Gender-based differences in prevalence and effects of ADHD in adults: A systematic review

Transgender Identity and Attention Deficit Hyperactivity Disorder Symptoms: Findings From the Adolescent Brain Cognitive Development Study

PURPOSE

The purpose of this study was to examine associations between identifying as transgender and attention deficit hyperactivity disorder (ADHD) symptoms in US early adolescents.

METHODS

We analyzed cross-sectional data from the Adolescent Brain Cognitive Development Study (Year 3, 2019-2021) to estimate associations between gender identity and ADHD symptoms using the Child Behavior Checklist Diagnostic and Statistical Manual of Mental Disorders-oriented attention problem scale scores, adjusting for age, sex, ethnicity, parent education, household income, and study site. Additional models adjusted for stress problems and depression symptoms. Multiple linear regression analyses estimated the association between gender identity and ADHD symptoms.

RESULTS

In a sample of 10,277 adolescents, mostly 12-13-year-olds, 1.0% self-identified as transgender and 1.1% self-identified as gender-questioning. Self-reported transgender status (B = 3.41; 95% confidence interval = 0.79-6.04; p = .011) and gender-questioning status (B = 2.72; 95% confidence interval = 0.79-4.65; p = .006) were both associated with higher ADHD symptom scores when compared to cisgender peers after adjusting for sociodemographic variables. In models adjusting for stress problems and depression as well as sociodemographic variables, the associations between transgender and gender-questioning status and ADHD symptoms were attenuated and no longer statistically significant.

DISCUSSION

Our results indicate that gender minority status may be linked to higher ADHD symptom scores, potentially due to higher minority stress.

Interpretable machine learning approaches for children's ADHD detection using clinical assessment data: an online web application deployment

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent mental disorder characterized by hyperactivity, impulsivity, and inattention. This study aims to develop a verifiable and interpretable machine learning model to identify ADHD and its subtypes in children using clinical assessment scales data.

METHODS

This study utilized the ADHD-200 dataset, including demographic data, Behavioral Rating Scale, and Wechsler Intelligence Scale assessments, to train and validate our models. The model's performance was evaluated using 10-fold cross-validation within the internal dataset, and the best model will be used for external validation. Seven machine learning models were evaluated. The SHapley Additive exPlanations (SHAP) method was employed for model interpretation. Finally, a web application will deploy the prediction model to provide ADHD probabilities based on user input.

RESULTS

The Random Forest (RF) model performing best in identifying ADHD and the Support Vector Machine (SVM) model excelling in distinguishing ADHD subtypes. The RF model achieved an AUC of 0.99 in 10-fold cross-validation and an AUC of 0.99 in external validation, and the SVM model achieved a micro-average AUC of 0.96 and an accuracy of 0.83 in internal validation and a micro-average AUC of 0.96 and an accuracy of 0.85 in external validation. We used SHAP to interpret the models, revealing that higher ADHD Index pushed the model towards ADHD classification. Additionally, lower IQ scores were correlated with a higher likelihood of ADHD, consistent with previous studies. The dependency analysis found that the model can identify different behavioral scales. We deployed the final model online using a web application and showed users how the model made decisions.

CONCLUSIONS

Our findings highlight the potential of using machine learning and clinical assessment scales to support the diagnosis and subtype identification of ADHD in children, offering a practical solution for improving diagnostic accuracy and efficiency in clinical settings.

An item-level systematic review of the presentation of ADHD in females

Previous studies examining sex differences in attention deficit hyperactivity disorder (ADHD) have primarily examined total or subscale scores. This systematic review aimed to examine which symptoms contribute to the female presentation of ADHD at an item-level. Six research literature databases were searched for studies comparing ADHD symptoms and their impact at an item-level in females with ADHD compared with: 1) males with ADHD and 2) females without ADHD. Thirteen studies were included. In childhood, females were more likely to display the symptoms 'fails to sustain attention in tasks' and 'often easily distracted', whereas males were more likely to display the symptoms 'often fidgets', 'difficulty remaining seated when required', 'runs/climbs in situations when inappropriate', 'always on the go', 'often noisy in playing', 'difficulty waiting turn', 'often blurts out answers' and 'often interrupts others'. In adulthood, females were more likely to endorse the symptoms 'easily distracted', 'difficulty organising tasks', 'blurts out answers' and 'talks excessively', as well as to report mind wandering and adverse home impacts. Females with ADHD differ in their symptom profile to males with ADHD, highlighting the need for future research to identify and characterise symptoms typical of female ADHD.

Occupational future time perspective and mental health problems across adolescence: Random-intercept cross-lagged panel analysis and alternative variations

INTRODUCTION

Adolescence is a crucial developmental stage characterized by escalating mental health issues as well as an increasing awareness of future career possibilities. Occupational future time perspective has been shown to be a promotive factor for social functioning and mental health, and a component in evidence-based clinical practices and randomized controlled trial intervention studies. However, it requires more rigorous and ecological corroboration from longitudinal analysis at the within-person level.

METHODS

Random intercept cross-lagged panel models with several adjustments and sensitivity analyses were applied to the longitudinal data from the Zurich Project on the Social Development from Childhood to Adulthood (Zurich, Switzerland), to analyze how occupational future time perspective and psychological/neurodevelopmental outcomes (attention deficit hyperactivity disorder symptoms/externalizing/internalizing problems) covaried across ages 13 (N = 1365), 15 (N = 1446), and 17 (N = 1305) in the years 2016, 2018, and 2020, after controlling for sex (52% male), SES, and school type.

RESULTS

A small effect was found in a random intercept cross-lagged panel model whereby occupational future time perspective at age 15 predicted externalizing problems at age 17 (β = .146, p = .05, [95% CI = 0.000, 0.292]), and in a random intercept (contemporaneous) reciprocal panel model specification attention deficit hyperactivity disorder symptoms at age 17 were contemporaneously associated with occupational future time perspective at age 17 (β = -.310, p < .05, [95% CI = -0.580, -0.041]). No cross-lagged associations were found to be robust across different model specifications/adjustments.

CONCLUSIONS

These findings suggest that improving occupational future time perspective may have limited impact on enhancing mental health, offering valuable insights for school-based interventions. Further research and replication are necessary to confirm these results.

Application of the international classification of functioning, disability, and health in autism and attention-deficit hyperactivity disorder: A scoping review

LAY ABSTRACT

The International Classification of Functioning, Disability, and Health (ICF) is a framework designed by the World Health Organization (WHO) to help different sectors, such as healthcare, social services, education, and policy, understand how people with health-related issues function (do the things they want to and need to do) in their daily lives. This framework has also been used to guide clinical practice and research in autism and attention-deficit hyperactivity disorder (ADHD). To make it more practical, shorter versions of the ICF called Core Sets have been developed. We wanted to explore how the ICF and the ICF Core Sets have been used in research relating to autism and ADHD. We looked at the research that had been previously published on this topic by conducting a systematic search and review. Seventy-eight studies meeting our criteria were included in our review. Results show that the ICF has been applied in many ways across various contexts. However, most of the research has focused on autism, mainly involving children. The review highlights that although the ICF was used in some studies, the underlying philosophies of the framework were not always followed. The medical perspective still influenced the way research was done and interpreted. Nevertheless, using the ICF in the right way can help shift research on neurodevelopmental conditions like autism and ADHD toward a more holistic approach, moving away from solely focusing on medical aspects.

ADHD and Academic Performance in College Students: A Systematic Review

OBJECTIVES

The present study performed a systematic review of the scientific literature that deals with the academic performance of university students with ADHD, collecting the research conducted between 2018 and 2024. Likewise, we aimed to know the factors that influence on academic performance and evaluate the tools used in the collection of ADHD symptoms and educational data.

METHODS

The electronic databases PubMed, PsycInfo, and Scopus were used to search studies using PRISMA guidelines. Quantitative studies selected had to discuss about academic performance in college students with ADHD. For each study, quality of evidence was examined using the Quality Assessment Tool of the National Heart Lung and Blood Institute.

RESULTS

Fifteen studies with good-fair quality were included in the review. These studies demonstrated that an ADHD diagnosis or significant ADHD symptoms are associated with lower academic performance in college students, particularly those with inattention symptoms. Additionally, factors such as executive functions, medication use, and study strategies also influence the academic performance of these students. The most commonly used instruments for the assessment of ADHD were the screening measures ADHD Self-Report Scale and the ADHD Rating Scale-Self Report Version. To assess academic performance half of the studies collected the Grade Point Average directly from university records, while in other studies, students were asked directly for their grades.

CONCLUSION

Overall, ADHD has a relevant impact on the academic performance of university students, but the evaluation methodology used has some differences with respect to child's evaluations procedures. Therefore, studies in this population must include not only self-reported symptomatology, but also assessments from clinicians specialized in adult ADHD.

Evaluation of Frontal QRS-T Angle in Children With ADHD and Healthy Controls

INTRODUCTION

Conflicting findings exist regarding the link between attention deficit hyperactivity disorder (ADHD) and cardiovascular diseases. This study aimed to evaluate the frontal QRS-T (fQRS-T) angle and its correlation with symptom severity in children diagnosed with ADHD.

METHODS

The study population consisted of 172 patients diagnosed with ADHD (120 drug naive and 52 drug positive) and 82 healthy controls. ADHD symptoms were assessed using the Atilla Turgay DSM-IV-Based Screening and Assessment Scale for Disruptive Conduct Disorders (T-DSM-IV-Scale). The fQRS-T angle and corrected QT (QTc) interval were obtained from the automated reports of 12-lead electrocardiography device for each patient.

RESULTS

QTc interval and fQRS-T angle were significantly different among the groups. Post hoc analyses showed that QTc interval and fQRS-T angle of ADHD drug naive and ADHD drug positive patients were significantly higher than the healthy control groups. However, there was no significant difference between drug naive and drug positive patients regarding QTc interval and fQRS-T angle. Both QTc interval and fQRS-T angle showed positive correlations with the severity of ADHD symptoms (r = 0.263, p = .001 and r = 0.175, p = .023 respectively).

CONCLUSION

We found that fQRS-T angle was significantly wider in children with ADHD. Therefore, we suggest that fQRS-T angle may help in cardiovascular risk assessment in children with ADHD.

Autism, ADHD, and Their Traits in Adults With Bulimia Nervosa and Binge Eating Disorder: A Scoping Review

OBJECTIVE

This review maps existing literature on the prevalence of autism and ADHD in adult patients with Bulimia Nervosa (BN) and Binge Eating Disorder (BED); patient and stakeholder perspectives on this comorbidity; clinical differences in this population; and potential treatment adaptations or adjunct therapies. This is with the aim to inform future research priorities to improve clinical practice.

METHOD

As pre-registered, and following PRISMA guidelines, six databases (Embase, MEDLINE via Ovid, PsycINFO, Web of Science, CENTRAL, and Scopus) were searched for studies regarding autism and/or ADHD (diagnosed, probable, or traits) in adult patients with BN or BED. Screening and data extraction were conducted twice independently for each record.

RESULTS

Twenty-nine studies were included, with 25,416 participants, mostly women (69.3%). Thirteen prevalence studies suggested autism and ADHD are more common in BN or BED than non-ED populations. One study explored the expert perspectives on autism and ADHD in BED, while 15 studies considered treatment options, mainly medications.

CONCLUSION

This review highlights a need for more research on the experiences, clinical differences, and non-medical treatment options for Autistic/ADHD patients with BN or BED. Findings suggest these conditions commonly co-occur but remain under-explored in terms of patient-centred interventions and clinical outcomes.

The effects of psychostimulants in menstruating women with ADHD - A gender health gap in ADHD treatment?

INTRODUCTION

Attention-deficit/hyperactivity disorder is a chronic disorder that begins in childhood and often persists into adulthood. There are clinical observations of a cycle-dependent efficacy of psychostimulants in the treatment of ADHD. This relationship appears to be poorly researched.

METHODS

A narrative literature review is used to provide an overview of the current state of research and to draw implications for necessary future research.

RESULTS

Two studies examined the influence of psychostimulants on female sex hormones in women with ADHD. Another four studies suggested that ADHD symptoms worsen during the luteal phase of the menstrual cycle. Two studies provided a specific intervention tailored to the menstrual cycle.

DISCUSSION

Women with ADHD remain understudied and are likely to be mistreated. Investigation of the efficacy of psychostimulants in menstruating women with ADHD seems necessary and long overdue.

CONCLUSION

This highlights the gender health gap in our society and the need for further research to develop an understanding of behavioural and neuroscientific processes in order to adapt treatment strategies for women with ADHD.

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.

How does the predictive capacity of a virtual-reality CPT for children with ADHD differ by country? A transcultural study with Argentine and Spanish Children

BACKGROUND

Although many studies have analyzed the effectiveness of novel Continuous Performance Tests (CPTs) in diagnosing ADHD, very few studies have examined how cultural factors influence that effectiveness.

AIMS

The present study aimed to analyze performance in a Virtual-Reality CPT in a sample of children resident in Spain and Argentina.

METHODS AND PROCEDURES

138 students participated in this study. They were aged between 6 and 16 years old, with a mean age of 10.38 (SD = 2.46) and had been diagnosed with ADHD.

OUTCOMES AND RESULTS

Commissions was the only significant variable in both discriminant models. In the Spanish population, the commissions variable was shown to correctly classify 49.4 % of the three types of ADHD presentation. However, in the Argentine population, the commissions variable correctly classified 68.3 %.

CONCLUSIONS AND IMPLICATIONS

These results may have been biased by the severity of the different types of presentation. In fact, it seems reasonable to think that the greater the severity, the better Aula Nesplora would predict the three types of presentation of ADHD. These results emphasize the need to consider other variables with a notable impact on daily life as children develop.

The risk of attention deficit hyperactivity disorder symptoms in offspring of mothers with perinatal depression: A systematic review and meta-analysis

BACKGROUND

The existing epidemiological evidence on the link between maternal depression and the risk of attention deficit and hyperactivity disorder (ADHD) symptoms in children lacks consistency. This systematic review and meta-analysis aimed to comprehensively synthesise the existing evidence on the relationship between maternal depression during the antenatal and postnatal periods and the risk of ADHD symptoms in offspring.

METHODS

We systematically searched PubMed, Medline, Embase, Scopus, CINAHL, and PsychINFO to identify relevant articles. Random-effects meta-analysis models were employed to estimate the pooled odds ratio (OR) along with 95 % confidence intervals (CI). Statistical heterogeneity was assessed using Cochrane's Q-test and I2-test. Subgroup analysis was conducted to explore potential sources of variation within the included studies. Publication bias was assessed using a funnel plot and Egger's test for regression asymmetry.

RESULTS

Twenty-one observational studies, comprising 796,157 mother-offspring pairs, were included in the final analysis. Our meta-analysis found a 67 % (OR = 1.67, 95 % CI = 1.35-2.00) and a 53 % (OR = 1.53, 95 % CI = 1.27-1.78) increased risk of ADHD symptoms in the offspring of mothers experiencing antenatal and postnatal depression, respectively.

CONCLUSION

Our systematic review and meta-analysis identified an elevated risk of ADHD symptoms in the offspring of mothers who experienced both antenatal and postnatal depression. These findings underscore the importance of early screening and targeted intervention programs for at-risk children and adolescents.

Sex differences in attention-deficit hyperactivity disorder diagnosis and clinical care: a national study of population healthcare records in Wales

BACKGROUND

Population-based studies have observed sex biases in the diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD). Females are less likely to be diagnosed or prescribed ADHD medication. This study uses national healthcare records, to investigate sex differences in diagnosis and clinical care in young people with ADHD, particularly regarding recognition and treatment of other mental health conditions.

METHODS

The cohort included individuals diagnosed with ADHD, born between 1989 and 2013 and living in Wales between 2000 and 2019. Routine primary and secondary healthcare record data were used to derive diagnoses of ADHD and other neurodevelopmental and mental health conditions, as well as ADHD and antidepressant medications. Demographic variables included ethnicity, socioeconomic deprivation and contact with social services.

RESULTS

There were 16,458 individuals diagnosed with ADHD (20.3% females, ages 3-30 years), with a male-to-female ratio of 3.9:1. Higher ratios (4.8:1) were seen in individuals diagnosed younger (<12 years), with the lowest ratio (1.9:1) in those diagnosed as adults (>18). Males were younger at first recorded ADHD diagnosis (mean = 10.9 vs. 12.6 years), more likely to be prescribed ADHD medication and younger at diagnosis of co-occurring neurodevelopmental conditions. In contrast, females were more likely to receive a diagnosis of anxiety, depression or another mental health condition and to be prescribed antidepressant medications, prior to ADHD diagnosis. These sex differences were largely stable across demographic groups.

CONCLUSIONS

This study adds to the evidence base that females with ADHD are experiencing later recognition and treatment of ADHD. The results indicate that this may be partly because of diagnostic overshadowing from other mental health conditions, such as anxiety and depression, or initial misdiagnosis. Further research and dissemination of findings to the public are needed to improve awareness, timely diagnosis and treatment of ADHD in females.

Chronic Tic Disorders in Youth: Clinical Phenotypes and Response to Pharmacological Treatment with Aripiprazole

BACKGROUND/OBJECTIVES

Tic disorders are neurodevelopmental conditions often associated with comorbidities like attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Our aims were: (a) in a sample of youth with tic disorders to explore the clinical and psychopathological characteristics of different phenotypes based on the presence of comorbid ADHD and/or ASD and gender; (b) in a subgroup of patients treated with Aripiprazole, to evaluate symptoms variation over time and to identify potential predictors of response.

METHODS

A total of 95 subjects with tic disorders (age range 6 to 17.9 years, mean 11.1 ± 2.11 years, 80 males) were naturalistically recruited. Questionnaires and semi-structured interviews were administered to assess the symptomatology and investigate the presence of psychiatric comorbidities (Clinic Global Impression-Severity (CGI-S), Children's Global Assessment Scale (C-GAS), Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), Child Yale-Brown Obsessive Compulsive Scale for Children (CYBOCS), Child Behavior Checklist 6-18 (CBCL 6-18), Conners' Parent Rating Scale-Revised-short form (CRSR-S), Reactivity Intensity Polarity Stability Questionnaire-youth version (RIPoSt-Y), and Social Communication Questionnaire-lifetime version (SCQ); Autism Diagnostic Observation Scale-second version (ADOS-2) and Autism Diagnostic Interview-revised version (ADI-R) were administered where ASD was suspected). A total of 22 subjects treated with Aripiprazole were reassessed through the use of some of the clinical measures used at baseline.

RESULTS

The presence of ADHD was associated with higher externalizing problem scores on the CBCL 6-18, while ASD was linked to higher internalizing problem scores. A positive correlation was found between the ADHD-ASD interaction and increased internalizing symptoms on CBCL 6-18 and higher ADOS-2 scores. Patients treated with Aripiprazole showed significant improvement across all scales during follow-up. ADHD was identified as a negative predictor of reduced tic severity on the YGTSS.

CONCLUSIONS

Comorbid neurodevelopmental disorders, such as ADHD or ASD, result in worse emotional and behavioral functioning in patients with tic disorders. ADHD-ASD interaction may be linked to more internalizing symptoms and autistic behaviors. Aripiprazole improves overall clinical outcomes, although comorbid ADHD may hinder the reduction of tic symptoms.

The prevalence of undiagnosed attention-deficit/hyperactivity disorder among undergraduate medical students: a survey from Pakistan

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is now acknowledged as a significant public health concern, a persistent neurodevelopmental disorder. It poses challenges across various life domains, persisting into adulthood, and is often undiagnosed. From July 2023 to December 2023, this study investigated the prevalence, types, participants' knowledge and perceptions, and demographic determinants of undiagnosed adult ADHD among undergraduate medical students in Pakistan.

METHODS

This cross-sectional study enrolled 342 undergraduate medical students who fulfilled the selection criteria. The data was collected using an online self-administered survey consisting of three main parts using the WHO 18-question Adult ADHD Self-Report Scale, Version 1.1 (ASRS-v1.1), to assess adult ADHD symptoms. Data analysis was conducted using SPSS (version 26.0).

RESULTS

119 medical students, or 34.8%, had adult ADHD. Inattentive dominance was the most prevalent presentation at (86, 72.3%), followed by mixed dominance at (20, 16.8%), and hyperactive dominance at (13, 10.9%). There was a statistically significant (p < 0.05) association between individuals who screened positive for adult ADHD and had co-occurring psychological disorders (e.g., anxiety, depression) and a family history of psychiatric disorders (e.g., ADHD, generalized anxiety disorder, bipolar disorder). Additionally, these individuals perceived that individuals with adult ADHD could live a normal life despite their condition. While the type of ADHD was significantly associated with the use of medications for psychological disorders, it was significantly higher among hyperactive dominants (5,71.4%), and the family history of GAD was significantly higher (2,10.0%) among mixed dominants.

CONCLUSION

This study reveals a significant prevalence of undiagnosed adult ADHD and an inattentive dominance among medical students in Pakistan, highlighting gaps in awareness and screening. These findings emphasize the crucial need for implementing ADHD screening programs.

Gender Matters: A Critical Piece in Mental Health

Gender is a socially constructed concept influenced by social practices, norms, and expectations. The impact of gender differences on mental health has been long recognized, with consequences such as over-diagnosis and pathologization or under-diagnosis of some disorders depending on gender. This also has implications for the treatments that each gender receives. In this narrative review, we will analyze (a) the gender differences in the prevalence of mental disorders, (b) the explanations for gender differences in mental health, including biological, social constructionist, and sociocultural risk factors, and (c) the gender differences in the treatment of mental disorders, including differences in health-seeking behavior and treatment outcomes. Overall, there is a consistent pattern of differences in prevalence, with women more likely to have internalizing disorders (e.g., anxiety or depression) and men more likely to have externalizing disorders (e.g., antisocial personality or substance use). The explanations aimed at disentangling the reasons for these gender differences are complex, and several approaches should be considered to achieve a comprehensive explanation. In addition to biological factors (e.g., hormonal changes), social constructionist factors (e.g., biased diagnostic criteria and clinicians' gender bias) and sociocultural factors (e.g., feminization of poverty, gender discrimination, violence against women, and prescriptive beauty standards) should be considered. Future studies in the field of mental health should consider gender differences and explore the bio-psycho-socio-cultural factors that may underlie these differences.

Sex and intelligence quotient differences in age of diagnosis among youth with attention-deficit hyperactivity disorder

OBJECTIVES

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental condition and is characterized by inattention, hyperactivity, and impulsivity. Research suggests that some populations, such as females and individuals with high intelligence quotients may be a risk for late ADHD diagnosis and subsequent treatment. Our goal is to advance our understanding of ADHD diagnosis, by examining (1) how child sex and cognitive abilities together are related to the age of diagnosis and (2) whether symptom presentation, current internalizing and externalizing symptoms, and demographic factors are related to age of diagnosis.

METHODS

Our analyses contained children who completed the required tests (N = 568) from a pre-existing dataset of 1380 children with ADHD from the Province of Ontario Neurodevelopmental Disorders (POND) Network (pond-network.ca). First, we conducted a moderation analysis with sex as the predictor, cognitive abilities as the moderator, and age of diagnosis as the outcome. Second, we conducted correlation analyses examining how symptom presentation, current internalizing and externalizing symptoms, and demographic factors are related to age of diagnosis.

RESULTS

Higher IQ was related to a later age of diagnosis. Higher hyperactive-impulsive symptoms and externalizing symptoms were related to an earlier age of diagnosis. Internalizing symptoms were trend associated with a later age of diagnosis in girls. Higher socioeconomic status and non-White maternal ethnicity were related to later age of diagnosis.

CONCLUSIONS

IQ, sex, ADHD symptomology, internalizing symptoms, externalizing symptoms, and socio-demographic factors affect the age of diagnosis.

Gender-specific motivational pathways in ADHD-related inattention and gaming disorder symptoms

Comorbidity between attention-deficit/hyperactivity disorder (ADHD) and gaming disorder (GD) is widely recognized in the literature. Previous research has indicated gender-dependent underlying mechanisms in the development and maintenance of problematic gaming. Motivational research presents an opportunity to provide further insight regarding the nature of this association. Self-report data were collected from videogame players (N = 14,740) using an online survey in collaboration with a popular gaming magazine. The survey included items concerning symptoms of ADHD and GD, motives for gaming, and time spent playing videogames. Structural equation modeling was used to create two parallel mediation models (one for males, one for females), including motives to play games as mediators. This was done to potentially explain psychological drivers of the association between ADHD and GD. Results demonstrated a common pathway from inattention to GD symptom severity through the immersion/escapism motivation for both males (β = 0.068; p < 0.001) and females (β = 0.081; p < 0.05), while the paths from inattention to GD symptom severity through the habit/boredom motive (β = 0.094; p < 0.001) and competition motive (β = 0.021; p < 0.001) were only significant for males. Gamers experiencing symptoms of ADHD, especially inattentive symptoms, are at risk of the occurrence of GD symptoms through videogames becoming a source of maladaptive coping with daily psychological disturbances. Males experiencing inattentive symptoms tend to additionally develop problematic patterns of use through videogame playing, becoming a subjectively meaningless and boredom-reduction-oriented habitual activity or a platform of virtual competition. Unique differences suggest the necessity of different treatment approaches for males and females.

Global burden of ADHD medication-associated cardiovascular disease, 1967-2023: A comparative analysis using the WHO pharmacovigilance database

BACKGROUND

Despite the widespread use of attention-deficit hyperactivity disorder (ADHD) medications and their known sympathomimetic effects on the cardiovascular system, cardiovascular risk assessment of these medications using comprehensive global data is limited. This study investigated the association between individual ADHD medications and cardiovascular disease (CVD) using global pharmacovigilance data.

METHODS

Reports from the World Health Organization international pharmacovigilance database were utilized (1967-2023; total reports, n=131,255,418). Reporting odds ratios (ROR), and information components (IC) were calculated to evaluate the association between each medication and specific CVDs.

RESULTS

We identified 13,344 CVD cases related to ADHD medications out of 146,489 cases of all reports on ADHD medications. Cumulative reports on ADHD medications have shown a steady increase, notably in adults since 2010. ADHD medications were associated with a higher risk of CVD overall (ROR [95 % CI], 1.60 [1.58-1.63]; IC [IC0.25], 0.63 [0.60]), with a higher association observed in females than in males. Among specific CVDs, all drugs were associated with an increased risk of torsade de pointes/QT prolongation, cardiomyopathy, and myocardial infarction. Conversely, heart failure, stroke, and cardiac death/shock were exclusively associated with amphetamines. Lisdexamfetamine showed a weaker association with all CVDs compared to amphetamines, and methylphenidate exhibited the lowest overall association with CVD. Atomoxetine had the second-highest association with torsade de pointes/QT prolongation.

CONCLUSIONS

The associations between CVDs and ADHD medications vary, with amphetamines posing a higher risk, while lisdexamfetamine and methylphenidate exhibit better safety profiles.

Metalinguistic and Reading Skills in a Sample of Colombian Children with Attention Deficit Hyperactivity Disorder

Objective: This study aimed to examine metalinguistic skills and reading processes in children diagnosed with ADHD, compared to a matched control group. Method: An explanatory experimental design was employed, involving a sample of 194 children from Manizales, comprising 97 children diagnosed with ADHD and 97 controls. The study utilized tasks from the Children's Neuropsychological Assessment (CNA) protocol to assess metalinguistic and reading abilities. Results: Children with ADHD exhibited significantly lower performance across all metalinguistic and reading tasks compared to the control group, except for spelling and silent reading comprehension tasks. Conclusions: These findings corroborate previous research conducted in Manizales, underscoring the specific challenges in metalinguistic and reading domains among children with ADHD. Future research should explore the influence of working memory on phonological awareness and its implications for metalinguistic skills and reading development.

Absent or Hidden? Hyperactivity in Females With ADHD

OBJECTIVE

This study aimed to objectively assess signs of hyperactivity in adults suspected of having ADHD, addressing potential sex bias in diagnosis.

METHODS

About 13,179 (49% female) adults with an average age of 33 years with ADHD and 1,910 (41% female) adults with an average age of 36 years without ADHD were included. Motor activity was measured using the Quantified Behavioral Test, analyzing "provoked," and "basal" activity. Sex by group differences were analyzed using analysis of variance.

RESULTS

Results showed significant ADHD effects on the basal and provoked activity measures, while sex effects were only notable for provoked activity. Males, irrespective of diagnosis, exhibited higher provoked activity than females, while both sexes with ADHD displayed approximately twice the basal activity and about three times the provoked activity compared to their respective sex controls.

CONCLUSION

These findings suggest that females with ADHD suffer equally from hyperactivity compared to males, challenging the notion of a sex-dependent presentation of hyperactivity. This may lead to more accurate and timely diagnoses, reducing ADHD-related burdens and comorbidities in females.

Position Paper: fragmented youth healthcare services in the Netherlands endanger treatment of teenage boys with psychiatric disorders

For children who show strongly deviant behaviour in the Netherlands, a distinction is made between behavioural problems and psychiatric problems. As a result, two different domains have emerged over time, each with its own legal frameworks and inclusion and exclusion criteria. Consequently, there is no well-organized, coherent system for youth mental health care in the Netherlands. This strong dichotomy raises the question whether patients are being admitted to facilities where they are receiving appropriate care. In addition, referral bias can arise, because the type of complaint with which a young person presents is often dependent on the type of coping of the individual and thus, in turn, the gender of the patient. In this Position Paper, we examined the gender distribution at a youth psychiatric high and intensive care (HIC-Y) and other streams of youth care in the Netherlands to explore possible inequities in access to psychiatric care among children and adolescents. Results show that girls are significantly more likely than boys to be admitted to the HIC-Y for suicidal thoughts, self-harm and emotional dysregulation. In fact, girls account for 80% of all admissions, while boys account for only 20%. In contrast, regional and national reports from youth services and probation show a majority of boys being admitted (56-89%). The way care is organized (lack of cross-domain collaboration and the interplay between gender-dependent coping and exclusion criteria) seems to play a role in the underrepresentation of boys in acute psychiatry and their overrepresentation in secure youth care. Based on our research results, the concern is raised whether boys have a greater chance of undertreatment for psychiatric problems. Further research is needed to better understand the underlying factors that contribute to gender bias in psychiatric admissions, and to develop interventions that promote gender equality in healthcare.

Validation of the dispositional adult hyperfocus questionnaire (AHQ-D)

Hyperfocus (HF), or intense, deep concentration on a task, has gained significant research attention in recent years, particularly in regard to clinical populations such as Attention-Deficit/Hyperactivity Disorder (ADHD). The present work aims to provide validation of the 12-item dispositional adult hyperfocus questionnaire (AHQ-D) as a quantitative metric of HF in adults. We preregistered the study design and hypotheses. We administered the AHQ-D and several additional questionnaires to 347 adults (mean ± SD age: 33 ± 11 years; 47% female). Exploratory factor analysis revealed high factor loadings (0.57-0.81) on a single HF factor; item response theory analysis suggested that the questionnaire items had high discrimination and covered a wide range of responses; and we report strong internal consistency metrics (Cronbach's alpha 0.93, mean split-half reliability 0.93). Replicating our previous work, HF was positively correlated with Conners' Adult ADHD Rating Scale (CAARS) scores (r(345) = 0.53), suggesting that HF may be related to ADHD traits (though in this sample we did not specifically recruit individuals with ADHD). The AHQ-D demonstrated the hypothesized convergent validity; HF on the AHQ-D was positively correlated with HF measured using a different HF scale (r(344) = 0.69), as well as flow (r(345) = 0.12) and mind wandering (r(345) = 0.39) scores. AHQ-D HF scores showed a weak negative correlation with grit (r(345) = - 0.29). Though there was a weak negative correlation between HF and social desirability response tendency (r(345) = - 0.24), suggesting that those who care more about what others think may report less HF, there was no relationship between HF and extrasensory perception beliefs (r(345) = 0.01), suggesting that participants were not simply biased in their response tendencies. Taken together, we demonstrate strong scale metrics for the AHQ-D, the expected convergent validity, and a general lack of response bias, in addition to replicating our previous association of HF with ADHD traits. We suggest that the AHQ-D can be confidently used in future work as a valid way to measure HF in adults.

Correlation of altered intrinsic functional connectivity with impaired self-regulation in children and adolescents with ADHD

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) has a high prevalence of co-occurring impaired self-regulation (dysregulation), exacerbating adverse outcomes. Neural correlates underlying impaired self-regulation in ADHD remain inconclusive. We aimed to investigate the impact of dysregulation on intrinsic functional connectivity (iFC) in children with ADHD and the correlation of iFC with dysregulation among children with ADHD relative to typically developing controls (TDC).

METHODS

Resting-state functional MRI data of 71 children with ADHD (11.38 ± 2.44 years) and 117 age-matched TDC were used in the final analysis. We restricted our analyses to resting-state networks (RSNs) of interest derived from independent component analysis. Impaired self-regulation was estimated based on the Child Behavioral Checklist-Dysregulation Profile.

RESULTS

Children with ADHD showed stronger iFC than TDC in the left frontoparietal network, somatomotor network (SMN), visual network (VIS), default-mode network (DMN), and dorsal attention network (DAN) (FWE-corrected alpha < 0.05). After adding dysregulation levels as an extra regressor, the ADHD group only showed stronger iFC in the VIS and SMN. ADHD children with high dysregulation had higher precuneus iFC within DMN than ADHD children with low dysregulation. Angular gyrus iFC within DMN was positively correlated with dysregulation in the ADHD group but negatively correlated with dysregulation in the TDC group. Functional network connectivity showed ADHD had a greater DMN-DAN connection than TDC, regardless of the dysregulation level.

CONCLUSIONS

Our findings suggest that DMN connectivity may contribute to impaired self-regulation in ADHD. Impaired self-regulation should be considered categorical and dimensional moderators for the neural correlates of altered iFC in ADHD.

Prevalence of adult attention deficit hyperactivity disorder in India: a systematic review and a cross-sectional study among young adults in Delhi-NCR

PURPOSE

The epidemiology of adult attention deficit hyperactivity disorder (ADHD) is not well explored in India. The present study aims to systematically review the literature on the prevalence of adult ADHD in India and also estimate the prevalence and sociodemographic correlates of adult ADHD among the young adults in Delhi-NCR.

METHODS

For the systematic review, 494 articles were identified of which 10 were included in the review. Simultaneously, a cross-sectional study was conducted involving 1665 adults (18-25 years; mean age 19.92) of both sexes (69.1% females) from different colleges in Delhi-NCR, India. Data was collected using structured interviews and standardized diagnostic tool ASRS V1.1 was used for screening of ADHD.

RESULT

The systematic review revealed a high prevalence of adult ADHD ranging from 5.48 to 25.7% among general and specific populations of India. Further, in the cross-sectional study, 14% of participants were screened positive for ADHD. While factors like South Indian origin and higher maternal education were associated with an increased risk of adult ADHD, low socioeconomic status was found to be protective.

CONCLUSION

Considering the high prevalence of adult ADHD in India, there is an urgent need to increase awareness regarding adult ADHD and identify vulnerable populations to facilitate informed interventions.

A chromosome region linked to neurodevelopmental disorders acts in distinct neuronal circuits in males and females to control locomotor behavior

Biological sex shapes the manifestation and progression of neurodevelopmental disorders (NDDs). These disorders often demonstrate male-specific vulnerabilities; however, the identification of underlying mechanisms remains a significant challenge in the field. Hemideletion of the 16p11.2 region (16p11.2 del/+) is associated with NDDs, and mice modeling 16p11.2 del/+ exhibit sex-specific striatum-related phenotypes relevant to NDDs. Striatal circuits, crucial for locomotor control, consist of two distinct pathways: the direct and indirect pathways originating from D1 dopamine receptor (D1R) and D2 dopamine receptor (D2R) expressing spiny projection neurons (SPNs), respectively. In this study, we define the impact of 16p11.2 del/+ on striatal circuits in male and female mice. Using snRNA-seq, we identify sex- and cell type-specific transcriptomic changes in the D1- and D2-SPNs of 16p11.2 del/+ mice, indicating distinct transcriptomic signatures in D1-SPNs and D2-SPNs in males and females, with a ∼5-fold greater impact in males. Further pathway analysis reveals differential gene expression changes in 16p11.2 del/+ male mice linked to synaptic plasticity in D1- and D2-SPNs and GABA signaling pathway changes in D1-SPNs. Consistent with our snRNA-seq study revealing changes in GABA signaling pathways, we observe distinct changes in miniature inhibitory postsynaptic currents (mIPSCs) in D1- and D2-SPNs from 16p11.2 del/+ male mice. Behaviorally, we utilize conditional genetic approaches to introduce the hemideletion selectively in either D1- or D2-SPNs and find that conditional hemideletion of genes in the 16p11.2 region in D2-SPNs causes hyperactivity in male mice, but hemideletion in D1-SPNs does not. Within the striatum, hemideletion of genes in D2-SPNs in the dorsal lateral striatum leads to hyperactivity in males, demonstrating the importance of this striatal region. Interestingly, conditional 16p11.2 del/+ within the cortex drives hyperactivity in both sexes. Our work reveals that a locus linked to NDDs acts in different striatal circuits, selectively impacting behavior in a sex- and cell type-specific manner, providing new insight into male vulnerability for NDDs.

Highlights

- 16p11.2 hemideletion (16p11.2 del/+) induces sex- and cell type-specific transcriptomic signatures in spiny projection neurons (SPNs). - Transcriptomic changes in GABA signaling in D1-SPNs align with changes in inhibitory synapse function. - 16p11.2 del/+ in D2-SPNs causes hyperactivity in males but not females. - 16p11.2 del/+ in D2-SPNs in the dorsal lateral striatum drives hyperactivity in males. - 16p11.2 del/+ in cortex drives hyperactivity in both sexes.

Graphic abstract

Dissecting 16p11.2 hemi-deletion to study sex-specific striatal phenotypes of neurodevelopmental disorders

Neurodevelopmental disorders (NDDs) are polygenic in nature and copy number variants (CNVs) are ideal candidates to study the nature of this polygenic risk. The disruption of striatal circuits is considered a central mechanism in NDDs. The 16p11.2 hemi-deletion (16p11.2 del/+) is one of the most common CNVs associated with NDD, and 16p11.2 del/+ mice show sex-specific striatum-related behavioral phenotypes. However, the critical genes among the 27 genes in the 16p11.2 region that underlie these phenotypes remain unknown. Previously, we applied a novel strategy to identify candidate genes associated with the sex-specific phenotypes of 16p11.2 del/+ mice and highlighted three genes within the deleted region: thousand and one amino acid protein kinase 2 (Taok2), seizure-related 6 homolog-like 2 (Sez6l2), and major vault protein (Mvp). Using CRISPR/Cas9, we generated mice carrying null mutations in Taok2, Sez6l2, and Mvp (3 gene hemi-deletion (3g del/+)). Hemi-deletion of these 3 genes recapitulates sex-specific behavioral alterations in striatum-dependent behavioral tasks observed in 16p11.2 del/+ mice, specifically male-specific hyperactivity and impaired motivation for reward seeking. Moreover, RNAseq analysis revealed that 3g del/+ mice exhibit gene expression changes in the striatum similar to 16p11.2 del/+ mice exclusively in males. Subsequent analysis identified translation dysregulation and/or extracellular signal-regulated kinase signaling as plausible molecular mechanisms underlying male-specific, striatum-dependent behavioral alterations. Interestingly, ribosomal profiling supported the notion of translation dysregulation in both 3g del/+ and 16p11.2 del/+ male mice. However, mice carrying a 4-gene deletion (with an additional deletion of Mapk3) exhibited fewer phenotypic similarities with 16p11.2 del/+ mice. Together, the mutation of 3 genes within the 16p11.2 region phenocopies striatal sex-specific phenotypes of 16p11.2 del/+ mice. These results support the importance of a polygenic approach to study NDDs and underscore that the effects of the large genetic deletions result from complex interactions between multiple candidate genes.

Perceived associations between the menstrual cycle and Attention Deficit Hyperactivity Disorder (ADHD): A qualitative interview study exploring lived experiences

BACKGROUND

The research gap regarding Attention Deficit Hyperactivity Disorder (ADHD) in people who were assigned female at birth has led to a lack of knowledge and adequate approaches in clinical practice, as well as diagnosis processes. Recent studies report potential associations between reproductive hormones and ADHD, but existing research remains scarce.

AIM

This study aims to explore the experiences of people who perceive an association between their menstrual cycle and their ADHD symptoms.

METHODOLOGY

Design and Method. A qualitative research design with an inductive approach was used. Ten participants were interviewed, using semi-structured, in-depth interviews. The data was transcribed, coded, and analyzed using reflexive thematic analysis according to Braun and Clarke.

RESULTS

Findings show participant's perceived associations between their ADHD and their menstrual cycle: participants reported experiencing ADHD symptom mor severe during the mid-luteal phase of the menstrual cycle. Other results showed uncertainty around ADHD medication in relation to the cycle and varied experiences with health care encounters as well as heightened challenged around menstrual health management.

CONCLUSIONS

This study provides insights to how perceived associations between ADHD and the menstrual cycle might be experienced. This report highlights the need for further research and theory about the potential associations between ADHD and reproductive hormones. The researchers strongly suggested that forthcoming ADHD studies consider times of key hormonal changes, such as puberty and menarche, menopause, hormonal birth control, pregnancy, hormone treatment, and more.

A Female-Specific Treatment Group for ADHD-Description of the Programme and Qualitative Analysis of First Experiences

Background: The diagnostics and treatment of attention-deficit/hyperactivity disorder (ADHD) in women remain insufficient. Fluctuations of reproductive hormones during the premenstrual period, postpartum period, and (peri)menopause are neglected, even though they impact ADHD symptoms and associated mood disorders. Therefore, we created a female-specific treatment group for women with ADHD and premenstrual worsening of ADHD and/or mood symptoms. Methods: We describe the group programme and underlying rationale, offering a qualitative analysis of the participants' evaluation. Results: The seven bi-weekly sessions foreground the menstrual cycle and address several ADHD-specific topics in relation to this cyclical pattern. Concurrently, women track their menstrual cycle and (fluctuating) ADHD and mood symptoms with an adjusted premenstrual calendar. In total, 18 women (25-47 years) participated in three consecutive groups. We analysed the evaluation of the last group. Participants experienced the group as a safe and welcoming space. Recognition was valued by all. The topics discussed were deemed valuable, and the structure suited them well. Completing the premenstrual calendar augmented the awareness and recognition of individual cyclical symptoms. A lifespan approach increased self-understanding. Participants took their menstrual cycle more seriously, prioritising self-acceptance and self-care. Conclusions: Exploring a cyclical approach in a group setting seems to be a positive addition to treatment for female ADHD.

Why are females less likely to be diagnosed with ADHD in childhood than males?

ADHD is less likely to be diagnosed in females than males, especially in childhood. Females also typically receive the diagnosis later than males and are less likely to be prescribed ADHD medication. Understanding why these sex differences in clinical care and treatment for ADHD occur is key to improving timely diagnosis in people affected by ADHD. This Personal View is a conceptual review synthesising literature on this topic. This publication considers potential biological explanations (eg, genetic factors), influence of diagnostic practices (eg, criteria suitability, diagnostic overshadowing, and sex-specific diagnostic thresholds), and sociocultural explanations (eg, sex differences in presentation and compensatory behaviours), for the observed sex differences in ADHD clinical practice. This Personal View also outlines future research directions for improving understanding of sex differences in recognition and diagnosis of ADHD.

[Spectrum of Complex Partial Performance Disorders in Patients with Mental Illnesses]

INTRODUCTION

Recent research highlights a high prevalence of minimal cerebral dysfunctions (MCD) in patients with mental disorders. Nonetheless, empirical understanding of minimal cerebral dysfunctions and diffuse neuropsychological impairments in adult patients remains limited.

METHOD

In our study, we examined 399 patients with diverse common mental disorders on minimal cerebral dysfunctions. 329 patients were in psychosomatic rehabilitation, 40 in forensic psychiatry, and 30 in an addiction ward of a psychiatric hospital at the time of the study. Symptom patterns and anamnesis of MCD and sociodemographic characteristics of the patients were recorded using structured questionnaires.

RESULTS

Overall, about 29% of all patients reported MCD symptoms. Patients with MCD reported greater problem burden in everyday coping (attention, arithmetic, memory, sensitivity to noise, orientation) and social interaction (outsider, excitability) than patients without partial performance disorders.

CONCLUSIONS

Patients with mental illness reported a heterogeneous pattern of minimal cerebral dysfunctions. These frequent disorders should be recognized in diagnostics and treatment. Further studies should investigate therapeutic approaches for MCD according to Baltes' Selective Optimization and Compensation model.

Prevalence of somatic diseases in adults with attention deficit hyperactivity disorder in Japan is highest in people aged ≥40 years with mental disorders: a cross-sectional study of a Japanese health insurance claims database

Introduction

Studies have reported an association between attention deficit hyperactivity disorder (ADHD) and somatic diseases; however, the correlation of mental disorders with the association between ADHD and somatic diseases remains uninvestigated. This study investigated and compared the prevalence of somatic diseases among adults with/without ADHD, stratified by the presence or absence of mental disorders.

Methods

This cross-sectional study (October 2020-September 2021), using data (June 2013-September 2021) from a Japanese health insurance claims database, included adult participants with a medical record of and receiving medication for ADHD (ADHD group); the control group (matched 1:5 by age/sex) comprised participants without ADHD. The prevalence and odds ratio (OR; ADHD versus control) of type 2 diabetes mellitus (T2DM), diabetes complications, hypertension, cardiovascular disease (CVD), dyslipidemia, gout and hyperuricemia, chronic obstructive pulmonary disease (COPD), non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH), and atopic dermatitis were investigated. Pooled ORs for stratified analysis were calculated using the Mantel-Haenszel method.

Results

In the matched analysis sets, the ORs for all somatic diseases were significantly higher for the ADHD group (n=15,028) versus the control group (n=74,796). On stratified analysis, the Mantel-Haenszel ORs were significant for NAFLD/NASH (1.53; 95% confidence interval [CI]: 1.34, 1.73), diabetes complications (1.39; 95% CI: 1.09, 1.77), and gout and hyperuricemia (1.34; 95% CI: 1.19, 1.51). Furthermore, the stratum-specific ORs for T2DM, hypertension, and dyslipidemia were >1 and <1 in the presence and absence of mental disorders, respectively. The prevalence of all somatic diseases except atopic dermatitis increased with age. For participants aged ≥40 years, the Mantel-Haenszel ORs were significant for all somatic diseases except CVD, COPD, and atopic dermatitis.

Conclusions

The prevalence of several somatic diseases, including chronic disorders, was high among adults with ADHD, particularly in those aged ≥40 years and those with mental disorders.

Aripiprazole and its adverse effects in the form of impulsive-compulsive behaviors: A systematic review of case reports

Aripiprazole is an efficacious treatment for both the positive and negative symptoms of schizophrenia and is also commonly used as a mood stabilizer. It is associated with better tolerability compared with other antipsychotics. However, there are reports of patients who experience problem gambling, hypersexuality, obsessive-compulsive symptoms, and other impulsive and/or compulsive behaviors as a result of aripiprazole administration and/or dosage increase. We aimed to do a systematic review of case reports published in this regard. After screening more than 6000 titles and abstracts in ten scientific search engines, we found 35 related records comprising 59 cases. The majority of cases (n = 42, 71.18%) were male, the mean age was 33.83 years (± 13.40), and the average daily dose of aripiprazole was 11.63 mg (± 6.94). The results of our review showed that the most frequently published impulsivity adverse effect of aripiprazole is gambling, followed by hypersexuality, obsessive-compulsive symptoms/disorder, problem eating, trichotillomania, problem shopping, and kleptomania. These symptoms were experienced both by patients who had previous problems in these areas and those who did not. In the majority of cases, the symptoms appeared within 30 days after aripiprazole administration started and ceased within 30 days of its discontinuation and/or dose decrease. Clinicians should be aware of impulsivity adverse effects, monitor them, and educate both patients and the family about them.

Prevalence of attention-deficit hyperactivity disorder in children, adolescents and adults in the Middle East and North Africa region: a systematic review and meta-analysis

OBJECTIVES

To systematically estimate the overall prevalence of attention-deficit hyperactivity disorder (ADHD) in children, adolescents and adults across the Middle East and North Africa (MENA) region.

DESIGN

Systematic review and meta-analysis conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement.

DATA SOURCES

Medline and Scopus databases were comprehensively and systematically searched between 1990 and February 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included all cross-sectional or cohort studies that diagnosed ADHD using validated diagnostic tools (eg, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, ADHD rating scales and ADHD diagnostic interview) or non-validated tools (eg, brain imaging techniques, computerised cognitive tests and quantitative electroencephalography).

DATA EXTRACTION AND SYNTHESIS

Two reviewers performed the data extraction independently using standardised data collection sheet. Newcastle-Ottawa Scale was used to assess the quality of the included studies. Individualised and pooled event rate and upper and lower limit at 95% CI were calculated according to the ADHD cases and the total sample size using a random-effect model. The subgroup prevalence analyses according to ADHD subtypes, gender, MENA country and age were also performed.

RESULTS

A total of 63 articles met the inclusion criteria involving 849 902 participants. The overall prevalence of ADHD was 10.3% (95% CI 0.081 to 0.129). The prevalence rate ranged from 1.3% (Yemen) to 22.2% (Iran). Subgroup analyses showed that the prevalence in adults was 13.5 and 10.1 in children and adolescents. Males exhibited significantly higher prevalence compared with females as these were 11.1% and 7%, respectively. Attention-deficit subtype was significantly the most prevalent (46.7%) compared with hyperactivity/impulsivity (33.7%) and combined types (20.6%).

CONCLUSION

The overall prevalence of ADHD was high in the MENA region. It is crucial to allocate more attention and resources towards the prevention and treatment of ADHD in children, adolescents and adults within the region.

[Attention deficit hyperactivity disorder in adults]

The article presents a review of scientific publications devoted to the study of the characteristics of the clinical picture and the dynamics of the main symptoms in adult patients with attention deficit hyperactivity disorder (ADHD). The authors present current data on the prevalence of this disease, leading clinical manifestations and the most common comorbid pathology. Research data on the impact of ADHD in adulthood on educational and professional activities are presented, and the economic and criminological aspects of ADHD are considered. The main methods of psychotherapeutic correction and pharmacological therapy are presented.

Lifetime ADHD symptoms highly prevalent in women with cardiovascular complaints. A cross-sectional study

Patients with Attention Deficit Hyperactivity Disorder (ADHD) are at greater cardiovascular risk. We investigated the association between ADHD symptoms and cardiovascular disease in women at a specialized Dutch cardiological clinic. Lifetime ADHD symptoms were found in 35% of women (n = 300) with cardiac complaints. Women with ADHD symptoms compared to those without were significantly younger but had no different cardiological profile. To protect women's health, further research and multidisciplinary cooperation is required to better understand the relationship between ADHD and cardiovascular disease.

Prevalence and Comorbidities of Adult Attention-deficit/hyperactivity Disorder in a Community Sample from Korea

Objective

: Attention-deficit/hyperactivity disorder (ADHD) is prevalent in adults, and psychiatric comorbidities are common in adults with ADHD. We aimed to examine the prevalence of adult ADHD with several common psychiatric conditions in a community sample in Korea and the association between adult ADHD and risk of psychiatric comorbidities.

Methods

: This study used a cross-sectional survey design. We provided supplementary and optional self-report questionnaires, including the Korean version of the World Health Organization Adult ADHD Self-Report Scale (ASRS) short screening scale, Patient Health Questionnaire-9 for screening for depression, Alcohol Use Disorders Identification Test alcohol consumption questions, and the Korean version of the Mood Disorders Questionnaire, to Korean adults who visited one of six centers of a large private healthcare company for the National General Health Examination.

Results

: A total of 17,799 subjects included in this study, and 430 (2.4%) were positive on the ASRS screen. ADHD was significantly associated with the 19-30-year-old age group (odds ratio [OR] = 3.938), lower income (OR = 1.298), depression (OR = 11.563), and bipolar disorder (OR = 3.162).

Conclusion

: Adult ADHD was highly associated with depression and bipolar disorder, suggesting that clinicians should carefully evaluate and treat such psychiatric disorders in adults with ADHD symptoms.

Low Persistence of Inattention Symptoms From Childhood to Adolescence: A Population-Based Study

OBJECTIVE

To investigate the persistence of dimensional measures of inattention in a population-based, gender-balanced sample of adolescents with parent reports of inattention from childhood and self-reports of inattention in adolescence.

METHOD

Adolescents, 16-19 years old, completed the Adult ADHD Self Report Scale. Their parents completed the Swanson, Nolan, and Pelham Rating Scale-4th Edition when they were 7-9 and 11-13 years old.

RESULTS

More severe inattention in boys than girls in childhood shifted to a female predominance in adolescence. The correlation between reports of inattention in childhood and adolescence was weak, with parent reports explaining only ~5% of the variance in the inattention score reported in adolescence.

CONCLUSION

The weak association between inattention in childhood and adolescence is consistent with the emerging challenges associated with being an adolescent, but the impact of shifts in informants, gender and age on symtpom presentations should be investigated in future studies.

Current and future directions of drug delivery for the treatment of mental illnesses

Mental illnesses including anxiety disorders, autism spectrum disorder, post-traumatic stress disorder, schizophrenia, depression, and others exact an immense toll on the healthcare system and society at large. Depression alone impacts 21 million adults and costs over $200 billion annually in the United States. However, pharmaceutical strategies to treat mental illnesses are lagging behind drug development in many other disease areas. Because many of the shortcomings of therapeutics for mental illness relate to delivery problems, drug delivery technologies have the potential to radically improve the effectiveness of therapeutics for these diseases. This review describes the current pharmacotherapeutic approaches to treating mental illnesses as well as drug delivery approaches that have improved existing therapies. Approaches to improve drug bioavailability, provide controlled release of therapeutics, and enable drug targeting to the central nervous system (CNS) will be highlighted. Moreover, next-generation delivery approaches such as environmentally-controlled release and interval/sequential drug release will be addressed. Based on the evolving landscape of the treatment of mental illnesses, the nascent field of drug delivery in mental health has tremendous potential for growth in terms of both economic and patient impact.

Alterations in the Glycan Composition of Serum Glycoproteins in Attention-Deficit Hyperactivity Disorder

Changes in protein glycosylation are associated with most biological processes, and the importance of glycomic analysis in the research of disorders is constantly increasing, including in the neurodevelopmental field. We glycoprofiled sera in 10 children with attention-deficit hyperactivity disorder (ADHD) and 10 matching healthy controls for 3 types of samples: whole serum, sera after depletion of abundant proteins (albumin and IgG), and isolated IgG. The analytical methods used were a lectin-based glycoprotein microarray enabling high-throughput glycan analysis and matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) as a standard method for the identification of glycan structures. For microarray analysis, the samples printed on microarray slides were incubated with biotinylated lectins and detected using the fluorescent conjugate of streptavidin by a microarray scanner. In the ADHD patient samples, we found increased antennary fucosylation, decreased di-/triantennary N-glycans with bisecting N-acetylglucosamine (GlcNAc), and decreased α2-3 sialylation. The results obtained by both independent methods were consistent. The study's sample size and design do not allow far-reaching conclusions to be drawn. In any case, there is a strong demand for a better and more comprehensive diagnosis of ADHD, and the obtained results emphasize that the presented approach brings new horizons to studying functional associations of glycan alterations in ADHD.

Dissecting 16p11.2 hemi-deletion to study sex-specific striatal phenotypes of neurodevelopmental disorders

Neurodevelopmental disorders (NDDs) are polygenic in nature and copy number variants (CNVs) are ideal candidates to study the nature of this polygenic risk. The disruption of striatal circuits is considered a central mechanism in NDDs. The 16p11.2 hemi-deletion (16p11.2 del) is one of the most common CNVs associated with NDD, and 16p11.2 del/+ mice show sex-specific striatum-related behavioral phenotypes. However, the critical genes among the 27 genes in the 16p11.2 region that underlie these phenotypes remain unknown. Previously, we applied a novel strategy to identify candidate genes associated with the sex-specific phenotypes of 16p11.2 del/+ mice and identified 3 genes of particular importance within the deleted region: thousand and one amino acid protein kinase 2 (Taok2), seizure-related 6 homolog-like 2 (Sez6l2), and major vault protein (Mvp). Using the CRISPR/Cas9 technique, we generated 3 gene hemi-deletion (3g del/+) mice carrying null mutations in Taok2, Sez6l2, and Mvp. We assessed striatum-dependent phenotypes of these 3g del/+ mice in behavioral, molecular, and imaging studies. Hemi-deletion of Taok2, Sez6l2, and Mvp induces sex-specific behavioral alterations in striatum-dependent behavioral tasks, specifically male-specific hyperactivity and impaired motivation for reward seeking, resembling behavioral phenotypes of 16p11.2 del/+ mice. Moreover, RNAseq analysis revealed that 3g del/+ mice exhibit gene expression changes in the striatum similar to 16p11.2 del/+ mice, but only in males. Pathway analysis identified ribosomal dysfunction and translation dysregulation as molecular mechanisms underlying male-specific, striatum-dependent behavioral alterations. Together, the mutation of 3 genes within the 16p11.2 region phenocopies striatal sex-specific phenotypes of 16p11.2 del/+ mice, unlike single gene mutation studies. These results support the importance of a polygenic approach to study NDDs and our novel strategy to identify genes of interest using gene expression patterns in brain regions, such as the striatum, which are impacted in these disorders.

Dissecting 16p11.2 hemi-deletion to study sex-specific striatal phenotypes of neurodevelopmental disorders

Neurodevelopmental disorders (NDDs) are polygenic in nature and copy number variants (CNVs) are ideal candidates to study the nature of this polygenic risk. The disruption of striatal circuits is considered a central mechanism in NDDs. The 16p11.2 hemi-deletion (16p11.2 del) is one of the most common CNVs associated with NDD, and 16p11.2 del/+ mice show sex-specific striatum-related behavioral phenotypes. However, the critical genes among the 27 genes in the 16p11.2 region that underlie these phenotypes remain unknown. Previously, we applied a novel strategy to identify candidate genes associated with the sex-specific phenotypes of 16p11.2 del/+ mice and identified 3 genes of particular importance within the deleted region: thousand and one amino acid protein kinase 2 ( Taok2 ), seizure-related 6 homolog-like 2 ( Sez6l2 ), and major vault protein ( Mvp ). Using the CRISPR/Cas9 technique, we generated 3 gene hemi-deletion (3g del/+) mice carrying null mutations in Taok2, Sez6l2 , and Mvp . We assessed striatum-dependent phenotypes of these 3g del/+ mice in behavioral, molecular, and imaging studies. Hemi-deletion of Taok2, Sez6l2 , and Mvp induces sex-specific behavioral alterations in striatum-dependent behavioral tasks, specifically male-specific hyperactivity and impaired motivation for reward seeking, resembling behavioral phenotypes of 16p11.2 del/+ mice. Moreover, RNAseq analysis revealed that 3g del/+ mice exhibit gene expression changes in the striatum similar to 16p11.2 del/+ mice, but only in males. Pathway analysis identified ribosomal dysfunction and translation dysregulation as molecular mechanisms underlying male-specific, striatum-dependent behavioral alterations. Together, the mutation of 3 genes within the 16p11.2 region phenocopies striatal sex-specific phenotypes of 16p11.2 del/+ mice, unlike single gene mutation studies. These results support the importance of a polygenic approach to study NDDs and our novel strategy to identify genes of interest using gene expression patterns in brain regions, such as the striatum, which are impacted in these disorders.