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Ward JH, McBride A, Price A, Delgado TN. Psychosocial interventions for improving the physical health of young people and adults with attention deficit hyperactivity disorder: a scoping review. BMC Psychiatry 2024; 24:569. [PMID: 39164688 PMCID: PMC11337789 DOI: 10.1186/s12888-024-06009-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 08/08/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Young people and adults with ADHD are at risk of a range of physical health problems. There is limited guidance on how to approach health problems in ADHD, and especially around 16-25 year olds who will be transitioning from paediatric to adult care. The aim of this scoping review was to identify psychosocial interventions that target physical health in young people and adults with ADHD. METHODS We constructed searches in MEDLINE, PsycInfo, EMBASE of adolescents, young people and adults. Inclusion criteria were; studies of psychosocial interventions examining a component of physical health, applicable to people aged 16-25, with clinical or research diagnoses of ADHD. Data were extracted using a data extraction tool and tabulated, including study intervention framing/aims, population, intervention, and relevant outcomes (including specific statistics where relevant). RESULTS Our search identified 22 unique papers covering, psychosocial interventions targeting at least one of sleep (n=7), smoking (n=3), substance/alcohol use (n=4), physical health/exercise (n=6) and general health (n=3). Studies examined psychotherapy/behaviour interventions (n=12), psychoeducation (n=4), digital (n=2) and social interventions (n=4). There was significant heterogeneity in intervention framing, outcome measures and population. CONCLUSION Further work on the impact of targeted physical health interventions, with explicit reference to a conceptual framework of poor health in ADHD is required. Furthermore, future work standardising reporting of physical health outcomes in ADHD is crucial for the development of an evidence base in this field.
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Affiliation(s)
- John Headley Ward
- 2.05 South Cloisters, 2.05 South Cloisters, St Luke's Campus, University of Exeter Medical School, Heavitree Road, Exeter, EX2 4TH, UK.
- Royal Devon University NHS Foundation Trust, Exeter, UK.
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Audrey McBride
- 2.05 South Cloisters, 2.05 South Cloisters, St Luke's Campus, University of Exeter Medical School, Heavitree Road, Exeter, EX2 4TH, UK
| | - Anna Price
- 2.05 South Cloisters, 2.05 South Cloisters, St Luke's Campus, University of Exeter Medical School, Heavitree Road, Exeter, EX2 4TH, UK
| | - Tamsin Newlove Delgado
- 2.05 South Cloisters, 2.05 South Cloisters, St Luke's Campus, University of Exeter Medical School, Heavitree Road, Exeter, EX2 4TH, UK
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Austgulen A, Posserud MB, Hysing M, Haavik J, Lundervold AJ. Deliberate self-harm in adolescents screening positive for attention-deficit / hyperactivity disorder: a population-based study. BMC Psychiatry 2024; 24:564. [PMID: 39160455 PMCID: PMC11334607 DOI: 10.1186/s12888-024-06008-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 08/08/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Adolescents with attention-deficit / hyperactivity disorder (ADHD) have an increased risk of self-harm. The risk of self-harm among adolescents who display an elevated level of ADHD symptoms, but without a formal diagnosis, is not well-studied and understood. OBJECTIVE To investigate the relationship between self-reported symptoms of ADHD and self-harm in a population-based sample of adolescents. METHODS Adolescents in the population-based youth@hordaland study were invited to complete the Adult ADHD Self-Report Scale (ASRS) and the Short Mood and Feelings Questionnaire (SMFQ). They were asked whether they ever deliberately have taken an overdose or tried to harm themselves on purpose, once or multiple times, defined according to the code used in the Child and Adolescent Self-harm in Europe (CASE) Study. Adolescents reporting severe problems on ≥ four of six selected items on the ASRS-v 1.1 screener were defined as ADHD-screen positive (ADHD-SC+), and the remaining sample as ADHD-screen negative (ADHD-SC-). SMFQ score ≥ 12 was used to define a high level of depressive symptoms. RESULTS A total of 9692 adolescents (mean age 17.4 years, 53.1% females) participated in the study, of which 2390 (24.7%) screened positive on the ASRS. ADHD-SC+ adolescents engaged in self-harm more often than the ADHD-SC- group (14.6% vs. 5.4%, OR = 3.02, 95%CI [2.57-3.24]). This remained significant after adjustment for demographic variables, SMFQ score ≥ 12, symptoms of conduct disorder and familial history of self-harm and suicide attempts (OR = 1.58, 95%CI [1.31-1.89]). They were also more likely to report an overdose as their method of self-harm (OR = 1.52, 95%CI [1.05-2.23]). Within the ADHD-SC+ group female sex, high levels of inattention and hyperactivity/impulsivity symptoms, SMFQ score ≥ 12, symptoms indicating conduct disorder and familial history of self-harm and suicide attempts increased the likelihood of engaging in deliberate self-harm. CONCLUSION Adolescents who screened positive for ADHD had increased risk of engaging in self-harm. Clinicians should consider the increased risk of such engagement in adolescents who present with high level of ADHD symptoms, even in the absence of a clinical ADHD diagnosis.
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Affiliation(s)
- Amalie Austgulen
- Department of Biomedicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Maj-Britt Posserud
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Jan Haavik
- Department of Biomedicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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Lin PI, Wu WT, Azasu EK, Wong TY. Pathway from attention-deficit/hyperactivity disorder to suicide/self-harm. Psychiatry Res 2024; 337:115936. [PMID: 38705042 DOI: 10.1016/j.psychres.2024.115936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/20/2024] [Accepted: 04/28/2024] [Indexed: 05/07/2024]
Abstract
To evaluate the effect of ADHD diagnosis by the age of 10 on the suicide/self-harm risk at age 14 and examine factors that may modify/mediate the association, a longitudinal study based on the nationwide survey consisting of 5,107 children in Australia was used. Self-harm and suicidal risks in children with ADHD at age 14 were the main outcomes; ADHD medication, history of bullied or depression, and other sociodemographic disadvantages, were treated as covariates. The diagnosis of ADHD at age 10 is associated with elevated risks of self-harm, suicidal thoughts, planning, or attempts by age 14, with greater susceptibility in males. The pathway from ADHD symptoms to suicide/self-harm could also be mediated by depression and exposure to bullying assessed at age 12. Note that depression and exposure to bullying might at best contribute to less than 10 % of the total effect of ADHD diagnosis on either the risk of suicide or self-harm. Early gender-tailored intervention and prevention strategies are crucial in clinical practice and health policy.
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Affiliation(s)
- Ping-I Lin
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, New South Wales, Australia; Department of Mental Health, Western Sydney University, New South Wales, Australia; Neuroscience Research Australia, Australia.
| | - Weng Tong Wu
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, New South Wales, Australia
| | - Enoch Kordjo Azasu
- Department of Psychiatry and Neurobehavioral Science, Saint Louis University, Missouri, USA
| | - Tsz Ying Wong
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, New South Wales, Australia
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Moseley RL, Gregory NJ, Smith P, Allison C, Cassidy S, Baron-Cohen S. Potential Mechanisms Underlying Suicidality in Autistic People with Attention Deficit/Hyperactivity Disorder: Testing Hypotheses from the Interpersonal Theory of Suicide. AUTISM IN ADULTHOOD 2024; 6:9-24. [PMID: 38435325 PMCID: PMC10902282 DOI: 10.1089/aut.2022.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Background Autistic people with co-occurring attention deficit/hyperactivity disorder (ADHD) appear to be at heightened risk of suicide. To understand why, we explored two explanatory mechanisms from the interpersonal theory of suicide: first, that co-occurring ADHD might be associated with greater risk through greater thwarted belongingness and perceived burdensomeness and, secondly, that hyperactive/impulsive features might incur additional risk through their association with painful and provocative events, which are suggested to create "capability" for suicide. Methods Autistic adults (n = 314) completed an online survey including measures of thwarted belongingness, perceived burdensomeness, painful and provocative events, acquired capability for suicide, and ADHD features. Creating an overall index of likely ADHD, we examined associations between likely ADHD, suicide ideation, and lifetime suicide attempts through the parallel mediators of thwarted belongingness, perceived burdensomeness, anxiety, and depression. In several models, we then examined hyperactive, impulsive, and inattentive features as predictors of exposure to painful and provocative events and subsequent capability for suicide, and examined whether these two variables, sequentially or individually, mediated an association with lifetime suicide attempts. Results Likely ADHD was associated with past-year suicide ideation through greater depression and perceived burdensomeness, which also mediated its association with more suicide attempts. Hyperactive and impulsive features were associated with exposure to painful and provocative events and through this acquired suicide capability. Both features were associated with more numerous suicide attempts through these two mediators sequentially, and through exposure to painful and provocative events alone. Conclusions These data suggest that suicidality in autistic people with ADHD may be partially related to perceived burdensomeness and to acquired suicide capability after exposure to painful and provocative events. However, as we observed a pathway to suicidality associated with painful and provocative events alone, it is likely that there are also other explanatory mechanisms for the influence of traumatic events on suicide risk.
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Affiliation(s)
- Rachel L. Moseley
- Department of Psychology, Bournemouth University, Poole, United Kingdom
| | - Nicola J. Gregory
- Department of Psychology, Bournemouth University, Poole, United Kingdom
| | - Paula Smith
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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Su R, John JR, Lin PI. Machine learning-based prediction for self-harm and suicide attempts in adolescents. Psychiatry Res 2023; 328:115446. [PMID: 37683319 DOI: 10.1016/j.psychres.2023.115446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Abstract
This study aimed to use machine learning (ML) models to predict the risk of self-harm and suicide attempts in adolescents. We conducted secondary analysis of cross-sectional data from the Longitudinal Study of Australian Children dataset. Several key variables at the age of 14-15 years were used to predict self-harm or suicide attempt at 16-17 years. Random forest classification models were used to select the optimal subset of predictors and subsequently make predictions. Among 2809 participants, 296 (10.54%) reported an act of self-harm and 145 (5.16%) reported attempting suicide at least once in the past 12 months. The area under the receiver operating curve was fair for self-harm (0.7397) and suicide attempt (0.7220), which outperformed the prediction strategy solely based on prior suicide or self-harm attempt (AUC: 0.6). The most important factors identified were similar, and included depressed feelings, strengths and difficulties questionnaire scores, perceptions of self, and school- and parent-related factors. The random forest classification algorithm, an ML technique, can effectively select the optimal subset of predictors from hundreds of variables to forecast the risks of suicide and self-harm among adolescents. Further research is needed to validate the utility and scalability of ML techniques in mental health research.
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Affiliation(s)
- Raymond Su
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James Rufus John
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Ping-I Lin
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Academic Unit of Child Psychiatry Services, South Western Sydney Local Health District, Liverpool, NSW, Australia; Department of Mental Health, School of Medicine, Western Sydney University, Penrith, NSW, Australia.
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Predescu E, Calugar I, Bibu-Monus C, Sipos R. Trends and Prevalence of Hospital Admissions Related to Deliberate Self-Poisoning and Used Substances in Romanian Adolescents between 2016 and 2022. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050790. [PMID: 37238338 DOI: 10.3390/children10050790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
Rates of self-poisoning are increasing substantially all around the world, with self-poisoning being the most common form of self-harm leading to hospitalization in children and adolescents. This study aims to investigate the trends in the number of deliberate self-poisoning admissions in Romanian adolescents during the period of 2016-2022, as well as the most frequently used substances and the impact of the COVID-19 pandemic on hospital admissions due to self-poisoning and substance use in relation to these episodes. The sample included 178 patients admitted to the Clinic of Pediatric Psychiatry in Cluj-Napoca from 2016 to 2022 due to an episode of self-poisoning. Data were collected on patients' sociodemographic characteristics, psychosocial characteristics, and medical histories. We report a slight overall increase in the self-poisoning admission rate during the studied period. There was a decrease during the initial period of the pandemic, with significantly increasing rates in the second year of the pandemic. The mean prevalence rate of hospital admissions due to self-poisoning episodes during the study period was 3.14% (95% CI 2.72, 3.63). Adolescent girls were identified as the most vulnerable group, with the female-to-male ratio increasing dramatically. In terms of substance use, benzodiazepines; over-the-counter analgesics, including paracetamol; and antidepressants were the most frequently used substances. We emphasize the importance of careful consideration in prescribing psychotropic drugs, as well as the need for regulation of over-the-counter drug dispensation.
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Affiliation(s)
- Elena Predescu
- Department of Neuroscience, Psychiatry and Pediatric Psychiatry, "IuliuHatieganu" University of Medicine and Pharmacy, 400489 Cluj-Napoca, Romania
| | - Iulia Calugar
- Clinic of Pediatric Psychiatry and Addiction, Clinical Emergency Hospital for Children, 400489 Cluj-Napoca, Romania
| | - Cristian Bibu-Monus
- 1st Surgical Clinic, Emergency Clinical County Hospital Cluj, 400006 Cluj-Napoca, Romania
| | - Roxana Sipos
- Department of Neuroscience, Psychiatry and Pediatric Psychiatry, "IuliuHatieganu" University of Medicine and Pharmacy, 400489 Cluj-Napoca, Romania
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Wu J, Li P, Luo H, Lu Y. Complementary and Alternative Medicine Use by ADHD Patients: A Systematic Review. J Atten Disord 2022; 26:1833-1845. [PMID: 35880494 DOI: 10.1177/10870547221111557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aimed to review the prevalence of complementary and alternative medicine (CAM) use and its different used types, characteristics of the studied cohorts, the reasoning for CAM use, and possible predictive factors for its use amongst ADHD patients. METHOD The Web of Science Core Collection, PubMed, and Scopus were searched from inception to 10 February 2022. All of the original papers published in English which report data on CAM use by patients with ADHD were included. RESULTS Twelve original researches including 4,447 patients were included. The prevalence of CAM use varied from 7.5% to 67.6%. The most-reported CAM modalities were dietary modifications and natural products. Moreover, higher parental education should be considered as a predictive factor for CAM use. CONCLUSION CAM use by ADHD patients seems to be prevalent. Healthcare providers should be trained about the most commonly used CAM therapies and their possible adverse events.
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Affiliation(s)
| | - Ping Li
- Sichuan University, Chengdu, China
| | - Hong Luo
- Sichuan University, Chengdu, China
| | - You Lu
- Sichuan University, Chengdu, China
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Dwyer S, Rogan A. Seeing the unseen: Neurodiversity in the emergency department. Emerg Med Australas 2022; 34:609-612. [PMID: 35785441 DOI: 10.1111/1742-6723.14038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sophie Dwyer
- Australasian Faculty of Public Health Medicine Specialist Training Program, Sydney, New South Wales, Australia
| | - Alice Rogan
- Te Pae Tiaki/Emergency Department, Wellington Regional Hospital, Wellington, New Zealand.,Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
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Screening for ADHD Symptoms among Criminal Offenders: Exploring the Association with Clinical Features. Healthcare (Basel) 2022; 10:healthcare10020180. [PMID: 35206795 PMCID: PMC8872480 DOI: 10.3390/healthcare10020180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Attention-deficit/hyperactivity disorder (ADHD) is a disabling disorder. High rates of ADHD have been consistently reported among prisoners. The main objectives were (1) to estimate the prevalence of ADHD symptoms in a sample of male inmates and (2) to investigate the relationship between ADHD symptoms and socio-demographic/clinical features. According to the high prevalence of childhood trauma among inmates, we assessed whether exposition to childhood trauma can be related to the presence of ADHD symptoms. Methods: A total of 159 male prisoners admitted to Monza prison between January 2020 and June 2021 were included. Both Wender Utah ADHD rating scale and adult ADHD self-report scale were administered to assess ADHD symptoms. Moreover, inmates completed the childhood trauma questionnaire. Results: Data were available for 108 inmates. Thirty-five prisoners (32.4%) were found on screening to meet the criteria for symptoms of ADHD. Cocaine use disorder, prescription of mood stabilizers and a history of emotional abuse significantly increased the likelihood of having clinically significant ADHD symptoms. Furthermore, patients who experienced physical neglect resulted in meeting the criteria for ADHD symptoms. Conclusions: ADHD symptoms are widespread among inmates and are associated with specific risk factors. Screening for ADHD should be done to provide appropriate intervention strategies.
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Wilson E, Ougrin D. Commentary: Defining self-harm: how inconsistencies in language persist - a commentary/reflection on Ward and Curran (2021). Child Adolesc Ment Health 2021; 26:372-374. [PMID: 34414651 DOI: 10.1111/camh.12502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 01/04/2023]
Abstract
Self-harm definition is an important focus of academic research and clinical practice. The precise definition of self-harm has been contested for decades, and current terminology varies across, and sometimes within, countries. This commentary has been written to highlight the problematic use of the term 'deliberate' self-harm (i.e. DSH) and to clarify the terminology currently recommended by clinical agencies in the United Kingdom. Comparisons will be made to other definitions in the field, such as non-suicidal self-injury (NSSI), with the aim of contributing to the worldwide discussion about how we conceptualise, discuss and treat suicidal and non-suicidal behaviours. The commentary concludes by highlighting the findings of Ward and Curran (2021). It is suggested that undiagnosed ADHD may be a potential driver for self-harm, particularly among girls, further highlighting the ongoing challenges in identifying and predicting which youth are at risk for self-harm and suicidal behaviours. Central to this challenge has been the long-standing confusion around the best way to define self-harm.
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Affiliation(s)
- Emma Wilson
- Health Service and Population Research, Institute for Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Dennis Ougrin
- Child and Adolescent Psychiatry, King's College London, London, UK
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