Subtype differences in adults with attention-deficit/hyperactivity disorder (ADHD) with regard to ADHD-symptoms, psychiatric comorbidity and psychosocial adjustment

Functional impairment and quality of life in newly diagnosed adults attending a tertiary ADHD clinic in Ireland

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.

Efficacy of Cognitive Behavioral Therapy Combined with Pharmacotherapy Versus Pharmacotherapy Alone in Adult ADHD: A Systematic Review and Meta-Analysis

BACKGROUND

ADHD diagnosis rates are rising; however, currently, no effective treatment method that has been identified. This study compared the efficacy of CBT + M with M for adult ADHD.

METHODS

PubMed, Embase, WOS, and Cochrane Library databases were searched up to July 29, 2023. Literature screening and data analysis were conducted.

RESULTS

The six randomized controlled studies included. Meta-analysis showed that CBT + M was more effective than M in improving ADHD symptoms. Subgroup analysis showed developed countries significant in ADHD symptoms improvement. At the 3-month, CBT + M was superior to M, but at the 6 and 9 months, no statistically significant differences were observed.

CONCLUSION

CBT + M is more effective than M in improving adult ADHD symptoms and maintains an advantage for at least 3 months. It is recommended to intensifying CBT treatment after 3 months. Country and economy may influence results. Combined therapy for ADHD should be prioritized in developed countries.

The effect of cognitive training on children with attention deficit and hyperactivity disorder: A meta-analysis

OBJECTIVE

This document is a meta-analysis of randomized controlled trials that evaluated the effect of cognitive training interventions on attention deficit and hyperactivity disorder (ADHD) symptoms.

METHODS

A systematic literature search was conducted using databases such as PubMed, Web of Science, and Embase from the inception of each database to April 28, 2022. Data were analyzed using Stata 15 software. The risk of bias assessment was conducted using five domains from the Cochrane Collaborations tool.

RESULTS

A total of 10 studies with 446 children with ADHD were included. The results showed that cognitive training was effective in improving attention symptoms [SMD= -0.78 (95% CI: -1.46, -0.1)] and executive function [SMD = -0.3 (95% CI: -0.56, -0.05)] in children with ADHD compared to controls. No significant difference in the degree of improvement in hyperactivity/impulsivity with cognitive training compared to the control group [SMD = -0.65 (95% CI: -1.35, 0.05)]. In addition, subgroup analyses also found that cognitive training significantly improved attention in children with ADHD <10 years of age [SMD = -1.3 (95% CI: -2.58, -0.02)] and children with ADHD with length of training >30 days [SMD = -0.94 (95% CI: -1.81, -0.07)] compared to controls.

CONCLUSION

This meta-analysis found that the beneficial effects of cognitive training on attention (particularly for children with ADHD <10 years old and >30 days of training) and executive function in children with ADHD, but not on hyperactivity/impulsivity.

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.

Perceived Social Support on the Relationship Between ADD/ADHD and Both Anxious and Depressive Symptoms Among Canadian Adults

OBJECTIVE

The primary goal of the present research was to examine whether the relationships that social support demonstrates with both anxiety and depression varied between adults with and without ADD/ADHD in a Canadian sample.

METHOD

Data were obtained from the 2012 Canadian Community Health Survey-Mental Health (N ≥ 16,354). Presence of social support, diagnosis of generalized anxiety disorder (GAD), and experience of major depressive episodes (MDEs) were estimated in the self-report ADD/ADHD and non-ADD/ADHD groups.

RESULTS

Although social support was negatively associated with having GAD or experiencing an MDE, and self-report ADD/ADHD was positively associated with these outcomes. Presence of self-report ADD/ADHD did not significantly modify the relationships between social support and GAD or MDE.

CONCLUSION

Social support may be a protective factor against symptoms of anxiety and depression in the general Canadian population, for adults with and without ADHD.

Alarmingly high prevalence and lack of gender differences in ADHD among high school students: Screening for ADHD with ASRS among adolescents and working adults

Introduction: The aim was to examine the psychometric properties of the Polish version of the Adult ADHD Self-Report Scale (ASRS) among adolescents and adult working populations of different genders, the prevalence of ADHD, and its relationship to stress.

Materials and methods: A sample of 723 professionally active people and 1744 high school students participated in the study. Part A of the Adult ADHD Self-Report Scale (ASRS) was used to measure ADHD and the 4-item Perceived Stress Scale (PSS-4) was used to measure stress.

Results: Confirmatory factor analyses showed that the original 6-item two-factor solution of ASRS Part A had a satisfactory fit and showed basic measurement invariance between age groups and genders. Inattention and hyperactivity were related mostly similarly to stress in all groups. The prevalence of ADHD among adolescents was much higher than in previous reports, and no gender differences were found. About every fifth high school student and every tenth adult showed a risk of ADHD. The potential cause of the difference in the prevalence in the studied groups can be generation change.

Conclusions: ASRS is a well-functioning screening measure with good psychometric properties. It is a convenient option for large-scale epidemiological surveys necessary to understand potential generational changes in the prevalence of ADHD and the lack of gender differences among adolescents.

Adult attention-deficit hyperactivity disorder among patients with substance use disorders

Background

Attention-deficit/hyperactivity disorder (ADHD) is a childhood neurodevelopmental disorder that persists into adulthood. ADHD is a well-known risk factor for substance use disorder (SUD). However, the actual contribution of comorbidity is largely unknown. The current study investigated the prevalence of ADHD in a sample of abstinent patients compared to healthy controls.

Compared to 51 healthy controls, 51 patients seeking medical treatment for SUD were abstinent from any substance for at least 1 month, interviewed by the use of the ICD-10 symptom checklist, the Social Classification Scale, the Addiction Severity Index, Conners adult ADHD Rating Scales Self-Report (CAARS-S:L), and the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL).

Results

Using CAARS-S:L, the ADHD index showed that 9 subjects (17.6%) were diagnosed with adult ADHD. Using K-SADS-PL, 8 of the participants (15.7%) were found to have an adult ADHD diagnosis. Lower scores of the ADHD index are related to increased patients’ age, while increased scores of the ADHD index are related to more alcohol-related problems of the patients. The strongest predicting factors of increased ADHD index were drug problems and legal status.

Conclusions

The current study provides evidence of an increased diagnosis of adult ADHD in patients with substance use disorder, regardless of the type of substance abuse.

Multimodal treatment efficacy differs in dependence of core symptom profiles in adult Attention-Deficit/Hyperactivity Disorder: An analysis of the randomized controlled COMPAS trial

There is broad consensus that to improve the treatment of adult Attention-Deficit/Hyperactivity Disorder (ADHD), the various therapy options need to be tailored more precisely to the individual patient's needs and specific symptoms. This post-hoc analysis evaluates the multimodal effects of first-line medication (methylphenidate [MPH] vs placebo [PLB]) and psychotherapeutic (group psychotherapy [GPT] vs clinical management [CM]) treatments on the ADHD core symptoms inattention, hyperactivity and impulsivity. For the two-by-two factorial, observer-blinded, multicenter, randomized controlled Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS; ISRCTN54096201), 419 outpatients with ADHD were considered for analysis. ADHD symptoms were assessed by blind observer-rated and patient-rated Conners Adult ADHD Rating Scales before treatment (T1), 13 weeks (T2) and 26 weeks (T3) after T1, at treatment completion after 52 weeks (T4), and at follow-up (130 weeks, T5). MPH was superior to PLB in improving symptoms of inattention at almost all endpoints (observer-rated T2, T3, T4, T5; patient-rated T2, T3, T4), while a significant decrease in hyperactivity and impulsivity was at first found after 6 months of treatment. CM compared to GPT decreased inattention and impulsivity in the early treatment phase only (observer-rated T2, patient-rated T2, T3). In conclusion, while MPH seems to have a direct and sustained effect on inattention, premature medication discontinuation should particularly be avoided in patients with hyperactive-impulsive symptoms. Also, especially in high inattention and/or impulsivity presentations, initial individual patient management might be beneficial. Consequently, considering individual core symptom profiles may enhance the efficacy of treatments in adult ADHD.

Methylphenidate significantly improves neurocognitive impairments in children with ADHD

This study aimed to investigate the effects of methylphenidate (MPH) on scores on a neurocognitive test battery for individuals with various presentations of attention deficit/hyperactivity disorder (ADHD) and the effect of comorbidities on executive function. This study included 861 children and adolescents aged 7-17 years who were diagnosed with ADHD according to DSM-V criteria. The CNS Vital Signs Battery was utilized to compare the neuropsychological characteristics and MPH treatment responses of patients with predominantly inattentive (ADHD-I) and combined (ADHD-C) presentations of ADHD. Before MPH administration, a statistically significant difference was observed between groups only for complex attention. In addition, the overall prevalence rate of psychiatric comorbidities was 45.5%, and no statistically significant differences were found in the ADHD-I group pre- versus post-MPH administration. Prior to the administration of MPH, statistically significant differences were observed within the ADHD-C group between those with or without comorbidities. However, after MPH administration, these differences between the groups disappeared. The effects of MPH on improving scores on neuropsychological subtests were similar between the groups with different presentations of ADHD. Additionally, MPH treatment was effective despite the presence of comorbidities.

The association between pragmatic language impairment, social cognition and emotion regulation skills in adolescents with ADHD

OBJECTIVE

Attention Deficit and Hyperactivity Disorder (ADHD) is associated with significant pragmatic language impairment and theory of mind deficits, but there are only a handful of studies have investigated the relationship between them in these conditions. This study aimed that investigate two different aspects of Theory of Mind (ToM) (ToM decoding and reasoning), pragmatic language impairment, and emotion regulation in patients with ADHD.

METHOD

Seventy adolescents with ADHD were compared to matched 64 healthy controls. We administered Social Responsiveness Scale-2 (SRS-2), Difficulties in Emotion Regulation Scale (DERS), Kiddie-SADS, Conners Parent Rating Scale, Children's Communication Checklist-2 (CCC-2), Faux Pas, Comprehension Test, and Reading Mind in the Eyes Test (RMET) to all study participants.

RESULTS

The CCC-2 scores were found to be statistically significantly higher in the ADHD group than in healthy controls. ADHD group had lower performance in the Faces Test and RMET compared to healthy controls, which did not survive from false discovery rate correction. We also found that CCC-2 performance and Conners scores were significant predictors of social responsiveness.

CONCLUSION

Our results point to widespread impairment in pragmatic language use and communication from many perspectives. These results might be important to understand the difficulties in social functioning and interpersonal relationship in adolescents with ADHD.Key pointsADHD is associated with significant impairment in pragmatic language use and social cognitive functions.ToM-Decoding (RMET) is impaired much more than ToM-Reasoning (Faux Pas) in ADHD.Pragmatic language skills and severity of ADHD may be significant predictors of social responsiveness.Emotion regulation problems may affect communication and pragmatic language use.

The subject matters: relations among types of anxiety, ADHD symptoms, math performance, and literacy performance

In this study, we extended a model of the relations among ADHD symptoms, anxiety, and academic performance. Undergraduates (N = 515) completed self-report measures of anxiety (i.e. trait, test, math, and literacy) and ADHD symptoms. During the study, they completed math and literacy measures and reported their current (i.e. state) anxiety three times. There were significant correlations among ADHD symptoms and all measures of anxiety. However, neither ADHD symptoms nor trait anxiety were correlated with math or literacy performance. Test-anxious students reported increasing state anxiety as the study progressed. In contrast, math-anxious students reported increased state anxiety following the math tasks but not the literacy tasks and literacy-anxious students reported increased state anxiety following the literacy tasks but not the math tasks. With respect to performance, math-anxious students had worse math performance and literacy-anxious students had worse literacy performance whereas test anxiety was not directly related to performance on either math or literacy tasks. Patterns of relations did not differ for men and women, but, except for literacy anxiety, women reported higher levels of all types of anxiety. These results could help educators understand how affective responses are related to university students' academic performance.

ADHD at the workplace: ADHD symptoms, diagnostic status, and work-related functioning

Adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) commonly experience impairments in multiple domains of daily living. Work has a central role in daily life and is susceptible to ADHD due to its cognitive demands. The present study seeks to examine the nature of work-related problems and impairments of adults with ADHD, and explores the association to ADHD symptoms and neuropsychological test performance. A community sample of 1231 individuals took part in this study and completed a set of questionnaires assessing ADHD symptoms and work-related problems. Furthermore, a clinical sample of 134 adults diagnosed with ADHD were recruited from an ADHD outpatient clinic, who completed the same set of questionnaires. A subsample of 51 patients with ADHD additionally performed a neuropsychological assessment using tests of attention and executive functions. Work-related problems were found both in individuals of the community sample with symptoms of ADHD and individuals diagnosed with ADHD. Individuals with ADHD reported work related problems particularly in not meeting their own standards and perceived potential, yet it less commonly manifests in negative performance evaluations at work or job loss. ADHD symptoms, in particular symptoms of inattention, were found to be strongly associated with work-related problems, whereas neuropsychological test performance was no meaningful predictor of functioning at work. This study emphasizes the susceptibility of individuals’ functioning at work to ADHD symptoms and impairments associated with ADHD. ADHD related difficulties at work should be considered in the clinical evaluation and targeted screening at the work place to provide support when indicated.

Attention-deficit/hyperactivity disorder and the explore/exploit trade-off

The ability to maximize rewards and minimize the costs of obtaining them is vital to making advantageous explore/exploit decisions. Exploratory decisions are theorized to be greater among individuals with attention-deficit/hyperactivity disorder (ADHD), potentially due to deficient catecholamine transmission. Here, we examined the effects of ADHD status and methylphenidate, a common ADHD medication, on explore/exploit decisions using a 6-armed bandit task. We hypothesized that ADHD participants would make more exploratory decisions than controls, and that MPH would reduce group differences. On separate study days, adults with (n = 26) and without (n = 23) ADHD completed the bandit task at baseline, and after methylphenidate or placebo in counter-balanced order. Explore/exploit decisions were modeled using reinforcement learning algorithms. ADHD participants made more exploratory decisions (i.e., chose options without the highest expected reward value) and earned fewer points than controls in all three study days, and methylphenidate did not affect these outcomes. Baseline exploratory choices were positively associated with hyperactive ADHD symptoms across all participants. These results support several theoretical models of increased exploratory choices in ADHD and suggest the unexplained variance in ADHD decisions may be due to less value tracking. The inability to suppress actions with little to no reward value may be a key feature of hyperactive ADHD symptoms.

Comorbidity of ADHD and adult bipolar disorder: A systematic review and meta-analysis

Attention-deficit / hyperactivity disorder (ADHD) and Bipolar Disorder (BD) are common mental disorders with a high degree of comorbidity. However, no systematic review with meta-analysis has aimed to quantify the degree of comorbidity between both disorders. To this end we performed a systematic search of the literature in October 2020. In a meta-analysis of 71 studies with 646,766 participants from 18 countries, it was found that about one in thirteen adults with ADHD was also diagnosed with BD (7.95 %; 95 % CI: 5.31-11.06), and nearly one in six adults with BD had ADHD (17.11 %; 95 % CI: 13.05-21.59 %). Substantial heterogeneity of comorbidity rates was present, highlighting the importance of contextual factors: Heterogeneity could partially be explained by diagnostic system, sample size and geographical location. Age of BD onset occurred earlier in patients with comorbid ADHD (3.96 years; 95 % CI: 2.65-5.26, p < 0.001). Cultural and methodological differences deserve attention for evaluating diagnostic criteria and clinicians should be aware of the high comorbidity rates to prevent misdiagnosis and provide optimal care for both disorders.

Attention Networks in ADHD Adults after Working Memory Training with a Dual n-Back Task

Patients affected by Attention-Deficit/Hyperactivity Disorder (ADHD) are characterized by impaired executive functioning and/or attention deficits. Our study aim is to determine whether the outcomes measured by the Attention Network Task (ANT), i.e., the reaction times (RTs) to specific target and cue conditions and alerting, orienting, and conflict (or executive control) effects are affected by cognitive training with a Dual n-back task. We considered three groups of young adult participants: ADHD patients without medication (ADHD), ADHD with medication (MADHD), and age/education-matched controls. Working memory training consisted of a daily practice of 20 blocks of Dual n-back task (approximately 30 min per day) for 20 days within one month. Participants of each group were randomly assigned into two subgroups, the first one with an adaptive mode of difficulty (adaptive training), while the second was blocked at the level 1 during the whole training phase (1-back task, baseline training). Alerting and orienting effects were not modified by working memory training. The dimensional analysis showed that after baseline training, the lesser the severity of the hyperactive-impulsive symptoms, the larger the improvement of reaction times on trials with high executive control/conflict demand (i.e., what is called Conflict Effect), irrespective of the participants’ group. In the categorical analysis, we observed the improvement in such Conflict Effect after the adaptive training in adult ADHD patients irrespective of their medication, but not in controls. The ex-Gaussian analysis of RT and RT variability showed that the improvement in the Conflict Effect correlated with a decrease in the proportion of extreme slow responses. The Dual n-back task in the adaptive mode offers as a promising candidate for a cognitive remediation of adult ADHD patients without pharmaceutical medication.

Driving Accidents, Driving Violations, Symptoms of Attention-Deficit-Hyperactivity (ADHD) and Attentional Network Tasks

Background: Iran has serious problems with traffic-related injuries and death. A major reason for traffic accidents is cognitive failure due to deficits in attention. In this study, we investigated the associations between traffic violations, traffic accidents, symptoms of attention-deficit/hyperactivity disorder (ADHD), age, and on an attentional network task in a sample of Iranian adults. Methods: A total of 274 participants (mean age: 31.37 years; 80.7% males) completed questionnaires covering demographic information, driving violations, traffic accidents, and symptoms of ADHD. In addition, they underwent an objective attentional network task (ANT), based on Posner’s concept of attentional networks. Results: More frequent traffic violations, correlated with lower age and poorer performance on the attentional network tasks. Higher symptoms of ADHD were associated with more accidents and more traffic violations, but not with the performance of the attentional tasks. Higher ADHD scores, a poorer performance on attentional network tasks, and younger age predicted traffic violations. Only higher symptoms of ADHD predicted more traffic accidents. Conclusions: In a sample of Iranian drivers, self-rated symptoms of ADHD appeared to be associated with traffic violations and accidents, while symptoms of ADHD were unrelated to objectively assessed performance on an attentional network task. Poor attentional network performance was a significant predictor of traffic violations but not of accidents. To increase traffic safety, both symptoms of ADHD and attentional network performance appear to merit particular attention.

The effect of serotonin transporter gene promoter polymorphism on adolescent and adult ADHD symptoms and educational attainment: A longitudinal study

Introduction:

The purpose of this longitudinal study was to investigate the relationship between the 5-HTTLPR genotype, symptoms of ADHD in adolescence and adulthood, and educational attainment in a population representative sample. Neuroticism, depressive symptoms and general mental abilities were controlled for as possible confounding factors.

Methods:

ADHD symptoms were reported at age 15 and 18 by teachers using the Hyperactivity Scale of af Klinteberg and SNAP-IV, and self-reported at age 25 using the ASRS. Data about education were reported at age 25.

Results:

At age 15, subjects with the l/l genotype had more concentration difficulties compared to s-allele carriers, and they also had more inattention symptoms according to SNAP-IV at age 18. These results were not altered by taking neuroticism or depressive symptoms into account. No 5-HTTLPR genotype effect on self-reported ADHD symptoms at age 25 was found. Inattention symptoms in adolescence were associated with lower education in young adulthood. The proportion of subjects with higher education at age 25 was significantly larger among s/s genotype compared to the l/l or s/l genotype.

Conclusions:

The l/l genotype of the 5-HTTLPR is associated with inattentive symptoms during adolescence in the general population, and increases the likelihood of inferior educational level in young adulthood.

The Implementation of Extended Examination Duration for Students With ADHD in Higher Education

OBJECTIVE

Recently, research indicated that extended examination duration was perceived as effective by students with ADHD. However, the objective effectiveness of this accommodation has not been researched extensively. This study addresses this gap in literature.

METHOD

A total of 30 students with ADHD and 30 matched typically developing controls (TDC) participated in a simulation of a real-life examination. They filled in three parallel versions of a paper-and-pencil test in three time conditions: 1 hr (+0%), 1 hr 20 min (+33%), and 1 hr 30 min (+50%).

RESULTS

When granted extended examination duration, students with ADHD and TDC use extra time but their performance does not increase. In addition, test-taking strategies were altered to a limited extent, and strategies that are perceived as effective (e.g., marking key words) were rarely used by the students.

CONCLUSION

It is concluded that extended examination duration is not objectively effective in an experimental design. Limitations and guidelines for future research are formulated.

Probabilities of ADD/ADHD and Related Substance Use Among Canadian Adults

Objective: The aim of this study was to estimate the prevalence and probabilities of comorbidities between self-reported ADD/ADHD and smoking, alcohol binge drinking, and substance use disorders (SUDs) from a national Canadian sample. Method: Data were taken from the Public Use Microdata File of the 2012 Canadian Community Health Survey-Mental Health (N = 17 311). The prevalence of (a) smoking, (b) alcohol binge drinking, and (c) SUDs was estimated among those with an ADD/ADHD diagnosis versus those without an ADD/ADHD diagnosis. Results: After controlling for potential socioeconomic and mental health covariates, self-reported ADD/ADHD acted as a significant predictor for group membership in the heaviest smoking, heaviest drinking, and heaviest drug usage categories. Conclusion: Individuals self-reporting a diagnosis of ADD/ADHD were found to have a significantly higher likelihood of engaging in smoking and alcohol binge drinking, and were more likely to meet criteria for SUDs than individuals not reporting an ADD/ADHD diagnosis.

Impact of Sex and ADHD Status on Psychiatric Comorbidity in Treatment-Seeking Alcoholics

Objective: To assess for intrasex and intersex differences in psychiatric comorbidity according to ADHD status in treatment-seeking adults with alcohol use disorders (AUDs). Method: This study was a secondary analysis of data utilizing descriptive statistics from 472 treatment-seeking alcoholics who completed the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Results: The prevalence of ADHD in males and females was 6.0% and 6.4%, respectively. Males with ADHD and AUDs had higher rates of current and lifetime drug use disorders, current depressive disorders, and current and lifetime anxiety disorders than male alcoholics without ADHD. No intrasex differences in psychiatric comorbidities were identified in female alcoholics with respect to ADHD status. Males with ADHD and AUDs were more likely to have had opioid dependence than ADHD-positive females. No other intersex differences were found. Conclusion: Positive ADHD status was associated with increased psychiatric comorbidity among treatment-seeking alcoholic men.

Exploring the Relationships Between Problem Gambling and ADHD: A Meta-Analysis

Objective: At present, there are inconsistencies in the literature pertaining to the association between ADHD and problem gambling. This study utilized meta-analytic techniques to clarify the association between symptoms of problem gambling and symptoms of ADHD. Method: Several meta-analyses were conducted using a random effects model. PsycINFO, PubMed, ProQuest Dissertations & Theses, and Google Scholar were searched for relevant studies. Results: The weighted mean correlation between ADHD symptomology and gambling severity was r = .17, 95% confidence interval (CI) = [0.12, 0.22], p < .001. Mean age of the sample was the only moderator to approach significance, with greater age being linked to a stronger relationship between symptoms of ADHD and gambling severity. Conclusion: Clinicians needs to be cognizant of the greater risk of ADHD symptoms when working with problem gamblers and vice versa.

The importance of avoidant personality in social anxiety disorder with and without attention-deficit/hyperactivity disorder

In the present study, our primary aim was to compare the generalized social anxiety (GSAD) patients with and without attention-deficit/hyperactivity disorder (ADHD) in terms of avoidant personality disorder (AVPD), and some clinical variables. We also investigated the relationship of AVPD and depression with ADHD and GSAD. We hypothesized that ADHD may be associated with AVPD in patients with GSAD. Seventy-six patients with GSAD were evaluated for depression, AVPD, and childhood and adulthood diagnoses of ADHD. The GSAD patients with (n = 34) and without adulthood ADHD (n = 30) were compared with respect to some sociodemographic and clinical variables. GSAD patients with adulthood ADHD had significantly higher comorbid diagnosis of AVPD, more avoidant personality and depression symptoms than those without ADHD. Pearson's correlation coefficient in total sample (n = 76) showed that the mean number of AVPD criteria was significantly associated with the severity of Beck Depression Inventory, Wender Utah Rating Scale (WURS), and inattention symptoms of ADHD. There were no correlations between the total and subscale scores of Liebowitz Social Anxiety Scale and the mean number of AVPD criteria. The scores of WURS significantly predicted the mean number of AVPD criteria (β = 0.305, p= 0.007). The severity of current depression (β = 0.143, p = 0.30) and inattention symptoms of adulthood ADHD (β = 0.112, p = 0.46) were not associated with the severity of AVPD symptoms. These results might demonstrate that comorbid AVPD in adult SAD patients was related to a childhood ADHD independent from depression, and inattention symptoms of ADHD in adulthood.

Learning Disorder Confers Setting-Specific Treatment Resistance for Children with ADHD, Predominantly Inattentive Presentation

Attention deficit/hyperactivity disorder-predominantly inattentive presentation (ADHD-I) and specific learning disorder (SLD) are commonly co-occurring conditions. Despite the considerable diagnostic overlap, the effect of SLD comorbidity on outcomes of behavioral interventions for ADHD-I remains critically understudied. The current study examines the effect of reading or math SLD comorbidity in 35 children with comorbid ADHD-I+SLD and 39 children with ADHD-I only following a behavioral treatment integrated across home and school (Child Life and Attention Skills [CLAS]). Pre- and posttreatment outcome measures included teacher-rated inattention, organizational deficits, and study skills and parent-rated inattention, organizational deficits, and homework problems. A similar pattern emerged across all teacher-rated measures: Children with ADHD-I and comorbid ADHD-I+SLD did not differ significantly at baseline, but between-group differences were evident following the CLAS intervention. Specifically, children with ADHD-I and comorbid ADHD-I+SLD improved on teacher-rated measures following the CLAS intervention, but children with ADHD-I only experienced greater improvement relative to those with a comorbid SLD. No significant interactions were observed on parent-rated measures-all children improved following the CLAS intervention on parent-rated measures, regardless of SLD status. The current results reveal that children with ADHD-I+SLD comorbidity benefit significantly from multimodal behavioral interventions, although improvements in the school setting are attenuated significantly. A treatment-resistant fraction of inattention was identified only in the SLD group, implying that this fraction is related to SLD and becomes apparent only when behavioral intervention for ADHD is administered.

Influence of Psychopharmacotherapy on the Quality of Life of Children with Attention-Deficit/Hyperactivity Disorder

Objective: Attention-deficit/hyperactivity disorder (ADHD) may have a lasting effect on the quality of life (QoL) of children and their parents. Children with ADHD as well as their parents report a lower QoL compared with healthy children and children with chronic diseases such as bronchial asthma. The primary objective of this study was to investigate the changes of QoL of children with ADHD and their parents' subjective well-being before and after starting pharmacotherapy. We used the appropriate KINDL questionnaire for assessing the children's QoL and the World Health Organization (WHO) Big Five Questionnaire for assessing parental well-being. Methods: We assessed the QoL and the parental well-being in 60 children and adolescents with ADHD between the ages of 6 and 12 years [mean age 8.7 years, (standard deviation = 1.8)], treated at the Department of Child and Adolescent Psychiatry of the Medical University of Vienna. QoL was rated using the KINDL questionnaires, and parental well-being was assessed using the WHO Big Five Questionnaire (WHO-5) before and after starting pharmacotherapy. We used t-tests and three-way GLM-ANOVA (SPSS, version 22; IBM Corp.) for evaluating the statistical significance of pre-post differences. Results: The QoL of the children with ADHD and the subjective well-being of the parents improved significantly after introducing pharmacotherapy. Conclusions: Pharmacotherapy is recommended in children with clinically significant ADHD not only because it helps to improve the symptoms of ADHD, but also their QoL and the well-being of their parents.

Associations Between ADHD Symptoms and Occupational, Interpersonal, and Daily Life Impairments Among Pregnant Women

OBJECTIVE

Past research links symptoms of depression and anxiety with functional impairments among pregnant women. However, no prior research has examined the impact of ADHD symptoms among this population. The current study examines associations between ADHD symptoms and impairment in several life domains.

METHOD

Self-report measures of ADHD symptoms, impairment, and demographic information were collected from 250 pregnant women at an urban women's health clinic in the Southeast. Data were assessed using multivariate path analysis.

RESULTS

Inattentive symptoms were significant predictors of professional life impairment, daily life impairment, and relationship impairment. Impulsivity uniquely predicted variability in professional life impairment and relationship impairment. Hyperactivity was not a significant predictor.

CONCLUSION

Future research should focus on the mechanisms by which inattention and impulsivity affect daily functioning in pregnant women, in addition to investigating potential interventions. Health care professionals should assess for impulsivity and inattention among pregnant women.

Psychiatric comorbid patterns in adults with attention-deficit hyperactivity disorder: Treatment effect and subtypes

Psychiatric comorbidities are common in individuals with attention-deficit/hyperactivity disorder (ADHD). In this study, we sought to evaluate the effects of medication and childhood ADHD subtypes on psychiatric comorbidities among adults with ADHD as compared to healthy adult controls. We assessed 121 drug-naïve adults with ADHD, 93 treated adults with ADHD, and 145 healthy controls (age 18–36 years) using semi-structured psychiatric interviews, intelligence tests, and medical records. Drug-naïve adults with ADHD had more comorbidities than treated adults with ADHD and controls. Childhood ADHD-combined subtype, relative to ADHD-inattentive subtype, was associated with higher risks of comorbidities. Current medication treatment was associate with a higher risk for anxiety disorders, and longer treatment duration was associated with lower risks of mood disorders and sleep disorders. Our results indicate that no medication treatment, short treatment duration, and childhood ADHD-combined subtype are associated with increased risks for psychiatric comorbidities among adults with ADHD.

Subtypes of stuttering determined by latent class analysis in two Swiss epidemiological surveys

Aims

Associations between stuttering in childhood and a broad spectrum of risk factors, associated factors and comorbidities were examined in two large epidemiological studies. Subtypes of stuttering were then identified based on latent class analysis (LCA).

Methods

Data were from two representative Swiss population samples: PsyCoLaus (N = 4,874, age 35–82 years) and the ZInEP Epidemiology Survey (N = 1,500, age 20–41 years). Associations between stuttering and sociodemographic characteristics, familial aggregation, comorbidity and psychosocial risk / associated factors were investigated in both samples. LCAs were conducted on selected items from people in both samples who reported having stuttered in childhood.

Results

Initial analyses linked early anxiety disorders, such as separation anxiety disorder and overanxious disorder, to stuttering (PsyCoLaus). ADHD was associated with stuttering in both datasets. In the analyses of risk / associated factors, dysfunctional parental relationships, inter-parental violence and further childhood adversities were mutual predictors of stuttering. Moreover, comorbidities were seen with hay fever, asthma, eczema and psoriasis (PsyCoLaus). Subsequent LCA identified an unspecific group of persons who self-reported that they stuttered and a group defined by associations with psychosocial adversities (ZINEP, PsyCoLaus) and atopic diseases (PsyCoLaus).

Conclusions

The two subtypes of developmental stuttering have different risk / associated factors and comorbidity patterns. Most of the factors are associated with vulnerability mechanisms that occur early in life and that have also been linked with other neurodevelopmental disorders. Both psychosocial and biological factors appear to be involved in the etiopathogenesis of stuttering.

Mindfulness vs psychoeducation in adult ADHD: a randomized controlled trial

BACKGROUND

Mindfulness training is a promising treatment approach in adult ADHD. However, there has not yet been a randomized controlled trial comparing mindfulness to an active control condition. In this study, we assessed the efficacy of a mindfulness training program (MAP) compared to structured psychoeducation (PE).

METHODS

After randomization 81 medication-free adult ADHD patients participated either in an 8-week MAP or PE group program. At baseline (T1), after 8 weeks (T2) and after 8 months (T3), severity of ADHD and associated symptoms (depression, general psychopathology, quality of life) were measured with the Conner's ADHD Rating Scales (CAARS), the Beck Depression Inventory (BDI), the Brief Symptom Inventory (BSI) and the SF-36 by self and blind observer ratings.

RESULTS

Both groups showed significant pre-post improvements in observer-rated Inattention scale (p < .001, partial η² = 0.18) and in associated symptomatology, which persisted through 6 months of follow-up. There were no significant differences regarding symptom reduction between the treatment groups. Women benefited more compared to men irrespective of treatment group. Men showed the most pronounced changes under MAP.

CONCLUSIONS

In the current study, MAP was not superior to PE regarding symptom reduction in adult ADHD. Both interventions, mindfulness meditation and PE, were efficacious in reducing symptom load in adult ADHD. Furthermore in exploratory post hoc tests the study provides evidence for a potential gender-specific treatment response in adult ADHD.

The Association Between Insomnia and Sleep Duration in Adults With Attention-Deficit Hyperactivity Disorder: Results From a General Population Study

STUDY OBJECTIVES

Insomnia and short or long sleep duration are important comorbid conditions in adults with attention-deficit hyperactivity disorder (ADHD), but reports of the association vary. In a general population study, we evaluated the relationship between ADHD symptom severity, insomnia symptoms, and sleep duration in adults.

METHODS

Data were from the third wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2; n = 4,618). ADHD symptom severity and symptom dimensions (hyperactivity and inattention) were assessed using the Adult ADHD Self-Report Scale screener. Self-reported insomnia symptoms (Insomnia Rating Scale; IRS) were defined as clinically relevant if IRS ≥ 9. Self-reported short sleep duration was defined as ≤ 6 hours, and long sleep duration as ≥ 10 hours.

RESULTS

Within the group with clinically relevant ADHD symptoms, 43% reported significant insomnia symptoms (odds ratio [OR] = 2.66, 95% confidence interval [CI] 1.74-4.07); 41% short sleep duration (relative risk ratio [RRR] = 1.94, 95% CI 1.31-2.85) and 6% long sleep (RRR = 5.87, 95% CI 1.97-17.45). Increased inattention symptoms were associated with IRS ≥ 9, short and long sleep duration in fully adjusted models (OR = 1.10, 95% CI 1.06-1.14; RRR = 1.06, 95% CI 1.02-1.09; RRR = 1.16, 95% CI 1.05-1.28, respectively). Increased hyperactivity symptoms were associated with IRS ≥ 9 (OR = 1.17, 95% CI 1.11-1.23) and short sleep duration (RRR = 1.12, 95% CI 1.05-1.19).

CONCLUSIONS

Both clinically significant ADHD symptoms and inattention and hyperactivity symptom dimensions were consistently associated with insomnia symptoms and altered sleep duration. These associations confirm that sleep disturbances should be assessed and given appropriate clinical attention in adults with ADHD.

Functional impairment in adult bipolar disorder with ADHD

BACKGROUND

It is well established that patients with either bipolar disorder (BD) or attention-deficit/hyperactivity disorder (ADHD) present functional impairment even when in remission. Nevertheless, research on functional impairment with adult patients with bipolar disorder comorbid to ADHD (BD+ADHD) is very scarce. The main objective of the current report was to evaluate the overall and specific domains of functioning, in patients with BD+ADHD compared to patients with pure bipolar disorder (pBD) and healthy controls (HCs).

METHOD

162 subjects from 3 groups were compared: 63 pBD, 23 BD+ADHD and 76 HCs. All the patients with BD had been euthymic for at least 6 months and they were recruited at the Hospital Clinic of Barcelona. All the participants were assessed with the 17-item Hamilton Depression Rating Scale (HAM-D), the Young Mania Rating Scale (YMRS) and the Functioning Assessment Short Test (FAST). Clinical, and sociodemographic data were also recorded.

RESULTS

Clinical groups, pBD and BD+ADHD, showed lower overall functioning (p < 0.001) in each domain of the FAST scale compared to the HCs. Moreover, the Tukey post hoc test revealed that the BD+ADHD group showed a worse score than pBD in the cognitive domain of the FAST. However, after controlling for potential confounding variables, only the HDRS scores (p < 0.026) remained significant for the cognitive domain of the FAST.

LIMITATIONS

The small sample size of the comorbid BD+ADHD group.

CONCLUSIONS

Adult patients with BD+ADHD showed the worst scores in functioning compared with the HCs, but did not show more severe functional impairment than the pBD group except for the cognitive domain. Therefore our findings suggest that depressive symptoms in adults with BD+ADHD may negatively influence cognitive functioning. Further studies are needed to confirm our findings for the management of BD+ADHD.

Prevalence and Correlates of Self-Reported ADD/ADHD in a Large National Sample of Canadian Adults

OBJECTIVE

The objective of this study was to examine the prevalence and correlates of self-reported attention deficit disorder (ADD)/ADHD in Canadian adults.

METHOD

Prevalence of self-reported ADD/ADHD was examined in a large national sample of Canadians ( n = 16,957). Demographic variables, lifetime, and current psychiatric comorbidities were then compared in a group of adults with self-reported ADD/ADHD ( n = 488) and an age- and gender-matched control group ( n = 488).

RESULTS

The prevalence of self-reported ADD/ADHD was 2.9%. Significantly higher lifetime and current prevalence rates of major depressive disorder, bipolar I and II disorders, generalized anxiety disorder, and substance use disorders were observed in the ADD/ADHD group compared with the control group. Within the ADD/ADHD group, lifetime and 12-month prevalence rates of major depressive disorder and generalized anxiety disorder were significantly higher in women, whereas lifetime and current rates of some substance use disorders were significantly higher in men.

CONCLUSION

In a national sample of Canadian adults, self-reported ADD/ADHD was associated with significant psychiatric comorbidity. Gender differences were also noted.

Children with ADHD and symptoms of oppositional defiant disorder improved in behavior when treated with methylphenidate and adjuvant risperidone, though weight gain was also observed - Results from a randomized, double-blind, placebo-controlled clinical trial

Children with ADHD often show symptoms of oppositional defiant disorders (ODD). We investigated the impact of adjuvant risperidone (RISP) to a standard treatment with methylphenidate (MPH) in children with ADHD and symptoms of ODD. Eighty-four children with ADHD and ODD (age: M=8.55; range: 7.28-9.95 years; 73.8% males) took part in a double-blind, randomized, placebo-controlled, clinical trial lasting eight weeks. Participants were randomly assigned either to the MPH+RISP (1mg/kg/d+0.5mg/d) or to the MPH+PLCO (1mg/kg/d+placebo) condition. Symptoms of ADHD, weight, height, and blood pressure were assessed at baseline, and at weeks 2, 4, 6 and 8. Symptoms of ADHD decreased over time, but more so in the MPH+RISP than in the MPH only condition. In the MPH+RISP condition weight, waist circumference and prolactine levels increased over time. Data suggest that adjuvant RISP improved symptoms in children with ADHD and ODD, but weight gain and higher prolactine levels were also observed, which are two alarming side effects. This may become an issue, once children become adolescents, a period of life in which body shape and body self-image are closely linked to self-confidence and peer acceptance. Health care professionals should carefully balance the short-term and long-term costs and benefits of administration of RISP.

The Investigation of Symptoms and Diagnoses of Adult-Attention Deficit/ Hyperactivity Disorder in Women with Iron Deficiency Anemia

INTRODUCTION

The aim of this study was to investigate symptoms and diagnoses of Adult-Attention Deficit/Hyperactivity Disorder (ADHD) in women with iron deficiency anemia, to evaluate relationship between ADHD with clinical features and to compare with the women without iron deficiency anemia.

METHODS

Eighty-three newly diagnosed iron deficiency anemia patients and 70 healthy controls were included in this study. All participants were assessed using a sociodemographic form, Structured Clinical Interview I (SCID-I), Wender Utah Rating Scale (WURS); Moreover, participants having WURS scores 36 and above were also assessed using the Adult ADD/ADHD Evaluation Scale and interviewed according to DSM-5 criteria.

RESULTS

In the study, 22.9% of patients with iron deficiency anemia and 12.9% of healthy controls were found to have WURS scores 36 and above. Fifteen patients (18.1%) in iron deficiency anemia group and two patients (2.9%) in control group had adult ADHD, when they were evaluated with Adult ADD/ADHD Evaluation Scale and interviewed according to DSM-5 criteria (p=0.007). The patients with iron deficiency anemia had significantly higher WURS scores compared to controls (p=0.002). The levels of iron and ferritin had negative correlation (r=-0.166, p<0.05; r=-0.255, p<0.01, respectively) and the levels of serum iron binding capacity had positive correlation (r=0.255, p<0.01) with the scores of WURS.

CONCLUSION

The prevalence of adult ADHD is higher than those reported for general population in patients with iron deficiency anemia. Early diagnose and treatment of adult ADHD may positively contribute to the patients with iron deficiency anemia.

Psychiatric Comorbidities in a New Zealand Sample of Adults With ADHD

OBJECTIVE

To examine the rates of psychiatric comorbidities within a New Zealand sample of adults with ADHD compared with a community control group.

METHOD

We merged six data sets to obtain a sample of 222 adults (158 ADHD, 64 controls). Comorbidities were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed. text rev. [DSM-IV-TR]) Axis-I disorders.

RESULTS

Both groups were equivalent in IQ, socioeconomic status, gender, education, income levels, and age. Lifetime rates of psychiatric disorders were significantly higher in the ADHD group (83%) versus the control group (52%) with higher rates of major depressive disorder (MDD; 65% vs. 36%), social phobia (31% vs. 11%), substance abuse (26% vs. 8%), and alcohol abuse (32% vs. 14%). Within the ADHD group, other than a group difference in specific phobias, there were no gender differences.

CONCLUSION

The findings are consistent with international research; adults with ADHD in New Zealand have higher rates of psychiatric disorders than the general population.

Associations of Age, Gender, and Subtypes With ADHD Symptoms and Related Comorbidity in a Danish Sample of Clinically Referred Adults

OBJECTIVE

The aim was to examine associations of age and gender with ADHD subtypes and subsequently to examine associations of age, gender, and subtypes with comorbid psychiatric disorders.

METHOD

Odds ratios were calculated and logistic regression performed using information from a clinical sample of 155 ADHD adults referred to a Danish specialized ADHD unit from 2010 to 2011.

RESULTS

A majority of men (65%) was found in the sample. Most patients were subtyped ADHD combined (78%), followed by ADHD inattentive (18%), and ADHD hyperactive-impulsive (4%). No significant differences were found in gender and age across subtypes. Current comorbid disorders were found in 57% of the ADHD patients. Significantly more comorbidity was found in the ADHD combined type and in patients ≥25 years. Significantly more men had substance use disorders and significantly more women had personality disorders.

CONCLUSION

When assessing adult ADHD patients' age, gender, subtype, and related comorbid symptom profiles should be taken into account.

Sex- and Subtype-Related Differences in the Comorbidity of Adult ADHDs

OBJECTIVE

Comorbidity in adult ADHD (aADHD) has been investigated in a large number of studies using varying research approaches with divergent results. In contrast, there is limited information about sex- or subtype-related differences from studies with small sample size.

METHOD

A large sample of 910 individuals (458 males, 452 females) affected with aADHD was recruited at a tertiary referral center. All probands underwent a four-step procedure for diagnosing aADHD, including the Structured Clinical Interview of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Axis I disorders to assess comorbidity. This study will provide additional information regarding the co-morbidity of Axis I disorders in the currently largest clinical referral sample. However, the main objective of this study is to gain information about sex- or subtype-related differences.

RESULTS

Affected females show higher rates of mood (61% vs. 49%), anxiety (32% vs. 22%), and eating disorders (16% vs. 1%) than affected males, while substance use disorders were more frequent in affected males (45% vs. 29%), which mirrors sex differences in prevalence in the general population. There were hardly any relevant differences in comorbidities between subtypes, with the exception of the inattentive subtype having an especially low prevalence of panic disorder. Comorbidity in general and substance use disorders in particular, but not sex or subtype, were highly predictive of lower psychosocial status.

CONCLUSION

Sex-related differences in the comorbidity of aADHD are more pronounced than subtype-related differences.

Diagnostic profiles of adult psychiatric outpatients with and without attention deficit hyperactivity disorder

OBJECTIVE

Despite growing recognition that attention deficit/hyperactivity disorder (ADHD) is a highly prevalent, impairing, and comorbid disorder that persists into adulthood, reports on the nature and extent of its psychiatric comorbidities have been mixed to date. This study compared the prevalence rates of all major Axis I disorders as well as borderline personality disorder in an unselected sample of adult psychiatric outpatients with and without ADHD.

METHODS

As part of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we administered a DSM-IV-based semi-structured diagnostic interview assessing ADHD and other psychiatric disorders to 1134 patients presenting for initial evaluation at an outpatient psychiatric practice. Logistic regression analyses were used to compare the rates of each disorder in patients with versus without an ADHD diagnosis (both overall and by Combined and Inattentive type).

RESULTS

Patients with (versus without) any ADHD diagnosis had significantly higher rates of bipolar disorder, social phobia, impulse control disorders, eating disorders, and BPD, and significantly lower rates of major depressive disorder and adjustment disorder (all p<.05). Patients with (versus without) ADHD-Inattentive type had significantly higher rates of social phobia and eating disorders, whereas those with (versus without) the ADHD-Combined type had significantly higher rates of bipolar disorder, alcohol dependence, and BPD (all p<.05).

CONCLUSION

In this novel investigation of the psychiatric profiles of an unselected sample of treatment-seeking adult outpatients with versus without ADHD, a distinct pattern of comorbidities emerged across subtypes, with implications for the accurate assessment and treatment of patients presenting for psychiatric care.

ADHD subtypes and neuropsychological performance in an adult sample

The study investigated, with an adult sample, the hypothesis that differences between subtypes of ADHD on neuropsychological tests contribute to the poor separation of ADHD and healthy groups on tests of this kind. Groups of ADHD inattentive (n=16) and combined (n=16) subtypes were carefully identified using DSM-IV criteria, and their performance on 14 measures of attention, memory, and executive function (EF) was compared between subtypes and between the two subtypes combined and a group of healthy controls (n=30). Multivariate analyses showed statistically significant differences between the two subtypes, and between the two subtypes combined and the healthy controls. Importantly for the hypothesis, where differences for neuropsychological tests in terms of effect sizes between subtypes were largest, the differences in effect sizes between the two groups combined and controls were smallest (r=-0.64, 95% CI [-0.15, -0.87]).

Häufigkeiten von adulten ADHS-assoziierten Symptomen in der Normalbevölkerung – Referenzwerte der ADHS-Selbstbeurteilungsskala und des Wender-Reimherr-Interviews

Zusammenfassung. Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) ist eine Erkrankung, welche sich im Kindesalter erstmalig manifestiert und bei bis zu 60 % der Betroffenen in Teil- oder Vollausprägung in das Erwachsenenalter persistiert. Dabei charakterisieren sich ADHS-Syndrome nicht als qualitativ auftretende Merkmale, sondern entsprechen Beeinträchtigungen, welche auch in einem gesunden Kollektiv auftreten können, und lediglich in Abhängigkeit ihres Schweregrads eine krankheitswertige Valenz innehaben. Mit Blick auf die Dimensionalität der ADHS-Symptomatik und unter Berücksichtigung epidemiologischer Daten, welche bereits im subklinischen Bereich ADHS-assoziierter Symptome Beeinträchtigungen in der Alltagsfunktionalität Erwachsener berichten, erscheinen daher Referenzwerte, welche eine Einschätzung ADHS-assoziierter Symptome in Bezug auf eine nicht-klinische Stichprobe ermöglichen, wünschenswert. Diese Lücke soll mit der vorliegenden Arbeit geschlossen werden. Es werden altersabhängige Referenzwerte für die Selbstbeurteilungsskala ADHS-SB und die deutsche Übersetzung des halbstandardisierten Wender-Reimherr-Interviews zur Einschätzung ADHS-assoziierter Symptome in einer nicht-klinischen Stichprobe vorgelegt. Ferner unterstützen unsere Ergebnisse bisherige Befunde, dass bereits unterhalb der diagnostischen Schwelle der Klassifikationssysteme psychopathologische Phänomene aus dem ADHS-Spektrum einen negativen Einfluss auf den Lebensalltags der Betroffenen haben können.

Atomoxetine treatment in adults with attention-deficit/hyperactivity disorder

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a CNS disorder that has its onset in childhood, but often persists into adulthood. There is growing recognition that adult ADHD can result in multiple negative consequences for individuals. ADHD is also often associated with a number of comorbid psychiatric disorders. Atomoxetine (ATX), a nonstimulant, selective noradrenergic reuptake inhibitor, was approved in the United States in 2002 for the treatment of ADHD in children and adolescents, as well as adults. We review here the safety and efficacy of ATX in adults with ADHD, including data in special populations, functional outcomes, as well as provider and patient real-world perceptions.

METHODS

We searched the databases Embase, MEDLINE and PsycINFO using the terms 'ADHD' and 'adult' and 'ATX' capturing publications from January 1, 1998, to March 27, 2014. Only publications in English were considered.

RESULTS

ATX demonstrated significantly greater improvement than placebo (PBO) on the Conners Adult ADHD Rating Scale-Investigator rated:Screening Version (CAARS-Inv:SV) in all trials (N = 6; total score difference ranged from -3.5 to -5.5). For long-term trials using the CAARS-Inv:SV, ATX demonstrated significantly greater improvement than PBO in three of four trials (total score differences ranged from -0.1 to -6.0). In short-term studies, ATX showed significantly greater improvement than PBO on the Adult ADHD Quality-of-Life scale total score in three of three studies, but results were mixed on the Sheehan Disability Scale. Three studies of ATX have reported statistically significant improvement (compared with PBO) on the Behavior Rating Inventory of Executive Function-Adult Version Self Report scale. The most common adverse events (occurring in ≥ 10% of patients taking ATX) were nausea, dry mouth, decreased appetite, insomnia and fatigue.

CONCLUSIONS

ATX is an important treatment option for the right patient. ATX can provide long-term, consistent symptom relief and functional improvement for adults with ADHD.

Prevalence of ADHD in nonpsychotic adult psychiatric care (ADPSYC): A multinational cross-sectional study in Europe

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood. This study was designed to estimate the prevalence of ADHD in adult psychiatric outpatients in several European countries.

METHOD

ADHD diagnosis was made using the Diagnostic Interview for ADHD in Adults, version 2.0 (DIVA), according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) and 5th Edition (DSM-5).

RESULTS

Of 5662 patients present/approached, 2284 (40.3 %) consented, of whom 1986 patients (87.0 %) completed the study. Based on the DIVA, and applying DSM-IV-TR or DSM-5 criteria, 15.8 % (95 % confidence interval [CI] 14.2 %-17.4 %) or 17.4 % (95 % CI 15.7 %-19.0 %) of patients were diagnosed with ADHD, respectively. The prevalence of ADHD was 15.3 % when counting as non-ADHD those patients who screened positive but did not complete the DIVA (DSM-5).

CONCLUSIONS

Estimates from this study indicate that a relevant part of the psychiatric outpatient care population suffers from ADHD.

Adult attention-deficit/hyperactivity disorder: Associations between subtype and lifetime substance use - a clinical study

ADHD is the one of the most prevalent childhood disorders and has been associated with impairments persisting into adulthood. Specifically, childhood ADHD is an independent clinical risk factor for the development of later substance use disorders (SUD). Moreover, adults who meet diagnostic criteria for ADHD have shown high rates of comorbid SUDs. Few studies, however, have reported on the relationship between ADHD subtypes and SUD in adult samples. The purpose of this study was to characterize a clinical sample of adults with ADHD and to identify possible associations between ADHD subtypes, lifetime substance use, and if ADHD subtypes may be preferentially associated with specific substances of abuse. We recruited 413 adult ADHD patients, performed an evaluation of their ADHD and conducted an interview on their use of psychotropic substances. Complete data was obtained for 349 patients. Lifetime substance abuse or dependence was 26% and occasional use was 57% in this sample. The inattentive subtype was significantly less likely to abuse or be dependent on cocaine than the combined subtype. Our findings underscore the high rate of comorbidity between substance use and ADHD in adults. The more frequent abuse/dependence of cocaine by adult patients with hyperactive-impulsive symptoms should be kept in mind when treating this patient group.

Differences in ADHD medication usage patterns in children and adolescents from different cultural backgrounds in the Netherlands

PURPOSE

Differences in incidence and prevalence of ADHD medication use between ethnic groups have been reported. Goal of this study was to determine whether there are also differences in usage patterns of ADHD medication among native Dutch children and adolescents and those with a Moroccan, Turkish and Surinam cultural background in the Netherlands between 1999 and 2010.

METHODS

In a cohort of ADHD patients <19 years (N = 817) incident use and discontinuation of ADHD medication were measured for ethnicity and adjusted for age, gender and socio-economic status.

RESULTS

A significant higher proportion of ADHD-diagnosed patients from Moroccan (32 %) and Turkish (42 %) cultural background never used ADHD medication compared to Dutch natives (21 %). One-fifth of native Dutch and Turkish patients already used ADHD medication before the ADHD diagnosis date. Discontinuation of ADHD medication within 5 years was significantly higher in Moroccan [HR 2.4 (95 % CI 1.8-3.1)] and Turkish [HR 1.7 (95 % CI 1.1-2.6)] patients. A sensitivity analysis with a zip code-matched comparison between Dutch natives and non-natives showed similar results, suggesting this effect is probably not explained by socio-economic status (SES).

CONCLUSION

Differences are found in prescribing and use of ADHD medication between patients with a different cultural background. Native Dutch and Turkish patients start more frequently with ADHD medication before the ADHD diagnose date, which can be an indication of differences in either referral patterns and/or access to care. A higher percentage of patients with a Moroccan and Turkish cultural background never start using ADHD medication at all and discontinuation rate is higher compared to Dutch natives and Surinamese.

Functioning Assessment Short Test (FAST): validity and reliability in adults with attention-deficit/hyperactivity disorder

Studies highlight that the functional deficits in different areas of a subject's life are an important characteristic that define adult attention-deficit/hyperactivity disorder (ADHD). On the other hand, in the scientific literature, there are no evaluation instruments with psychometric studies concerning their reliability and validity for this variable in adults with ADHD. The aim of the present study is to evaluate the psychometric properties of the Functioning Assessment Short Test (FAST), regarding its reliability and validity, as a measure of adult ADHD functioning. A case-control study was carried out in a sample of 152 adult subjects (88 with ADHD diagnosis and 64 healthy controls). The psychometric properties of the instrument were analyzed regarding feasibility, internal consistency, concurrent validity, discriminant validity (ADHD vs. controls) and factor analysis. For the total scale, Cronbach's alpha was of 0.83, and strong values in the measures of its discriminant capacity were obtained, AUC ROC = 0.98, IC (0.96-0.99). The test is reliable as the internal consistency was high. Significant differences are observed in the correlation between domains, between healthy subjects and subjects with ADHD. ADHD subjects showed impairments in all areas of their life, especially in the cognitive functioning domain, followed by the autonomy, occupational functioning and interpersonal relationships domains. The FAST is an easily administered short interview and has good psychometric properties, in terms of reliability and validity, as a measure of the functional level in adults with ADHD. The study also showed that subjects with adult ADHD may be functionally impaired.

In a randomized case-control trial with 10-years olds suffering from attention deficit/hyperactivity disorder (ADHD) sleep and psychological functioning improved during a 12-week sleep-training program

OBJECTIVES

We tested the hypothesis that sleep training would improve emotional, social and behavioural functioning in children with attention-deficit/hyperactivity disorder (ADHD) compared to children with ADHD without such intervention and to healthy controls.

METHODS

Forty children with ADHD were randomly assigned to intervention and control conditions. Parents of 20 children with ADHD were instructed and thoroughly supervised in improving their children's sleep schedules and sleep behaviour. Parents of the other 20 children with ADHD and parents of 20 healthy children received general information about sleep hygiene. At baseline and 12 weeks later, parents and children completed questionnaires related to children's sleep and psychological functioning.

RESULTS

Relative to the control groups, children in the intervention group improved sleep quantitatively and qualitatively (F values < 3.33, P values < 0.05). The intervention group children reported improvements in mood, emotions, and relationships (F values < 2.99, P values < 0.05). Parents reported that their children improved in physical and psychological wellbeing, mood, emotions, relationships, and social acceptance (F values < 3.02, P values < 0.05).

CONCLUSIONS

Training and monitoring parents of children with ADHD in regulating and supervising children's sleep schedules leads to positive changes in the emotions, behaviour and social lives of these children.

Attention deficit hyperactivity disorder in children is found to be related to the occurrence of ADHD in siblings and the male gender, but not to birth order, when compared to healthy controls

OBJECTIVE

The aim of the present study was to explore the extent to which the prevalence of attention deficit hyperactivity disorder (ADHD) in childhood is associated with birth order and gender, and the prevalence of ADHD and mental retardation (MR) in siblings, as compared to healthy controls. Methods. Data from 200 children diagnosed with ADHD (mean age: 11.13 years; 10.5% females) were compared to data from 200 healthy controls (mean age: 11.0 years; 27.5% females). The data were related to symptoms of ADHD, birth order, gender, family size, and the occurrence of ADHD and MR in siblings.

RESULTS

Compared to controls, the occurrence of ADHD was found to be related to the male gender and to the occurrence of ADHD-related symptoms in siblings (odds ratio: 13.50). Birth order and MR were not associated with the occurrence of ADHD and ADHD-related symptoms. ADHD- related symptoms increased if a further sibling also suffered from ADHD. Conclusions. Among a sample of Iranian children suffering from ADHD, the ADHD and ADHD-related symptoms in childhood were found to be related to the male gender and to the occurrence of ADHD in siblings. Moreover, birth order was found to be unrelated. The fact that symptoms of ADHD-related symptoms increased if a further sibling was suffering from ADHD, and decreased if a further sibling was suffering from MR, is intriguing and needs further explanation.

Adult attention-deficit/hyperactivity disorder and nicotine use: a qualitative study of patient perceptions

BACKGROUND

Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with high rates of comorbid substance use disorders, and cigarette smoking has a particularly high prevalence in this population. However, there is an ongoing debate as to whether this tobacco use is an attempt at "self-medication" or due to behavioral disinhibition. There is a surprising lack of qualitative studies that investigate the subjective perceptions of adults with ADHD regarding cigarette smoking. The present study was designed to fill this gap in the literature.

METHODS

We recruited twelve adult patients with ADHD and comorbid tobacco use from our ADHD consultation service, an outpatient facility of the Zurich University Psychiatric Hospital. Subjects were interviewed using qualitative methodology, and Mayring's qualitative content analysis was used to evaluate findings.

RESULTS

We identified two explanatory models linking ADHD and tobacco use: smoking as an attempt at self-medication and "smoking as a social behavior". On one hand, subjects considered tobacco a therapeutic aid, reporting positive effects on "inner tension" and cognitive function, and noted possible antidepressant properties as well. On the other hand, subjects considered smoking to enhance social functioning and to have a positive impact on interpersonal relationships. The majority believed that stimulant medications offered only a transient decrease in patterns of tobacco use because their ability to reduce nicotine cravings wore off quickly. Others believed that stimulants had no effect or even reinforced cigarette use.

CONCLUSIONS

Participants had different views about the link between cigarette smoking and ADHD. While the majority thought of nicotine as a sort of therapy, viewing smoking as a way to self-medicate symptoms of ADHD, motivations for nicotine use were also related to self-image, desire to belong to a peer-group, and a drive to undermine perceived social norms. Ultimately, these findings can be used by clinicians to improve treatment alliance and collaboration.