Significant improvements were also observed in measures of inattention (d=1.1) and hyperactivity-impulsivity (d=0.9). However, no significant improvements were found in the domains of depression, anxiety, quality of life, and executive functioning. CONCLUSIONS The results are encouraging, both in terms of feasibility and the preliminary clinical results on emotion dysregulation. The blended format, combining digital and face-to-face elements, may also seem to offer some advantages: the group-based format was valued as it facilitated peer interaction, while a rather high completion of modules in the companion app highlights its potential to enhance skills training between the group sessions. Future randomized controlled trials are called for to further evaluate the clinical effectiveness of the intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT05644028; https://clinicaltrials.gov/study/NCT05644028.
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Affiliation(s)
- Emilie S Nordby
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Frode Guribye
- Department of Information Science and Media Studies, Faculty of Social Sciences, University of Bergen, Bergen, Norway
| | - Viktor Schønning
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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Lindvall MA, Holmqvist KL, Svedell LA, Philipson A, Cao Y, Msghina M. START - physical exercise and person-centred cognitive skills training as treatment for adult ADHD: protocol for a randomized controlled trial. BMC Psychiatry 2023; 23:697. [PMID: 37749523 PMCID: PMC10521407 DOI: 10.1186/s12888-023-05181-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Core symptoms in attention deficit hyperactivity disorder (ADHD) are inattention, impulsivity and hyperactivity. Many individuals with this disorder also have a sedentary lifestyle, co-morbid mental illness such as depressive and anxiety disorders, and reduced quality of life. People with ADHD often have impaired executive function, which among other things may include difficulty in time management and structuring of everyday life. Pharmacological treatment is often the first-line option, but non-pharmacological treatment is also available and is used in clinical settings. In children and adolescents with ADHD, physical exercise is used as a non-pharmacological treatment. However, the evidence for the effectiveness of exercise in adults is sparse. OBJECTIVE To implement the START intervention (START = Stöd i Aktivitet, Rörelse och Träning [Support in activity, movement and exercise]) consisting of a 12-week, structured mixed exercise programme with or without a cognitive intervention, in adults with ADHD, and study whether it has an effect on core symptoms of ADHD as well as physical, cognitive, mental and everyday functioning compared with usual treatment. A secondary aim is to investigate the participants' experiences of the intervention and its possible benefits, and to evaluate the cost-effectiveness of START compared with usual treatment. METHODS This is a randomized controlled trial planned to be conducted in 120 adults with ADHD, aged 18-65. The intervention will be given as an add-on to standard care. Participants will be randomized to three groups. Group 1 will be given a physiotherapist-led mixed exercise programme for 12 weeks. Group 2 will receive the same intervention as group 1 with the addition of occupational therapist-led cognitive skills training. Group 3 will be the control group who will receive standard care only. The primary outcome will be reduction of ADHD symptoms measured using the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS-v1.1), Clinical Global Impression-Severity scale (CGI-S) and CGI-Improvement scale (CGI-I). The effect will be measured within 1 week after the end of the intervention and 6 and 12 months later. DISCUSSION Data collection began in March 2021. The final 12-month follow-up is anticipated to be completed by autumn 2024. TRIAL REGISTRATION ClinicalTrials.gov (Identifier: NCT05049239). Registered on 20 September 2021 (last verified: May 2021).
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Affiliation(s)
- Mialinn Arvidsson Lindvall
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, 70182, SE, Sweden.
| | - Kajsa Lidström Holmqvist
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, 70182, SE, Sweden
- Department of Neurology and Rehabilitation Medicine, Faculty of Medicine and Health, Örebro University, Örebro, 70182, SE, Sweden
| | - Lena Axelsson Svedell
- Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, 70182, SE, Sweden
| | - Anna Philipson
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, 70182, SE, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, 70182, SE, Sweden
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mussie Msghina
- Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, 70182, SE, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Forsström D, Oscarsson M, Buhrman M, Rozental A. A study protocol of a randomized controlled study of internet-based cognitive behavioral therapy for adult attention deficit hyperactivity disorder. Internet Interv 2023; 33:100652. [PMID: 37529408 PMCID: PMC10388197 DOI: 10.1016/j.invent.2023.100652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a disorder characterized by hyperactivity, impulsivity and lack of attention. It can have a major impact on everyday life and result in negative consequences for one's personal, academic, and work situation. For individuals with symptoms of ADHD, increased levels of anxiety and depression are common, and an overall reduction of quality of life is often present. This study protocol describes a clinical trial of internet-based cognitive behavioral therapy (iCBT), using a randomized controlled study design, with the primary aim to increase quality of life, as well as to reduce symptoms of ADHD, anxiety, depression, and stress. A second aim is to investigate, by qualitative means, what aspects of treatment were perceived as helpful and hindering when it comes to completing iCBT. Two hundred participants with symptoms of ADHD will be included and randomized to two conditions (treatment and wait-list control). The treatment period is comprised of a maximum of ten weeks, with two mandatory modules and ten modules from which the participants can choose freely. Self-report measures will be completed by the participants at baseline and end of treatment, as well as at a six-month follow-up. The treatment is guided by therapists and consists of weekly correspondence with the participants. The study will utilize an intention to treat design, with ANOVAs and Reliable Change Index to evaluate treatment effects. The qualitative part of the project will be interview-based and employ thematic analysis. Lastly, a psychometric evaluation of a common instrument for determining ADHD-symptoms will also be made. The results will hopefully contribute to the evidence base for iCBT for individuals with symptoms of ADHD and help disseminate potentially effective interventions.
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Affiliation(s)
- David Forsström
- Department of Psychology, Uppsala University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Department of Psychology, Stockholm University, Sweden
| | | | | | - Alexander Rozental
- Department of Psychology, Uppsala University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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Svedell LA, Holmqvist KL, Lindvall MA, Cao Y, Msghina M. Feasibility and tolerability of moderate intensity regular physical exercise as treatment for core symptoms of attention deficit hyperactivity disorder: a randomized pilot study. Front Sports Act Living 2023; 5:1133256. [PMID: 37255729 PMCID: PMC10225649 DOI: 10.3389/fspor.2023.1133256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/21/2023] [Indexed: 06/01/2023] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is associated with sedentary lifestyle, low quality of life and low physical fitness. Studies in children with ADHD have shown that regular physical exercise can help reduce core ADHD symptoms, but evidence for this is lacking in adults. Although guidelines recommend multi-modal treatment, central stimulants (CS) remain the mainstay of treatment. CS are effective in the short-term, but their long-term efficacy remains to be established. There is thus huge unmet need for developing non-pharmacological treatment options, and for well-designed randomized controlled trials (RCTs). Objective The study aimed to test the feasibility and tolerability of structured moderate-intensity 12-week physical exercise program for adults with ADHD, as a prelude to an adequately powered RCT which includes long-term follow-up. Materials and methods Fourteen adults with ADHD were recruited, 9 randomized to an intervention group and 5 to a control group. The intervention group received physiotherapist-led 50-minute mixed exercise program, three times a week for 12 weeks, and the control group treatment as usual. Participants were assessed at baseline and after 6 and 12 weeks using clinical and physical evaluations, self-rating questionnaires, and functional magnetic resonance imaging (fMRI) together with paradigms that tested attention, impulsivity and emotion regulation. Results Three participants (21%) dropped out shortly after inclusion before receiving any intervention, while roughly 80% completed the intervention according to protocol. One participant from the intervention group participated in less than 60% of treatment sessions, and one who had done baseline fMRI was unwilling to do post-intervention imaging. Four participants in the intervention group (67%) reported increased stress in prioritizing the intervention due to time-management difficulties. Overall, consistent trends were observed that indicated the feasibility and potential benefits of the intervention on core ADHD symptoms, quality of life, body awareness, sleep and cognitive functioning. Conclusion Physiotherapist-led twelve-week regular physical exercise is a feasible and potentially beneficial intervention for adults with ADHD. There was a 20% drop-out initially and 67% of those who completed the intervention reported stress with time management difficulties due to participation. A third arm was thus added to the planned RCT where cognitive intervention administered by an occupational therapist will be given together with physical exercise.Clinical Trial Registration: https://clinicaltrials.gov, identifier NCT05049239.
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Affiliation(s)
- L. A. Svedell
- Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - K. L. Holmqvist
- Department of Neurology and Rehabilitation Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - M. A. Lindvall
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Y. Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M. Msghina
- Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Kastner L, Velder-Shukrun Y, Bonne O, Bar-Ilan RT, Maeir A. Pilot Study of the Cognitive–Functional Intervention for Adults (Cog-Fun A): A Metacognitive–Functional Tool for Adults With Attention Deficit Hyperactivity Disorder. Am J Occup Ther 2022; 76:23242. [DOI: 10.5014/ajot.2022.046417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Importance: Adults with attention deficit hyperactivity disorder (ADHD) often experience chronic challenges in their life roles. There is a need for evidence-based occupational therapy interventions to help enhance their functioning.
Objective: To determine the preliminary effectiveness of the Cognitive–Functional Intervention for Adults (Cog–Fun A), a metacognitive–functional occupational therapy tool for the improvement of occupational performance (OP) and quality of life (QoL) in adults with ADHD.
Design: One-group pretest–posttest design with a 3-mo follow-up.
Setting: Community setting in Jerusalem, Israel.
Participants: Fourteen adults, ages 18–60 yr, with a valid diagnosis of ADHD and an indication of executive function (EF) impairment.
Intervention: Participants received 15 1-hr weekly sessions that addressed self-awareness of strengths and challenges through education and guided discovery as well as strategy acquisition and implementation within a context of occupational goal attainment.
Outcomes and Measures: The Behavioral Rating Inventory of Executive Function–Adult version, an adult ADHD QoL measure, the Canadian Occupational Performance Measure, and the Self-Regulation Skills Interview were administered.
Results: Twelve participants completed the intervention. Posttreatment scores revealed statistically significant improvements in EF, awareness, OP, and QoL. Gains in QoL showed a modest reduction at the 3-mo follow-up.
Conclusions and Relevance: The Cog–Fun A is a promising intervention for improving OP and QoL among adults with ADHD and should be investigated further.
What This Article Adds: The Cog–Fun A offers an effective nonpharmacological, metacognitive–functional, occupation-centered treatment option for adults with ADHD.
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Affiliation(s)
- Libby Kastner
- Libby Kastner, MSc, OTR, is Occupational Therapist, private practice, Jerusalem, Israel, and Clinical Supervisor, School of Occupational Therapy, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yifat Velder-Shukrun
- Yifat Velder-Shukrun, MSc, OTR, is Occupational Therapist and Clinical Supervisor, School of Occupational Therapy, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Omer Bonne
- Omer Bonne, MD, is Professor and Director, Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
| | - Ruthi Traub Bar-Ilan
- Ruthi Traub Bar-Ilan, PhD, OTR, is Lecturer and Researcher, School of Occupational Therapy, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adina Maeir
- Adina Maeir, PhD, OTR, is Professor, School of Occupational Therapy, Hebrew University of Jerusalem, Jerusalem, Israel;
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Groenman AP, van der Werf S, Geurts HM. Subjective cognition in adults with common psychiatric classifications; a systematic review. Psychiatry Res 2022; 308:114374. [PMID: 34995830 DOI: 10.1016/j.psychres.2021.114374] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 12/22/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
The aim is to assess whether instruments developed to measure subjective cognitive complaints (SCCs) and in neurology and aging can reliably be used in ADHD and other common psychiatric classifications. MEDLINE, PsycINFO, CINAHL and EMBASE+EMBASE CLASSIC were searched for relevant work on SCCs in psychiatric classifications (ADHD, autism, mood disorders, schizophrenia) in two phases: 1 identify instruments, 2 relevant studies. 35 studies with varying study quality were included. SCCs are most commonly studied in ADHD and mood disorders, but are found in all psychiatric classifications. SCCs show inconsistent and low associations to objective cognition across disorders, but higher and consistent relations are found with behavioral outcomes. SCCs are not qualitatively different for ADHD compared to other psychiatric classifications, and should thus not be seen as analogous to well validated measures of objective cognition. However, SCCs do reflect suffering, behavioral difficulties and problems experienced by across those with psychiatric problems in daily life.
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Affiliation(s)
- Annabeth P Groenman
- Dutch Autism & ADHD Research Center, Department of Psychology, Univeersity of Amsterdam, Amsterdam, Netherlands; Department of Psychology, University of Amsterdam, Amsterdam, Netherlands.
| | - Sieberen van der Werf
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands; Dept Medical Psychology, Rijnstate Hospital Arnhem, Netherlands
| | - Hilde M Geurts
- Dutch Autism & ADHD Research Center, Department of Psychology, Univeersity of Amsterdam, Amsterdam, Netherlands; Department of Psychology, University of Amsterdam, Amsterdam, Netherlands; Dr. Leo Kannerhuis, autism clinic (Youz/Parnassia Group), Amsterdam, Netherlands
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9
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Ben-Dor Cohen M, Eldar E, Maeir A, Nahum M. Emotional dysregulation and health related quality of life in young adults with ADHD: a cross sectional study. Health Qual Life Outcomes 2021; 19:270. [PMID: 34930314 PMCID: PMC8691086 DOI: 10.1186/s12955-021-01904-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Attention Deficit Hyperactivity Disorder (ADHD) is associated with emotional dysregulation (ED) and impaired health related quality of life (HRQoL). However, the role of ED in explaining the relationship between ADHD and HRQoL is unclear. The purpose of the present study was to do so in a sample of non-referred young adults with and without ADHD. Method The study design was cross-sectional. A non-clinical sample of 63 young adults with ADHD (mean age = 24.86 years, SD = 3.25, 78% university students) and 69 gender-matched controls (mean age = 23.84 years, SD = 2.59, 89% university students) were recruited. The Adult ADHD Quality-of-Life scale was used to measure HRQoL; The Self-Report Wender–Reimherr Adult Attention Deficit Disorder Scale and the Difficulties in Emotion Regulation Scale were used to measure ED. Group differences on all measures were tested using univariate and multivariate analyses of covariance, while controlling for age. Finally, a moderation analysis was used in order to examine the impact of ED on HRQoL beyond that accounted for by ADHD symptoms. Results Both HRQoL and ED were significantly worse for the ADHD group compared to the control group. The medication status of the ADHD group participants had no significant effect on the level of ADHD symptoms, ED or HRQoL. ED moderated the effect of ADHD symptoms on HRQoL for the ADHD group. Conclusion The findings support the centrality of ED in ADHD and its crucial influence on HRQoL. Young adults with ADHD and high levels of ED are at risk for aversive impact on their well-being regardless of their ADHD symptoms level. Young adults with Attention Deficit Hyperactivity Disorder (ADHD) struggle with poor quality of life (QoL). Emotional regulation is one’s ability to modify their emotional state to promote adaptive, goal-oriented behaviors. Emotional dysregulation is a common yet neglected feature of people with ADHD. Our results show that young adults with ADHD are twice more likely to suffer from emotional dysregulation then their peers. Moreover, higher levels of emotional dysregulation predicted lower levels of QoL. These findings support the centrality of ED in ADHD and their crucial influence on everyday QoL. These findings are important not only on the theoretical level, but may also contribute to the design of interventions that aim to promote quality of life.
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Affiliation(s)
- Maayan Ben-Dor Cohen
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Eran Eldar
- Psychology Department, Faculty of Social Sciences, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Cognitive Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adina Maeir
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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10
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Nordby ES, Kenter RM, Lundervold AJ, Nordgreen T. A self-guided Internet-delivered intervention for adults with ADHD: A feasibility study. Internet Interv 2021; 25:100416. [PMID: 34401375 PMCID: PMC8350603 DOI: 10.1016/j.invent.2021.100416] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/03/2021] [Accepted: 06/11/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder that tends to persist into adulthood. Many adults with ADHD seek non-pharmacological treatment in addition to pharmacological treatment. Still, there are few non-pharmacological treatment options available. The aim of the current study was to explore the feasibility of a self-guided Internet-delivered intervention for adults with ADHD. METHODS The study has an uncontrolled, within-group, pre-post design. Thirteen participants with an ADHD diagnosis were included and given access to the first three modules of a seven-module intervention. To explore the feasibility of the intervention, the adherence, credibility, and treatment satisfaction were examined. Preliminary efficacy of the intervention was examined through self-report measures of inattention, hyperactivity, depression, anxiety, stress, and quality of life. RESULTS In terms of adherence, seven participants (54%) completed all three intervention modules (M = 1.85, SD = 1.3). The participants reported both good credibility and treatment satisfaction with the intervention. The participants also reported challenges related to usability and technical issues. Although the clinical outcomes must be interpreted with caution due to the study design and the small sample size, a statistically significant reduction in severity of inattention was reported by the participants following the intervention (p = .006, d = 1.57). The reduction was non-significant for hyperactivity (p = .326, d = 0.33). The participants who completed all three modules in the intervention (n = 7) also reported a significant decrease in stress (p = .042, d = 0.67) and a significant increase in quality of life (p = .016, d = 0.99). No significant changes were found on measures of anxiety and depression. CONCLUSION The adherence to the intervention was relatively low, but the participants who completed the study reported good credibility and satisfaction with the intervention. These results indicate that there is a need to improve the intervention to make it more engaging before conducting a randomized-controlled trial investigating the clinical effects of the full seven-module intervention.
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Affiliation(s)
- Emilie S. Nordby
- Division of Psychiatry, Haukeland University Hospital, Haukelandsbakken 15, 5009 Bergen, Norway
| | - Robin M.F. Kenter
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Christies gate 12, 5015 Bergen, Norway
| | - Astri J. Lundervold
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Jonas Lies vei 91, 5009 Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Haukelandsbakken 15, 5009 Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Årstadveien 17, Block D, 5009 Bergen
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Björk A, Rönngren Y, Wall E, Vinberg S, Hellzen O, Olofsson N. A nurse-led lifestyle intervention for adult persons with attention-deficit/hyperactivity disorder (ADHD) in Sweden. Nord J Psychiatry 2020; 74:602-612. [PMID: 32493144 DOI: 10.1080/08039488.2020.1771768] [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: 12/13/2022]
Abstract
Introduction: Attention-deficit/hyperactivity disorder (ADHD) is associated with lifestyle-related diseases. Therefore, a nurse-led lifestyle intervention including interpersonal relationships, health education and cognitive support was developed to facilitate healthier lifestyle habits.Aim: The aim was to develop a lifestyle intervention and investigate its impact on mental and physical healthMethod: The 52-week intervention included 35 adults with ADHD. In a pre- and post-test design, symptoms of ADHD were measured with the Adult ADHD Self-Report Scale, quality of life was measured with the Adult ADHD Quality of Life scale and mental health was measured with the Hospital Anxiety and Depression scale. Lifestyle habits and dimensions of health were measured by the Lifestyle-Performance-Health Questionnaire and physical fitness was measured by the VO2 Max Test and calculations of waist circumference and body mass index. Result: Post-tests for a group of 25 persons showed positive changes following the intervention regarding weekly physical activity, quality of life and general and mental health. Lifestyle habit support was found to be important. The impact of the intervention should be confirmed in a long-term study with a control group.Conclusion: This intervention may be beneficial and may be implemented in a primary healthcare setting or in other open care units.
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Affiliation(s)
- Annette Björk
- Department of Health Sciences, Mid Sweden University, Sundsvall/Östersund, Sweden
| | - Ylva Rönngren
- Department of Nursing Sciences, Mid Sweden University, Sundsvall/Östersund, Sweden
| | - Erika Wall
- Department of Health Sciences, Mid Sweden University, Sundsvall/Östersund, Sweden
| | - Stig Vinberg
- Department of Health Sciences, Mid Sweden University, Sundsvall/Östersund, Sweden
| | - Ove Hellzen
- Department of Nursing Sciences, Mid Sweden University, Sundsvall/Östersund, Sweden
| | - Niclas Olofsson
- Department of Health Sciences, Mid Sweden University, Sundsvall/Östersund, Sweden
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Quintero J, Morales I, Vera R, Zuluaga P, Fernández A. The Impact of Adult ADHD in the Quality of Life Profile. J Atten Disord 2019; 23:1007-1016. [PMID: 28974134 DOI: 10.1177/1087054717733046] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In this multicenter, cross-sectional study, we aimed to investigate the quality of life (QoL) and the neuropsychological and clinical characteristics of adults with ADHD with different developmental pathways. METHOD Our study sample included 25 control (healthy) participants, 31 patients with newly diagnosed ADHD without comorbidities (ADHD-C-D), 31 with newly diagnosed ADHD with comorbidities (ADHD+C-D), and 29 with previously diagnosed ADHD with comorbidities (ADHD+C+D). RESULTS Compared with controls, ADHDs had little differences in the attentional performance but showed higher impulsivity, more severe symptoms of depression and anxiety, and lower QoL. The ADHD+C-D group showed more severe symptoms of depression and anxiety than the ADHD+C+D group ( p = .037 and p = .008, respectively), and poorer QoL in the psychological health sphere ( p = .003). CONCLUSION Differences between ADHD and control subjects were particularly remarkable in mood symptoms and QoL. Previous diagnosis might have a positive impact on mood symptoms and QoL in ADHD adults.
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Affiliation(s)
- Javier Quintero
- 1 Hospital Universitario Infanta Leonor, Madrid, Spain.,2 Complutense University of Madrid, Spain
| | | | - Rosa Vera
- 2 Complutense University of Madrid, Spain
| | | | - Alberto Fernández
- 2 Complutense University of Madrid, Spain.,4 Technical University of Madrid, Spain
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Gjervan B, Torgersen T, Hjemdal O. The Norwegian Translation of the Adult Attention-Deficit/Hyperactivity Disorder Quality of Life Scale: Validation and Assessment of QoL in 313 Adults With ADHD. J Atten Disord 2019; 23:931-939. [PMID: 27033881 DOI: 10.1177/1087054716640087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of the study was to validate the Norwegian version of the Adult Attention-Deficit/Hyperactivity Disorder Quality of Life (AAQoL) scale and to explore Quality of Life (QoL) and functional outcomes in adults with ADHD. METHOD A total of 313 adults with ADHD participated in the study. Data were collected from medical records and self-report questionnaires. Confirmatory factor analysis was performed to assess the model fit of the translated AAQoL. Chi-square statistics and t tests were used to investigate sample characteristics. RESULTS The analyses showed acceptable model fit between data and the model. Chi square = 863.179 (371 df, p < .0000), root mean square error of approximation (RMSEA) = 0.069 (90% confidence interval [CI]), comparative fit index (CFI) = 0.873, and Tucker-Lewis index (TLI) = 0.821. Cronbach's alpha range for the scales was .761 to .869. The sample was characterized by poor QoL and impairment. CONCLUSION The translated AAQoL is showing good initial indications of validity with acceptable psychometric properties in the sample. ADHD was associated with impairments in QoL, symptoms, and functional outcomes.
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Affiliation(s)
- Bjørn Gjervan
- 1 North-Trondelag Hospital Trust, Levanger, Norway.,2 Norwegian University of Science and Technology, Trondheim, Norway
| | - Terje Torgersen
- 2 Norwegian University of Science and Technology, Trondheim, Norway.,3 St. Olavs Hospital, Trondheim, Norway
| | - Odin Hjemdal
- 2 Norwegian University of Science and Technology, Trondheim, Norway
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14
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Vaag JR, Lara-Cabrera ML, Hjemdal O, Gjervan B, Torgersen T. Psychoeducational groups versus waitlist in treatment of attention-deficit hyperactivity/impulsivity disorder (ADHD) in adults: a protocol for a pilot randomized waitlist-controlled multicenter trial. Pilot Feasibility Stud 2019; 5:17. [PMID: 30693097 PMCID: PMC6343320 DOI: 10.1186/s40814-019-0401-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 01/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Psychoeducation is included in the Norwegian national guidelines for treatment of adult ADHD. Despite some promising results for the treatment of other conditions and ADHD, little is known about the efficacy of such interventions. This paper presents a protocol for a pilot randomized controlled trial featuring a psychoeducational group program for patients with ADHD. The main objective of this pilot trial is to investigate adherence, feasibility, and preliminary efficacy of a ten-session psychoeducational group designed to address specific challenges faced by adults diagnosed with ADHD. Methods This pilot study will evaluate patient satisfaction and preliminary efficacy of a psychoeducational group treatment using a randomized waitlist-controlled trial at two different outpatient clinics in mid-Norway. All participants will receive treatment as usual, concomitant with the intervention and waitlist period. Client satisfaction (CSQ 8), general self-efficacy (GSE-6), ADHD-related quality of life (AAQoL), symptoms of ADHD (SCL-9; ASRS), and work participation will be assessed at the time of recruitment prior to randomization (T0), pre-intervention (T1), post-intervention (T2), and at 10 weeks follow-up (T3). Recruitment and dropout rates along with treatment adherence will also be evaluated. Discussion This study offers valuable insight into the preliminary efficacy of educational programs implemented in outpatient clinics. The aim of the trial is to evaluate adherence, feasibility, patient satisfaction, and the preliminary efficacy of a psychoeducational group intervention for patients with adult ADHD and provide further insight into the design and construction of a large-scale trial. The results also offer preliminary empirical evidence to inform the development of larger and more complex studies. Trial registration NCT03337425, Registered 9 November 2017.
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Affiliation(s)
- J R Vaag
- 1Faculty of Nursing and Health Science, Nord University, Levanger, Norway.,2Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - M L Lara-Cabrera
- 3Division of Mental Healthcare, St. Olavs Hospital Trust, Trondheim, Norway
| | - O Hjemdal
- 2Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - B Gjervan
- Department of Mental Healthcare, Nord Trøndelag Hospital Trust, Levanger, Norway
| | - T Torgersen
- 3Division of Mental Healthcare, St. Olavs Hospital Trust, Trondheim, Norway
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15
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Tanaka Y, Brod M, Lane JR, Upadhyaya H. What Is a Clinically Relevant Improvement in Quality of Life in Adults With ADHD? J Atten Disord 2019; 23:65-75. [PMID: 25876607 DOI: 10.1177/1087054715580395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate a minimal clinically important difference (MCID) on the adult ADHD Quality of Life (AAQoL) scale. METHOD The MCID was determined from data from short-term ( N = 537) and long-term ( N = 440), placebo-controlled atomoxetine trials in adults with ADHD. For the anchor-based approach, change in clinician-rated Clinical Global Impressions-ADHD-Severity (CGI-ADHD-S) scores was used to derive MCID. For the distribution-based approach, baseline-to-endpoint mean ( SD) changes in AAQoL scores corresponding to 0.5 SD were computed. RESULTS The MCID was similar (approximately 8-point difference) between the short-term and the long-term treatment groups when either the anchor-based or distribution-based approach was used. CONCLUSION These results suggest that approximately 8 points in the change from baseline on the AAQoL is a MCID.
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Affiliation(s)
- Yoko Tanaka
- 1 Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
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Zinnow T, Banaschewski T, Fallgatter AJ, Jenkner C, Philipp-Wiegmann F, Philipsen A, Retz W, Sobanski E, Thome J, Rösler M. ESCAlate - Adaptive treatment approach for adolescents and adults with ADHD: study protocol for a randomized controlled trial. Trials 2018; 19:280. [PMID: 29776383 PMCID: PMC5960079 DOI: 10.1186/s13063-018-2665-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the last decade, a wide range of attention-deficit/hyperactivity disorder (ADHD) treatment approaches for adults, including both pharmacological interventions and psychosocial treatments, have been proposed and observed to be efficient. In practice, individual treatment concepts are based on results of clinical studies as well as international guidelines (NICE Guidelines) that recommend a step-by-step treatment approach. Since the evidence supporting this approach is limited, the aim of the present study is to determine an optimal intervention regarding severity levels of ADHD symptomatology conducting a randomized controlled trial. METHOD We aim to include 279 ADHD subjects aged between 16 and 45 years. First, participants are randomized to either a face-to-face psychoeducation, telephone assisted self-help (TASH), or a waiting control group (Step 1). All participants assigned to the control group are treated using TASH after a 3-month waiting period. Participants are then allocated to one of three groups, based on their remaining severity level of ADHD symptoms, as (1) full responder, (2) partial responder, or (3) non-responder (Step 2). Full responders receive counseling, partial responders receive either counseling only or counseling and neurofeedback (NF), and non-responders receive either pharmacological treatment only or pharmacological treatment and NF, followed by a 3 month period without intervention. DISCUSSION The naturalistic sample is one of the study's advantages, avoiding highly selective inclusion or exclusion criteria. The efficacy of an evidence-based stepped care intervention is explored by primary (reduction of severity of ADHD symptoms) and secondary outcomes (functional outcomes, e.g., quality of life, anger management, enhancement of psychosocial well-being). Predictors of therapeutic response and non-response are being investigated at each step of intervention. Further, sex differences are also being explored. TRIAL REGISTRATION This study is registered by the German Trial Register (reference number: DRKS00008975 ), 23 October 2015.
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Affiliation(s)
- Toivo Zinnow
- Institute for Forensic Psychology and Psychiatry, Saarland University, Kirrberger Straße, 66421, Homburg, Saarland, Germany.
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry, University of Tübingen, Osianderstr. 24, 72076, Tübingen, Germany.,LEAD Graduate School, University of Tübingen, Tübingen, Germany
| | - Carolin Jenkner
- Clinical Trials Unit at University Medical Center Freiburg, Elsässer Str. 2, 79110, Freiburg, Germany
| | - Florence Philipp-Wiegmann
- Institute for Forensic Psychology and Psychiatry, Saarland University, Kirrberger Straße, 66421, Homburg, Saarland, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Siegmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Wolfgang Retz
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacherstraße 8, 55131, Mainz, Germany
| | - Esther Sobanski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Johannes Thome
- Department of Psychiatry and Psychotherapy, University Hospital Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Michael Rösler
- Institute for Forensic Psychology and Psychiatry, Saarland University, Kirrberger Straße, 66421, Homburg, Saarland, Germany
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Nicastro R, Desseilles M, Prada P, Weibel S, Perroud N, Gex-Fabry M. Subjective Distress Associated with Adult ADHD: evaluation of a new self-report. ACTA ACUST UNITED AC 2017; 10:77-86. [PMID: 28601956 DOI: 10.1007/s12402-017-0234-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 06/02/2017] [Indexed: 11/28/2022]
Abstract
The current study aims at documenting the psychometric properties of the Subjective Distress Associated with Adult ADHD-Self-Report (SDAAA-SR), a newly developed instrument for the assessment of psychological suffering in ADHD adults. The SDAAA-SR was administered to 247 students and 142 ADHD adults. Factor structure, internal consistency, test-retest reliability, convergent validity and discriminant validity were assessed. Sensitivity to change was examined in a subsample of 25 ADHD patients who participated in a 1-year therapy. The initial pool of 62 items was reduced to 33 items distributed in a three-component structure. Internal consistency was excellent for the "distress due to inattention/disorganization" subscale and good for the "distress due to hyperactivity/impulsivity" and "distress due to self-esteem deficit" subscales. Test-retest reliability in a subsample of 98 students was substantial for all three subscales. ADHD patients scored significantly higher than students on distress due to "inattention/disorganization" and "hyperactivity/impulsivity," but no difference was observed for "self-esteem deficit." The components "inattention/disorganization" and "hyperactivity/impulsivity" displayed moderate to large correlations with the corresponding dimensions of the Adult Self-Report Scale for ADHD (ASRS-V1.1). Distress due to "inattention/disorganization" and "self-esteem deficit" was significantly associated with lower satisfaction with social behaviors (QFS, social functioning questionnaire) and quality of life (WHOQOL-BREF). Distress due to "inattention/disorganization" and "self-esteem deficit" significantly decreased after a 1-year therapy. The SDAAA-SR represents a reliable and valid measure of adult ADHD-associated distress, an important but often undocumented parameter in the clinical setting. Its use as an outcome variable in psychological interventions deserves further investigation.
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Affiliation(s)
- Rosetta Nicastro
- TRE Program, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20 bis rue de Lausanne, 1201, Geneva, Switzerland.
| | | | - Paco Prada
- TRE Program, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20 bis rue de Lausanne, 1201, Geneva, Switzerland
| | - Sébastien Weibel
- TRE Program, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20 bis rue de Lausanne, 1201, Geneva, Switzerland
| | - Nader Perroud
- TRE Program, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20 bis rue de Lausanne, 1201, Geneva, Switzerland
| | - Marianne Gex-Fabry
- TRE Program, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 20 bis rue de Lausanne, 1201, Geneva, Switzerland
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De Bruyckere K, Bushe C, Bartel C, Berggren L, Kan CC, Dittmann RW. Relationships Between Functional Outcomes and Symptomatic Improvement in Atomoxetine-Treated Adult Patients with Attention-Deficit/Hyperactivity Disorder: Post Hoc Analysis of an Integrated Database. CNS Drugs 2016; 30:541-58. [PMID: 27224994 DOI: 10.1007/s40263-016-0346-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atomoxetine treatment is associated with improvements in functional outcomes in patients with attention-deficit/hyperactivity disorder (ADHD), although relationships between improvements in these outcomes and reductions in ADHD symptoms have not been comprehensively investigated in adults. OBJECTIVES The aim of this study was to assess relationships between functional outcomes and ADHD symptoms (primary objective), and to assess time courses of changes in functional outcomes from baseline to weeks 10 and 24 (secondary objective). METHODS We analyzed data pooled from seven Eli Lilly-sponsored placebo-controlled trials of atomoxetine in adults with ADHD that had Conners' Adult ADHD Rating Scales-Investigator Rated: Screening Version (CAARS-Inv:SV) total scores and functional outcome data at baseline and at week 10. Two trials also had these data at week 24. Patients were included in these pooled analyses if they had a CAARS-Inv:SV total score at baseline and at one or more post-baseline visits at weeks 10 or 24, or had post-baseline scores that would allow missing scores at weeks 10 or 24 to be imputed. To address the primary objective, changes in functional outcomes during treatment with atomoxetine versus placebo were assessed using last observation carried forward (LOCF) analysis of covariance (ANCOVA) and mixed-effects model repeated measures (MMRM) analysis, and correlations between score changes in CAARS-Inv:SV total and functional outcomes were assessed using Spearman's rank correlation coefficient (r) at weeks 10 and 24. The secondary objective was addressed using MMRM. RESULTS At baseline, patients generally had moderately severe or worse ADHD symptoms (based on CAARS-Inv:SV total scores) and impaired functional outcomes (based on Adult ADHD Quality-of-Life [AAQoL], Behavior Rating Inventory of Executive Function-Adult Version [BRIEF-A], Sheehan Disability Scale [SDS], and 36-item Short-Form Health Survey [SF-36] scores). These baseline characteristics were comparable in the atomoxetine and placebo groups. For atomoxetine versus placebo, statistically significant improvements were detected in AAQoL total and subscores at weeks 10 and 24, and in BRIEF-A Self-Report scores at week 10, but not in BRIEF-A Informant Report or SDS scores at week 10 (no BRIEF-A or SDS data were available at week 24), and not in SF-36 at weeks 10 or 24. All functional improvements were gradual. During treatment with atomoxetine, there were moderate correlations between reductions in CAARS-Inv:SV total scores and increases in AAQoL total and subscores at weeks 10 and 24 (r range -0.58 to -0.39; n = 394-545), and also with reductions in BRIEF-A Self-Report at week 10 (r = 0.49; n = 256). With placebo, moderate correlations were also found between reductions in CAARS-Inv:SV total scores and increases in AAQoL total and subscores at weeks 10 and 24 (r range -0.56 to -0.28; n = 321-542), and with reductions in BRIEF-A Self-Report at week 10 (r = 0.49; n = 271). However, correlations between changes in CAARS-Inv:SV and BRIEF-A Informant at week 10 were low for atomoxetine-treated patients (r = 0.25; n = 65), moderate with placebo (r = 0.42; n = 72), and there were low/no correlations between changes in CAARS-Inv:SV and functional outcome rating scales that are not specific to ADHD; that is, for atomoxetine-treated patients, SDS total r = 0.19 (n = 32 at week 10) and SF-36 r range - 0.20 to -0.01 (n = 51 at week 10, n = 183 at week 24). CONCLUSIONS Atomoxetine-treated adult patients experienced improvements in functional outcomes (AAQoL and BRIEF-A Self-Report) that correlated with reductions in ADHD symptoms. Although atomoxetine improved both the ADHD symptoms and functional outcomes, the correlation between symptoms and functional outcomes was low to moderate, suggesting that they measure overlapping but different aspects of the disorder. Hence, clinicians should assess not just ADHD symptoms, but also the functional impairments.
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Affiliation(s)
| | - Chris Bushe
- Medical Department, Lilly Research Centre, Eli Lilly, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey, GU20 6PH, United Kingdom.
| | | | - Lovisa Berggren
- Global Statistical Sciences, Eli Lilly, Bad Homburg, Germany
| | - Cornelis C Kan
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ralf W Dittmann
- Paediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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