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Roessner V, Ehrlich S, Backhausen L, Rempel S, Uhlmann A. Heterogeneous courses of obsessive-compulsive disorders-better data on a lifetime perspective urgently needed. Eur Child Adolesc Psychiatry 2022; 31:1-3. [PMID: 35829779 PMCID: PMC9343295 DOI: 10.1007/s00787-022-02043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Stefan Ehrlich
- grid.412282.f0000 0001 1091 2917Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany ,grid.4488.00000 0001 2111 7257Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Lea Backhausen
- grid.412282.f0000 0001 1091 2917Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Sarah Rempel
- grid.412282.f0000 0001 1091 2917Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Anne Uhlmann
- grid.412282.f0000 0001 1091 2917Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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Takahashi N, Ishizuka K, Inada T. Peripheral biomarkers of attention-deficit hyperactivity disorder: Current status and future perspective. J Psychiatr Res 2021; 137:465-470. [PMID: 33798973 DOI: 10.1016/j.jpsychires.2021.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/08/2021] [Indexed: 01/28/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. Since the diagnosis of ADHD is defined by operational diagnostic criteria consisting of several clinical symptoms, a number of heterogeneous mechanisms have been considered to be implicated in its pathophysiology. Although no clinically reliable biomarkers are available for the diagnosis of ADHD, several plausible candidate biomarkers have been proposed based on recent advances in biochemistry and molecular biology. This review article summarizes potential peripheral biomarkers associated with ADHD, mainly from recently published case-control studies. These include 1) biochemical markers: neurotransmitters and their receptors, neurotrophic factors, serum electrolytes, and inflammation markers; 2) genetic and epigenetic markers: microRNA, mRNA expression, and peripheral DNA methylation; 3) physiological markers: eye movement and electroencephalography. It also discusses the limitations and future directions of these potential biomarkers for application in clinical practice.
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Affiliation(s)
- Nagahide Takahashi
- Department of Child and Adolescent Psychiatry, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan; Research Center for Child Mental Development, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, 431-3192, Shizuoka, Japan
| | - Kanako Ishizuka
- Department of Child and Adolescent Psychiatry, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan
| | - Toshiya Inada
- Department of Psychiatry and Psychobiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Aichi, Japan.
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von Wirth E, Mandler J, Breuer D, Döpfner M. The Accuracy of Retrospective Recall of Childhood ADHD: Results from a Longitudinal Study. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09852-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AbstractAttention-deficit/hyperactivity disorder (ADHD) is a childhood-onset condition that may continue into adulthood. When assessing adult patients, clinicians usually rely on retrospective reports of childhood symptoms to evaluate the age-of-onset criterion. Since inaccurate symptom recall may impede the diagnosis and treatment of ADHD, knowledge about the factors influencing retrospective reports is needed. This longitudinal study investigated (a) the accuracy of retrospective symptom ratings by adult participants with a childhood diagnosis of ADHD (self-ratings) and parents or significant others (proxy ratings), and (b) the influence of current ADHD symptom severity and ADHD-associated impairments on retrospective symptom ratings. Participants (N = 55) were members of the Cologne Adaptive Multimodal Treatment (CAMT) study who had been referred and treated for ADHD in childhood and were reassessed in adulthood (average age 27 years). Participants’ retrospective self-ratings were substantially lower than, and did not correlate with, parents’ ADHD symptom ratings provided at study entry, while retrospective symptom ratings provided by proxy respondents correlated moderately with parents’ childhood ratings. In addition, participants were more likely to underreport childhood symptoms (79%) and more frequently denied the presence of three or more childhood symptoms (17%) compared to proxy respondents (65% underreporting, 10% false-negative recall). Proxy respondents’ symptom recall was best predicted by childhood ADHD, while participants’ symptom recall was best predicted by current ADHD symptom severity. ADHD-associated impairments were not correlated with symptom recall after controlling for childhood ADHD. Together, these findings suggest a recall bias in adult patients and question the validity of retrospective reports, even in clinical samples.
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Soleimani R, Jalali MM, Faghih HA. Comparing the prevalence of attention deficit hyperactivity disorder in hearing-impaired children with normal-hearing peers. Arch Pediatr 2020; 27:432-435. [PMID: 33011031 DOI: 10.1016/j.arcped.2020.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/28/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The most important aspect of hearing loss is its effect on the communication abilities of individuals. The aim of this study was to compare the prevalence of attention deficit hyperactivity disorder (ADHD) in hearing-impaired (HI) children with normal-hearing (NH) peers. METHODS A total of 130 children (65 children with severe-to-profound hearing loss and 65 NH peers) participated in this cross-sectional study from November 2013 to May 2014. ADHD Rating Scale IV questionnaires were given to children's parents to collect data. Descriptive and analytical analyses were used in order to achieve the objectives of the study. RESULTS The mean age of the HI children and NH peers was 14.1 and 13.3 years, respectively. In the case group, 52 children suffered from congenital hearing loss and 10 children had acquired hearing loss. In total, 19 cases (29.2%) and eight controls (12.3%) were diagnosed with ADHD. This difference was statistically significant (P=0.017). The prevalence of ADHD in children with hereditary or acquired hearing loss was 30.7% and 20.0%, respectively. However, this difference was not significant (P=0.71). CONCLUSION The prevalence of ADHD in school-aged children with hearing loss is higher than that in the general population of the same age. We could not find significant differences between the different subgroups due to the small sample size. Therefore, we recommend a further larger study to determine the interaction between hearing loss and ADHD.
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Affiliation(s)
- R Soleimani
- Kavosh Cognitive Behavior and Addiction Research Center, Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - M M Jalali
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - H A Faghih
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Breda V, Rohde LA, Menezes AMB, Anselmi L, Caye A, Rovaris DL, Vitola ES, Bau CHD, Grevet EH. Revisiting ADHD age-of-onset in adults: to what extent should we rely on the recall of childhood symptoms? Psychol Med 2020; 50:857-866. [PMID: 30968792 DOI: 10.1017/s003329171900076x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND ADHD diagnosis requires the presence of symptoms before the age of twelve. In clinical assessment of adults, the most frequent strategy to check this criterion is investigating self-report recall of symptoms, despite little evidence on the validity of this approach. We aim to evaluate the recall accuracy and factors associated with its reliability in a large population-based sample of adults. METHODS Individuals from the 1993 Pelotas Birth Cohort were followed-up from childhood to adulthood. At the age of 22, 3810 individuals were assessed through structured interviews by trained psychologists regarding mental health outcomes, including ADHD diagnosis and ADHD symptoms in childhood. The retrospective recall was compared with available information on ADHD childhood symptoms at the age of eleven. We also assessed factors related to recall accuracy through multiple regression analyses. RESULTS Self-reported recall of childhood symptoms at 22 years of age had an accuracy of only 55.4%, with sensitivity of 32.8% and positive predictive value of 40.7%. Current inattention symptoms were associated with lower risk and social phobia with higher risk for false-positive endorsement, while higher levels of schooling correlated with lower risk and male gender with higher risk for false-negative endorsement. CONCLUSIONS Clinicians treating male patients with social phobia and ADHD symptoms should assess even more carefully retrospective recall of ADHD childhood symptoms. Moreover, characteristics associated with recall improvement do not impact accuracy robustly. In this context, the recall of childhood ADHD symptoms seems an unreliable method to characterize the neurodevelopmental trajectory in adults with currently-impairing ADHD symptomatology.
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Affiliation(s)
- V Breda
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - L A Rohde
- Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, Brazil
| | - A M B Menezes
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - L Anselmi
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - A Caye
- Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - D L Rovaris
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - E S Vitola
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - C H D Bau
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - E H Grevet
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Lin YJ, Gau SSF. Comparison of Neuropsychological Functioning Between Adults With Early- and Late-Onset DSM-5 ADHD. J Atten Disord 2020; 24:29-40. [PMID: 28895460 DOI: 10.1177/1087054717730609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: We aimed to compare the visually dependent neuropsychological functioning among adults with Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) ADHD who recalled symptom onset by and after age 7 and non-ADHD controls. Method: We divided the participants, aged 17 to 40 years, into three groups-(a) ADHD, onset <7 years (early-onset, n = 142); (b) ADHD, onset between 7 and <12 years (late-onset, n = 41); (c) non-ADHD controls (n = 148)-and compared their neuropsychological functioning, measured by the Cambridge Neuropsychological Testing Automated Battery. Results: Both ADHD groups had deficits in attention and signal detectability, spatial working memory, and short-term spatial memory, but only the early-onset group showed deficits in alertness, set-shifting, and planning after controlling for age, sex, and psychiatric comorbidities. There was no statistical difference between the two ADHD groups in neuropsychological functioning. Conclusion:DSM-5 criteria for diagnosing adult ADHD are not too lax regarding neuropsychological functioning.
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Affiliation(s)
- Yu-Ju Lin
- Far Eastern Memorial Hospital, New Taipei City, Taiwan.,National Taiwan University, Taipei, Taiwan
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Sanders S, Thomas R, Glasziou P, Doust J. A review of changes to the attention deficit/hyperactivity disorder age of onset criterion using the checklist for modifying disease definitions. BMC Psychiatry 2019; 19:357. [PMID: 31718626 PMCID: PMC6849294 DOI: 10.1186/s12888-019-2337-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 10/23/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Widening definitions of health conditions have the potential to affect millions of people and should only occur when there is strong evidence of benefit. In the last version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5 Committee changed the Attention Deficit Hyperactivity Disorder (ADHD) age of onset criterion in two ways: raising the age of symptom onset and removing the requirement for symptoms to cause impairment. Given concerns about ADHD prevalence and treatment rates, we aimed to evaluate the evidence available to support these changes using a recently developed Checklist for Modifying Disease Definitions. METHODS We identified and analysed research informing changes to the DSM-IV-TR ADHD age of onset criterion. We compared this evidence to the evidence recommended in the Checklist for Modifying Disease Definitions. RESULTS The changes to the DSM-IV-TR age of onset criterion were based on a literature review (publicly available as a 2 page document with online table of included studies), which we appraised as at high risk of bias. Estimates of the change in ADHD prevalence resulting from change to the age of onset criterion were based on a single study that included only a small number of children with ADHD (n = 68) and only assessed the impact of change to the age component of the criterion. No evidence was used by, or available to the Committee regarding the impact on prevalence of removal of the requirement for impairment, or the effect of the criterion changes on diagnostic precision, the prognosis of, or the potential benefits or harms for individuals diagnosed by the new, but not old criterion. CONCLUSIONS The changes to the age of onset criterion were based on minimal research evidence that suffered from either high risk of bias or poor applicability. The minimal documentation available makes it difficult to judge the rigor of the process behind the criterion changes. Use of the Checklist for Modifying Disease Definitions would assist future proposed modifications of the DSM ADHD criteria, provide guidance on the studies needed to inform potential changes and would improve the transparency and documentation of the process.
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Affiliation(s)
- Sharon Sanders
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Level 4, Building 5, Gold Coast, Queensland, 4226, Australia.
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Level 4, Building 5, Gold Coast, Queensland, 4226, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Level 4, Building 5, Gold Coast, Queensland, 4226, Australia
| | - Jenny Doust
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Level 4, Building 5, Gold Coast, Queensland, 4226, Australia
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Kim JS, Oh S, Jeon HJ, Hong KS, Baek JH. Resting-state alpha and gamma activity in affective disorder with ADHD symptoms: Comparison between bipolar disorder and major depressive disorder. Int J Psychophysiol 2019; 143:57-63. [PMID: 31255738 DOI: 10.1016/j.ijpsycho.2019.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/21/2019] [Accepted: 06/17/2019] [Indexed: 11/19/2022]
Abstract
Although comorbid attention deficit/hyperactivity disorder (ADHD) symptoms are very common in mood disorder, its neurophysiological correlates have not been explored. This study aimed to examine clinical and neurophysiological correlates of ADHD symptoms in major depressive disorder (MDD) and bipolar disorder (BP). A total of 67 subjects with mood disorder, current depressive episode (38 subjects with MDD and 29 subjects with BP depression) were included in the analysis. Resting quantitative electroencephalography (qEEG) recordings were collected under eyes closed condition. ADHD symptoms, depression, anxiety, and lifetime hypomania were evaluated using self-report questionnaires. In MDD, ADHD symptoms did not show significant associations with anxiety and depression. In BP, ADHD symptoms showed significant associations with depression, anxiety and lifetime hypomania. Significant correlations with Adult ADHD self-report scales (ASRS) inattention score and total score were detected in left and right frontal alpha powers in MDD while significant correlation with ASRS hyperactivity score and ASRS total score were detected in right frontal gamma power in BP. Linear regression analyses revealed that left and right frontal alpha powers, depression and lifetime hypomania showed significant association with ASRS inattention score and ASRS total score in MDD. In BP, linear regression analysis showed ASRS hyperactivity score was associated with lifetime hypomania and the right frontal gamma power. MDD and BP showed different correlation patterns between frontal qEEG measures and ADHD symptoms. This might be associated with distinct neurobiological underpinnings of co-occurring ADHD symptoms in MDD and BP.
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Affiliation(s)
- Ji Sun Kim
- Department of Psychiatry, Sooncheonhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do Province, Republic of Korea
| | - Soohwan Oh
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Sue Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Asherson P, Agnew-Blais J. Annual Research Review: Does late-onset attention-deficit/hyperactivity disorder exist? J Child Psychol Psychiatry 2019; 60:333-352. [PMID: 30843223 DOI: 10.1111/jcpp.13020] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2018] [Indexed: 12/20/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is conceptualized as an early onset childhood neurodevelopmental disorder. Prevalence in adults is around two-thirds that in childhood, yet longitudinal outcome studies of children with ADHD found a minority continue to meet full criteria in adulthood. This suggests that not all adult cases meet ADHD criteria as children, a conclusion supported by earlier studies relying on retrospective recall in adolescent and adult samples. More recently prospective follow-up of population and control samples suggest that adolescent and young adult ADHD is not always a continuation of childhood ADHD. Here, we review the literature on age of onset, to explore whether late-onset ADHD exists, and if so, examine the evidence for whether this should be considered the same or a different disorder as childhood onset ADHD. We conclude that current evidence supports the view that a significant proportion of young adults meeting criteria for ADHD would not have met full diagnostic criteria for ADHD as children. However, many in the late-onset group show some ADHD symptoms in childhood, or an externalizing disorder such as oppositional defiant disorder. Furthermore, the current studies suggest that most (but not all) cases of late-onset ADHD develop the disorder between the ages of 12-16 and can therefore be considered adolescent or early adult onset ADHD. There is a relative lack of data spanning young to older adulthood to address the question of adult-onset. Currently, there is insufficient data to clarify the extent to which early and late onset ADHD reflect a different balance of genetic and environmental risks or share the same underlying neural mechanisms. Clinicians should be aware that significantly impairing forms of ADHD can emerge beyond the age of 12 years, although perhaps rarely in the context of a complete absence of precursors. The current evidence on treatment responses is limited.
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Affiliation(s)
- Philip Asherson
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Jessica Agnew-Blais
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
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10
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Healthcare Utilization and Morbidity among Adolescents with ADHD in Children Aged 11-17 Years, NHIS, 2017. ACTA ACUST UNITED AC 2019. [DOI: 10.1155/2019/4047395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose. Children with ADHD have known behaviors of hyperactivity and impulsivity which may result in adverse outcomes. The purpose of this study is to examine the association of serious adverse outcomes (emergency department visits within the previous year) in preadolescents and adolescents with ADHD as compared with preadolescents and adolescents without ADHD. Method. The researchers conducted a cross-sectional, secondary data analysis of National Health Interview Survey (NHIS) 2017 data concerning 2,965 children (>11 to 17 years). The NHIS data resulted from face-to-face interviews of a household member selected from a multistage area probability design representing households in the US. Data analyses for this study included Chi-square bivariate analyses and logistic regression analyses. Results. There were 13.2% of children in the sample who had ADHD. Children with ADHD were more likely to be male and non-Hispanic white. They were also more likely to have one or more additional disease or condition excluding ADHD. In adjusted logistic regression analysis on emergency department utilization by ADHD status, the adjusted odds ratio was 1.93 (95%CI: 1.35, 2.74; p = 0.0003) for preadolescents and adolescents with ADHD as compared with preadolescents and adolescents without ADHD. Conclusion. Children with ADHD were more likely to have emergency department utilization than children without ADHD. Preventive medical visits were similar between preadolescent and adolescent children with and without ADHD. Characteristics associated with ADHD may explain the increased need for emergent care. Developing interventions for children with ADHD may decrease emergency department utilization.
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Haack LM, Meza J, Jiang Y, Araujo EJ, Pfiffner L. Influences to ADHD Problem Recognition: Mixed-Method Investigation and Recommendations to Reduce Disparities for Latino Youth. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:958-977. [PMID: 29770911 PMCID: PMC6239986 DOI: 10.1007/s10488-018-0877-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
ADHD problem recognition serves as the first step of help seeking for ethnic minority families, such as Latinos, who underutilize ADHD services. The current mixed-method study explores underlying factors influencing recognition of ADHD problems in a sample of 159 school-aged youth. Parent-teacher informant discrepancy results suggest that parent ethnicity, problem domain, and child age influence ADHD problem recognition. Emerging themes from semi-structured qualitative interviews/focus groups conducted with eighteen Spanish-speaking Latino parents receiving school-based services for attention and behavior concerns support a range of recognized ADHD problems, beliefs about causes, and reactions to ADHD identification. Findings provide recommendations for reducing disparities in ADHD problem recognition and subsequent help seeking.
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Affiliation(s)
- Lauren M Haack
- University of California, San Francisco (UCSF), 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Jocelyn Meza
- University of California Berkeley and UCSF, Berkeley, CA, USA
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12
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Abstract
The behavior patterns of hyperactivity, impulsivity and inattention that would ultimately become recognized as Attention-Deficit Hyperactivity Disorder (ADHD) have been described for centuries. Nevertheless, in the past 35 years, advances in diagnostic methods, identification of biomarkers, and treatments have advanced at an exponential rate. ADHD is now recognized as the most common behavioral disorder of childhood, with risks extending well into adulthood for both males and females, leading to its identification as a significant public health issue. This historical neuropsychological review of ADHD emphasizes scientific highlights in the past 35 years related to ADHD, including the evolution of the diagnosis (from Hyperkinetic Reaction of Childhood to ADHD), influential theories (executive functions, cognitive-energetic, delay aversion), landmark treatment studies (Multimodal Treatment of ADHD [MTA] and Preschool ADHD Treatment Study [PATS]), and advances in brain mapping techniques (anatomic, functional, and resting state magnetic resonance imaging, diffusion tensor imaging). The review concludes by highlighting the challenges of studying and treating a heterogeneous neurodevelopmental disorder like ADHD, with emphasis on associated disorders and conditions (learning disabilities, sluggish cognitive tempo), special populations (girls, preschoolers, adults), and recommendations for scientific inquiry in the next 35 years. Neuropsychologists are well positioned to address the clinical and research challenges of the next generation of studies, especially involving advances in understanding the sexual dimor.phism, full developmental course, and dynamic risks associated with ADHD. (JINS, 2017, 23, 916-929).
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Affiliation(s)
- E. Mark Mahone
- Kennedy Krieger Institute, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martha B. Denckla
- Kennedy Krieger Institute, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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13
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Moore E, Sunjic S, Kaye S, Archer V, Indig D. Adult ADHD Among NSW Prisoners: Prevalence and Psychiatric Comorbidity. J Atten Disord 2016; 20:958-967. [PMID: 24134874 DOI: 10.1177/1087054713506263] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Given the paucity of research among prisoners, this study aimed to examine the prevalence and psychiatric comorbidity associated with adult ADHD. METHOD The study was conducted at four NSW correctional facilities (2 male; 2 female). RESULTS Thirty-five percent of the sample screened positive for adult ADHD, and 17% of the sample met criteria for a full diagnosis. After adjustment, benzodiazepine dependence, borderline personality disorder, social phobia, antisocial personality disorder, and a number of lifetime psychological disorders remained significantly and independently associated with the diagnosis of adult ADHD. Lowering the threshold on the ADHD Self-Rating Scale to ≥3 (vs. ≥4) increased the sensitivity (80%-93%), but lowered the specificity (55%-47%). CONCLUSION Adult ADHD among NSW prisoners is elevated, with substance use disorders and psychiatric comorbidity common. A greater acceptance of this disorder among prisoners, and appropriate treatment, is warranted.
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Affiliation(s)
- Elizabeth Moore
- Justice and Forensic Mental Health Network, Pagewood, Australia University of New South Wales, Sydney, Australia
| | - Sandra Sunjic
- Justice and Forensic Mental Health Network, Ermington, Australia
| | | | - Vicki Archer
- Justice and Forensic Mental Health Network, Pagewood, Australia
| | - Devon Indig
- Justice and Forensic Mental Health Network, Pagewood, Australia University of New South Wales, Sydney, Australia
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14
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Joelsson P, Chudal R, Gyllenberg D, Kesti AK, Hinkka-Yli-Salomäki S, Virtanen JP, Huttunen J, Ristkari T, Parkkola K, Gissler M, Sourander A. Demographic Characteristics and Psychiatric Comorbidity of Children and Adolescents Diagnosed with ADHD in Specialized Healthcare. Child Psychiatry Hum Dev 2016; 47:574-82. [PMID: 26399420 DOI: 10.1007/s10578-015-0591-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Recent studies have shown an increasing incidence of attention-deficit/hyperactivity disorder (ADHD) among children diagnosed in specialized services. This study aims to describe children with ADHD in Finnish specialized healthcare by reporting the demographic characteristics, time trends in diagnosis, psychiatric comorbidity, and the validity of register-based diagnoses. All the singletons born in Finland between 1991 and 2005 and diagnosed with ADHD by 2011 were identified and their psychiatric comorbidity data was obtained from the Finnish Hospital Discharge Register (FHDR). Parents of 69 patients were interviewed via telephone for a diagnostic validation. A total of 10,409 children were identified with ADHD, with a male: female ratio of 5.3:1 and a psychiatric comorbidity rate of 76.7 %. Of the validation sample 88 % met the diagnostic criteria of ADHD for DSM-IV. There is an increasing trend of ADHD diagnosis among both males and females. Psychiatric comorbidity is common and includes a wide range of disorders among children with ADHD. There was an increase of ADHD diagnoses especially among boys. More attention is needed to detect ADHD among girls in health services. Diagnoses in the FHDR show diagnostic validity and their sociodemographic patterns are in line with previous studies.
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Affiliation(s)
- Petteri Joelsson
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.
| | - Roshan Chudal
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - David Gyllenberg
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Anna-Kaisa Kesti
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Juha-Pekka Virtanen
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Jukka Huttunen
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Terja Ristkari
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Kai Parkkola
- Navy Command Finland, Turku, Finland.,School of Medicine, University of Tampere, Tampere, Finland
| | - Mika Gissler
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.,Nordic School of Public Health, Gothenburg, Sweden.,National Institute for Health and Welfare, Helsinki, Finland.,New York State Psychiatric Institute, New York, NY, USA
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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15
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Breda V, Rovaris DL, Vitola ES, Mota NR, Blaya-Rocha P, Salgado CAI, Victor MM, Picon FA, Karam RG, Silva KL, Rohde LA, Bau CHD, Grevet EH. Does collateral retrospective information about childhood attention-deficit/hyperactivity disorder symptoms assist in the diagnosis of attention-deficit/hyperactivity disorder in adults? Findings from a large clinical sample. Aust N Z J Psychiatry 2016; 50:557-65. [PMID: 26460329 DOI: 10.1177/0004867415609421] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES In accordance with consolidated clinical practice, Diagnostic and Statistical Manual of Mental Disorders, 5th edition suggests a key role of collateral information in the evaluation of retrospective childhood attention-deficit/hyperactivity disorder symptoms in adults despite poor evidence supporting its use. This study aims to assess the incremental value of collateral information on the presence of childhood attention-deficit/hyperactivity disorder symptoms when evaluating adults with attention-deficit/hyperactivity disorder. METHODS Adult patients with attention-deficit/hyperactivity disorder (n = 449) and non-attention-deficit/hyperactivity disorder subjects (n = 143) underwent an extensive clinical assessment based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria. For patients, retrospective collateral information regarding childhood attention-deficit/hyperactivity disorder was obtained and used to sort them into two groups: agreement (n = 277) and disagreement (n = 172) between self- and collateral reports. We compared demographic, clinical and response to treatment profiles among groups to test the relevance of collateral information on the specific issue of childhood attention-deficit/hyperactivity disorder symptoms. RESULTS Both attention-deficit/hyperactivity disorder groups had higher rates of several comorbidities (oppositional defiant, conduct, substance use and bipolar disorders; all p < 0.001) and impairments than controls. Disagreement between self- and collateral reports on childhood attention-deficit/hyperactivity disorder symptoms occurred in 38% of patients. Overall, attention-deficit/hyperactivity disorder disagreement and agreement groups had similar profiles in response to treatment and comorbidity, and the few differences detected in impairment measures were of small magnitude (Eta(2) < 0.05). CONCLUSION Although collateral report has an important role for diagnosing attention-deficit/hyperactivity disorder in children, it has no incremental value in the evaluation of childhood attention-deficit/hyperactivity disorder symptoms in adults with a self-reported history of attention-deficit/hyperactivity disorder assessed in clinical settings.
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Affiliation(s)
- Vitor Breda
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Diego Luiz Rovaris
- Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Nina Roth Mota
- Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Paula Blaya-Rocha
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Felipe Almeida Picon
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Rafael Gomes Karam
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Katiane Lilian Silva
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Luis Augusto Rohde
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Claiton Henrique Dotto Bau
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eugenio Horacio Grevet
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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16
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Lin YJ, Yang LK, Gau SSF. Psychiatric comorbidities of adults with early- and late-onset attention-deficit/hyperactivity disorder. Aust N Z J Psychiatry 2016; 50:548-56. [PMID: 26460330 DOI: 10.1177/0004867415609423] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We evaluated the psychiatric comorbidities in adults who were diagnosed with Diagnostic and Statistical Manual of Mental disorders, 5th edition attention-deficit/hyperactivity disorder as a function of recalled symptom onset before and after the age of 7 years and whether the childhood attention-deficit/hyperactivity disorder symptoms were associated with psychiatric comorbidities. METHOD In all, 214 adults who were diagnosed with Diagnostic and Statistical Manual of Mental disorders, 5th edition attention-deficit/hyperactivity disorder and 174 non-attention-deficit/hyperactivity disorder controls (aged 17-40 years) received psychiatric interviews to confirm their previous and current attention-deficit/hyperactivity disorder status and other psychiatric diagnoses. Demographics and risks of lifetime psychiatric disorders were compared among three groups: (1) attention-deficit/hyperactivity disorder, onset <7 years (early-onset); (2) attention-deficit/hyperactivity disorder, onset between 7 and 12 years (late-onset) and (3) non-attention-deficit/hyperactivity disorder controls. We also tested the effects of attention-deficit/hyperactivity disorder symptoms on the risk of later psychiatric comorbidities by Cox regression analyses. RESULTS Regardless of the age of onset, attention-deficit/hyperactivity disorder was significantly associated with a wide range of psychiatric comorbidities. There were similar comorbid patterns between early- and late-onset attention-deficit/hyperactivity disorder. Regardless of attention-deficit/hyperactivity disorder diagnosis, increased severity of attention-deficit/hyperactivity disorder symptoms was associated with higher risks of oppositional defiant disorder, conduct disorder, dysthymia and sleep disorder but not major depression, which was associated with the attention-deficit/hyperactivity disorder diagnosis. CONCLUSION Our findings suggest that elevating the threshold of age of onset to 12 years in Diagnostic and Statistical Manual of Mental disorders, 5th edition would not over-diagnose attention-deficit/hyperactivity disorder in the adult population. Recalled childhood attention-deficit/hyperactivity disorder symptom severity was correlated with conduct disorder, oppositional defiant disorder, dysthymia and sleep disorders.
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Affiliation(s)
- Yu-Ju Lin
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Li-Kuang Yang
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan Department of Psychiatry, National Defense Medical Center, Tri-Service General Hospital, Beitou Branch, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan Graduate Institute of Brain and Mind Sciences, Graduate Institute of Clinical Medicine, and Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
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17
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Hogue A, Bobek M, Evans SW. Changing Academic Support in the Home for Adolescents with Attention-Deficit/Hyperactivity Disorder: A Family-Based Clinical Protocol for Improving School Performance. COGNITIVE AND BEHAVIORAL PRACTICE 2016; 23:14-30. [PMID: 34103882 DOI: 10.1016/j.cbpra.2014.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescent clinical populations and associated with myriad deficits in school functioning. Yet, behavior therapists have few developmentally appropriate tools for addressing school problems in this group. This article introduces a behavioral protocol designed to fill the gap: Changing Academic Support in the Home for Adolescents with ADHD (CASH-AA). CASH-AA is a family-based intervention that targets home environment, adolescent skills, and family-school partnership characteristics in order to improve school performance. Protocol components are derived from three evidence-based approaches for adolescent behavior problems: family psychoeducation, clinical family interventions to heighten adolescent and caregiver motivation to change, and training interventions for homework planning and organization skills. CASH-AA contains four treatment modules: (1) Psychoeducation: ADHD and Academic Functioning; (2) Motivation & Preparation: Home Academic Environment; (3) Behavior Change: School Attendance and Homework Plan; (4) Collaboration: Therapist-Family-School Partnership. The protocol can be implemented as a stand-alone intervention for ADHD or an adjunct to other behavioral interventions for co-occurring disorders. Two case examples with markedly different treatment profiles are presented to illustrate the utility and flexibility of the protocol.
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Affiliation(s)
- Aaron Hogue
- The National Center on Addiction and Substance Abuse at Columbia University
| | - Molly Bobek
- The National Center on Addiction and Substance Abuse at Columbia University
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18
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Storebø OJ, Ramstad E, Krogh HB, Nilausen TD, Skoog M, Holmskov M, Rosendal S, Groth C, Magnusson FL, Moreira‐Maia CR, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Forsbøl B, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2015; 2015:CD009885. [PMID: 26599576 PMCID: PMC8763351 DOI: 10.1002/14651858.cd009885.pub2] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children with ADHD find it difficult to pay attention, they are hyperactive and impulsive.Methylphenidate is the drug most often prescribed to treat children and adolescents with ADHD but, despite its widespread use, this is the first comprehensive systematic review of its benefits and harms. OBJECTIVES To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. SEARCH METHODS In February 2015 we searched six databases (CENTRAL, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, Conference Proceedings Citations Index), and two trials registers. We checked for additional trials in the reference lists of relevant reviews and included trials. We contacted the pharmaceutical companies that manufacture methylphenidate to request published and unpublished data. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. At least 75% of participants needed to have an intellectual quotient of at least 70 (i.e. normal intellectual functioning). Outcomes assessed included ADHD symptoms, serious adverse events, non-serious adverse events, general behaviour and quality of life. DATA COLLECTION AND ANALYSIS Seventeen review authors participated in data extraction and risk of bias assessment, and two review authors independently performed all tasks. We used standard methodological procedures expected within Cochrane. Data from parallel-group trials and first period data from cross-over trials formed the basis of our primary analyses; separate analyses were undertaken using post-cross-over data from cross-over trials. We used Trial Sequential Analyses to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach for high risk of bias, imprecision, indirectness, heterogeneity and publication bias. MAIN RESULTS The studies.We included 38 parallel-group trials (5111 participants randomised) and 147 cross-over trials (7134 participants randomised). Participants included individuals of both sexes, at a boys-to-girls ratio of 5:1, and participants' ages ranged from 3 to 18 years across most studies (in two studies ages ranged from 3 to 21 years). The average age across all studies was 9.7 years. Most participants were from high-income countries.The duration of methylphenidate treatment ranged from 1 to 425 days, with an average duration of 75 days. Methylphenidate was compared to placebo (175 trials) or no intervention (10 trials). Risk of Bias.All 185 trials were assessed to be at high risk of bias. Primary outcomes. Methylphenidate may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.77, 95% confidence interval (CI) -0.90 to -0.64; 19 trials, 1698 participants; very low-quality evidence). This corresponds to a mean difference (MD) of -9.6 points (95% CI -13.75 to -6.38) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points; DuPaul 1991a). A change of 6.6 points on the ADHD-RS is considered clinically to represent the minimal relevant difference. There was no evidence that methylphenidate was associated with an increase in serious (e.g. life threatening) adverse events (risk ratio (RR) 0.98, 95% CI 0.44 to 2.22; 9 trials, 1532 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 0.91 (CI 0.02 to 33.2). SECONDARY OUTCOMES Among those prescribed methylphenidate, 526 per 1000 (range 448 to 615) experienced non-serious adverse events, compared with 408 per 1000 in the control group. This equates to a 29% increase in the overall risk of any non-serious adverse events (RR 1.29, 95% CI 1.10 to 1.51; 21 trials, 3132 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 1.29 (CI 1.06 to 1.56). The most common non-serious adverse events were sleep problems and decreased appetite. Children in the methylphenidate group were at 60% greater risk for trouble sleeping/sleep problems (RR 1.60, 95% CI 1.15 to 2.23; 13 trials, 2416 participants), and 266% greater risk for decreased appetite (RR 3.66, 95% CI 2.56 to 5.23; 16 trials, 2962 participants) than children in the control group.Teacher-rated general behaviour seemed to improve with methylphenidate (SMD -0.87, 95% CI -1.04 to -0.71; 5 trials, 668 participants; very low-quality evidence).A change of seven points on the Child Health Questionnaire (CHQ; range 0 to 100 points; Landgraf 1998) has been deemed a minimal clinically relevant difference. The change reported in a meta-analysis of three trials corresponds to a MD of 8.0 points (95% CI 5.49 to 10.46) on the CHQ, which suggests that methylphenidate may improve parent-reported quality of life (SMD 0.61, 95% CI 0.42 to 0.80; 3 trials, 514 participants; very low-quality evidence). AUTHORS' CONCLUSIONS The results of meta-analyses suggest that methylphenidate may improve teacher-reported ADHD symptoms, teacher-reported general behaviour, and parent-reported quality of life among children and adolescents diagnosed with ADHD. However, the low quality of the underpinning evidence means that we cannot be certain of the magnitude of the effects. Within the short follow-up periods typical of the included trials, there is some evidence that methylphenidate is associated with increased risk of non-serious adverse events, such as sleep problems and decreased appetite, but no evidence that it increases risk of serious adverse events.Better designed trials are needed to assess the benefits of methylphenidate. Given the frequency of non-serious adverse events associated with methylphenidate, the particular difficulties for blinding of participants and outcome assessors point to the advantage of large, 'nocebo tablet' controlled trials. These use a placebo-like substance that causes adverse events in the control arm that are comparable to those associated with methylphenidate. However, for ethical reasons, such trials should first be conducted with adults, who can give their informed consent.Future trials should publish depersonalised individual participant data and report all outcomes, including adverse events. This will enable researchers conducting systematic reviews to assess differences between intervention effects according to age, sex, comorbidity, type of ADHD and dose. Finally, the findings highlight the urgent need for large RCTs of non-pharmacological treatments.
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Affiliation(s)
- Ole Jakob Storebø
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- University of Southern DenmarkDepartment of Psychology, Faculty of Health ScienceCampusvej 55OdenseDenmark5230
| | - Erica Ramstad
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Helle B. Krogh
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | | | | | | | - Susanne Rosendal
- Psychiatric Centre North ZealandThe Capital Region of DenmarkDenmark
| | - Camilla Groth
- Herlev University HospitalPediatric DepartmentCapital RegionHerlevDenmark
| | | | - Carlos R Moreira‐Maia
- Federal University of Rio Grande do SulDepartment of PsychiatryRua Ramiro Barcelos, 2350‐2201APorto AlegreRSBrazil90035‐003
| | - Donna Gillies
- Western Sydney Local Health District ‐ Mental HealthCumberland HospitalLocked Bag 7118ParramattaNSWAustralia2124
| | | | - Dorothy Gauci
- Department of HealthDirectorate for Health Information and Research95 G'Mangia HillG'MangiaMaltaPTA 1313
| | - Morris Zwi
- Whittington HealthIslington Child and Adolescent Mental Health Service580 Holloway RoadLondonLondonUKN7 6LB
| | - Richard Kirubakaran
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Center for Evidence‐Informed Health Care and Health PolicyCarman Block II FloorCMC Campus, BagayamVelloreTamil NaduIndia632002
| | - Bente Forsbøl
- Psychiatric Department, Region ZealandChild and Adolescent Psychiatric ClinicHolbaekDenmark
| | - Erik Simonsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- Copenhagen UniversityInstitute of Clinical Medicine, Faculty of Health and Medical SciencesCopenhagenDenmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
- Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchCopenhagenDenmark
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Moffitt TE, Houts R, Asherson P, Belsky DW, Corcoran DL, Hammerle M, Harrington H, Hogan S, Meier M, Polanczyk GV, Poulton R, Ramrakha S, Sugden K, Williams B, Rohde LA, Caspi A. Is Adult ADHD a Childhood-Onset Neurodevelopmental Disorder? Evidence From a Four-Decade Longitudinal Cohort Study. Am J Psychiatry 2015; 172:967-77. [PMID: 25998281 PMCID: PMC4591104 DOI: 10.1176/appi.ajp.2015.14101266] [Citation(s) in RCA: 346] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Despite a prevailing assumption that adult ADHD is a childhood-onset neurodevelopmental disorder, no prospective longitudinal study has described the childhoods of the adult ADHD population. The authors report follow-back analyses of ADHD cases diagnosed in adulthood, alongside follow-forward analyses of ADHD cases diagnosed in childhood, in one cohort. METHOD Participants belonged to a representative birth cohort of 1,037 individuals born in Dunedin, New Zealand, in 1972 and 1973 and followed to age 38, with 95% retention. Symptoms of ADHD, associated clinical features, comorbid disorders, neuropsychological deficits, genome-wide association study-derived polygenic risk, and life impairment indicators were assessed. Data sources were participants, parents, teachers, informants, neuropsychological test results, and administrative records. Adult ADHD diagnoses used DSM-5 criteria, apart from onset age and cross-setting corroboration, which were study outcome measures. RESULTS As expected, childhood ADHD had a prevalence of 6% (predominantly male) and was associated with childhood comorbid disorders, neurocognitive deficits, polygenic risk, and residual adult life impairment. Also as expected, adult ADHD had a prevalence of 3% (gender balanced) and was associated with adult substance dependence, adult life impairment, and treatment contact. Unexpectedly, the childhood ADHD and adult ADHD groups comprised virtually nonoverlapping sets; 90% of adult ADHD cases lacked a history of childhood ADHD. Also unexpectedly, the adult ADHD group did not show tested neuropsychological deficits in childhood or adulthood, nor did they show polygenic risk for childhood ADHD. CONCLUSIONS The findings raise the possibility that adults presenting with the ADHD symptom picture may not have a childhood-onset neurodevelopmental disorder. If this finding is replicated, then the disorder's place in the classification system must be reconsidered, and research must investigate the etiology of adult ADHD.
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Affiliation(s)
- Terrie E. Moffitt
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
- Center for Genomic & Computational Biology, Duke University, Durham, NC, USA
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
| | - Renate Houts
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Philip Asherson
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
| | - Daniel W Belsky
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
- Social Science Research Institute, Duke University, Durham, NC, USA
| | - David L Corcoran
- Center for Genomic & Computational Biology, Duke University, Durham, NC, USA
| | - Maggie Hammerle
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Honalee Harrington
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Sean Hogan
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Madeline Meier
- Department of Psychology, Arizona State University, Tempe, AZ
| | | | - Richie Poulton
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Karen Sugden
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Benjamin Williams
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Luis Augusto Rohde
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Allegre, Brazil
| | - Avshalom Caspi
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
- Center for Genomic & Computational Biology, Duke University, Durham, NC, USA
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
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20
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Hogue A, Bobek M, Tau GZ, Levin FR. Clinical Strategies for Integrating Medication Interventions Into Behavioral Treatment for Adolescent ADHD: The Medication Integration Protocol. CHILD & FAMILY BEHAVIOR THERAPY 2014; 36:280-304. [PMID: 25505817 PMCID: PMC4258514 DOI: 10.1080/07317107.2014.967631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescents enrolled in behavioral health services but remains undertreated in this age group. Also the first-line treatment for adolescent ADHD, stimulant medication, is underutilized in routine practice. This article briefly describes three behavioral interventions designed to promote stronger integration of medication interventions into treatment planning for adolescent ADHD: family ADHD psychoeducation, family-based medication decision-making, and behavior therapist leadership in coordinating medication integration. It then introduces the Medication Integration Protocol (MIP), which incorporates all three interventions into a five-task protocol: ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about best practices for medication integration across diverse settings and populations: integrating medication interventions into primary care, managing medication priorities and polypharmacy issues for adolescents with multiple diagnoses, providing ADHD medications to adolescent substance users, and the compatibility of MIP intervention strategies with everyday practice conditions.
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Affiliation(s)
- Aaron Hogue
- The National Center on Addiction and Substance Abuse at Columbia University, New York, New York, USA
| | - Molly Bobek
- The National Center on Addiction and Substance Abuse at Columbia University, New York, New York, USA
| | - Gregory Z Tau
- Division of Child and Adolescent Psychiatry at Columbia University, New York, New York, USA and New York State Psychiatric Institute
| | - Frances R Levin
- Division on Substance Abuse at Columbia University, New York, New York, USA and New York State Psychiatric Institute
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21
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Vande Voort JL, He JP, Jameson ND, Merikangas KR. Impact of the DSM-5 attention-deficit/hyperactivity disorder age-of-onset criterion in the US adolescent population. J Am Acad Child Adolesc Psychiatry 2014; 53:736-44. [PMID: 24954823 DOI: 10.1016/j.jaac.2014.03.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 03/06/2014] [Accepted: 04/15/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The present study aims to compare the prevalence and clinical correlates of DSM-IV versus DSM-5-defined attention-deficit/hyperactivity disorder (ADHD) and subtypes in a nationally representative sample of US youth based on the age-of-onset criterion. METHOD The sample includes 1,894 participants 12 to 15 years of age from cross-sectional National Health and Nutrition Examination Survey (NHANES) surveys conducted from 2001 to 2004. Data on DSM-IV and DSM-5 criteria for ADHD were derived from administration of the parental ADHD module of the National Institute of Mental Health (NIMH) Diagnostic Interview Schedule for Children, Version IV (DISC-IV). RESULTS Extension of the age-of-onset criterion from 7 to 12 years led to an increase in the prevalence rate of ADHD from 7.38% (DSM-IV) to 10.84% (DSM-5). Youth with later age of onset did not differ from those with earlier age of onset in terms of severity and patterns of comorbidity. However, the group with later age of onset was more likely to be from lower income and ethnic minority families. CONCLUSION The comparability of the clinical significance of the early and later age-of-onset groups supports the DSM-5 extension of the age-of-onset criterion in ADHD.
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Affiliation(s)
- Jennifer L Vande Voort
- Genetic Epidemiology Research Branch in the Intramural Research Program at the National Institute of Mental Health (NIMH) in Bethesda, Maryland
| | - Jian-Ping He
- Genetic Epidemiology Research Branch in the Intramural Research Program at the National Institute of Mental Health (NIMH) in Bethesda, Maryland
| | - Nicole D Jameson
- Genetic Epidemiology Research Branch in the Intramural Research Program at the National Institute of Mental Health (NIMH) in Bethesda, Maryland
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch in the Intramural Research Program at the National Institute of Mental Health (NIMH) in Bethesda, Maryland.
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How evidence on the developmental nature of attention-deficit/hyperactivity disorder can increase the validity and utility of diagnostic criteria. J Am Acad Child Adolesc Psychiatry 2014; 53:723-5. [PMID: 24954821 DOI: 10.1016/j.jaac.2014.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 04/25/2014] [Indexed: 11/22/2022]
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Banaschewski T, Döpfner M. DSM-5 – Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2014; 42:271-5; quiz 276-7. [DOI: 10.1024/1422-4917/a000299] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Die Modifikationen, die im DSM-5 bei den Kriterien für die Diagnose einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) vorgenommen wurden, werden vorgestellt und kritisch diskutiert. Die wichtigsten Veränderungen beziehen sich auf den Beginn der Symptomatik, die Reduktion der Anzahl der notwendigen Kriterien ab dem Alter von 17 Jahren und die Streichung von Autismusspektrumstörungen als Ausschlussdiagnose. Diese Veränderungen sind überwiegend zu begrüßen, bei der Heraufsetzung des Alters für den Störungsbeginn müssen jedoch auch problematische Aspekte bedacht werden.
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Affiliation(s)
- Tobias Banaschewski
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für seelische Gesundheit, Medizinische Fakultät Mannheim der Universität Heidelberg
| | - Manfred Döpfner
- Klinik und Poliklinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Uniklinik Köln
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Effects of the SAFE Children preventive intervention on developmental trajectories of attention-deficit/hyperactivity disorder symptoms. Dev Psychopathol 2014; 26:1161-79. [PMID: 24713426 DOI: 10.1017/s0954579414000170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study examined whether a family-based preventive intervention for inner-city children entering the first grade could alter the developmental course of attention-deficit/hyperactivity disorder (ADHD) symptoms. Participants were 424 families randomly selected and randomly assigned to a control condition (n = 192) or Schools and Families Educating Children (SAFE) Children (n = 232). SAFE Children combined family-focused prevention with academic tutoring to address multiple developmental-ecological needs. A booster intervention provided in the 4th grade to randomly assigned children in the initial intervention (n =101) evaluated the potential of increasing preventive effects. Follow-up occurred over 5 years with parents and teachers reporting on attention problems. Growth mixture models identified multiple developmental trajectories of ADHD symptoms. The initial phase of intervention placed children on more positive developmental trajectories for impulsivity and hyperactivity, demonstrating the potential for ADHD prevention in at-risk youth, but the SAFE Children booster had no additional effect on trajectory or change in ADHD indicators.
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Hogue A, Dauber S, Lichvar E, Spiewak G. Adolescent and caregiver reports of ADHD symptoms among inner-city youth: agreement, perceived need for treatment, and behavioral correlates. J Atten Disord 2014; 18:212-25. [PMID: 22544384 PMCID: PMC3664252 DOI: 10.1177/1087054712443160] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study investigated adolescent and caregiver reports of ADHD symptoms in a sample of clinically referred inner-city adolescents. METHOD Participants (N = 168) included youth ages 12-18 (54% male, 98% ethnic minority) and their caregivers who each completed diagnostic interviews of ADHD symptoms and assessments of perceived need for ADHD treatment and correlated behavior problems. RESULTS Informants showed poor agreement on DSM-IV diagnostic categories and also dimensional scales, Inattention/Disorganization (I/D) and Hyperactivity/Impulsivity (H/I). Both caregiver and adolescent reports of I/D symptoms, but not H/I symptoms, were related to perceived need for ADHD treatment. Caregiver reports were linked to behavioral correlates typically associated with ADHD: I/D symptoms correlated with planning/organization and socioemotional deficits, and H/I symptoms correlated with externalizing and behavior regulation deficits. In contrast, adolescent reports of I/D were related to internalizing and externalizing problems, and their reports of H/I correlated with externalizing only. Few gender effects were found. CONCLUSION Study results underscore the developmental salience of I/D symptoms and have implications for ADHD diagnosis and treatment planning for adolescents.
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Tannock R. Rethinking ADHD and LD in DSM-5: proposed changes in diagnostic criteria. JOURNAL OF LEARNING DISABILITIES 2013; 46:5-25. [PMID: 23144062 DOI: 10.1177/0022219412464341] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is currently undergoing revision that will lead to a fifth edition (DSM-5) in 2013. This article first provides a brief synopsis of the DSM-5 administrative structure, procedures, and guiding principles to enhance understanding of how changes are made in the DSM. The next two sections (on attention-deficit/hyperactivity disorder and learning disorders, respectively) highlight the major concerns and controversies surrounding the DSM-IV diagnostic criteria for these two disorders and provide a rationale for the proposed changes to the criteria, along with a commentary on the empirical evidence on which the proposed changes were based.
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Guimarães-da-Silva PO, Silva KL, Grevet EH, Salgado CAI, Karam RG, Victor MM, Vitola ES, Mota NR, Fischer AG, Picon FA, Bertuzzi GP, Polina ER, Rohde LA, Belmonte-de-Abreu P, Bau CHD. Does age of onset of impairment impact on neuropsychological and personality features of adult ADHD? J Psychiatr Res 2012; 46:1307-11. [PMID: 22817999 DOI: 10.1016/j.jpsychires.2012.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 06/08/2012] [Accepted: 06/14/2012] [Indexed: 10/28/2022]
Abstract
The consideration of age of onset of impairment as part of the ADHD diagnosis is controversial and has been a revisited issue with the emergence of the new classifications in Psychiatry. The aim of this study is to compare patients with early and late onset of ADHD impairment in terms of neuropsychological and personality characteristics. Adult patients with ADHD (n = 415) were evaluated in the ADHD outpatient program at Hospital de Clínicas de Porto Alegre, Brazil. The diagnostic process for ADHD and comorbidities was based on DSM-IV criteria. The comparison between the two ages of onset groups (before 7; n = 209 or from 7 to 12 years; n = 206) was performed with ANOVA, followed by Stepwise forward regression analyses to restrict the number of comparisons and access the possible effect of multiple confounders. Patients with early onset ADHD present higher scores in novelty seeking in both analyses (respectively P = 0.016 and P = 0.002), but similar cognitive and attention features as compared with the late onset group. These data add to previous evidence that despite a more externalizing profile of early onset ADHD, the overall performance is similar reinforcing the need for awareness and inclusion of the late onset group in DSM-V diagnostic criteria.
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Affiliation(s)
- Paula O Guimarães-da-Silva
- ADHD Outpatient Program - Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Kóbor A, Takács Á, Urbán R, Csépe V. The latent classes of subclinical ADHD symptoms: convergences of multiple informant reports. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1677-1689. [PMID: 22584200 DOI: 10.1016/j.ridd.2012.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 04/06/2012] [Accepted: 04/10/2012] [Indexed: 05/31/2023]
Abstract
The purpose of the present study was to conduct latent class analysis on the Hyperactivity scale of the Strengths and Difficulties Questionnaire in order to identify distinct subgroups of subclinical ADHD in a multi-informant framework. We hypothesized a similar structure between teachers and parents, and differences in symptom severity across latent classes. Data was collected from a non-referred sample of children aged 8-13 years. We performed latent class analyses on parent (n = 383) and teacher (n = 391) ratings of the Hyperactivity scale items from both versions of the questionnaire. Those children who had ratings from both informants (n = 272) were included in the cross-informant analyses, in which the similar or equivalent classes across raters were determined. A three-class solution for parent report and a five-class solution for teacher report emerged in the subsample of boys. For girls, a three-class structure for parents and a four-class structure for teachers were optimal. Besides non-symptomatic groups, mild and severe combined classes, mild inattentive-impulsive classes, and among boys, a mild hyperactive-impulsive class was obtained. The cross-informant analyses demonstrated that quite similar subgroups were detached regardless of informant; however, the teacher classes were somewhat more elaborated. The results are in line with the previous latent class analytic studies, and support the combination of dimensional and categorical approaches. The importance of milder symptoms and sub-threshold ADHD categories are emphasized for the fields of neuropsychology, neuroscience, and education, as well as for diagnosis and personalized treatment.
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Affiliation(s)
- Andrea Kóbor
- Doctoral School of Psychology, Eötvös Loránd University, Izabella utca 46, H-1064 Budapest, Hungary.
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Matte B, Rohde LA, Grevet EH. ADHD in adults: a concept in evolution. ATTENTION DEFICIT AND HYPERACTIVITY DISORDERS 2012; 4:53-62. [PMID: 22588789 DOI: 10.1007/s12402-012-0077-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/03/2012] [Indexed: 11/27/2022]
Abstract
Although attention-deficit/hyperactivity disorder (ADHD) has been recognized as a disorder affecting individuals across the life cycle since the end of the nineties, there is still considerable debate on how to conceptualize the disorder in adults, and on the best way to operationalize diagnostic criteria for this age range. In this comprehensive non-systematic review of the literature, we provide data about prevalence and presentation of ADHD in adulthood as well as discuss major problems in applying criteria developed for children in assessing adults (clinical utility, threshold of symptoms for diagnosis, full ADHD diagnosis in childhood, information source, and additional dimensions for diagnosis-executive functioning impairment and emotional impulsivity). In addition, we provide some recommendations for improving ADHD diagnostic criteria in adulthood.
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Affiliation(s)
- Breno Matte
- ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2350, Porto Alegre, Rio Grande do Sul, Brazil
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von Polier GG, Vloet TD, Herpertz-Dahlmann B. ADHD and delinquency--a developmental perspective. BEHAVIORAL SCIENCES & THE LAW 2012; 30:121-139. [PMID: 22371085 DOI: 10.1002/bsl.2005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders of childhood and adolescence. Until now, it has been unclear whether ADHD by itself constitutes a risk factor for later delinquency or does so only in combination with other disruptive symptoms. This article seeks to give a comprehensive account of the literature to shed light on the developmental pathway from childhood ADHD to adult criminality. Comorbid ADHD and conduct disorder (CD) are significantly related to a range of biological and environmental risk factors such as neurocognitive impairment, high parental psychopathology, poor social functioning, and other comorbid mental disorders, particularly substance abuse, that are described in this review. In addition, the results of treatment studies are presented, with a special focus on the results of the Multimodal Treatment Study of Children with ADHD (MTA). Although treatment programs, including medication and psychosocial treatment, can be very effective in improving the functioning of children with ADHD in the social and academic domains in the short term, there is no conclusive evidence that such treatments lower the risk for developing delinquency in adulthood.
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Affiliation(s)
- G G von Polier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
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Baxter AJ, Charlson FJ, Somerville AJ, Whiteford HA. Mental disorders as risk factors: assessing the evidence for the Global Burden of Disease Study. BMC Med 2011; 9:134. [PMID: 22176705 PMCID: PMC3305628 DOI: 10.1186/1741-7015-9-134] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 12/16/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mental disorders are associated with a considerable burden of disease as well as being risk factors for other health outcomes. The new Global Burden of Disease (GBD) Study will make estimates for both the disability and mortality directly associated with mental disorders, as well as the burden attributable to other health outcomes. Herein we discuss the process by which health outcomes in which mental disorders are risk factors are selected for inclusion in the GBD Study. We make suggestions for future research to strengthen the body of evidence for mental disorders as risk factors. METHODS We identified a list of potential associations between mental disorders and subsequent health outcomes based on a review of the literature and consultation with mental health experts. A two-stage filter was applied to identify mental disorders and health outcomes that meet the criteria for inclusion in the GBD Study. Major limitations in the current literature are discussed and illustrated with examples identified during our review. RESULTS AND DISCUSSION Only two associations are included in the new GBD Study. These associations are the increased risk of ischemic heart disease with major depression and mental disorders as a risk factor for suicide. There is evidence that mental disorders are independent risk factors for cardiovascular disease (CVD), type 2 diabetes and injuries. However, these associations were unable to be included because of insufficient data. The most common reasons for exclusion were inconsistent identification of 'cases', uncertain validity of health outcomes, lack of generalizability, insufficient control for confounding factors and lack of evidence for temporality. CONCLUSIONS CVD, type 2 diabetes and injury are important public health policy areas. Prospective community studies of outcomes in patients with mental disorders are required, and their design must address a range of confounding factors.
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Affiliation(s)
- Amanda J Baxter
- Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Wacol, Qld 4076, Australia
- School of Population Health, University of Queensland, Herston Road, Herston, Qld 4006, Australia
| | - Fiona J Charlson
- Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Wacol, Qld 4076, Australia
- School of Population Health, University of Queensland, Herston Road, Herston, Qld 4006, Australia
| | - Adele J Somerville
- Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Wacol, Qld 4076, Australia
- School of Population Health, University of Queensland, Herston Road, Herston, Qld 4006, Australia
| | - Harvey A Whiteford
- Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Wacol, Qld 4076, Australia
- School of Population Health, University of Queensland, Herston Road, Herston, Qld 4006, Australia
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Harvey EA, Metcalfe LA, Herbert SD, Fanton JH. The role of family experiences and ADHD in the early development of oppositional defiant disorder. J Consult Clin Psychol 2011; 79:784-95. [PMID: 21942501 DOI: 10.1037/a0025672] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The present study examined the role of family experiences in the early development and maintenance of oppositional defiant disorder (ODD) symptoms in preschool-age children with behavior problems. METHOD Participants were 199 3-year-old children with behavior problems who took part in 4 annual child and family assessments. RESULTS Children with behavior problems who were exposed to overreactive parenting practices, maternal depression, marital conflict, and lower family income tended to have more ODD symptoms 3 years later. Moreover, initial changes in paternal overreactivity and changes in maternal depression corresponded to initial changes in ODD symptoms. Children who met criteria for attention-deficit/hyperactivity disorder at 6 years of age were less likely to show improvement in ODD symptoms from 3 to 6 years of age, and they were more likely to have been exposed to negative parenting practices, marital conflict, and parental depression during the preschool years. Maternal depression and overreactivity mediated the relation between early hyperactivity and later ODD symptoms. CONCLUSIONS Results point to the importance of early family functioning in the development of ODD.
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Affiliation(s)
- Elizabeth A Harvey
- Department of Psychology, University of Massachusetts Amherst, Amherst, MA 01003, USA.
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Abstract
BACKGROUND Delays in development are a fundamental feature in diagnosing autism spectrum disorders (ASD). Age of language acquisition, usually obtained through retrospective caregiver report, is currently used to distinguish between categories within ASD. Research has shown that caregivers often report children as having acquired developmental milestones earlier or later than they were actually achieved. The current study examines the extent to which this phenomenon, referred to as 'telescoping,' impacts retrospective reports provided by caregivers of children with ASD. METHODS Participants were 127 caregivers of children referred for possible ASD or non-spectrum developmental delay. Caregivers were interviewed when children were 2, 3, 5, and 9 years of age. Caregiver-reported ages of first concern, language and non-diagnostic developmental milestones and interviewer-estimated age of onset were compared over time using linear models. RESULTS Significant telescoping of language milestones resulted in more children meeting language delay criteria as they grew older, in spite of original reports that their language was not delayed. There was little evidence of consistent telescoping of caregiver-reported ages of first concern, daytime bladder control, and independent walking. With time, the interviewers' judged ages of symptom onset increased, but remained prior to age three. CONCLUSIONS Telescoping of caregiver-reported ages of language acquisition has implications for both clinical diagnosis and genetic studies using these milestones to increase homogeneity of samples. Results support proposals to remove specific age-based criteria in the diagnosis of ASD. Telescoping should be considered when working with any clinical population in which retrospectively recalled events are used in diagnosis.
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Affiliation(s)
- Vanessa Hus
- University of Michigan Autism & Communication Disorders Center, USA.
| | - Amanda Taylor
- Human Development and Family Sciences, Oregon State University, USA
| | - Catherine Lord
- University of Michigan Autism & Communication Disorders Center, USA,Department of Psychology, University of Michigan, USA
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Rutter M. Research review: Child psychiatric diagnosis and classification: concepts, findings, challenges and potential. J Child Psychol Psychiatry 2011; 52:647-60. [PMID: 21434914 DOI: 10.1111/j.1469-7610.2011.02367.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The conceptual issues are briefly noted with respect to the distinctions between classification and diagnosis; the question of whether mental disorders can be considered to be 'diseases'; and whether descriptive psychiatry is outmoded. The criteria for diagnosis are reviewed, with the conclusion that, at present, there are far too many diagnoses, and a ridiculously high rate of supposed comorbidity. It is concluded that a separate grouping of disorders with an onset specific to childhood should be deleted, the various specific disorders being placed in appropriate places, and the addition for all diagnoses of the ways in which manifestations vary by age. A new group should be formed of disorders that are known to occur but for which further testing for validity is needed. The overall number of diagnoses should be drastically reduced. Categorical and dimensional approaches to diagnosis should be combined. The requirement of impairment should be removed from all diagnoses. Research and clinical classifications should be kept separate. Finally, there is a need to develop a primary care classification for causes of referral to both medical and non-medical primary care.
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Affiliation(s)
- Michael Rutter
- Medical Research Council Social Genetic & Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College, London.
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Kooij SJJ, Bejerot S, Blackwell A, Caci H, Casas-Brugué M, Carpentier PJ, Edvinsson D, Fayyad J, Foeken K, Fitzgerald M, Gaillac V, Ginsberg Y, Henry C, Krause J, Lensing MB, Manor I, Niederhofer H, Nunes-Filipe C, Ohlmeier MD, Oswald P, Pallanti S, Pehlivanidis A, Ramos-Quiroga JA, Rastam M, Ryffel-Rawak D, Stes S, Asherson P. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 2010; 10:67. [PMID: 20815868 PMCID: PMC2942810 DOI: 10.1186/1471-244x-10-67] [Citation(s) in RCA: 505] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 09/03/2010] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. METHODS The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. RESULTS Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? CONCLUSIONS ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.
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Affiliation(s)
- Sandra JJ Kooij
- PsyQ, psycho medische programma's, Department Adult ADHD, Carel Reinierszkade 197, Den Haag, The Netherlands
| | - Susanne Bejerot
- Department of Clinical Neuroscience, Karolinksa Institutet, Section Psychiatry, St. Goran, Stockholm, Sweden
| | - Andrew Blackwell
- University Department of Psychiatry, Addenbrookes Hospital, Cambridge, UK
| | - Herve Caci
- Pediatric Department, Hôpitaux Pédiatriques CHU-Lenval, 06200 Nice, France
| | - Miquel Casas-Brugué
- Servicio de Psiquiatria, Hospital Universitari Vall d' Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Pieter J Carpentier
- Reinier van Arkel Groep, Postbus 70058, 5201 DZ 's-Hertogenbosch, The Netherlands
| | - Dan Edvinsson
- Department of Neuroscience/Psychiatri Ulleråker, MK 75, S-750 17 Uppsala, Sweden
| | - John Fayyad
- Institute of Development, Research, Advocacy and Applied Care (IDRAAC), Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Centre, Balamand University, Beirut, Lebanon
| | - Karin Foeken
- Centre des Consultations, Institut A Tzanck, Mougins, France
| | - Michael Fitzgerald
- Department of Psychiatry, Trinity College Dublin (TCD), Dublin 2, Ireland
| | - Veronique Gaillac
- Clinique des Maladies Mentales et de l'Encéphale (CMME), Sainte Anne Hospital Paris, France
| | - Ylva Ginsberg
- Affektiva mottagningen, M 59, Psykiatri Sydväst, 141 86 Stockholm, Sweden
| | - Chantal Henry
- Département de Psychiatrie Adulte, Unité Lescure, CH Charles Perrens, Bordeaux, France
| | - Johanna Krause
- Private clinic for psychiatry and psychotherapy, 11a Schillerstrasse, Ottobrunn, Germany
| | - Michael B Lensing
- Department of Child Neurology, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Iris Manor
- Geha Mental Health Center, Petach-Tiqva, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Helmut Niederhofer
- Department of Child Psychiatry, Regional Hospital of Bolzano, Via Guncina, Bolzano, Italy
| | - Carlos Nunes-Filipe
- Faculty of Medical Sciences, New University of Lisbon, Campo dos Mártires da Pátria, 1169-056 Lisboa, Portugal
| | - Martin D Ohlmeier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany
| | - Pierre Oswald
- Department of Psychiatry, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefano Pallanti
- Department of Neurosciences, Florence University, Florence, Italy
| | - Artemios Pehlivanidis
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Josep A Ramos-Quiroga
- Programa Integral del Déficit de Atención en el Adulto (P.I.D.A.A), Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria Rastam
- Department of Clinical Sciences, Lund, Child and Adolescent Psychiatry, Lund University, Sweden
| | | | - Steven Stes
- ADHD Program, University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Philip Asherson
- MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Kings College London, London, UK
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Cubillo A, Rubia K. Structural and functional brain imaging in adult attention-deficit/hyperactivity disorder. Expert Rev Neurother 2010; 10:603-20. [PMID: 20367211 DOI: 10.1586/ern.10.4] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a childhood disorder that persists into adulthood. Nevertheless, there are far fewer imaging studies in adult compared with childhood ADHD. Here we review the imaging literature on brain structure, function and structural and functional connectivity in adult ADHD, as well as the effects of psychostimulants on brain dysfunctions. Importantly, we discuss similarities and differences between these deficit findings and those in childhood ADHD to address the key question of continuity of brain abnormalities into adulthood. Findings show strikingly similar but more inconsistent abnormalities in adult ADHD in key childhood ADHD deficit areas of frontostriatal, temporoparietal and cerebellar regions, presumably due to highly prevalent confounding factors in adult ADHD of elevated rates of comorbidity and medication history.
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Affiliation(s)
- Ana Cubillo
- Department of Child Psychiatry/SGDP, P046, Institute of Psychiatry, 16 De Crespigny Park, London, SE5 8AF, UK.
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Ghanizadeh A. Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder? ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n2p155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Ahmad Ghanizadeh
- Research Center for Psychiatry and Behavioral Sciences, Hafez Hospital, Shiraz University of Medical Sciences, Iran
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Kieling C, Kieling RR, Rohde LA, Frick PJ, Moffitt T, Nigg JT, Tannock R, Castellanos FX. The age at onset of attention deficit hyperactivity disorder. Am J Psychiatry 2010; 167:14-6. [PMID: 20068122 PMCID: PMC4478075 DOI: 10.1176/appi.ajp.2009.09060796] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE New attention-deficit/hyperactivity disorder (ADHD) subtypes identified through latent class analysis have been recently proposed. Here, we assess the accuracy of simple rules based on symptom counts for the assignment of youths to clinically relevant population-derived ADHD subtypes: severe inattentive (SI) and severe combined (SC). METHOD Data from 9,675 twins and siblings from Missouri and Australia aged 7 to 19 years were analyzed using continuous and categorical models of ADHD symptoms using principal components analysis and subtyping by DSM-IV and by latent class criteria. Cut points were derived for classifying SI and SC subtypes by positive predictive value, negative predictive value, percent positive agreement, and Matthew coefficient of agreement. RESULTS Principal components analysis suggested two underlying factors: total number of symptoms and symptom type, with SI and SC latent class subtypes clearly mapping to distinct areas on a plot of these factors. Having six or more total symptoms and fewer than three hyperactive-impulsive symptoms accurately predicts the latent class SI subtype. The latent class SC subtype was best identified by 11 or more total symptoms and 4 or more hyperactive-impulsive. The DSM-IV ADHD subtype criteria accurately identified the SC subtype but only poorly for the SI subtype. CONCLUSIONS Symptom counts criteria allow the simple and accurate identification of subjects with severe ADHD subtypes defined by latent class analysis. Such simple symptom counts corresponding to screening cut points selected latent class-derived SI subtype subjects with greater precision than DSM-IV criteria.
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Karam RG, Bau CHD, Salgado CAI, Kalil KLS, Victor MM, Sousa NO, Vitola ES, Picon FA, Zeni GD, Rohde LA, Belmonte-de-Abreu P, Grevet EH. Late-onset ADHD in adults: milder, but still dysfunctional. J Psychiatr Res 2009; 43:697-701. [PMID: 19007940 DOI: 10.1016/j.jpsychires.2008.10.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 09/27/2008] [Accepted: 10/02/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The requirement in classificatory systems that some impairment from attention-deficit/hyperactivity disorder (ADHD) symptoms starts before 7 years of age (age of onset of impairment criteria - AOC) has been harshly criticized. Although there is evidence that late-onset ADHD is a valid diagnosis, little is known about the role of age of onset of impairment on the clinical profile of adult patients. METHODS The diagnoses of 349 adults with ADHD followed DSM-IV criteria. ADHD and oppositional defiant disorder (ODD) were evaluated with the K-SADS-E, and other comorbidities with the SCID-IV and the MINI. Subjects were divided in early and late-onset groups (age of onset of impairment between 7 and 12 years old). The effect of age of onset over clinical and demographic characteristics was tested by regression models. RESULTS Late-onset subjects were diagnosed later (P=0.04), had a lower frequency of problems with authority and discipline (P=0.004), and lower scores in SNAP-IV (P<0.001) and in Barkley's scale for problems in areas of life activities (P=0.03). On the other hand, late-onset patients presented a higher prevalence of comorbid general anxiety disorder (GAD) (P=0.01). Both groups had a similar profile in the remaining comorbidities and sociodemographic characteristics. CONCLUSIONS This study provides initial evidence that adults with late-onset ADHD have less severity, lower frequency of externalizing symptoms and increased comorbidity with GAD, but similar profile in other comorbidities. In addition, the data suggest that late-onset patients have a higher probability of delayed diagnosis despite the significant impairment of their condition.
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Affiliation(s)
- Rafael G Karam
- ADHD Outpatient Program - Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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