The experiences of adults with ADHD in interpersonal relationships and online communities: A qualitative study

Weak ties and the value of social connections for autistic people as revealed during the COVID-19 pandemic

A diverse portfolio of social relationships matters for people's wellbeing, including both strong, secure relationships with others ('close ties') and casual interactions with acquaintances and strangers ('weak ties'). Almost all of autism research has focused on Autistic people's close ties with friends, family and intimate partners, resulting in a radically constrained understanding of Autistic sociality. Here, we sought to understand the potential power of weak-tie interactions by drawing on 95 semi-structured interviews with Autistic young people and adults conducted during the COVID-19 pandemic. We analysed the qualitative data using reflexive thematic analysis within an essentialist framework. During the COVID-19 lockdowns, Autistic people deeply missed not only their close personal relationships but also their "incidental social contact" with acquaintances and strangers. These weak-tie interactions appear to serve similar functions for Autistic people as they do for non-autistic people, including promoting wellbeing. These findings have important implications both for future research into Autistic sociality and for the design of practical services and supports to enhance Autistic people's opportunities to flourish.

Parents' Experiences of Raising 7- to 11-Year-Old Children With ADHD and Perception of a Proposed Parenting Program: A Qualitative Study

OBJECTIVE

To examine the experiences of Australian parents raising primary school-aged children with ADHD and gather feedback on a proposed ADHD parenting program.

METHODS

Reflexive thematic analysis of semi-structured interviews undertaken with 11 Australian parents of 7- to 11-year-old children with ADHD. Interviews were conducted over Webex, audio recorded, transcribed verbatim, and analyzed in NVivo Ltd. software.

RESULTS

We identified four themes: (1) "I love my child but their ADHD traits are challenging," (2) "Compliance, control, and completion," (3) "It's hard, burdensome, and exhausting and I can feel like I'm alone," and (4) "What a welcome relief."

CONCLUSION

Parents report that although raising neurotypical children is difficult, the presence of childhood ADHD increases the emotional and support burden placed on them. Parents were also very interested in and supportive of the proposed ADHD parenting program. The program aims to enhance parents' understanding of the neurocognitive implications of ADHD and to foster secure parent-child attachment, attuned parental responsiveness, and age-appropriate development of traits that promote well-being, adaption and recovery in people with ADHD.).

Unraveling the insomnia puzzle: sleep reactivity, attention deficit hyperactivity symptoms, and insomnia severity in ADHD Patients

Introduction

Insomnia is the most common sleep problem among adults with attention deficit hyperactivity disorder (ADHD). The severity of insomnia can exacerbate the symptoms of ADHD. Identifying the predictive factors that contribute to insomnia severity may be crucial in treating insomnia among adults with ADHD. One potential factor contributing to insomnia is sleep reactivity, which refers to the tendency to experience insomnia triggered by stress. This phenomenon, also known as vulnerability to stress-related insomnia, reflects the extent to which individuals are prone to developing insomnia in response to stressful situations. To date, sleep reactivity in adults with ADHD has not been studied. This study aimed to investigate the relationship between sleep reactivity, attention deficit hyperactivity symptoms, and the severity of insomnia in adults with ADHD.

Methods

This study included 61 adults with ADHD with no comorbid psychiatric or medical diseases and 61 adult healthy controls (HCs) matched for age, sex, body mass index, and years of education. All participants completed the sociodemographic data form, Ford Insomnia Response to Stress Test (FIRST), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Adult ADHD Self-Report Scale (ASRS), and Wender Utah Rating Scale (WURS).

Results

Sleep reactivity, insomnia severity, and poor sleep quality were higher in adults with ADHD compared to HCs. Higher sleep reactivity was associated with worse sleep outcomes in both groups, whereas higher sleep reactivity was associated with severe ADHD symptoms in the HCs group. In the ADHD group, insomnia severity was predicted by higher sleep reactivity, ASRS, and being female (R2 = 0.32, F (6, 61) = 4.36, p = 0.001), not age, ADHD medication use, and WURS.

Conclusion

Our findings suggest that higher sleep reactivity, increased ADHD symptoms, and being female may predict the severity of insomnia in adults with ADHD.

Online social activity time predicts ADHD problems in youth from late childhood to early adolescence in the ABCD study

Online social interactions increase into adolescence. Although cross-sectional studies have positively associated online social activity (OSA) time and attention-deficit/hyperactivity disorder (ADHD) problems, the directionality remains unclear. Therefore, we examined longitudinal associations between OSA time and ADHD problems using data from the Adolescent Brain Cognitive Development (ABCD) study. Four waves of ABCD data from 11,819 youth participants (52.1% boys; Baseline: Mage = 9.92 years, SDage = 0.62) were utilized. Random-intercepts cross-lagged panel models (RI-CLPMs) adjusting for potential confounds were employed to estimate longitudinal bidirectional associations. Multiple-group RI-CLPM analyses examined potential moderation effects of OSA content type and child's sex. The results revealed that greater OSA time was associated with more ADHD problems in early adolescence, while more ADHD problems did not predict greater OSA time. In moderation analyses, the cross-lagged effects of OSA time on ADHD problems were only significant for girls, and boys showed an inverse relation between ADHD problems and subsequent OSA time. No moderation effect of OSA content type was observed. These findings highlight the potential detrimental effect of OSA time on the development of attentional processes, especially for girls, thereby offering insights that could guide the development and targeting of interventions to mitigate future risks for ADHD problems during adolescence.

Camouflaging, internalized stigma, and mental health in the general population

BACKGROUND

Camouflaging, the strategies that some autistic people use to hide their differences, has been hypothesized to trigger mental health ramifications. Camouflaging might reflect ubiquitous impression management experiences that are not unique to autistic people and similarly impact the mental health of non-autistic people.

AIMS

We first examined whether individuals in the general population camouflage and manage impressions while experiencing mental health repercussions, and how gender and neurodivergent traits modified these associations. We then assessed how camouflaging and impression management arose from internalized stigma, and their inter-relationships in shaping mental health outcomes.

METHODS

Data were collected from 972 adults from a representative U.S. general population sample, with measures pertaining to camouflaging, impression management, mental health, internalized stigma, and neurodivergent traits. Multivariate hierarchical regression and moderated mediation analyses were used to address the two research aims.

RESULTS

Both camouflaging and self-presentation (a key component of impression management) were associated with mental health presentations in the general population, which overlapped with those previously reported in autistic people. These associations were more pronounced in women compared with men and were of different directions for individuals with higher autistic traits versus higher ADHD traits. Internalized stigma might be a key stressor that could elicit camouflaging and impression management through social anxiety, which in turn might lead to adverse mental health outcomes.

CONCLUSIONS

These findings advance the conceptual clarity and clinical relevance of camouflaging and impression management across social and neurodiverse groups in the general population. The ramifications of camouflaging and impression management underscore the need to alleviate internalized stigma for better mental health across human groups.

An investigation of the Bernstein's strengths Scale: factorial validity and network analysis of attention-deficit/hyperactivity symptoms, mental health, and the strengths of the healthy adult self

BACKGROUND

Bernstein's heuristic model of personal strengths describes 16 positive attributes of the healthy adult self, grouped into four higher-order factors: self-directedness (identity, self-reflection, self-confidence, self-assertion, imagination/creativity), self-regulation (emotional balance, resilience, self-control, self-care, reality testing), connection (empathy, compassion, humour, responsibility), and transcendence (gratitude and wisdom). The study aimed to explore the factorial validity of Bernstein's Strengths Scale developed for the assessment of these constructs. Furthermore, we explored the association of strengths with attention-deficit hyperactivity (ADHD) symptoms and mental health in a nonclinical sample using a network approach.

METHODS

Five hundred and twenty-eight adults filled out an online questionnaire, including Bernstein's Strengths Scale (BSS), the Mental Health Continuum - Short Form (MHC-SF), and the Adult ADHD Self-Report Scale (ASRS).

RESULTS

Though our data showed an acceptable fit to the 16-factor model, the Self-control subscale and item 28 of the Compassion subscale were excluded because of reliability issues. The final model with 15 factors and 44 items showed excellent fit, χ2(797) = 1130.149, p < .001, RMSEA = 0.028, 90% CI [0.024, 0.032], SRMS = 0.049, CFI = 0.993, TLI = 0.991. Principal component analysis revealed three instead of four second-order factors. In the network model, Self-confidence and Wisdom emerged as the most influential nodes. ADHD symptoms were negatively connected to Responsibility, Self-care, Identity, Emotional balance, Self-confidence, and mental health, while they had positive edges with Humor, Self-reflection, and Imagination/creativity. Mental health was positively related to several strengths, with the strongest association being between mental health and Gratitude.

CONCLUSION

The BSS has acceptable factorial validity and is a reliable tool for assessing the personal strengths of the healthy adult self. ADHD symptoms in adults may be associated with deficits in personal strengths, but protective factors could also be identified. Addressing personal strengths in psychosocial interventions for ADHD in adults may improve patients' emotional well-being and everyday functioning.

Life Gets Better: Important Resilience Factors When Growing Up With ADHD

OBJECTIVE

To explore emerging adults' descriptions of important resilience factors when growing up with ADHD.

METHOD

Individual interviews with 10 emerging adults (21-24 years) who participated in a 10-year follow-up study, analyzed using thematic analysis.

RESULTS

The main theme was that "life gets better." Resilience factors contributing to this positive development were strategies to regulate ADHD, valuable relationships, acceptance, seeing positive attributes of ADHD, receiving tailored, non-stigmatizing support, and participating in meaningful activities.

CONCLUSION

Growing up with ADHD was associated with both challenges and positives, but the main resilience theme was that life gets better. A variety of resilience factors contributed to this, but relational and environmental factors seemed particularly important. Acceptance, both from society and self-acceptance, were related to all resilience factors in various ways indicating that better knowledge of ADHD might foster better understanding and acceptance of children and adolescents with 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.

Problematic Use of Internet Associates with Poor Quality of Life via Psychological Distress in Invididuals with ADHD

Background

Problematic use of internet (PUI) may have negative impacts on psychological distress and quality of life (QoL). This situation might be more profound in people with attention-deficit/hyperactivity disorder (ADHD) due to poorer behavioral control and regulatory capacity. However, there is little evidence regarding mediated effects in the associations between PUI, psychological distress, and QoL in people with ADHD.

Aims

To investigate mediating effects of psychological distress in the associations of problematic smartphone use (PSPU), problematic use of social media (PUSM), and problematic gaming (PG) with QoL in individuals with ADHD.

Methods and Procedures

PUI behaviors of participants with ADHD (n = 99) were assessed using the Smartphone Application-Based Addiction Scale, Bergen Social Media Addiction Scale, and Internet Gaming Disorder-Short Form. Psychological distress was assessed using the Depression, Anxiety, Stress Scale and QoL using the Kid-KINDL.

Outcomes and Results

Psychological distress mediated the associations between PUI and different domains of QoL, except for self-esteem QoL. There were also positively direct effects between PG and physical QoL, PUSM and friends' QoL, and PSPU and physical QoL.

Conclusions and Implications

PUI may associate with poor QoL in people with ADHD via psychological distress. Programs on reducing PUI for people with ADHD are needed.

Proposition of a transdiagnostic processual approach of emotion dysregulation based on core triggers and interpersonal styles

Emotion dysregulation (ED) has primarily been described in patients suffering from borderline personality disorder (BPD) and is an integral part of this diagnosis, but it is also a transdiagnostic construct that can be found in several other psychiatric disorders. The strong relationships between ED and BPD may lead clinicians to underestimate ED associated to other clinical contexts. This can lead to difficulties in diagnostic and treatment orientation, especially in the context of comorbidities. In this article, after reviewing the literature on the development and functioning of emotion dysregulation, and on the evidence for emotion dysregulation in eight disorders (borderline personality disorder, pathological narcissism with/without narcissistic personality disorder, obsessive-compulsive personality disorder, antisocial personality disorder, bipolar disorder, autism spectrum disorder, complex post-traumatic stress disorder, and adult attention deficit hyperactivity disorder), we present a transdiagnostic processual model of emotion dysregulation based on core triggers and interpersonal styles to try to address this issue and to provide a simple but technical tool to help clinicians in their diagnostic assessment and treatment orientation. By focusing more on typical patterns and interpersonal dynamics than only on categories, we believe that this model may contribute to the actual need for improvement of our current psychiatric classifications, alongside other well-studied and under-used dimensional models of psychopathology (e.g., HiTOP, AMPD), and may be useful to build more specific treatment frameworks for patients suffering from ED.

Cross-Cultural Adult ADHD Assessment in 42 Countries Using the Adult ADHD Self-Report Scale Screener

OBJECTIVE

We analyzed adult ADHD symptoms in a cross-cultural context, including investigating the occurrence and potential correlates of adult ADHD and psychometric examination of the Adult ADHD Self-Report Scale (ASRS) Screener.

METHOD

Our analysis is based on a large-scale research project involving 42 countries (International Sex Survey, N=72,627, 57% women, Mage=32.84; SDage=12.57).

RESULTS

The ASRS Screener demonstrated good reliability and validity, along with partial invariance across different languages, countries, and genders. The occurrence of being at risk for adult ADHD was relatively high (21.4% for women, 18.1% for men). The highest scores were obtained in the US, Canada, and other English-speaking Western countries, with significantly lower scores among East Asian and non-English-speaking European countries. Moreover, ADHD symptom severity and occurrence were especially high among gender-diverse individuals. Significant associations between adult ADHD symptoms and age, mental and sexual health, and socioeconomic status were observed.

CONCLUSIONS

Present results show significant cross-cultural variability in adult ADHD occurrence as well as highlight important factors related to adult ADHD. Moreover, the importance of further research on adult ADHD in previously understudied populations (non-Western countries) and minority groups (gender-diverse individuals) is stressed. Lastly, the present analysis is consistent with previous evidence showing low specificity of adult ADHD screening instruments and contributes to the current discussion on accurate adult ADHD screening and diagnosis.

Adult attention-deficit/hyperactivity symptoms and parental cognitions: a meta-analysis

Introduction

Attention-deficit/hyperactivity disorder (ADHD) symptoms in adults interfere with parental functioning. Dysfunctional parental cognitions may play a role in this impairment. Despite the importance of parental cognitions on parents and children's outcomes, up to now, no systematic review or meta-analysis of these findings is available. To fill this gap, this meta-analysis aimed to evaluate the relationship between adult ADHD symptoms and parental cognitions.

Methods

We conducted searches in Web of Science, PubMed, and ProQuest from January 2000 to June 2023. Studies were included if they provided data on the relationship between parental ADHD symptoms and parental cognitions by means of a row correlational coefficient, or means and standard deviation were reported for each study group. A random-effects model was used. Publication bias was assessed by funnel plot and Rosenthal's fail-safe N. Moderator analyses were conducted by means of subgroup analysis and meta-regression analyses.

Results

Fifteen published papers were included (N = 2851), and 51 effect sizes were analysed. The weighted mean effect size was small but significant (Fisher's Z = 0.186, k = 15, 95% CI [0.120 - 0.252], z = 5.539, p < 0.001), indicating that ADHD symptoms in adults are associated with more negative and less positive parental cognitions. The Fail-Safe N analysis suggested a robust effect. Tweedie's trim and fill results suggested that five studies were missing; after five missing studies had been imputed, the mean overall effect size dropped to 0.116 (0.080 - 0.152). There was significant heterogeneity among effect sizes. The methodology of the study was found to be a significant moderator. Meta-regression analyses revealed that the lower age of the parent and the child were related to more negative parental cognitions.

Discussion

Though the analysis might be inflated by publication bias, our results suggest a significant association between ADHD symptom level and dysfunctional parental cognitions. Biased negative perceptions of the parental role, the child and co-parenting may play a central mediator role between parental ADHD and parent and child outcomes. Given the familiar nature of ADHD, targeting dysfunctional parental cognitions in parent training programs is warranted.

Systematic review registration

osf.io/pnur7.

Cognitive-attentional mechanisms of cooperation-with implications for attention-deficit hyperactivity disorder and cognitive neuroscience

People's cooperativeness depends on many factors, such as their motives, cognition, experiences, and the situation they are in. To date, it is unclear how these factors interact and shape the decision to cooperate. We present a computational account of cooperation that not only provides insights for the design of effective incentive structures but also redefines neglected social-cognitive characteristics associated with attention-deficit hyperactivity disorder (ADHD). Leveraging game theory, we demonstrate that the source and magnitude of conflict between different motives affected the speed and frequency of cooperation. Integrating eye-tracking to measure motivation-based information processing during decision-making shows that participants' visual fixations on the gains of cooperation rather than its costs and risks predicted their cooperativeness on a trial-by-trial basis. Using Bayesian hierarchical modeling, we find that a situation's prosociality and participants' past experience each bias the decision-making process distinctively. ADHD characteristics explain individual differences in responsiveness across contexts, highlighting the clinical importance of experimentally studying reactivity in social interactions. We demonstrate how the use of eye-tracking and computational modeling can be used to experimentally investigate social-cognitive characteristics in clinical populations. We also discuss possible underlying neural mechanisms to be investigated in future studies.

"Dysregulated not deficit": A qualitative study on symptomatology of ADHD in young adults

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) is a common condition that often persists into adulthood, although data suggest that the current diagnostic criteria may not represent how the condition presents in adults. We aimed to use qualitative methods to better understand ADHD symptomatology in young adults, especially regarding attentional and emotional dysregulation.

METHODS

Nine focus groups involving young adults (aged 18-35 years; N = 43; 84% female; 86% US and Canada) with diagnoses of ADHD were conducted. Participants were asked about their perceptions of the current diagnostic criteria and how their symptoms have presented and changed over time. Data were analyzed using an interpretive phenomenological analysis framework.

RESULTS

Most participants reported that the diagnostic criteria did not accurately capture their experiences with ADHD. They reported struggling with attention dysregulation, including hyperfocusing, and emotional dysregulation, including rejection-sensitive dysphoria. Many participants believed that their changing environments and behavioral adaptations influenced how their symptoms presented into adulthood.

CONCLUSION

Current diagnostic criteria for ADHD may not capture the range of symptoms present in young adults. More research is needed to characterize attentional and emotional dysregulation in this population.