Attention deficit hyperactivity symptoms and risky sexual behavior in young adult women

Having Reliable Support: A Prerequisite to Promote Sexual and Reproductive Health in Young Women with ADHD

Living with attention deficit hyperactivity disorder (ADHD) may influence sexual behaviors and intimate relationships in young women, resulting in a higher risk of unwanted pregnancy, sexual victimization, and sexual dysfunction. To develop adequate support, the study aimed to describe conceptions of how to promote sexual and reproductive health (SRH) in young women with ADHD. A secondary analysis using phenomenography was performed on qualitative interview data exploring variations of support. The study involved 15 young women with ADHD, aged 15-29 years, and 16 health care professionals, with various professions, working in the fields of gynecology, youth health, and psychiatry. Having reliable support was conceptualized as fundamental for promoting SRH. Access to information concerning SRH and living with ADHD as well as early support from health care contributed to a reliable support enabling self-knowledge and management of sexual relationships. Trustful relationships in health care were perceived as important because of previous experiences of feeling misunderstood and criticized in life, making them feel comfortable discussing SRH. Clinical encounters with a clear structure were further perceived to make information more accessible and clinics that provided appropriate organizational conditions and collaborated with other clinics were described to enhance the availability of support. This study reveals the need for clinics to provide conditions that ensure SRH support is available, accessible, and free of stigmatization. Early intervention programs for young women with ADHD may be considered, offering guidance on SRH issues in both psychiatric and sexual health clinics.

Sexual and reproductive health in young women with ADHD from the view of health care professionals

BACKGROUND

Sexual risk-taking and struggles in managing romantic relationships may put young women with Attention Deficit Hyperactivity Disorder (ADHD) at risk of sexually transmitted diseases, unplanned pregnancies, and low relational satisfaction. To gain understanding of sexual behaviors and intimate relationships, this study aimed to identify and describe health care professionals' (HCPs) perceptions and experiences of sexual and reproductive health (SRH) in young women with ADHD.

METHODS

Qualitative interviews were performed with 16 HCPs. Data was analyzed using reflexive thematic analysis.

RESULTS

Analysis resulted in the themes Struggling to meet expectations, Sexual risk-taking, and Complex romantic relationships. HCPs' perceptions and experiences indicated that some women were afraid to be judged in clinical meetings when not living up to perceived expectations of sexual behaviors. Lack of impulse control was interpreted by HCPs to result in risk-taking behaviors leading to both negative and positive sexual experiences. Difficulties in assessing intentions of sexual partners were further perceived by HCPs to sometimes lead to sexual regrets or sexual victimization. The HCPs had experience of women wishing for romantic relationships but described these as being complicated by previous experiences, low self-esteem and conflict. ADHD medication and self-knowledge were perceived by HCPs to facilitate the women's relationship quality.

CONCLUSIONS

This study highlights that, from the perspective of HCPs, self-stigmatization and hesitation to raise issues concerning sexuality with HCPs may pose risks for young women with ADHD. It provides insight into sexual risk-taking behaviors, showing the link to regretted sex and sexual victimization. The study concludes that there is a need for HCPs to understand the influence of stigma concerning ADHD and female sexuality as well as how symptoms and outcomes of living with ADHD may impact SRH in order to promote healthy behaviors and relationships in young women.

Sexually Transmitted Diseases and Attention-Deficit/Hyperactivity Disorder: A Systematic Literature Review

Patients with attention-deficit/hyperactivity disorder (ADHD) suffer from inattention, hyperactivity, and impulsivity. Clinicians often assume that the specific difficulties associated with ADHD are bound to affect sexual behaviors, and favor risky sexual behaviors, thereby increasing the frequency of sexually transmitted diseases (STDs). This review provides an up-to-date synthesis of the literature concerning STDs in patients with ADHD. A systematic review of the literature was performed using the PubMed, PsychInfo, and Embase databases, with STDs as the main outcome measure. Patients with ADHD report more STDs than the general population. Results are limited by the small number of existing studies, as well as the heterogeneity of the outcome measures. Findings from this first systematic review of data on STDs in individuals with ADHD suggest that ADHD affects sexual health and sexual behaviors. Clinicians treating patients with ADHD should explore risky sexual behaviors in their patients and raise awareness about the risk of contracting STDs. Further studies are warranted to better evaluate the risk of contracting an STD in patients with ADHD.

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

BACKGROUND

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

AIM

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

METHODOLOGY

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

RESULTS

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

CONCLUSIONS

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

Paraphilic fantasies and behavior in attention deficit/hyperactivity disorder and their association with hypersexuality

Previous research has found some peculiarities in sexual functioning of adults with attention deficit/hyperactivity disorder (ADHD). Using a set of questionnaires that had to be answered online, we assessed the prevalence of paraphilic fantasies and behaviors in a sample of 160 adults with ADHD in comparison to 75 adults without ADHD and evaluated the association between paraphilias and hypersexuality in the ADHD group. Both groups reported high rates of paraphilic fantasies and behaviors. ADHD individuals were more likely to report about very sexually arousing paraphilic fantasies (ADHD: 58.2% vs. non-ADHD: 40.5%; χ2 = 6.323, p = 0.01) and behaviors (ADHD: 44.9% vs. non-ADHD: 28.4%; χ2 = 5.774, p = 0.02). Furthermore, ADHD individuals reported on average about more very sexually arousing paraphilic behaviors compared to non-ADHD individuals (ADHD: M = 1.28, SD = 0.10 vs. non-ADHD: M = 0.81, SD = 0.09; T = 2.68, p < 0.01). Furthermore, in ADHD individuals both very sexually arousing paraphilic interests in masturbation fantasies (r(158) = 0.17, p = 0.03) and in sexual behaviors (r(158) =0.19, p = 0.02) showed a significant correlation with hypersexuality. In non-ADHD individuals no such significant correlation could be found. Altogether, it can be concluded that individuals with ADHD seem to be more prone to develop and act out paraphilic sexuality than those without ADHD, however, found differences were rather small. The results of the present study add to the current trend to depathologize paraphilic sexuality in the general as well as in clinical populations.

Associations between attention-deficit hyperactivity disorder genetic liability and ICD-10 medical conditions in adults: utilizing electronic health records in a Phenome-Wide Association Study

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is often comorbid with other medical conditions in adult patients. However, ADHD is extremely underdiagnosed in adults and little is known about the medical comorbidities in undiagnosed adult individuals with high ADHD liability. In this study we investigated associations between ADHD genetic liability and electronic health record (EHR)-based ICD-10 diagnoses across all diagnostic categories, in individuals without ADHD diagnosis history.

METHODS

We used data from the Estonian Biobank cohort (N = 111 261) and generated polygenic risk scores (PRS) for ADHD (PRSADHD) based on the ADHD genome-wide association study. We performed a phenome-wide association study (PheWAS) to test for associations between standardized PRSADHD and 1515 EHR-based ICD-10 diagnoses in the full and sex-stratified sample. We compared the observed significant ICD-10 associations to associations with (1) ADHD diagnosis and (2) questionnaire-based high ADHD risk analyses.

RESULTS

After Bonferroni correction (p = 3.3 × 10-5) we identified 80 medical conditions associated with PRSADHD. The strongest evidence was seen with chronic obstructive pulmonary disease (OR 1.15, CI 1.11-1.18), obesity (OR 1.13, CI 1.11-1.15), and type 2 diabetes (OR 1.11, CI 1.09-1.14). Sex-stratified analysis generally showed similar associations in males and females. Out of all identified associations, 40% and 78% were also observed using ADHD diagnosis or questionnaire-based ADHD, respectively, as the predictor.

CONCLUSIONS

Overall our findings indicate that ADHD genetic liability is associated with an increased risk of a substantial number of medical conditions in undiagnosed individuals. These results highlight the need for timely detection and improved management of ADHD symptoms in adults.

Toward an Increased Attention on ADHD Symptoms and Traits in Young Adults: Prevalence Data From Screening Tools in a Psychiatric Outpatient Clinic

OBJECTIVE

to analyze the prevalence of ADHD symptoms and traits in a heterogeneous clinical psychiatric sample of young adults (aged 18-24 years old), who referred to a specialized outpatient clinic for various psychiatric and psychological disturbances.

METHOD

259 participants completed three validated self-report screening questionnaires for ADHD: the Wender Utah Rating Scale (WURS), the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 (ASRS-5), and the Conners' adult ADHD rating scale (CAARS).

RESULTS

12.4% of our sample scored above the cut-off at both the WURS and the ASRS-5 and was considered at risk of ADHD.

CONCLUSION

the prevalence rate in our sample is higher than the one found in the adult general population (6.76%), and in the lower range of the one found in the adult clinical population (6.9%-38.8%). The potential role of sociodemographic (age, sex, gender identity, and employment) and comorbidity factors is discussed.

Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment

OBJECTIVE

Among untreated adults, functional impairments associated with ADHD are widespread and cumulative, and can include social, educational, and professional impairments, increased risk of accidents and mortality, and reduced quality of life. Here, we review the most prominent functional impairments in adults with ADHD and summarize evidence describing the potential role of medication in improving outcomes.

METHOD

Articles related to the search terms "ADHD," "adult," and functional impairments were identified through Google Scholar and PubMed and selected for inclusion based on four criteria: strength of evidence, relevance to current challenges in adult ADHD, impact on the field, and recency of the results.

RESULTS

We identified 179 papers to support the conclusions on the relationship between ADHD and functional impairments, and the impact of pharmacological therapy on functional impairments.

CONCLUSION

This narrative review provides evidence that pharmacological treatment can be effective in minimizing not only the symptoms of ADHD, but its functional consequences as well.

Risk behaviors in substance use disorder in a sample of Egyptian female patients with or without symptoms of attention-deficit hyperactivity disorder

Background

Risk-taking behaviors are associated with attention-deficit hyperactivity disorder (ADHD) and substance use disorder (SUD). Individuals with both diagnoses have been reported to have an earlier onset, a longer course, and greater severity, with more relapses and greater difficulty remaining abstinent.

The current study was assessing females seeking treatment for SUDs for the presence of comorbid ADHD, to investigate the association between severity of SUD and co-occurring ADHD symptoms and to examine related risk behaviors. Therefore, thirty female patients were enrolled, and demographic data was collected. Participants were interviewed by SCID I, addiction severity index, Arabic-translated and validated version of the adult ADHD Self-Report Scale Barratt Impulsiveness Scale Version 11, and Arabic version of the Adult Scale of Hostility and Aggression.

Results

Thirty female patients were included in the study, and 33.3% had extreme severity, on the addiction severity index scale. Fifteen patients had ADHD symptoms; 33.3% had high likely scores, according to Adult ADHD Self-Reported Scale (ASRS). There is a significant difference regarding the age of onset of substance use and smoking (P = 0.029), first sexual activity (P = 0.002), number of sexual partners (P = 0.009), impairment in employment, and family and social relationships items (P = 0.024, P = 0.028, respectively) in SUD patients with ADHD symptoms than in SUD patients without ADHD symptoms.

Conclusion

Female patients diagnosed with adult ADHD have an earlier age of smoking and substance use, having first sexual activity at younger age, and having more sexual partners with more employment, family, and social relationship problems.

Maternal age at birth and child attention-deficit hyperactivity disorder: causal association or familial confounding?

BACKGROUND

Causal explanations for the association of young motherhood with increased risk for child attention-deficit hyperactivity disorder (ADHD) remain unclear.

METHODS

The ABCD Study recruited 11,878 youth from 22 sites across the United States between June 1, 2016 and October 15, 2018. This cross-sectional analysis of 8,514 children aged 8-11 years excluded 2,260 twins/triplets, 265 adopted children, and 839 younger siblings. We examined associations of maternal age with ADHD clinical range diagnoses based on the Child Behavior Checklist and NIH Toolbox Flanker Attention Scores using mixed logistic and linear regression models, respectively. We conducted confounding and causal mediation analyses using genotype array, demographic, socioeconomic, and prenatal environment data to investigate which genetic and environmental variables may explain the association between young maternal age and child ADHD.

RESULTS

In crude models, each 10-year increase in maternal age was associated with 32% decreased odds of ADHD clinical range diagnosis (OR = 0.68; 95% CI [0.59, 0.78]) and 1.09-points increased NIH Flanker Attention Scores (β = 1.09; 95% CI [0.76, 1.41]), indicating better child visual selective attention. However, adjustment for confounders weakened these associations. The strongest confounders were family income, caregiver education, and ADHD polygenic risk score for ADHD clinical range diagnoses, and family income, caregiver education, and race/ethnicity for NIH Flanker Attention Scores. Breastfeeding duration, prenatal alcohol exposure, and prenatal tobacco exposure were responsible for up to 18%, 6%, and 4% mediation, respectively.

CONCLUSIONS

Socioeconomic disadvantages were likely the primary explanation for the association of young maternal age with child ADHD, although genetics and modifiable environmental factors also played a role. Public policies aimed at reducing the burden of ADHD associated with young motherhood should target socioeconomic inequalities and support young pregnant women by advocating for reduced prenatal tobacco exposure and healthy breastfeeding practices after childbirth.

An Exploratory Investigation of Childhood Sexual Abuse and Other Theory-Driven Predictors of Sex Work Among Women with and without Childhood ADHD

Limited research has identified prospective risk factors for young-adult sex work or examined overlapping predictors concurrently. We investigated childhood sexual abuse (CSA), along with other theory-driven predictors of sex work, among a well-characterized sample of girls with and without childhood diagnoses of attention/deficit-hyperactivity disorder (ADHD).

METHODS

Participants were a racially and socioeconomically diverse sample of 140 girls with rigorously diagnosed ADHD (47 Inattentive [ADHD-I], 93 Combined [ADHD-C]), and 88 age- and ethnicity-matched comparison girls, all followed longitudinally into adulthood. Self-report data on young-adult occupations revealed a subsample of 7 participants reporting engagement in "sex work" or "prostitution." Logistic regressions tested whether CSA, measured both dichotomously and by discrete age ranges, predicted later sex work, accounting for other risk factors.

RESULTS

A lifetime history of CSA was positively associated with sex work in initial analyses (β = 1.51, p = .045), but not after adjusting for additional risk factors. When examined by age ranges, only CSA occurring between ages 9-15 significantly predicted sex work (β = 2.84, p = .043), even after adjusting for additional risk factors. Childhood ADHD-C also emerged as a significant predictor (β = 4.94, p = .015). ADHD-related medication and years of education were protective factors only when CSA was considered dichotomously.

CONCLUSIONS

Findings from this exploratory study underscore the need for longitudinal research that (a) considers the developmental timing of CSA and (b) accounts for impulsivity and inattention as risk factors for sex work among young-adult women. Implications for clinical practice are briefly discussed.

Self-experienced sexual and reproductive health in young women with Attention Deficit Hyperactivity Disorder: A qualitative interview study

Background

Sexual risk behaviors and struggles in romantic relationships result in higher risk of unplanned pregnancy, sexually transmitted diseases, sexual victimization and lower satisfaction in relationships for young women with Attention Deficit Hyperactivity Disorder (ADHD). There is a need to better understand sexual behaviors and the consequences of relational difficulties to help health professionals promote sexual and reproductive health. To deepen knowledge in this area, this study aimed to identify and describe self-experienced sexual and reproductive health in young women with ADHD.

Methods

A qualitative design was used. Data was collected with individual and focus group interviews with 15 young women, aged 15–29, with an ADHD diagnosis, and analyzed with thematic analysis.

Results

Data analysis identified the themes Acceptance of being different and Feeling sexually secure. The women reveal feelings of being different from others without ADHD as they break norms of sexual behavior, struggle with romantic relationships, and have difficulties concentrating during sex. There is a need to be understood and accepted, to not feel judged, and to manage romantic relationships. Self-knowledge helps them to recognize needs for support and to develop strategies that can improve sexual satisfaction. Feeling sexually secure illustrates the women’s need to feel comfortable with their own sexuality and in control in the sexual situation. Low self-esteem and a negative self-image, described as a consequence of living with ADHD, can compromise communication in sexual situations and increase fear of being rejected. Further, misjudging sexual partners and situations can contribute to sexual victimization.

Conclusions

This study provides knowledge of how ADHD affects emotions and sexual behaviors in young women. The results highlight the need for understanding and acceptance by peers and partners. It accentuates the value of involving the partner in counselling and the importance of self-knowledge. Feeling insecure in sexual relationships further implies the importance of early diagnosis to prevent secondary outcomes of ADHD, and the need for sexual victimization screening in professional settings.

Sexuality in Adults With ADHD: Results of an Online Survey

Establishing a secure sexual identity is a major developmental goal of an individual's transition from childhood to adolescence and the years that follow. Attention deficit/hyperactivity disorder (ADHD) as a neurodevelopmental disorder defined by the core symptoms of inattention, hyperactivity, and impulsivity, but also with emotional dysregulation, oppositional behaviors, or disorganization appearing early in life, can affect several areas of an individual's personal and social development, including sexual health. Yet, the scientific knowledge about the relationship between ADHD and sexual functioning is still scarce. Using an anonymous online survey, we compared different sexual behaviors including risky sexual behaviors, hypersexual behaviors, and sexual dysfunctions between 206 individuals with (n = 139) and without (n = 76) ADHD. Individuals with ADHD reported significantly more hypersexual behaviors than non-ADHD individuals, whereas no differences were found concerning risky sexual behaviors or sexual dysfunctions. In women with ADHD, hypersexual behaviors, sexual risk-taking as well as sexual dysfunctions were closely related to symptoms of emotional dysregulation, impulsivity, and oppositional symptoms. In men with ADHD, the associations between ADHD symptomatology and the sexuality-related measures were less clear, however, signs of emotional dysregulation seemed to be relevant as well. Since individuals with ADHD seem to be at an increased risk of some peculiarities in sexual behavior, sexuality-related issues should be routinely addressed during clinical consultations to provide more holistic treatment in order to enhance individual well-being and quality of life.

Talking About Sexuality With Youth: A Taboo in Psychiatry?

BACKGROUND

Young people who have psychiatric problems are more likely than their peers to endure difficulties during their sexual and gender identity development.

AIM

This study aims to examine the communication between mental health care providers and their patients about the topics of relations, sexuality and gender identity, including a description of professionals' attitudes toward these topics and the factors that contribute to and inhibit communication.

METHODS

Study participants (n = 242, response rate = 31%) were a representative sample of a large multicenter cohort of 768 mental health care professionals (eg, medical doctors, psychiatrists, psychologists, group counselors, parent counselors) of 7 institutions and 5 solo practices in the Netherlands, who completed a survey on communication about sexuality and gender identity with their young patients (age 12-21 years).

OUTCOMES

Sexuality and gender identity are infrequently discussed by mental health care providers with their young patients or their patients' parents.

RESULTS

Of the study sample, 99.5 % valued sexuality as an important topic to discuss with their patients. However, only 17.1% of the professionals reported that they discussed sexuality-related issues with the majority (>75%) of their patients (adolescents: 19.9%, parents: 14.4%) Additionally, only 2.3 % of the participants discussed gender nonconformity regularly with patients. Information about sexual side effects of prescribed medication was infrequently (20.3%) provided: antidepressants (40.0%), antipsychotics (34.0%), benzodiazepines (5.1%) and stimulants (2.4%). The most frequently cited reasons for not discussing these topics were a lack of awareness, own feelings of discomfort, and the patients' supposed feelings of shame. There was no gender differences observed.

CLINICAL IMPLICATIONS

Recommendations for professionals include to be aware of these topics, initiating age-appropriate conversation and use inclusive language.

STRENGTHS AND LIMITATIONS

The present study included a diverse and representative group of mental health care professionals. Frequency of sexual communication was based on self-report, which brings a risk of bias.

CONCLUSION

Despite a recognized need to engage in age-appropriate communication about sexuality and gender identity in youth mental health care, mental health providers seem to remain hesitant to discuss such topics. Bungener SL, Post L, Berends I, et al. Talking About Sexuality With Youth: A Taboo in Psychiatry?. J Sex Med 2022;19:421-429.

Attention-Deficit/Hyperactivity Disorder Medication Adherence in the Transition to Adulthood: Associated Adverse Outcomes for Females and Other Disparities

PURPOSE

The purpose of this study was to assess the association between attention-deficit/hyperactivity disorder (ADHD) medication adherence and adverse health outcomes in older adolescents transitioning to adulthood.

METHODS

In a cohort of 17-year-old adolescents with ADHD at Kaiser Permanente Northern California, we assessed medication adherence (medication possession ratio ≥70%) and any medication use and associations with adverse outcomes at 18 and 19 years of age. We conducted bivariate tests of association and multivariable logistic regression models.

RESULTS

Adherence declined from 17 to 19 years of age (36.7%-19.1%, p < .001). Non-white race/ethnicity, lower estimated income, and male sex were associated with nonadherence. Model results show nonadherent females experienced several adverse outcomes: Adherence at 18 years of age (referent: nonadherence) was associated with lower odds of pregnancy (adjusted odds ratio [AOR]: .13, 95% confidence interval [CI]: .03-.54). Any use (referent: nonuse) at 18 years of age was associated with lower odds of sexually transmitted infections among females (AOR: .39, 95% CI: .19-.83), pregnancies (AOR: .26, 95% CI: .13-.50), emergency department visits (AOR: .69, 95% CI: .55-.85), and greater odds of injuries (AOR: 1.16, 95% CI: 1.02-1.32). Adherence at 19 years of age was associated with lower odds of pregnancy (AOR: .13, 95% CI: .02-.95). Any use at 19 years of age was associated with lower odds of injury in females (AOR: .77, 95% CI: .60-.99) pregnancy (AOR: .35, 95% CI: .16-.78), and, in both sexes, substance use (AOR: .71, 95% CI: .55-.92).

CONCLUSIONS

Late adolescence is associated with decline in ADHD medication use and adherence. ADHD medication adherence and any ADHD medication use is associated with fewer adverse health outcomes, particularly in females.

Diagnostic delay in ADHD: Duration of untreated illness and its socio-demographic and clinical predictors in a sample of adult outpatients

AIM

To investigate the Duration of Untreated Illness (DUI) and its socio-demographic and clinical predictors in a sample of adult ADHD outpatients.

METHODS

The DUI of 150 adult outpatients with a confirmed diagnosis of DSM-IV ADHD was calculated. Non-parametric tests were used to evaluate differences in DUI among subgroups and to build a correlation matrix. Subsequently, a multiple linear regression model was performed.

RESULTS

The median DUI was 17 years (interquartile range [IQR] = 14). DUI was longer in employed patients, those with a family history of ADHD, those with a history of major depressive disorder and those who had predominantly inattentive ADHD in childhood. The current age, age at administration of the first proper treatment and education level were correlated with DUI. Current age (63.3% of total variance), family history of ADHD and the presence of a predominantly inattentive type in childhood (together, 2.6% of total variance) were all predictors of DUI.

CONCLUSIONS

Information programmes for caregivers and training for health care professionals should be promoted to foster the early recognition of covert inattentive symptoms and shorten DUI.

Amphetamine-Dextroamphetamine and Pregnancy: Neonatal Outcomes After Prenatal Prescription Mixed Amphetamine Exposure

Objective: A retrospective cohort study was performed to evaluate whether birthweight was less among infants of women taking amphetamine-dextroamphetamine during pregnancy at our academic institution. Method: We identified mother-infant pairs with documented exposure to amphetamine-dextroamphetamine in pregnancy from 2005 through 2015. Patients were matched 2:1 with unexposed controls. Charts were reviewed for known causes of intrauterine growth restriction. Analysis of birthweight used generalized estimating equation blocking on matching. Medical histories were analyzed with χ² test or Fisher's exact test. Results: We identified 53 exposed mother-infant pairs. The difference in mean birthweight of infants exposed to amphetamine-dextroamphetamine versus those not exposed was 26.9 g, which is not significant (95% confidence interval [CI] = [-141, 195 g]; p = .75). A significant difference was noted for exposed versus unexposed mothers for comorbid psychiatric illness and history of substance abuse (p < .001). Conclusion: With a limited sample size, our study suggests no significant difference in birthweight.

Early Pregnancy Risk Among Adolescents With ADHD: A Nationwide Longitudinal Study

Objective: ADHD potentially leads to risky sexual behaviors, and is considered a major risk factor for early pregnancy (EP). However, the association between ADHD and subsequent EP remains unknown. Method: Seven thousand five hundred five adolescents with ADHD and 30,020 age- and sex-matched individuals without ADHD were enrolled from 2001 to 2009 and were followed until the end of 2011. Adolescents who developed any pregnancy (at age ≤30 years) or EP (at age <20 years) during the follow-up period were identified. Results: Adolescents with ADHD were found to be prone to pregnancy (hazard ratio [HR] = 1.27) and EP (HR = 2.30) compared with those without ADHD. Long-term ADHD medication use was related to a lower risk of subsequent any pregnancy (HR = 0.72) and EP (HR = 0.69). Conclusion: Adolescents with ADHD had an increased risk of any pregnancy and EP compared with their non-ADHD counterparts. Long-term ADHD medication use was associated with a lower subsequent EP risk.

Parental Age and the Risk of ADHD in Offspring: A Systematic Review and Meta-Analysis

Evidence has suggested that parental age at birth is a risk factor of offspring attention deficit/hyperactivity disorder (ADHD). We conducted a meta-analysis of observational studies investigating the association between parental age and offspring ADHD. We conducted a systematic search that followed the recommended guidelines for performing meta-analyses on PUBMED, EMBASE, and Web of Science up to 8 April 2021. We calculated pooled risk estimates from individual age with and without adjusting for possible confounding factors. Dose–response analysis for parental age and ADHD risk was performed. Eleven studies were selected in this meta-analysis, which included 111,101 cases and 4,417,148 participants. Compared with the reference points, the lowest parental age category was associated with an increased risk of ADHD in the offspring, with adjusted odds ratios (ORs) of 1.49 (95% confidence intervals (95%CI) 1.19–1.87) and 1.75 (95%CI 1.31–2.36) for the mother and father, respectively. The highest parental age was statistically insignificant, with adjusted ORs of 1.11 (95%CI 0.79–1.55) and 0.93 (95%CI 0.70–1.23) for mother and father separately. Dose–response analysis indicated a non-linear relationship of parental age with offspring ADHD, with the lowest ADHD risk at 31–35 years old. The results of this meta-analysis support an association between young parental age and the risk of ADHD. More high-quality studies are needed to establish whether the association with parental age is causal.

ADHD Is Associated With a Widespread Pattern of Risky Behavior Across Activity Domains

Objective: ADHD has been linked to higher engagement in risky behaviors in circumscribed domains such as dangerous driving, substance abuse, and gambling. This study tests whether ADHD is associated with a pervasive tendency to engage in risky behavior across a spectrum of activities and domains, and whether this tendency is driven by comorbid disorders. Method: A sample of 97 adults with ADHD and 103 typically developing controls completed a self-report questionnaire measuring the likelihood and frequency of engaging in a broad range of risky behaviors. ADHD, comorbid psychiatric disorders, and demographic variables were extensively assessed using standardized instruments. Results: Participants with ADHD reported a pervasive tendency to engage in risky behaviors across multiple activities. This tendency was associated with ADHD over and above the contribution of comorbid psychiatric disorders. Conclusion: These results suggest that ADHD is uniquely linked to a pervasive pattern of engagement in risky behaviors.

The relationship between executive function, risky behaviour and HIV in young women from the HPTN 068 study in rural South Africa

Executive function (EF) may predict sexual risk-taking and HIV risk in young women in rural South Africa. We tested associations between EF and seven risky behavioural outcomes: binge drinking, illicit substance use, unprotected vaginal sex, concurrent sexual relationships, transactional sex, herpes simplex virus type 2 (HSV-2) infection, and HIV infection. We compared EF in young women with HIV to matched controls. 1080 young women underwent cognitive assessments. Better verbal short-term memory was associated with a lower risk of HSV-2 (OR 0.77; 95% CI 0.69, 0.86; p < 0.001). Uncorrected trends (p < 0.05) were better verbal working memory being associated with a lower risk of concurrency, better planning with a lower risk of illicit drug use, and better affective inhibition with a lower risk of transactional sex. 78 participants with sexually acquired HIV were matched with 153 HIV-negative controls and had poorer verbal working memory than controls (Hedge's g = -0.38; 95% CI -0.66, -0.10; p = 0.0076), but this was non-significant after adjustment. EF's contribution to young women's risky behaviour in this context does not hold when stringent statistical corrections are applied, with only verbal short term memory reaching statistical significance as predictor. Replication in other samples is recommended.

Attention-Deficit/Hyperactivity Disorder Symptoms Are Associated with Greater Delay Discounting of Condom-Protected Sex and Money

Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risk of detrimental life outcomes. Recent research also indicates that ADHD is associated with sexual risk behavior, such as unprotected sex. Some risky sexual behaviors may be driven, in part, by preference for immediate rewards, referred to as delay discounting, which is prominent in etiological models of ADHD. Therefore, the present study examined the effect of delay on preference for both monetary and sexual outcomes in adults with many ADHD symptoms (both on and off medication) and with fewer ADHD symptoms. Online participants (N = 275; n = 161 males, n = 114 females) completed a monetary delay discounting task, assessing preference for smaller sooner versus larger delayed hypothetical money, and the Sexual Delay Discounting Task, assessing preference for condom use in hypothetical casual sex scenarios based on delay until condom availability. Those with greater ADHD symptoms discounted delayed monetary outcomes as well as delayed condom-protected sex (i.e., preferred sooner money rewards and immediate unprotected sex) significantly more than those with fewer symptoms; however, no effect of current medication use was found across monetary or sexual delay discounting among those with greater ADHD symptoms. This study is the first to demonstrate the relation between ADHD symptoms and reduced condom-use likelihood. Increased discounting of delayed condom-protected sex might constitute one mechanism of risky sexual behavior among individuals with ADHD symptoms. Interventions geared toward increasing condom use in situations in which condoms may otherwise be unavailable, may mitigate risky sexual behaviors and their associated harms in this population.

A study on sexual functioning in adults with attention-deficit/hyperactivity disorder

PURPOSE

Sexual dysfunction has been ignored in adults with attention-deficit hyperactivity disorder (A-ADHD). This study examined sexual function in adults with ADHD compared to a healthy control group.

DESIGN AND METHODS

The experimental group (N = 63, mean age = 31.11 ± 4.29, females = 31) were recruited among referrals with ADHD to an outpatient A-ADHD clinic. The DIVA-2 (Diagnostic Interview for ADHD in adults) and the schedule for affective disorders and schizophrenia (SADS) were used to assess for A-ADHD and comorbid psychiatric disorders, respectively. The healthy groups (N = 66, mean age = 31.37 ± 4.30, females = 31) were demographically matched and had no psychiatric disorders based on the Conners' Adult ADHD Rating Scales-Self Report, Short Version and SADS. Sexual functions were evaluated using the Female Sexual Function Index (FSFI) for females and International Index of Erectile Function (IIEF) for males.

FINDINGS

Females with ADHD compared to the control group showed significantly (P < .001) poorer scores in all FSFI domains (desire, arousal, orgasm, satisfaction, pain, and lubrication). The IIEF mean scores in the males with A-ADHD were lower (P = .00) than their counterparts for all the subscales including orgasm, erectile function, intercourse satisfaction, and overall satisfaction, except for the desire (P = .75). The orgasmic function had a significant negative correlation with Conners Adult ADHD Rating Scale-Self Report: Short total scores in males (r = -.48) and females (r = -.40).

PRACTICE IMPLICATIONS

This study provides preliminary information on greater difficulties with sexual function in adults with ADHD. Assessment of sexual function in referrals with A-ADHD is suggested.

Attention Deficit Hyperactivity Disorder (ADHD) Subtypes, Co-Occurring Psychiatric Symptoms and Sexual Risk Behaviors among Adolescents Receiving Substance Abuse Treatment

Background: Adolescents entering substance abuse treatment report clustered psychiatric symptoms and sexual risk behaviors representing differential levels of impairment and risk for maladaptive health outcomes. Objectives: To examine the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) subtypes among adolescents receiving outpatient substance abuse treatment; To document group differences in (a) past-year psychiatric symptom scores and (b) sexual risk behaviors by ADHD subtype and gender. Methods: Self-report data were collected via structured interviews from 394 adolescents (280 males, M = 16.33 years, SD = 1.15 years), enrolled in an HIV/STI risk reduction intervention for adolescents receiving outpatient substance abuse treatment. ADHD diagnostic subtypes and other past-year psychiatric symptoms were assessed using the Brief Michigan Version of the Composite Internal Diagnostic Interview (UM-CIDI). Adolescents provided self-report data on sexual risk behaviors. Results: Multivariate analyses of variance (MANOVAs) documented that Inattentive and Hyperactive-Impulsive ADHD subtypes were significantly associated with higher scores for all past-year psychiatric symptoms. The combined ADHD subtype was significantly associated with higher scores for all psychiatric symptoms except affective disorder. Girls reported significantly higher mean symptoms than boys for alcohol abuse and dependence, anxiety, and affective disorder symptoms. Sexual risk behavior scores were not associated with ADHD status, but girls reported consistently higher scores for multiple risk behavior outcomes. Several psychiatric disorder symptoms were significant covariates of multiple sexual risk behaviors. Conclusion/Importance: Brief screenings for ADHD, other psychiatric disorders and sexual risk behaviors can provide data for tailoring substance abuse services to improve adolescent health outcomes for high-risk subgroups.

Attention Deficit/Hyperactivity Disorder and Increased Engagement in Sexual Risk-Taking Behavior: The Role of Benefit Perception

Attention deficit/hyperactivity disorder (ADHD) has been linked to higher engagement in sexual risk-taking behavior (SRTB). The current study aims to establish the link between ADHD symptoms and SRTB in the general population and to examine whether an exaggerated perceived benefit of the positive outcomes of SRTB explains that link. A scale for measuring the frequency, likelihood, perceived benefit, and perceived risk of SRTB was developed. Young adult sexually active participants who did not have a stable partnership completed the above scale, as well as a scale of ADHD symptoms. The level of ADHD symptoms positively correlated with the frequency and likelihood of SRTB, even when the overall level of sexual behavior was controlled for. ADHD symptoms also correlated with the perceived benefit of SRTB, but not with the perceived risk of SRTB. Mediation analysis confirmed an indirect pathway: ADHD symptoms predicted perceived benefit of SRTB, which in turn predicted increased likelihood to engage in SRTB. These findings suggest a positive link between ADHD symptoms and SRTB in the general population, which is accounted for by an exaggerated perceived benefit of SRTB.

Risk-Taking Behavior in Attention Deficit/Hyperactivity Disorder (ADHD): a Review of Potential Underlying Mechanisms and of Interventions

PURPOSE OF REVIEW

Attention deficit/hyperactivity disorder (ADHD) is associated with several forms of risk-taking behavior (RTB). This paper aims to examine the scope of ADHD-related RTB, to highlight potential underlying mechanisms of this association, and to review initial evidence for interventions aimed to treat ADHD-related RTB.

RECENT FINDINGS

Multiple lines of evidence indicate that ADHD is associated with real-life RTB across several domains (e.g., reckless driving, substance use, and unprotected sex), which is corroborated by evidence on laboratory risk-taking tasks. Several individual differences, some of them informed by decision theory, e.g., comorbid disorders, parental monitoring, and perceived enlarged benefits of RTB, may explain the link between ADHD and RTB. A number of studies showed that interventions designed for ADHD may reduce RTB. ADHD is linked to RTB across several domains. Decision theory may serve as a conceptual framework for understanding the underlying mechanisms, and thus may inform future research.

Risks of bipolar disorder, depressive disorder, and traumatic brain injury among siblings of patients with attention-deficit hyperactivity disorder

BACKGROUND

Previous studies have suggested that the unaffected siblings of patients with attention-deficit hyperactivity disorder (ADHD) experience deficits in attention, impulsivity control, and behavior inhibition, which are associated with health-risk behaviors. However, risks to mental and physical health among the unaffected siblings of ADHD probands have rarely been investigated.

METHODS

Using the Taiwan National Health Insurance Research Database, 5128 unaffected siblings of ADHD probands born between 1980 and 2000 were included in our study along with 20,512 age- and sex-matched controls, and they were followed from 1996 or birth until the end of 2011. Mental and physical health risks, including affective disorders, traumatic brain injury (TBI), and sexually transmitted infection were identified during the follow-up period.

RESULTS

Logistic regression analyses with adjustments for demographic data showed that the unaffected siblings were more likely to develop unipolar depression (odds ratio [OR]: 1.76, 95% confidence interval [CI]: 1.39-2.22), bipolar disorder (OR: 2.10, 95% CI: 1. 09-4.05), and TBI (OR: 1.24, 95% CI: 1.14-1.36) than were the control group.

DISCUSSION

The unaffected siblings of patients with ADHD were prone to developing unipolar depression, bipolar disorder, and TBI later in life.

Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder

Attention deficit/hyperactivity disorder (ADHD) is a highly heritable childhood behavioral disorder affecting 5% of children and 2.5% of adults. Common genetic variants contribute substantially to ADHD susceptibility, but no variants have been robustly associated with ADHD. We report a genome-wide association meta-analysis of 20,183 individuals diagnosed with ADHD and 35,191 controls that identifies variants surpassing genome-wide significance in 12 independent loci, finding important new information about the underlying biology of ADHD. Associations are enriched in evolutionarily constrained genomic regions and loss-of-function intolerant genes and around brain-expressed regulatory marks. Analyses of three replication studies: a cohort of individuals diagnosed with ADHD, a self-reported ADHD sample and a meta-analysis of quantitative measures of ADHD symptoms in the population, support these findings while highlighting study-specific differences on genetic overlap with educational attainment. Strong concordance with GWAS of quantitative population measures of ADHD symptoms supports that clinical diagnosis of ADHD is an extreme expression of continuous heritable traits.

Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder

Attention deficit/hyperactivity disorder (ADHD) is a highly heritable childhood behavioral disorder affecting 5% of children and 2.5% of adults. Common genetic variants contribute substantially to ADHD susceptibility, but no variants have been robustly associated with ADHD. We report a genome-wide association meta-analysis of 20,183 individuals diagnosed with ADHD and 35,191 controls that identifies variants surpassing genome-wide significance in 12 independent loci, finding important new information about the underlying biology of ADHD. Associations are enriched in evolutionarily constrained genomic regions and loss-of-function intolerant genes and around brain-expressed regulatory marks. Analyses of three replication studies: a cohort of individuals diagnosed with ADHD, a self-reported ADHD sample and a meta-analysis of quantitative measures of ADHD symptoms in the population, support these findings while highlighting study-specific differences on genetic overlap with educational attainment. Strong concordance with GWAS of quantitative population measures of ADHD symptoms supports that clinical diagnosis of ADHD is an extreme expression of continuous heritable traits.

Association Between Psychiatric Disorders, Substance Use, and Sexual Risk Behaviors in Perinatally HIV-Exposed Youth

As youth with perinatally acquired HIV infection age, there is a need for studies that identify predictors and correlates of sexual risk behaviors. We examined the association between psychiatric disorders and substance use disorders (SUD) with sexual risk behaviors in youth with perinatally acquired HIV infection and perinatally HIV-exposed but uninfected youth. Participants were recruited from four medical centers in New York City. The Diagnostic Interview Schedule for Children and the Adolescent Sexual Behavior Assessment were administered to assess psychiatric disorders and sexual behaviors, respectively. SUD and behavior disorders were correlated with either ever having had penetrative sex or recent condomless sex for participants with perinatally acquired HIV infection only. Results suggest that clinicians should screen and treat patients for SUD and behavioral disorders to reduce sexual risk behaviors in youth with perinatally acquired HIV infection.

Parental age and attention-deficit/hyperactivity disorder (ADHD)

Background

Previous studies have suggested that young mothers more often have children with ADHD. We used sibling comparisons to examine the nature of this association and to investigate if this association is explained by early environment or genetic and socioeconomic factors.

Methods

A large population-based cohort including all singletons born in Denmark from 1 January 1991 through 31 December 2005 was followed from birth until 30 April 2011. Data were available for 94% ( N  = 943 785) of the population. Offspring ADHD was identified by an ICD-10 diagnosis of Hyperkinetic Disorder (HKD). We used sibling-matched Cox regression to control for genetic and socioeconomic factors.

Results

In the population cohort we found that children born by parents aged 20 years or younger had more than twice the risk of being diagnosed with ADHD compared with children with parents between 26 and 30 years of age. When comparing full siblings the associations were attenuated, but we found a trend of increased risk of ADHD with decreasing maternal age, which was not seen for paternal age.

Conclusions

Sibling comparisons suggested that the associations between both maternal and paternal age and ADHD are partly explained by common genetic and socioeconomic factors. The trend of increased risk of ADHD with decreasing maternal age, but not with paternal age, may be linked to pregnancy or early-life environmental factors. Even though only a smaller part of the association can be attributed to environmental factors, there is a public health interest to support young parents through their first years of parenthood.

Attention-deficit/hyperactivity disorder symptom clusters differentially predict prenatal health behaviors in pregnant women

OBJECTIVE

To date, most investigations of mental health in pregnant women have focused on depression or substance use. This study aimed to (a) delineate the relationships between symptoms of attention-deficit/hyperactivity disorder (ADHD) and prenatal health behaviors and (b) explore whether the symptom clusters of ADHD differentially predict prenatal health behaviors (e.g., physical strain, healthy eating, prenatal vitamin use).

METHOD

A total of 198 pregnant women (mean age = 27.94 years) completed measures of ADHD symptoms, prenatal health behaviors, and depression.

RESULTS

Inattention, hyperactivity, and impulsivity/emotional lability all evidenced significant relationships with the prenatal health behaviors, each differentially predicting different prenatal health behaviors.

CONCLUSION

As decreased engagement in adequate prenatal health behaviors puts both the mother and fetus at risk for negative birth outcomes, future research should work to develop a brief ADHD screen to be used in obstetric clinics and should investigate these relationships within a sample of women with a diagnosis of ADHD.

Reproductive steroids and ADHD symptoms across the menstrual cycle

Although Attention-Deficit/Hyperactivity Disorder shows (ADHD) male predominance, females are significantly impaired and exhibit additional comorbid disorders during adolescence. However, no empirical work has examined the influence of cyclical fluctuating steroids on ADHD symptoms in women. The present study examined estradiol (E2), progesterone (P4), and testosterone (T) associations with ADHD symptoms across the menstrual cycle in regularly-cycling young women (N=32), examining trait impulsivity as a moderator. Women completed a baseline measure of trait impulsivity, provided saliva samples each morning, and completed an ADHD symptom checklist every evening for 35days. Results indicated decreased levels of E2 in the context of increased levels of either P4 or T was associated with higher ADHD symptoms on the following day, particularly for those with high trait impulsivity. Phase analyses suggested both an early follicular and early luteal, or post-ovulatory, increase in ADHD symptoms. Therefore, ADHD symptoms may change across the menstrual cycle in response to endogenous steroid changes.

Adult ADHD and Comorbid Somatic Disease: A Systematic Literature Review

OBJECTIVE

To systematically review, synthesize, and appraise available evidence, connecting adult ADHD with somatic disease.

METHOD

Embase, Psychinfo, and Medline databases were searched for studies published from 1994 to 2015 addressing adult ADHD and somatic comorbidity. Somatic conditions were classified according to International Classification of Diseases (ICD-10) codes. Levels of evidence were graded as inconclusive, tentative, or well documented.

RESULTS

Most of the 126 studies included in the qualitative synthesis were small and of modest quality. Obesity, sleep disorders, and asthma were well-documented comorbidities in adult ADHD. Tentative evidence was found for an association between adult ADHD and migraine and celiac disease. In a large health registry study, cardiovascular disease was not associated with adult ADHD.

CONCLUSION

There are few large systematic studies using standardized diagnostic criteria evaluating adult ADHD and somatic comorbidities. Significant associations are found between adult ADHD and several somatic diseases, and these are important to consider when assessing and treating either adult ADHD or the somatic diseases.

Sexually Transmitted Infection Among Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder: A Nationwide Longitudinal Study

OBJECTIVE

Previous studies have suggested that attention-deficit/hyperactivity disorder (ADHD) is related to risky sexual behaviors, which have been regarded as a major risk factor of sexually transmitted infection (STI). However, the association between ADHD and subsequent STIs remains unknown.

METHOD

Using the Taiwan National Health Insurance Research Database, 17,898 adolescents and young adults who were diagnosed with ADHD by psychiatrists and 71,592 age- and sex-matched comparisons without ADHD were enrolled from 2001 through 2009 and followed to the end of 2011. Participants who developed any STI during the follow-up period were identified. Cox regression analysis was performed to examine the risk of STIs between patients with ADHD and those without ADHD.

RESULTS

Patients with ADHD were prone to developing any STI (hazard ratio [HR] 3.36, 95% CI 2.69∼4.21) after adjusting for demographic data, psychiatric comorbidities, and ADHD medications compared with the comparison group. Substance use disorders (HR 1.94, 95% CI 1.27∼2.98) also were associated with STI risk. Short-term use (HR 0.70, 95% CI 0.53∼0.94) and long-term use (HR 0.59, 95% CI 0.37∼0.93) of ADHD medications were related to a lower risk of subsequent STIs. However, an association between substance use disorders and STIs was observed only in women. By contrast, the effect of ADHD medications on the decrease of STI risk was observed only in men.

CONCLUSION

Adolescents and young adults with ADHD had an increased risk of developing any STI later in life compared with the non-ADHD comparisons. Patients with ADHD who also had substance use disorders were at the highest risk of subsequent STIs. Treatment with ADHD medications was associated with a lower risk of subsequent STIs.

The danger of being inattentive - ADHD symptoms and risky sexual behaviour in Russian adolescents

BACKGROUND

Prior research has indicated that attention-deficit/hyperactivity disorder (ADHD) symptoms may be associated with an increased likelihood of engaging in risky sexual behaviour (RSB). However, research on this association among adolescents has been comparatively limited and mainly confined to North America. The aim of this study was to examine if inattention and hyperactivity/impulsivity symptoms were linked to RSB in a community cohort sample of Russian adolescents.

METHODS

The study was based on a group of 537 adolescents from Northern Russia. Information on inattention and hyperactivity/impulsivity as well as conduct problems was obtained through teacher ratings, while information on RSB (previous unprotected sex, number of sexual partners, sex while intoxicated and partner pregnancies), substance use, perception of risk, and parenting behaviour was based on students' self-reports. Binary logistic regression analysis was used to examine associations between the variables.

RESULTS

Teacher-rated inattention symptoms predicted RSB, independently of co-morbid conduct problems, substance use, risk perception, and different parenting styles (parental warmth, involvement and control). In addition, male sex, binge drinking and a lower assessment of perceived risk were all significantly associated with RSB in an adjusted model. Neither teacher-rated hyperactivity/impulsivity symptoms nor conduct problems were linked to RSB in the full model.

CONCLUSIONS

Deficits in planning and organizing behaviours, being easily distracted and forgetful seem to be of importance for RSB in Russian adolescents. This highlights the importance of discriminating between different ADHD symptoms in adolescence to prevent risk behaviours and their potentially detrimental outcomes on health and well-being.

ADHD and Emotion Dysregulation Among Children and Adolescents

Individuals with attention-deficit/hyperactivity disorder (ADHD) experience impairments in a number of functional domains. Although current evidence-based treatments for ADHD reduce symptoms and improve academic and behavioral functioning, they have minimal impact on social functioning or on risky behaviors (see Evans et al. in J Clin Child Adolesc Psychol, 43:527-551, 2014 for review). Preliminary evidence indicates that emotion dysregulation (ED) is associated with impairments across the developmental spectrum, such as social impairment and risky behaviors, and that its relative absence/presence is differentially associated with treatment response. It thus stands to reason that by incorporating a focus on ED in interventions targeting social impairment and risky behaviors, we may be able to increase the number of youth who respond to such interventions and decrease the prevalence or degree of these impairments and behaviors among youth and adults with ADHD. However, a number of questions remain unaddressed about the association between ADHD and ED, such as the portion of individuals with ADHD who experience ED, the extent to which ED is associated with the above impairments and behaviors, and whether or not ED is malleable. To begin addressing these questions, we summarize and critically evaluate the literature on the association between ADHD and ED and make recommendations for future basic, translational, and treatment outcome research.

Atopic Dermatitis Is Associated With Cervical High Risk Human Papillomavirus Infection

OBJECTIVE

High-risk human papillomavirus (hrHPV) infection is more likely to persist and cause cervical cancer in immunosuppressed women. Atopic dermatitis, which is known to affect cell-mediated immunity and skin barrier function, is associated with recalcitrant warts; therefore, we hypothesized that women with atopic dermatitis may be more likely to be positive for hrHPV infection and progress to high-grade cervical dysplasia.

MATERIALS AND METHODS

A retrospective case-control study of 1,160 women who were either positive or negative for hrHPV in their index cervical cytology. Patient age, race, history of atopic dermatitis, allergic rhinitis, smoking, body mass index, socioeconomic status, marital status, hormone contraceptive use, and 2-year clinical outcomes (follow-up hrHPV testing and cervical biopsy results) were recorded. All cases with atopic dermatitis (n = 74) were confirmed by a dermatologist. Analyses were restricted to females with documented clinical follow-up, which yielded 577 hrHPV-positive and 583 hrHPV-negative cases for comparison. Associations were examined by t test, χ test, and multivariate logistic regression.

RESULTS

Atopic dermatitis was more common in the hrHPV-positive cases (48/577, 8.3%) compared with HPV-negative controls (26/583, 4.5%, p = .007). Multivariate logistic regression analysis revealed an adjusted odds ratio of 3.75 (95% CI = 1.3-10.9, p = .02) after controlling for significant covariates, such as age and marital status. Smoking was not associated with hrHPV infection, persistence, or high-grade cervical dysplasia in these cases.

CONCLUSIONS

Atopic dermatitis is associated with cervical hrHPV infection in adult women.

Long-Term Outcomes of ADHD: A Systematic Review of Self-Esteem and Social Function

OBJECTIVE

To compare the long-term self-esteem and social function outcomes of individuals with untreated and treated ADHD across childhood, adolescence, and adulthood.

METHOD

A systematic search of 12 databases was performed to identify peer-reviewed, primary research articles, published January 1980 to December 2011, reporting long-term self-esteem and/or social function outcomes (≥2 years; life consequences distinct from symptoms) of individuals with untreated or treated ADHD.

RESULTS

Overall, 127 studies reported 150 outcomes. Most outcomes were poorer in individuals with untreated ADHD versus non-ADHD controls (57% [13/23] for self-esteem; 73% [52/71] for social function). A beneficial response to treatment (pharmacological, nonpharmacological, and multimodal treatments) was reported for the majority of self-esteem (89% [8/9]) and social function (77% [17/22]) outcomes.

CONCLUSION

Untreated ADHD was associated with poorer long-term self-esteem and social function outcomes compared with non-ADHD controls. Treatment for ADHD was associated with improvement in outcomes; however, further long-term outcome studies are needed.

[Has the prevalence of parent-reported diagnosis of attention deficit hyperactivity disorder (ADHD) in Germany increased between 2003-2006 and 2009-2012? Results of the KiGGS-study: first follow-up (KiGGS Wave 1)]

Recent international studies have reported a considerable increase in the diagnosis of attention deficit hyperactivity disorder (ADHD). Data from German statutory health insurance companies suggest a comparable trend for Germany. Based on data from the nationally representative study KiGGS Wave 1 (2009-2012) it was the aim of this study to report on the prevalence rates of parent-reported ADHD diagnoses in children and adolescents aged 3-17 years as well as to report on time trends in comparison with the KiGGS baseline study (2003-2006). ADHD caseness was met if a parent reported that a physician or a psychologist diagnosed their child with ADHD. Participants without a reported ADHD diagnosis but who scored ≥ 7 (clinical range) on the parent-rated hyperactivity subscale of the Strengths and Difficulties Questionnaire (SDQ) were considered as potential ADHD cases. The prevalence of diagnosed ADHD was 5.0% (prevalence of potential ADHD cases 6.0%). An ADHD diagnosis was more than four and a half times more likely to be reported among boys than girls. Children from families with low socioeconomic status (SES) were more than two and a half times more likely to be diagnosed with ADHD than children from families with high SES. Among potential cases, boys were twice as common as girls, and children from families with low SES were approximately three times more common compared with those from high SES families. The proportion of lifetime ADHD diagnoses increased with age and was highest in 11- to 17-year-olds. In every fifth child with ADHD the initial diagnosis was made by the age of 6 years and in 1 out of 11 children with ADHD the initial diagnosis was made by the age of 5 years. In total, we observed no significant changes regarding the frequency of ADHD diagnosis compared to the KiGGS baseline study. Increases reported using data from German statuary health insurance companies were not reflected in the KiGGS data.

ADHD symptomatology and risky health, driving, and financial behaviors in college: the mediating role of sensation seeking and effortful control

OBJECTIVE

To examine the extent to which effortful control (EC) and sensation seeking (SS) tendencies explain the association between the severity of ADHD symptoms and risky behaviors.

METHOD

Participants included 555 college students (66% females) who completed self-report measures assessing their ADHD symptoms, EC abilities, SS tendencies, and risky health (e.g., substance use) and driving/financial behaviors (e.g., misuse of credit cards).

RESULTS

Severity of college students' ADHD symptoms, EC abilities, and SS tendencies were related to all risky behaviors. Multiple mediational analyses further indicated that students' SS tendencies significantly mediated the association between ADHD symptoms and the risky health factor but not the risky driving/financial factor. EC, however, significantly mediated the association between ADHD symptoms and both the risky health and driving/financial factors.

CONCLUSION

The current study provides initial data showing potentially different mechanisms that explain the link between college students' severity of ADHD symptoms and risky behaviors.

A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis

OBJECTIVE

To describe the clinical presentation of attention-deficit/hyperactivity disorder (ADHD) in women and girls and factors influencing proper diagnosis and treatment.

DATA SOURCES

A PubMed search was conducted in April 9, 2012 for English-language publications from the previous 10 years. Search terms included attention deficit hyperactivity disorder, attention deficit/hyperactivity disorder, ADHD, and AD/HD combined with gender, girls, females, women, continuity, discontinuity, gap, treatment, untreated, and lack of treatment.

STUDY SELECTION/DATA EXTRACTION

A total of 41 articles were reviewed for relevance. Reference lists from relevant articles were reviewed for additional publications; sources known to the authors were also included.

RESULTS

Attitudes about ADHD among individuals with ADHD and knowledgeable informants (families, teachers, colleagues) vary on the basis of the diagnosed individual's gender. The ADHD prevalence rates are higher among boys than girls. A low index of clinical suspicion exists for girls; their presentation is considered "subthreshold" because inattentiveness is more prominent than hyperactivity/impulsivity. Females with ADHD may develop better coping strategies than males to mask their symptoms. Lastly, anxiety and depression, common comorbidities in female patients with ADHD, can lead to missed or misdiagnosis. If not properly diagnosed and treated, girls with ADHD experience the same negative consequences as boys, including poor academic performance and behavioral problems. Unique issues related to hormonal effects on ADHD expression and treatment response are also experienced by women and girls.

CONCLUSIONS

Accurate ADHD diagnosis in women and girls requires establishing a symptom history and an understanding of its gender-specific presentation. Coexisting anxiety and depression are prominent in female patients with ADHD; satisfactory academic achievement should not rule out an ADHD diagnosis.

Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology

Attention deficit hyperactivity disorder (ADHD) is a common condition with a high societal burden. The present guidelines summarise current literature, generating expert consensus recommendations for the treatment of ADHD in children and adults. These guidelines also provide a review of recent research in the fields of neuroimaging, neuropsychology and genetics of ADHD. Novel discoveries in these areas have informed physiological models for the disease. Since the publication of the previous British Association for Psychopharmacology guidelines in 2008, new drugs have been licensed and further compounds are being investigated. The publication of randomised controlled trials of psychological interventions has contributed to the range of treatment options for ADHD. As the disorder has been diagnosed more frequently there has been greater focus on comorbid conditions and how they impact treatment. Services have continued to develop for the treatment of ADHD in adults and care agreements have been introduced to facilitate access to treatment.

Attention-deficit/hyperactivity disorder in a chronic care paradigm

The prevalence and disease burden of adult attention-deficit/hyperactivity disorder (ADHD) suggests that primary care physicians (PCPs) have an opportunity to improve the functioning and quality of life of a significant number of adult patients. The American Academy of Pediatrics provides evidence-based clinical practice guidelines that recognize ADHD as a chronic condition, and a large proportion of children with ADHD continue to meet diagnostic criteria as adults. Therefore, the management of ADHD should incorporate principles common to the management of other chronic conditions, including proactive planning for continuity of treatment across the life span and integrated, multidisciplinary health care teams for optimal disease management. This article describes a clinical approach whereby adult ADHD is treated within a chronic care paradigm that prominently features the involvement of the PCP. If PCPs envision ADHD as a chronic illness, similar to asthma or diabetes, they may be less likely to refer individuals to be managed by specialists, and more likely to see their role in coordinating and monitoring adult ADHD care, knowing when and how to bring other resources into play, and when and how to educate patients.

Attention deficit hyperactivity disorder in the European adult population: prevalence, disease awareness, and treatment guidelines

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobiological disorder with childhood onset and persistence into adolescence and adulthood.

METHODS

Our literature review reports scientific publications and guidelines on the treatment of adult ADHD, with a particular focus on European countries, identified by literature searches in Medline and Embase. The final literature search was performed in July 2012, incorporating literature from 1974 to 2012. The primary research parameters were 'Europe' (including single European countries), 'ADHD', 'attention deficit disorder', 'attention deficit', 'attention disorder', and 'hyperactivity'. Secondary search parameters were 'comorbid', 'epidemiology' or 'prevalence', 'disease management', 'drug therapy', or 'therapy'. The main searches were also limited to adults and English language publications. The papers identified by this literature review were selected for inclusion by consensus of the authors based on clinical relevance.

RESULTS

Appropriate resources for the diagnosis and treatment of adult ADHD in Europe are scarce, and many cases go untreated, particularly because of the frequent presence of psychiatric comorbidities. Apart from atomoxetine, and an extended-release form of methylphenidate in Germany, no other medications have been approved for starting treatment in adult ADHD patients in the European Union. However, a variety of stimulant and non-stimulant medications are used off-label, and a number of studies have confirmed that these medications are well tolerated and effective in adult patients with ADHD.

CONCLUSIONS

Our results emphasize the need for broader access to effective treatments for adult ADHD patients in Europe.

Attention-deficit/hyperactivity disorder and adverse health outcomes

Attention-deficit/hyperactivity disorder (ADHD) is defined by extreme levels of inattention-disorganization and/or hyperactivity-impulsivity. In DSM-IV, the diagnostic criteria required impairment in social, academic, or occupational functioning. With DSM-5 publication imminent in 2013, further evaluation of impairment in ADHD is timely. This article reviews the current state of knowledge on health-related impairments of ADHD, including smoking, drug abuse, accidental injury, sleep, obesity, hypertension, diabetes, and suicidal behavior. It concludes by suggesting the need for new avenues of research on mechanisms of association and the potential for ADHD to be an early warning sign for secondary prevention of some poor health outcomes.