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Taylor LE, Kaplan-Kahn EA, Lighthall RA, Antshel KM. Adult-Onset ADHD: A Critical Analysis and Alternative Explanations. Child Psychiatry Hum Dev 2022; 53:635-653. [PMID: 33738692 DOI: 10.1007/s10578-021-01159-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is characterized as a neurodevelopmental disorder. However, data from several recent studies suggest that there may be adults who meet current criteria for ADHD, yet did not experience symptoms until adulthood (i.e., "adult-onset ADHD"). This systematic review evaluated and synthesized the empirical evidence on adult-onset ADHD to answer the question: Is the extant literature strong enough to evaluate adult-onset ADHD? Nine studies met strict inclusion/exclusion criteria. Results suggest that the methodologies of the extant studies were not strong enough to evaluate adult-onset ADHD. Insufficient methodologies provide presently unclear information about the nature of late-onset symptoms. These symptoms seem to exist but their source could be (1) adult-emergent symptoms that were previously surpassed due to lower environmental demands/supportive facilitators, (2) mimics that were not properly assessed, or (3) childhood-onset symptoms that were not detected earlier due to failure to come to clinical attention. Future directions, clinical recommendations, and limitations of the literature and the current review are discussed.
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Affiliation(s)
- Lea E Taylor
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA.
| | | | | | - Kevin M Antshel
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
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van Kernebeek MW, Vorspan F, Crunelle CL, van den Brink W, Dom G, Moggi F, Konstenius M, Franck J, Levin FR, van de Glind G, Ramos-Quiroga JA, Demetrovics Z, Coetzee C, Luderer M, Schellekens A, Matthys F, Icick R. Consensus International sur le dépistage, le diagnostic et le traitement des patients avec troubles de l’usage de substances en cas de comorbidité avec un trouble du déficit de l’attention avec ou sans hyperactivité. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kappi A, Martel M. Parental Barriers in Seeking Mental Health Services for Attention Deficit Hyperactivity Disorder in Children: Systematic Review. J Atten Disord 2022; 26:408-425. [PMID: 33472504 DOI: 10.1177/1087054720986909] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Many children at risk for negative outcomes related to untreated attention deficit hyperactivity disorder (ADHD) do not receive necessary mental healthcare. Parents' mental health-seeking behavior is important in the early identification of ADHD and preventing comorbidities with ADHD. Parents may experience some barriers that may delay or stop parents from seeking mental healthcare for their children. METHOD This systematic review summarized existing evidence of parents' barriers to seeking mental healthcare for their children at risk of ADHD. RESULTS This review included 21 studies that address different parental barriers under the three levels of the social-ecological model, including individual, interpersonal, and community levels. CONCLUSION Raising parents' awareness of the process of seeking mental healthcare has the potential to help identify children at risk for ADHD earlier. Developing psychoeducational intervention that improves parents' seeking behavior and reduces barriers toward seeking mental healthcare is needed.
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Abstract
INTRODUCTION Adult Attention Deficit/Hyperactivity Disorder (ADHD) is prone to misdiagnosis because its symptoms are subjective, share features with a broad range of mental, behavioral and physical disorders, and express themselves heterogeneously. Furthermore, Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for adult ADHD diagnosis remain underdeveloped, prompting a need for systematic and empirically-informed guidelines. METHOD This article presents a brief history of research on adult ADHD and reviews common sources of false positive and false negative diagnoses. A systematic, stepped diagnostic procedure is described that adheres to DSM guidelines and integrates the latest science on adult ADHD assessment and diagnosis. RESULTS Seven steps are recommended: a structured diagnostic interview with the patient, collection of informant ratings, casting a wide net on symptoms using "or rule" to integrate informant reports, providing checks and balances on the "or rule" by enforcing the impairment criterion, chronicling a symptom timeline, ruling out alternative explanations for symptoms, and finalizing the diagnosis. CONCLUSIONS Based on the extant research, it is expected that the stepped diagnostic procedure will increase detection of malingering, improve diagnostic accuracy, and detect non-ADHD cases with subclinical difficulties or non-ADHD pathologies.
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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Klefsjö U, Kantzer AK, Gillberg C, Billstedt E. The road to diagnosis and treatment in girls and boys with ADHD - gender differences in the diagnostic process. Nord J Psychiatry 2021; 75:301-305. [PMID: 33241961 DOI: 10.1080/08039488.2020.1850859] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The number of referrals for diagnostic assessments of Attention Deficit/Hyperactivity Disorder (ADHD) has increased in the last decade. There is a lack of studies examining the diagnostic process and the treatment provided, particularly from a gender perspective. METHODS From a consecutive cohort of Child and Adolescent Psychiatric (CAP) outpatients, the medical records of 50 boys and 50 girls (under 18 years of age) with a diagnosis of ADHD were selected by an Excel random numbers generator. Data about referral reason, diagnostic process and treatment were analysed. RESULTS Emotional symptoms were more common as a reason for referral to CAP among girls, whereas neurodevelopmental disorders were more common among boys. Compared to the boys, the girls were older at first visit to CAP and at the ADHD diagnosis. The girls had had more visits to the clinic prior to the ADHD diagnostic decision and had more often been prescribed non-ADHD medication both before and after the ADHD diagnosis. The rate of ADHD medication was similar in boys and girls. Girls had more often been admitted to a CAP inpatient care unit prior to the ADHD diagnosis due to acute psychiatric symptoms, and had received more individual psychotherapeutic counselling. CONCLUSION The results highlight the need for broader psychiatric investigations including neuropsychiatric symptoms in girls referred for 'emotional problems'.
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Affiliation(s)
- Ulrika Klefsjö
- Child and Adolescent Psychiatry, NU Hospital Group, Trollhättan, Sweden
| | - Anne K Kantzer
- Child and Adolescent Psychiatry, NU Hospital Group, Trollhättan, Sweden.,Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Child Neuropsychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
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Jordans MJD, Luitel N, Lund C, Kohrt BA. Evaluation of Proactive Community Case Detection to Increase Help Seeking for Mental Health Care: A Pragmatic Randomized Controlled Trial. Psychiatr Serv 2020; 71:810-815. [PMID: 32321389 PMCID: PMC7415529 DOI: 10.1176/appi.ps.201900377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Community Informant Detection Tool (CIDT) is a vignette- and picture-based method of proactive case detection to promote help seeking for persons with depression, psychosis, alcohol use disorder, and epilepsy. The authors evaluated the effectiveness of the CIDT to increase help-seeking behavior in rural Nepal, where a district mental health care plan was being implemented. METHODS Twenty-four health facilities were randomly assigned to one of two methods for training their all-female cadre of community health volunteers: standard training or standard training that included the CIDT. The authors compared the number of patients with depression, psychosis, alcohol use disorder, and epilepsy who were registered in the routine health information system prior to and 6 months after the training. RESULTS At health facilities where volunteers received CIDT training, 309 patients were registered as having depression, psychosis, alcohol use disorder, or epilepsy, compared with 182 patients at facilities where volunteers received standard training. The median number of patients registered was 47% greater at facilities where CIDT training was included (24 patients) than at facilities with standard training (16 patients) (p=0.04, r=0.42). The difference in the number of registered patients remained significant when the analysis factored in the population catchment (N=18 patients [CIDT] versus N=14 [standard] per 10,000 population; p=0.05, r=0.40). CONCLUSIONS The median number of patients registered as having a mental illness was 47% greater at primary care facilities in which community health volunteers used the CIDT than at facilities where volunteers received standard training. Proactive case finding holds promise for increasing help seeking for mental health care.
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Affiliation(s)
- Mark J. D. Jordans
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK; and Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Nagendra Luitel
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Crick Lund
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Brandon A. Kohrt
- Department of Psychiatry, George Washington University, Washington, D.C., USA; and Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
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Newlove-Delgado T, Ford TJ, Hamilton W, Janssens A, Stein K, Ukoumunne OC. Resumption of attention-deficit hyperactivity disorder medication in early adulthood: findings from a UK primary care prescribing study. Eur Child Adolesc Psychiatry 2019; 28:1589-1596. [PMID: 30949828 PMCID: PMC6861538 DOI: 10.1007/s00787-019-01325-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/26/2019] [Indexed: 11/30/2022]
Abstract
This study aimed to examine the resumption of attention-deficit hyperactivity disorder (ADHD) prescriptions in early adulthood in young people whose ADHD prescriptions stopped in adolescence. Whilst prescribing studies indicate that the proportion of those with ADHD stopping treatment in late adolescence remains in excess of the proportion expected to be symptom free, very few studies have examined patterns of resumption amongst young adults previously prescribed medication. Primary care records from the UK Clinical Practice Research Datalink from 2008 to 2013 were used to examine the outcome of resumption of ADHD prescriptions from age 20 years in a sample of cases with ADHD whose prescriptions stopped aged 14-18 years. A Cox regression model was fitted to explore variables that could theoretically be associated with resumption of prescriptions. Of 1440 cases, 109 (7.6%) had their ADHD prescriptions resumed. Characteristics associated with an increased probability of resumption included female gender, learning disability, referral to adult mental health services, and prescription of antipsychotic medication. In this study, only a small proportion of adolescents who stopped ADHD medication subsequently resumed their prescriptions in primary care. Those that did resume were a more complex group. As many vulnerable individuals with ongoing ADHD symptoms may not have the resources required to surmount the barriers to re-enter services, the implication is that not all those who could benefit from resuming medication are able to do so. The findings raise questions around whether current care models are flexible enough and whether primary care services are adequately supported in managing this group.
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Affiliation(s)
- Tamsin Newlove-Delgado
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Tamsin J Ford
- Child and Adolescent Psychiatry, University of Exeter Medical School, Exeter, UK
| | - Willie Hamilton
- Primary Care Diagnostics, University of Exeter Medical School, Exeter, UK
| | - Astrid Janssens
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ken Stein
- Public Health, NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Obioha C Ukoumunne
- Medical Statistics, NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
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Crunelle CL, van den Brink W, Moggi F, Konstenius M, Franck J, Levin FR, van de Glind G, Demetrovics Z, Coetzee C, Luderer M, Schellekens A, Matthys F. International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder. Eur Addict Res 2018; 24:43-51. [PMID: 29510390 PMCID: PMC5986068 DOI: 10.1159/000487767] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/18/2018] [Indexed: 12/22/2022]
Abstract
Adult attention deficit/hyperactivity disorder (ADHD) often co-occurs with substance use disorders (SUD) and is associated with early onset and more severe development of SUD and with reduced treatment effectiveness. Screening tools allow for a good recognition of possible ADHD in adults with SUD and should be used routinely, followed by an ADHD diagnostic process initiated as soon as possible. Simultaneous and integrated treatment of ADHD and SUD, using a combination of pharmaco- and psychotherapy, is recommended. Long-acting methylphenidate, extended-release amphetamines, and atomoxetine with up-titration to higher dosages may be considered in patients unresponsive to standard doses. This paper includes evidence- and consensus-based recommendations developed to provide guidance in the screening, diagnosis and treatment of patients with ADHD-SUD comorbidity.
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Affiliation(s)
- Cleo L. Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium,Toxicological Center, Antwerp University, Antwerp, Belgium
| | - Wim van den Brink
- Amsterdam Institute of Addiction Research (AIAR), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Franz Moggi
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | | | | | - Frances R. Levin
- Columbia University, New York State Psychiatric Institute, New York, NY, USA
| | | | | | - Corné Coetzee
- Department of Pharmacy, University of Limpopo, Sovenga, South Africa
| | - Mathias Luderer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Arnt Schellekens
- Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behavior, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | | | - Frieda Matthys
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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Huỳnh C, Caron J, Fleury MJ. Mental health services use among adults with or without mental disorders: Do development stages matter? Int J Soc Psychiatry 2016; 62:434-51. [PMID: 27074802 DOI: 10.1177/0020764016641906] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Mental health services (MHS) use is a complex behaviour that does not only concern individuals with current mental disorder. To date, few studies have examined age-related contextualisation of MHS use. Reasons for seeking help may vary according to development stages in adulthood. AIMS This study aimed to determine which predisposing, enabling and need factors, using Andersen's model, were associated with MHS use according to adult development stages among individuals with or without current psychiatric diagnosis. METHODS Three age groups were examined: 18- to 29-year-olds (n = 775), 30- to 49-year-olds (n = 1,560) and 50- to 64-year-olds (n = 960). Data were obtained from the Montreal Longitudinal Catchment Area Study. Bivariate and multivariate logistic regression analyses were conducted for each age group separately to determine which predisposing, enabling and need factors were associated with MHS use in the past 12 months. RESULTS For 18- to 29-year-olds, one enabling factor (Internet search) and two need factors (presence of major depressive disorder and number of stressful events) were positively associated with MHS use. For 30- to 49-year-olds, one predisposing factor (family history of mental disorder), four enabling factors (not currently working or in school, perceiving neighbourhood disorder, social cohesion and Internet searching) and one need factor (major depressive disorder) correlated with help seeking. For 50- to 64-year-olds, two predisposing factors (family history of mental disorder and higher self-perceived stigma), two enabling factors (low satisfaction in personal relationship and Internet searching) and one need factor (alcohol dependence) were associated with MHS use. CONCLUSIONS Factors associated with MHS use differ according to adult development stages. Programmes and policies should be based on age-related contextualisation to increase MHS use.
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Affiliation(s)
- Christophe Huỳnh
- Centre de réadaptation en dépendance de Montréal - Institut universitaire, Montréal, QC, Canada Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Jean Caron
- Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Marie-Josée Fleury
- Centre de réadaptation en dépendance de Montréal - Institut universitaire, Montréal, QC, Canada Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, QC, Canada
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Blanco C, Iza M, Rodríguez-Fernández JM, Baca-García E, Wang S, Olfson M. Probability and predictors of treatment-seeking for substance use disorders in the U.S. Drug Alcohol Depend 2015; 149:136-44. [PMID: 25725934 PMCID: PMC4789763 DOI: 10.1016/j.drugalcdep.2015.01.031] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 01/23/2015] [Accepted: 01/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about to what extent treatment-seeking behavior varies across individuals with alcohol abuse, alcohol dependence, drug abuse, and drug dependence. METHODS The sample included respondents from the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who reported a lifetime diagnosis alcohol abuse, alcohol dependence, drug abuse, or drug dependence. Unadjusted and adjusted hazard ratios are presented for time to first treatment contact by sociodemographic characteristics and comorbid psychiatric disorders. Individuals were censored from the analyses if their condition remitted prior to seeking treatment. RESULTS In the first year after disorder onset, rates of treatment-seeking were 13% for drug dependence, 5% for alcohol dependence, 2% for drug abuse, and 1% for alcohol abuse. The lifetime probability of seeking treatment among individuals who did not remit was also highest for drug dependence (90%), followed by drug abuse (60%), alcohol dependence (54%), and alcohol abuse (16%). Having had previous treatment contact for a substance use disorder (SUD) increased the probability of seeking treatment for another SUD. By contrast, an early age of SUD onset, belonging to an older cohort, and a higher level of education decreased the lifetime probability of treatment contact for SUD. The role of comorbid mental disorders was more complex, with some disorders increasing and other decreasing the probability of seeking treatment. CONCLUSIONS Given high rates of SUD and their substantial health and economic burden, these patterns suggest the need for innovative approaches to increase treatment access for individuals with SUD.
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Affiliation(s)
- Carlos Blanco
- New York State Psychiatric Institute, New York, NY, USA.
| | - Miren Iza
- New York State Psychiatric Institute, New York, NY, USA,Fundación Jiménez-Díaz, Department of Psychiatry, Madrid, Spain
| | | | - Enrique Baca-García
- New York State Psychiatric Institute, New York, NY, USA,Fundación Jiménez-Díaz, Department of Psychiatry, Madrid, Spain
| | - Shuai Wang
- New York State Psychiatric Institute, New York, NY, USA
| | - Mark Olfson
- New York State Psychiatric Institute, New York, NY, USA
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