The impact of attention deficit hyperactivity disorder (ADHD) in adulthood: a qualitative study

"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.

Silver linings of ADHD: a thematic analysis of adults' positive experiences with living with ADHD

OBJECTIVES

To identify and explore positive aspects of attention deficit hyperactivity disorder (ADHD) as reported by adults with the diagnosis.

DESIGN

The current study used a qualitative survey design including the written responses to an open-ended question on positive aspects of ADHD. The participants' responses were analysed using thematic analysis.

SETTING

The participants took part in trial of a self-guided internet-delivered intervention in Norway. As part of the intervention, the participants were asked to describe positive aspects of having ADHD.

PARTICIPANTS

The study included 50 help-seeking adults with an ADHD diagnosis.

RESULTS

The participants described a variety of positive aspects related to having ADHD. The participants' experiences were conceptualised and thematically organised into four main themes: (1) the dual impact of ADHD characteristics; (2) the unconventional mind; (3) the pursuit of new experiences and (4) resilience and growth.

CONCLUSIONS

Having ADHD was experienced as both challenging and beneficial, depending on the context and one's sociocultural environment. The findings provide arguments for putting a stronger emphasis on positive aspects of ADHD, alongside the challenges, in treatment settings.

TRIAL REGISTRATION NUMBER

NCT04511169.

Screening for Adulthood ADHD and Comorbidities in a Tertiary Mental Health Center Using EarlyDetect: A Machine Learning-Based Pilot Study

Screening for adult Attention-Deficit/Hyperactivity Disorder (ADHD) and differentiating ADHD from comorbid mental health disorders remains to be clinically challenging. A screening tool for ADHD and comorbid mental health disorders is essential, as most adult ADHD is comorbid with several mental health disorders. The current pilot study enrolled 955 consecutive patients attending a tertiary mental health center in Canada and who completed EarlyDetect assessment, with 45.2% of patients diagnosed with ADHD. The best ADHD classification model using composite scoring achieved a balanced accuracy of 0.788, showing a 2.1% increase compared to standalone ADHD screening, detecting four more patients with ADHD per 100 patients. The classification model including ADHD with comorbidity was also successful (balanced accuracy = 0.712). The results suggest the novel screening method can improve ADHD detection accuracy and inform the risk of ADHD with comorbidity, and may further inform specific comorbidity including MDD and BD.

The need for earlier recognition of attention deficit hyperactivity disorder in primary care: a qualitative meta-synthesis of the experience of receiving a diagnosis of ADHD in adulthood

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopment disorder that affects individuals across the lifespan. ADHD causes dysfunction when left untreated. Individuals receiving a diagnosis in adulthood have a unique life experience because of their delayed diagnosis.

OBJECTIVES

To identify and methodically review qualitative studies that explored the experiences of receiving a diagnosis of ADHD in adulthood, conduct an interpretive analysis of the identified studies, and produce a qualitative meta-synthesis to provide an understanding of these experiences.

METHODS

Studies with adults diagnosed with ADHD in adulthood, focussed on experiences of receiving a delayed ADHD diagnosis, used qualitative methods, and were cited in PubMed, OVID, and ProQuest databases. Out of 251 studies identified, 7 met inclusion criteria.

RESULTS

This qualitative meta-synthesis produced 2 main themes: ADHD as an identity and ADHD as a diagnosis, and 5 subthemes: identity before diagnosis, identity after diagnosis, the unnecessary struggle, the diagnosis as a revelation and a burden, and a functional life was finally possible.

CONCLUSION

Overall, this study showed that delayed diagnosis of ADHD causes suffering and dysfunction that could be mitigated through earlier diagnosis and treatment.

The lived experiences of adults with attention-deficit/hyperactivity disorder: A rapid review of qualitative evidence

Attention-deficit/hyperactivity disorder (ADHD) is a common condition that frequently persists into adulthood, although research and diagnostic criteria are focused on how the condition presents in children. We aimed to review qualitative research on lived experiences of adults with ADHD to characterize potential ADHD symptomatology in adulthood and provide perspectives on how needs might be better met. We searched three databases for qualitative studies on ADHD. Studies (n = 35) in English that included data on the lived experiences of adults with ADHD were included. These studies covered experiences of receiving a diagnosis as an adult, symptomatology of adult ADHD, skills used to adapt to these symptoms, relationships between ADHD and substance use, patients' self-perceptions, and participants' experiences interacting with society. Many of the ADHD symptoms reported in these studies had overlap with other psychiatric conditions and may contribute to misdiagnosis and delays in diagnosis. Understanding symptomatology of ADHD in adults may inform future diagnostic criteria and guide interventions to improve quality of life.

A self-guided Internet-delivered intervention for adults with ADHD: a protocol for a randomized controlled trial

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) in adulthood, with an estimated prevalence of 2-3%, is associated with several challenges in daily life functioning. The availability of evidence-based psychological interventions for adults with ADHD is still poor. Interventions delivered over the Internet on smartphones or personal computers may help to increase the availability of effective psychological interventions. The primary aim of this randomized controlled trial is to examine the efficacy of a self-guided Internet-delivered intervention on severity levels of ADHD symptomatology and quality of life.

METHODS

We aim to include 118 participants with a self-reported ADHD diagnosis in a randomized controlled trial with two arms: 1) self-guided Internet-delivered intervention for coping with ADHD (N = 59); 2) self-guided online psychoeducation (control group, N = 59). After 3 months, the control group will be given access to the intervention. The primary clinical outcomes are inattention and quality of life. Secondary clinical outcomes are hyperactivity, stress and depression. Measures will be obtained at three time points: before (baseline), immediately after (8 weeks) and 3 months after the intervention. Uptake, usage, adherence and satisfaction will be explored.

DISCUSSION

This RCT will provide valuable information on the clinical effectiveness of an Internet-delivered intervention for adults with ADHD. This study is, to our knowledge, one of the first randomized control trials that investigates the effects of a self-guided Internet-delivered psychological intervention in a fairly large group of adults with ADHD.

TRIAL REGISTRATION

ClinicalTrials.gov, Identifier NCT04726813, January 27, 2021.

Goal management training for adults with ADHD - clients' experiences with a group-based intervention

BACKGROUND

There is growing evidence for the efficacy of group-based interventions for adults with ADHD. However, there is still a lack of research investigating how clients experience participating in such interventions. The aim of the current study was to explore how adults with ADHD experience participating in a group-based intervention (Goal Management Training) for ADHD.

METHOD

We conducted individual, semi-structured, interviews with ten adults with ADHD who had participated in Goal Management Training administered as a group intervention. The interviews were transcribed verbatim and analyzed using thematic analysis within a hermeneutic phenomenological framework.

RESULTS

Our analysis identified three main themes. The participants' starting point captured the participants' motivation and expectations prior to treatment. The ambiguity of the group - the various meanings of the group consisted of three sub-themes (The group created a sense of belonging - "I am not alone"; The personal cost of participating in the group - "At times it was a hot mess"; and The group supported the learning experience - "We worked with it together"). The group promoted positive change - How the group affected the participants' everyday lives consisted of two sub-themes (Managing ADHD in daily life - "It's much easier to handle everyday life", and Personal growth - "Gaining new perspectives").

CONCLUSION

The group format was experienced as a valuable aspect of treatment. The structure provided by Goal Management Training allowed participants to expand their perspectives and experience improved management of ADHD, as well as personal growth. The opportunity to exchange experiences with others in similar situations was seen as particularly beneficial and brought feelings of recognition and belonging. However, some also experienced the group as a burden at times, for instance by stealing one's focus. This study expands existing knowledge by exploring clients' experiences of participating in group-based interventions for ADHD and shows how the group format provided participants with more than they had hoped for. While expecting a more instrumental outcome of treatment, such as tools to manage ADHD, participants also gained a welcomed, but unexpected outcome of personal growth.