Quality of life in older adults with ADHD: links to ADHD symptom levels and executive functioning deficits

ADHD in older adults - a scoping review

OBJECTIVES

This scoping review presents an overview of the available research on symptoms, comorbidities, and associated challenges among older adults with ADHD.

METHOD

The literature study followed Arksey and O'Malley's five-stage framework. The search was conducted in ProQuest Central, Scopus, PsycInfo, CINAHL, and PubMed. Articles were included if they were peer-reviewed, ethically approved primary studies, written in the English language, concerning ADHD, and including people 60 years of age and older.

RESULTS

The review included 17 articles. Symptoms of ADHD persist throughout life. Older adults with ADHD experience similar core symptoms as younger individuals, but their manifestation and intensity may differ. The most common comorbidity found was mental illness, for example depression and anxiety. ADHD in older adults is linked to several challenges, such as difficulty with relationships and social isolation.

CONCLUSION

Older adults with ADHD face various symptoms, comorbidities, and challenges that affect their quality of life. Age-related changes can amplify ADHD symptoms and increase the perceived burden of illness. More research is needed to understand the complex relationship between these factors and enable tailored interventions to improve their quality of life and well-being.

Support in Daily Living for Young Adults with Neurodevelopmental Conditions in Sweden: A Qualitative Description of Current Practice

In Sweden, people living independently and requiring daily living support can access 'housing support', a form of practical, educational, and social support provided by the municipalities. About two-thirds of those receiving this support have neurodevelopmental conditions, primarily autism or ADHD. Many are young adults in the process of adapting to new roles and expectations in different life domains, including education, work, and accommodation. This study aimed to provide a qualitative description of support workers' views on current practice in housing support for young adults (aged 18 to 29) with neurodevelopmental conditions. Semi-structured telephone interviews were conducted with 34 housing support workers across 19 Swedish regions. An inductive qualitative content analysis approach was used. The interviews depicted a complex service, subject to organizational aspects (roles, responsibilities, availability, and allocation), the joint effort of key players (young adults, relatives, and support workers), and practical aspects of service provision (finding common ground for the work, and delivery of support). Some elements of the service were poorly designed for the target group. The support workers expressed a need for more knowledge about neurodevelopmental conditions, but also described new insights related to remote delivery of support. The results raise important questions about how housing support should be organized and delivered to strike the right balance between support and autonomy, meet specific needs, and ensure equal services across municipalities. Future research should adopt multiple perspectives and approaches, to help translate best practice and available evidence into a flexible and sustainable service.

The effects of chronic administration of stimulant and non-stimulant medications on executive functions in ADHD: A systematic review and meta-analysis

Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with executive function deficits that are improved with medications. However, meta-analyses of stimulant effects on cognition have mostly tested single-dose effects, and there is no meta-analysis of non-stimulant effects. This systematic review and meta-analysis tested the clinically more relevant longer-term effects of Methylphenidate (20 studies; minimum 1 week) and Atomoxetine (8 studies; minimum 3 weeks) on reaction time, attention, inhibition, and working memory, searching papers on PubMed, Embase, Ovid MEDLINE, and PsycINFO. The meta-analysis of 18 studies in 1667 subjects showed that methylphenidate was superior to placebo in all cognitive domains with small to medium effect sizes (Hedges g of 0.34-0.59). The meta-analysis of atomoxetine included 7 studies in 829 subjects and showed no effects in working memory, but superior effects in the other domains with medium to large effect sizes (Hedge's g of 0.36-0.64). Meta-regression analysis showed no drug differences on cognitive effects. The meta-analyses show for the first time that chronic Methylphenidate and Atomoxetine have comparable effects of improving executive functions in people with ADHD.

Adult ADHD in the Republic of Ireland: the evolving response

Historically, attention-deficit hyperactivity disorder (ADHD) was conceptualised as a disorder of childhood that gradually improved and diminished as individuals transitioned to adulthood. Over the past decade, several studies have been published describing a cohort of adolescents with a childhood diagnosis of ADHD experiencing a continuity of ADHD symptoms into adulthood. Untreated ADHD in adults is associated with personal relationship difficulties, educational and occupational underachievement, comorbid mental health problems, substance misuse, and increased rates of road traffic accidents and criminality. These result in an increased economic burden and broader public health challenges. This review outlines the current framework and stage of development of ADHD services for adults in the Republic of Ireland.

The Role of Age in Adult ADHD Quality Care: A Longitudinal Analysis of Electronic Health Record Data

OBJECTIVE

Several studies have shown that Adult ADHD presents differently in younger and older adults. We sought to assess the difference in care between these two groups using previously identified quality measures (QMs).

METHODS

Using electronic health record data, we matched a younger group of ADHD patients to an older group. We then assessed the achievement of the QMs using probit models with and without interaction terms.

RESULTS

The majority of QMs shown an increase in achievement for both groups over time. However, significant differences in quality of care between younger and older adult ADHD patients persisted. By the end of the study period, with the exception of three QMs, younger patients achieved the QMs more.

CONCLUSION

While, in general, the quality of care for adult ADHD increased from 2010 to 2020, there were still differences in care between younger and older adult ADHD patients.

Attention-Deficit/Hyperactivity Disorder as a Potential Risk Factor for Dementia and Other Neurocognitive Disorders: A Systematic Review

Background

Attention-deficit/hyperactivity disorder (ADHD), a common neurodevelopmental condition now recognized to persist into older adulthood, has been postulated to be a risk factor for neurocognitive disorders given the overlap in clinical features and neurobiology, as well as the complex interplay between ADHD and known risk factors for dementia. Studies have emerged assessing this relationship, but there has not yet been a comprehensive systematic review addressing this topic.

Objective

To assess whether ADHD is a risk factor for neurocognitive disorders and to explore possible mechanisms for such an association.

Methods

A systematic review of the literature was conducted using Medline, Embase, and PsycINFO from inception until June 4, 2023. Studies were included if they assessed whether or how ADHD may be a risk factor for neurocognitive disorders. Studies were excluded if they were not primary literature, not published in a peer-reviewed journal, not in English, and/or used non-human subjects. Study quality was assessed using the QualSyst tool.

Results

Sixteen studies met inclusion criteria. Seven studies found a positive association between ADHD and neurocognitive disorders (all-cause dementia in four studies, Alzheimer's disease in three studies, Lewy body dementia in two studies, and mild cognitive impairment in one study). Four studies did not find an association. Five studies pertained to possible mechanisms for an association, including genetics, with minimal significant findings.

Conclusions

ADHD may be a risk factor for certain neurocognitive disorders, although the evidence base is limited, and the absolute risk is small. Possible explanations include genetic and lifestyle factors.

Effectiveness of executive functioning training among heterogeneous adolescent samples: A systematic review

The aim of the present systematic review was to discuss the reported efficacy of executive functioning training techniques among adolescents. A systematic review of the literature was conducted to retrieve and consolidate findings from articles evaluating executive functioning training techniques among adolescents. A total of 26 articles were located that examined the role of executive functioning training techniques among adolescents (age 10-19 years). Articles retrieved enabled comparison across psychiatric and medical diagnoses including attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), as well as adolescents with physical health concerns. Results revealed that among typically developing adolescents, executive functioning training was non-significant or yielded small effect size improvements in executive functioning as measured by behavioral and neuroimaging tasks among 62.5% of studies reviewed. In contrast, in those with medical conditions, ASD, ADHD, and conduct disorder, all but two studies reviewed yielded a medium to large effect size, supporting the effectiveness of EF training. Future research is needed to identify the long-term efficacy of these treatments, as well as their generalizability to real-world conditions.

Is quality of life related to high autistic traits, high ADHD traits and their Interaction? Evidence from a Young-Adult Community-Based twin sample

This study explored whether high autistic traits, high attention deficit hyperactivity disorder (ADHD) traits and their interaction were associated with quality of life (QoL) in a sample of 556 of young-adult twins (Mean age 22 years 5 months, 52% Female). Four participant groups were created: high autistic traits, high ADHD traits, high autistic/ADHD traits, and low ADHD/autistic traits. High autistic traits were associated with lower QoL across domains (physical, psychological, social, and environmental). High ADHD traits associated with lower physical, psychological, and environmental QoL. The interaction of autistic and ADHD traits was not significant in any domain. While mental health difficulties were associated with lower QoL, after accounting for mental health, most relationships between autistic traits, ADHD traits and QoL remained.

Networks of Neuropsychological Functions in the Clinical Evaluation of Adult ADHD

This study applied network analysis to explore the relations between neuropsychological functions of individuals in the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. A total of 319 participants from an outpatient referral context, that is, 173 individuals with ADHD (ADHD group) and 146 individuals without ADHD (n-ADHD group), took part in this study and completed a comprehensive neuropsychological assessment. A denser network with stronger global connectivity was observed in the ADHD group compared to the n-ADHD group. The strongest connections were consistent in both networks, that is, the connections between selective attention and vigilance, and connections between processing speed, fluency, and flexibility. Further centrality estimation revealed attention-related variables to have the highest expected influence in both networks. The observed relationships between neuropsychological functions, and the high centrality of attention, may help identify neuropsychological profiles that are specific to ADHD and optimize neuropsychological assessment and treatment planning of individuals with cognitive impairment.

The diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) in older adults

INTRODUCTION

There is a striking knowledge gap on ADHD in older adults, and the diagnosis as well as treatment for ADHD in this age group.

AREAS COVERED

The authors first review the literature on the prevalence, functional impairment, and health comorbidities of ADHD across the lifespan. Next, they address the diagnostic criteria for ADHD in adults according to the DSM/ICD, available screening/diagnostic tools, differential diagnosis, and the validity of diagnostic criteria for ADHD in older adults. Finally, the authors focus on empirical evidence on the prevalence rates, medication response, and safety of pharmacological treatment of ADHD in older adults, and national and international clinical guidelines on the treatment of ADHD in this age group.

EXPERT OPINION

It is expected that future editions of the DSM and ICD will provide specifiers to the standard ADHD criteria, to better inform the diagnosis of ADHD in older adults. It is also expected that the increasing number of epidemiological studies will provide rigorous estimates on the prevalence, incidence, and burden of ADHD in older adults. One may expect an increasing number of RCTs assessing the efficacy/effectiveness and tolerability/safety of pharmacological as well as non-pharmacological interventions which will inform future guidelines on ADHD in older adults.

Maternal cortisol in 3rd trimester is associated with traits of neurodevelopmental disorder in offspring. Odense Child Cohort

BACKGROUND

Prenatal cortisol exposure is essential for neurodevelopment. Maternal cortisol levels could be associated with offspring autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD).

AIM

To investigate associations between maternal 3rd trimester cortisol and offspring traits of ASD and ADHD.

MATERIAL AND METHODS

Mother-child pairs were included from the prospective study Odense Child Cohort. Morning serum cortisol and 24-hour urine cortisol/cortisone were collected at gestational week 27-30. Offspring ASD and ADHD traits were assessed at age three and five years using the Child Behavior Checklist. Maternal cortisol measurements and offspring ASD and ADHD traits assessment were available in (n = 1131; 52% boys) mother-child pairs at age three and (n = 717; 54% boys) at five years of age. Maternal 24-hour urine measurement was available in a subset, at offspring three years of age (n = 300) and at five years of age (n = 217). Associations between maternal cortisol (continuous and tertiles) and offspring ASD or ADHD traits were examined in regression models adjusted for offspring sex, maternal age, pre-pregnancy BMI, parity, maternal education level, parental psychiatric disorders, and maternal smoking and stratified for offspring sex.

RESULTS

Maternal mean age ( ± SD) was 30 years ( ± 4.4) and median BMI (25%; 75% percentiles) 23.5 kg/m² (21.3; 26.6). Higher maternal serum cortisol levels were associated with higher prevalence of offspring ASD traits at three years of age in the total study cohort and in boys after stratifying for offspring sex. In the total population, tertiles of serum cortisol showed a significant dose-response relationship to ASD traits in unadjusted and adjusted models (p-values for linear trend, p < 0.01 and p = 0.02, respectively). In offspring at five years, associations between maternal cortisol and offspring ASD traits were non-significant (all p-values > 0.2). Maternal cortisol was not associated with offspring ADHD traits (all p-values > 0.07) in offspring at three and five years. Maternal 24-hour urine cortisol, cortisone, or cortisol/cortisone ratio were not associated with offspring ASD or ADHD traits.

CONCLUSION

Higher maternal serum cortisol in 3rd trimester was associated with offspring ASD traits at three years of age in the whole study cohort and in boys, but not in girls. This association was non-significant at five years of age.

"For Me, 'Normality' is Not Normal": Rethinking Medical and Cultural Ideals of Midlife ADHD Diagnosis

According to psychiatry, Attention-Deficit/Hyperactivity Disorder (ADHD) is a chronic condition beginning in early life. Psychiatry advocates for early diagnosis to prevent comorbidities that may emerge in untreated cases. "Late"-diagnosis is associated with various hazards that might harm patients' lives and society. Drawing on fieldwork in Israel, we found that 'midlife-ADHDers,' as our informants refer to themselves, express diverse experiences including some advantages of being diagnosed as adults rather than as children. They share what it means to experience "otherness" without an ADHD diagnosis and articulate how being diagnosed "late" detached them from medical and social expectations and allowed some to nurture a unique ill-subjectivity, develop personal knowledge, and invent therapeutic interventions. The timeframe that psychiatry conceives as harmful has been, for some, a springboard to find their own way. This case allows us to rethink 'experiential time'-the meanings of timing and time when psychiatric discourse and subjective narratives intertwine.

ADHD and associated psychopathology in older adults in a German community sample

Attention deficit hyperactivity disorder (ADHD) is still a neglected disorder in older adults. The aim of the present study was to examine the prevalence and symptomatology of ADHD and associated psychopathology in adults aged 40-80 years in a German community sample. We examined 539 participants in two age groups: (1) 40-59 years old (n = 256) and (2) 60-80 years old (n = 283). To assess ADHD in both childhood and adulthood as well as current psychopathological impairments, we used self-report instruments and corresponding observer reports. We examined group differences between age groups and between ADHD and non-ADHD groups. The prevalence of ADHD in the total sample was 2.6% with no significant differences between the two age groups (40-59 years: 3.1% vs. 60-80 years: 2.1%). Although differences emerged in impulsivity/emotional lability and self-concept problems, overall ADHD symptom ratings did not differ between the age groups. The ADHD group showed more psychopathological peculiarities compared to individuals without ADHD with medium-to-large effect sizes. Self-reports and observer reports showed good concordance in the assessment of ADHD and comorbid psychopathological symptoms. Regarding current ADHD symptomatology, in 92.1%, self-report was corroborated by observer's information. Our findings underline that ADHD symptoms are relevant across the lifespan. Augmenting self-reports with observer reports could increase the assessment quality of ADHD. For successful treatment, clinicians should also focus on additional psychopathological impairments and comorbidities in older adults with ADHD.

Association between quality of life, sleep quality and mental disorders in Iranian older adults

Aging as a major challenge can affect the development and growth of countries all around the world. This study aimed to identify the subgroups of the elderly based on the quality of life (Qol), sleep quality, and common mental disorders and assess the role of demographic characteristics on the membership of participants in each latent class. This cross-sectional study was conducted on 1064 people over the age of 60 years. The sample was selected through cluster sampling in northern Iran. All participants completed six sets of checklists and questionnaires. Data analysis was performed using latent class analysis. Three latent classes were identified; namely, (1) healthy (66.8%), (2) anxious and with poor sleep quality (28.6%), and unhealthy (4.6%). Being Female significantly increased the odds of membership in classes 2 and 3 compared to class 1. Furthermore, living in urban areas increased the odds of belonging to class 2 and class 3 compared to class 1. Illiteracy was also shown to increase the odds of being in class 3 in comparison to class 1. Results from the present indicate that the co-occurrence of health problems in 33.2% of the elderly was observed in various forms. The results of this study can be used in prioritizing health programs for the elderly and emphasizing high-risk groups.

Association Between Mild Neurocognitive Disorder Due to Alzheimer's Disease and Possible Attention-deficit/Hyperactivity Disorder: A Case Report

Recent literature concerning attention-deficit/hyperactivity disorder (ADHD) underlines the persistence of this neurodevelopmental illness in older patients. Comorbidity with a neurodegenerative disease is thus possible. However, few studies have investigated this topic. To our knowledge, this is the first case report of such a possible association, which raises important questions about clinical presentation, symptoms, diagnosis, and treatment. A 72-year-old man, without any psychiatric history, presented with depression, subjective memory loss, and attention deficit and anxious symptoms, and was diagnosed with mild neurocognitive disorder due to Alzheimer's disease. However, the patient's attentional symptoms appeared to have been present since childhood. A formalized diagnostic interview assessing for ADHD did not allow for a clear diagnosis, possibly due to recall bias. The patient's anxiety symptoms also did not respond well to cognitive behavioral therapy coupled with different antidepressants. We hypothesized the presence of ADHD, with the symptoms balanced until now by the patient's high cognitive capacities, and we postulated that the onset of a neurogenerative process may have disrupted this balance. In this case report, we discuss symptom dimensionality, the interplay between neurodegenerative and neurodevelopmental diseases, and various treatment options. Attentional deficits and anxiety symptoms are frequent in mild neurocognitive disorders due to neurodegenerative illnesses. It is important to explore the time of onset of such symptoms since neurodegenerative processes can worsen neurodevelopmental conditions. Moreover, identification of a pre-existing neurodevelopmental condition can lead to alternative care and treatment options. In addition, the unexplained worsening of ADHD symptoms should prompt clinicians to assess for a neurodegenerative process.

The effects of psychostimulants on cognitive functions in individuals with attention-deficit hyperactivity disorder: A systematic review

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is associated with a broad range of deficits in cognitive functions which has significant implications for quality of life. Psychostimulants are demonstrated to improve symptoms of inattention and hyperactivity/impulsivity, however, their impact on cognition remains incompletely characterized. Herein, the aim of this systematic review is to synthesize the extant literature reporting on the effects of psychostimulants on cognitive function in individuals with ADHD.

METHOD

A systematic search of PubMed, Scopus, and Web of Science from inception to July 2021 was conducted. Additional studies were identified through Google Scholar and a manual search of the reference lists of relevant articles. Inclusion criteria were original studies that evaluated the cognitive function of individuals with ADHD taking psychostimulants drugs. We assessed the quality of the included papers using the Newcastle-Ottawa scale (NOS).

RESULTS

A total of 10 studies involving 753 subjects with ADHD and 194 healthy controls were identified and eligible for inclusion. Nine studies evaluated the impact of methylphenidate on cognitive function and one study investigated the use of lisdexamfetamine. Results indicated that attentional deficits such as memory, vigilance, divided attention, phasic and tonic alertness, and focused attention were improved in ADHD patients treated with psychostimulants. The efficacy of psychostimulants in improving other domains of cognition remains inconclusive due to conflicting evidence or insignificant findings (ie. academic performance and executive function). Overall, results indicate that psychostimulants may improve only select domains of cognition (ie. memory and attention).

CONCLUSION

Psychostimulants are reported to improve several disparate aspects of cognition among individuals with ADHD. Further research is needed to better understand the complex relationships between cognition and behavior in ADHD, as well as the impact of medication on these distinct aspects of functioning. Further research is also needed to determine whether the pro-cognitive effect of stimulants would be transferable to other mental disorders.

Emotional dysregulation and health related quality of life in young adults with ADHD: a cross sectional study

Objective

Attention Deficit Hyperactivity Disorder (ADHD) is associated with emotional dysregulation (ED) and impaired health related quality of life (HRQoL). However, the role of ED in explaining the relationship between ADHD and HRQoL is unclear. The purpose of the present study was to do so in a sample of non-referred young adults with and without ADHD.

Method

The study design was cross-sectional. A non-clinical sample of 63 young adults with ADHD (mean age = 24.86 years, SD = 3.25, 78% university students) and 69 gender-matched controls (mean age = 23.84 years, SD = 2.59, 89% university students) were recruited. The Adult ADHD Quality-of-Life scale was used to measure HRQoL; The Self-Report Wender–Reimherr Adult Attention Deficit Disorder Scale and the Difficulties in Emotion Regulation Scale were used to measure ED. Group differences on all measures were tested using univariate and multivariate analyses of covariance, while controlling for age. Finally, a moderation analysis was used in order to examine the impact of ED on HRQoL beyond that accounted for by ADHD symptoms.

Results

Both HRQoL and ED were significantly worse for the ADHD group compared to the control group. The medication status of the ADHD group participants had no significant effect on the level of ADHD symptoms, ED or HRQoL. ED moderated the effect of ADHD symptoms on HRQoL for the ADHD group.

Conclusion

The findings support the centrality of ED in ADHD and its crucial influence on HRQoL. Young adults with ADHD and high levels of ED are at risk for aversive impact on their well-being regardless of their ADHD symptoms level.

Young adults with Attention Deficit Hyperactivity Disorder (ADHD) struggle with poor quality of life (QoL). Emotional regulation is one’s ability to modify their emotional state to promote adaptive, goal-oriented behaviors. Emotional dysregulation is a common yet neglected feature of people with ADHD. Our results show that young adults with ADHD are twice more likely to suffer from emotional dysregulation then their peers. Moreover, higher levels of emotional dysregulation predicted lower levels of QoL. These findings support the centrality of ED in ADHD and their crucial influence on everyday QoL. These findings are important not only on the theoretical level, but may also contribute to the design of interventions that aim to promote quality of life.

Adults referred to a national ADHD clinic in Iceland: clinical characteristics and follow-up status

OBJECTIVE

Evaluate adults referred to a national ADHD clinic, by comparing those diagnosed with those who were not, and those who screened negative and to evaluate changes among those diagnosed at follow-up.

METHOD

Data obtained from 531 patients' medical records (49.7% males). One hundred thirty-six screened negative, 395 positive and 305 met diagnostic criteria for ADHD. Eighty-three of them were contacted by phone at follow-up.

RESULTS

ADHD diagnosis was associated with lower educational status and more concerns expressed by parents and teachers during childhood. Participants not diagnosed with ADHD more often met diagnostic criteria for dysthymia, agoraphobia and generalized anxiety, and were more likely to be diagnosed with two or more comorbid disorders. At follow-up, all reported a significant reduction of ADHD symptoms, irrespective of medication, but the medicated participants reported fewer symptoms of inattention and better functioning in daily life.

CONCLUSION

Adults referred to ADHD clinics may have multiple mental health problems, regardless of whether they receive ADHD diagnosis or not. This could have implications for differential diagnoses of ADHD in adults and emphasises the need to have appropriate treatment available for both groups. Psychoeducation about ADHD may be very helpful in decreasing anxiety and ADHD symptoms.

Adult ADHD, executive function, depressive/anxiety symptoms, and quality of life: A serial two-mediator model

BACKGROUND

Adult attention-deficit/hyperactivity disorder (ADHD) is associated with impaired executive function (EF), depressive/anxiety symptoms, and poor quality of life (QoL). In this study, we aimed to investigate correlations among these variables and to build a simple or serial mediation model for exploring the mechanisms between adult ADHD and QoL.

METHODS

This was a cross-sectional study. The sample included 223 participants with ADHD and 54 healthy volunteers. Participants were required to complete the following scales: ADHD Rating Scale (ADHD-RS), Brief Version of the World Health Organization Quality of Life Scale (WHOQOL-BREF), Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A), Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS). Correlations among EF, depressive/anxiety symptoms and QoL were analyzed using Pearson correlation. The simple and serial mediation models were analyzed using PROCESS (version 3.3).

RESULTS

The correlations between EF and QoL, depressive/anxiety symptoms and QoL, and depressive/anxiety symptoms and EF were statistically significant. In ADHD adults with comorbidities, the correlation coefficients were between -0.19 and -0.47, -0.20 and -0.62, 0.28 and 0.50, respectively. In simple mediation models, EF and depressive/anxiety symptoms were significant mediators respectively between ADHD and QoL, respectively. In a serial two-mediator model, ADHD could affect QoL indirectly via EF and then via depressive/anxiety symptoms significantly.

LIMITATIONS

The average age was young, the degree of education was high, and only self-reported scales were relied on.

CONCLUSIONS

There is a mutual effect between EF and emotional symptoms. This was the first study to build a serial two-mediator model between ADHD and QoL, suggesting the importance of EF and depressive/anxiety symptoms.

Helpful family climate moderates the relationship between perceived family support of ADHD symptoms and depression: a conditional process model

BACKGROUND

Symptoms of attention deficit hyperactivity disorder (ADHD) are commonly comorbid with depression This study aimed to examine the relationship between ADHD symptoms and depression through perceived family support and to explore whether the magnitude of the relationship depended on the type of family climate of medical students.

METHODS

This cross-sectional study was conducted among 124 first year medical students in Thailand. Participants completed questionnaires on ADHD symptoms, depression, perceived family support, and 9 types of family climate. The questionnaires included the Adult ADHD Self-Report Scale Screener, Patient Health Questionnaire-9, and revised Thai Multidimensional Scale of Perceived Social Support. Mediational analysis was adopted to examine the mediating role of perceived family support in the relationship between ADHD symptoms and depression, while moderation analysis was applied to examine the extent of the relationship depending on family climate.

RESULTS

The relationship between ADHD symptoms and depression was moderate. Perceived family support partially mediated this relationship after controlling for age and sex. Among the types of family climate, only helpful family climate was a significant moderator of perceived family support and depression. The moderated mediation model increased the variance in depression from 17% by the mediation model to 21%. However, follow-up conditional mediational analysis showed that the indirect effect of ADHD symptoms on depression via perceived family support was not significant and that this effect did not vary linearly as a function of helpful family climate.

CONCLUSION

The findings of the study revealed that poor family support might be one risk of developing depression in the context of ADHD symptoms. Further study on providing intervention concerning family support among those with ADHD symptoms should be warranted. In addition, a study on helpful family climate in a larger sample size, in other populations, and in a longitudinal fashion for a more robust conclusion is encouraged.

Impact of methylphenidate on sleep problems in adults with ADHD: a pilot polysomnography study

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is associated with disrupted sleep and circadian rhythm. Medication for ADHD may have side effects aggravating sleep-disturbances, however beneficial effects on ADHD may contribute to improve sleep.

AIMS

This pilot study aims to examine outcomes of first time stimulant treatment on objective and subjective sleep characteristics, and psychiatric symptoms, in adult ADHD patients with pretreatment sleep problems, but without any primary sleep disorder.

METHODS

In total, 9 previously unmedicated adult ADHD subjects who reported pretreatment sleep problems, completed polysomnography (PSG) and questionnaires on subjective sleep disturbances and psychiatric symptoms. Data was collected before and after 6 weeks on first time medication with immediate-release methylphenidate (MPH-IR), mean daily dose 43 mg.

RESULTS

Subjects on-medication showed an increased percentage of Stage 2 sleep compared to their non-treated baseline (46.6% versus 55.2%, p = .011). Otherwise, there were no significant changes in PSG variables. There were no firm changes in daytime sleepiness or symptoms of sleep disturbances.

CONCLUSIONS

These findings should be interpreted cautiously given the open-label design and small sample size, and should be examined in larger studies with more rigorous study designs.

The role of stress coping strategies for life impairments in ADHD

Attention-deficit/hyperactivity disorder (ADHD) is commonly accompanied by functional impairments within personal, professional, and social context as well as further psychological distress. The role of perceived stress has been examined in this regard, although little is known about the influence of stress coping strategies. We examined the dynamics between ADHD symptomatology, stress coping strategies, and life impairments in a sample of 230 clinical and non-clinical adult individuals. ADHD was associated with low probability of choosing adaptive but high probability of implementing maladaptive stress coping strategies as well as with increased life impairments. Adaptive stress coping showed little effects beyond the associations between ADHD and life impairments, whereas some maladaptive coping strategies increased current life impairments over and above the effects of ADHD and further psychological distress. The present findings emphasize the need of professional support in adults with ADHD and the necessity to include stress coping strategies in respective treatment approaches aimed at reducing life impairments.

Effects of a five-day HD-tDCS application to the right IFG depend on current intensity: A study in children and adolescents with ADHD

Impaired executive functions in ADHD are associated with hypoactivity of the right inferior frontal gyrus (IFG). This region was targeted via repetitive applications of anodal, high-definition transcranial direct current simulation (HD-tDCS) on five consecutive days in 33 ADHD patients (10-17years) and in a healthy control group (n=13, only sham). Patients received either sham (n=13) or verum tDCS with 0.5mA (n=9) or 0.25mA (n=11) depending on individual cutaneous sensitivity. During stimulation, participants performed a combined working memory and response inhibition paradigm (n-back/nogo). At baseline, post, and a 4-month follow up, electroencephalography was recorded during this task. Moreover, interference control (flanker task) and spatial working memory (spanboard task) were assessed to explore possible transfer effects. Omission errors and reaction time variability in all tasks served as measures of attention. In the 0.25mA group increased nogo commission errors indicated a detrimental tDCS effect on response inhibition. After the 5-day stimulation, attentional improvements in the 0.5mA group were indicated by reduced omission errors and reaction time variability. Variability improvements were still evident at follow up. In all groups, nogo P3 amplitudes were reduced post-stimulation, but in the 0.5mA group this reduction was smaller than in the 0.25mA group. Results of the current study suggest distinct effects of tDCS with different current intensities demonstrating the importance of a deeper understanding on the impact of stimulation parameters and repeated tDCS applications to develop effective tDCS-based therapy approaches in ADHD.

Executive functions, effortful control, and emotional lability in adults with ADHD. implications for functional outcomes

Adults with diagnosis of childhood attention-deficit hyperactivity disorder (ADHD) experience impairments in self-regulation (SR). This study examined whether subgroups of these impairments can be established based on differentiable patterns. The relationships between these subgroups and a group without ADHD were then analyzed, focusing on functional outcomes. Executive functions, effortful control, and emotional lability, in addition to self-concept, quality of life, and different comorbidities, were evaluated in 61 adults with a childhood diagnosis of ADHD and 54 adults without ADHD. Latent profile analysis (LPA) revealed three ADHD classes based on different self-regulation indicators: "Normalized" (49.18%), "Moderate impairments" (27.86%), and "Severe generalized impairments" (22.96%), who were compared with a Non-ADHD group on different functional measures. The "Normalized" profile showed significantly less dysfunctionality than the other two profiles, and it only exhibited significant differences with respect to the Non-ADHD group on the Hyperactivity index. By contrast, the "Severe generalized impairments" group, with the lowest self-regulatory skills, was impaired on all the functional outcomes. Self-regulatory skills could be a key target in interventions for adults with ADHD.

A nurse-led lifestyle intervention for adult persons with attention-deficit/hyperactivity disorder (ADHD) in Sweden

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is associated with lifestyle-related diseases. Therefore, a nurse-led lifestyle intervention including interpersonal relationships, health education and cognitive support was developed to facilitate healthier lifestyle habits.Aim: The aim was to develop a lifestyle intervention and investigate its impact on mental and physical healthMethod: The 52-week intervention included 35 adults with ADHD. In a pre- and post-test design, symptoms of ADHD were measured with the Adult ADHD Self-Report Scale, quality of life was measured with the Adult ADHD Quality of Life scale and mental health was measured with the Hospital Anxiety and Depression scale. Lifestyle habits and dimensions of health were measured by the Lifestyle-Performance-Health Questionnaire and physical fitness was measured by the VO2 Max Test and calculations of waist circumference and body mass index. Result: Post-tests for a group of 25 persons showed positive changes following the intervention regarding weekly physical activity, quality of life and general and mental health. Lifestyle habit support was found to be important. The impact of the intervention should be confirmed in a long-term study with a control group.Conclusion: This intervention may be beneficial and may be implemented in a primary healthcare setting or in other open care units.

Treatment of ADHD in adults - prevalence of discontinuation and associated factors - results from a cross-sectional analysis of Danish register data

BACKGROUND

A growing number of adults are receiving pharmacological treatment for ADHD but a sizable proportion also discontinues or have gaps in treatment. The primary aims of this study were to identify how many patients treated for ADHD in adulthood, have at least one event of discontinuation in treatment and to identify possible associated variables.

METHODS

Within the Danish population aged 18-60 years on the 1st of January 2013, we identified the number of individuals who had been prescribed ADHD-medication at least once during the 1st of January 2002-31st of December 2013 using Danish register data. Among those who filed more than one prescription, treatment discontinuation was defined as having more than 211 days between two prescriptions. In crude and adjusted logistic regression analysis, we explored potential associations to discontinuation for variables such as gender and age at treatment initiation.

RESULTS

In a population, if N = 3,165,844 individuals, n = 42,892 had received at least one prescription for ADHD medication. Among those with more than one prescription (N = 38,289), 29.4% had discontinued their treatment at least once, according to our definition of treatment discontinuation. ADHD treatment discontinuation was associated with being male, unemployment, lower educational attainment, receiving incapacity benefits and younger age at treatment initiation (p < 0.001).

CONCLUSIONS

A large proportion of individuals treated for ADHD had at least one discontinuation of treatment according to our definition. Although the present study does not allow for investigating the direction of these effects, nor whether some patients later resumed treatment, having at least one discontinuation was associated with a range of variables relating to e.g. age and gender, and provides an emerging profile for clinicians of patients more likely to discontinue.

The functional impact of cognition in adults with autism spectrum disorders

Purpose and aim: The overall aim of this study was to examine the relationship between adaptive function and cognitive factors in young adults diagnosed with autism spectrum disorder (ASD) in adult age.Methods: The study included 30 adults (age 18-30) diagnosed with ASD in adulthood. All participants were clinically referred to an adult psychiatric clinic for assessment. Adaptive functioning was measured with Adaptive Behavior Assessment System - 2nd edition (parent version). Wechsler scales of intelligence and Delis-Kaplan Executive Function System were used to measure intelligence and executive function.Results: We found considerable adaptive functioning deficits regardless of Full Scale Intelligence Quotient (FSIQ) level. FSIQ, working memory and processing speed were positively associated with adaptive functioning. No associations were found between adaptive functioning and cognitive flexibility, inhibition, word generation or shifting. Regression analysis showed that working memory and processing speed predicted 23% of the variance in adaptive functioning in this group.Conclusions: The results suggest that cognitive dysfunction could be an important area for intervention to improve adaptive functioning in ASD.