Coexisting psychiatric problems and stressful life events in adults with symptoms of ADHD--a large Swedish population-based study of twins

Prevalence, Correlates, and Comorbidities Among Young Adults Who Screened Positive for ADHD in South Korea During the COVID-19 Pandemic

OBJECTIVE

This study examined the prevalence, associated factors, and psychiatric comorbidities of adult ADHD during the COVID-19 pandemic by analyzing nationally representative data.

METHODS

Among the 5,511 respondents of the 2021 National Mental Health Survey, South Korea, 2,764 (18-49 years) were selected. The Korean versions of the Adult ADHD Self-Report Scale, Composite International Diagnostic Interview, and Structured Clinical Interview for Internet Gaming Disorder were used as diagnostic assessments.

RESULTS

The 6-month prevalence of positive screens for adult ADHD was 3.1%. In individuals aged 18 to 29 years exhibiting adult ADHD symptoms, high prevalence rates of alcohol use, depression, and Internet gaming disorders were observed in the last 12 months. Adults who screened positive for ADHD reported significantly lower life satisfaction and resilience, and higher loneliness and social isolation (vs. non-ADHD group).

CONCLUSION

Adult ADHD symptoms significantly influenced mental well-being, highlighting the need for an appropriate treatment/prevention system, particularly for individuals aged 18 to 29 years.

Longitudinal Associations Between Symptoms of ADHD and Life Success: From Emerging Adulthood to Early Middle Adulthood

OBJECTIVE

To expand on current adult ADHD literature by investigating the stability of ADHD symptomatology (i.e., inattention and hyperactivity-impulsivity) across a 15-year period (from emerging adulthood to early middle adulthood) and the relative contributions of ADHD symptomatology to life success.

METHOD

A sample of 320 post-secondary students was initially assessed for ADHD symptomatology using the Conners' Adult ADHD Rating Scale (CAARS). Fifteen years later, participants were re-assessed using the CAARS and several measures of life success (e.g., relationship satisfaction, career satisfaction, and stress levels).

RESULTS

Inattention and hyperactivity-impulsivity symptoms showed strong stability across the 15-year period. Additionally, inattention symptoms during emerging adulthood and early middle adulthood were consistently associated with poorer life success (i.e., lower relationship and career satisfaction), particularly for men. Associations for hyperactivity-impulsivity symptoms were less consistent.

CONCLUSION

ADHD symptomatology can be conceptualized as a stable, dimensional trait across adulthood, with important impacts on life success.

Sex-differential patterns of neuropsychological functioning in adults with attention-deficit/hyperactivity disorder

BACKGROUND

The sex-differential prevalence of attention-deficit/hyperactivity disorder (ADHD) varies across the lifespan, but little is known about sex differences in executive functions in adults with ADHD.

METHODS

We assessed 261 adults, aged 18-40 years, diagnosed with ADHD (170 males [assigned at birth], aged 25.81 ± 5.49; 91 females, aged 27.76 ± 5.42) and 308 neurotypical adults (176 males, aged 24.62 ± 5.14; 132 female, aged 25.37 ± 5.42) via psychiatric interviews to confirm ADHD and other psychiatric diagnoses. They were assessed by the Cambridge Neuropsychological Testing Automated Battery (CANTAB) on Reaction Time (arousal/processing speed), Rapid Visual Information Processing (sustained attention), Spatial Span (spatial memory), Spatial Working Memory, Intradimentional/Extradimensional Shift (set-shifting), and Stocking of Cambridge (spatial planning). The primary analyses were adjusted for age, full-scale IQ, and co-occurring psychiatric conditions.

RESULTS

Adults with ADHD had various co-occurring psychiatric conditions without sex differences in ADHD-neurotypical differences. Both adult males and females with ADHD performed poorer in all CANTAB tasks than same-sex neurotypical adults. Significant sex-moderating effects were observed in neuropsychological performance, including greater ADHD-neurotypical differences in arousal for females than males and in location memory for spatial tasks in males than females.

CONCLUSION

There were no sex-moderating effects in the presence of co-occurring psychiatric conditions in adult ADHD. However, there were sex-moderating effects on how ADHD related to neuropsychological functioning in adulthood. ADHD was associated with more challenges in arousal/processing speed in females and more challenges in strategy use or inhibition in spatial memory in males.

Adult ADHD Symptoms in a Large Metropolitan Area From Brazil: Prevalence and Associations with Psychiatric Comorbidity, Bullying, Sexual Abuse, and Quality of Life

OBJECTIVE

The aim of this study was to investigate the prevalence and psychiatric correlates of symptomatic ADHD in a large metropolitan area of a middle-income country.

METHODS

An in-person household survey with randomly selected 2,297 adults aged 19 to 60 from Rio de Janeiro, Brazil, assessed by trained lay interviewers. The Adult Self-Rating Scale Screener (ASRS-6) was used. Chi-square and logistic regression were conducted.

RESULTS

ADHD prevalence was 4.59 (95% CI [3.56, 5.44]). Those with ADHD were younger and more often unemployed; they displayed more psychiatric symptoms (depression, anxiety, and alcohol abuse) and a history of bullying and sexual abuse. They also had worse physical health indicators. Findings remained significant when controlling for socioeconomic variables.

CONCLUSION

Adults with symptomatic ADHD from a large metropolitan area in Brazil show a pattern of findings consistent with what has been observed in higher-income countries.

Integrative multi-omics analysis of genomic, epigenomic, and metabolomics data leads to new insights for Attention-Deficit/Hyperactivity Disorder

The evolving field of multi-omics combines data and provides methods for simultaneous analysis across several omics levels. Here, we integrated genomics (transmitted and non-transmitted polygenic scores [PGSs]), epigenomics, and metabolomics data in a multi-omics framework to identify biomarkers for Attention-Deficit/Hyperactivity Disorder (ADHD) and investigated the connections among the three omics levels. We first trained single- and next multi-omics models to differentiate between cases and controls in 596 twins (cases = 14.8%) from the Netherlands Twin Register (NTR) demonstrating reasonable in-sample prediction through cross-validation. The multi-omics model selected 30 PGSs, 143 CpGs, and 90 metabolites. We confirmed previous associations of ADHD with glucocorticoid exposure and the transmembrane protein family TMEM, show that the DNA methylation of the MAD1L1 gene associated with ADHD has a relation with parental smoking behavior, and present novel findings including associations between indirect genetic effects and CpGs of the STAP2 gene. However, out-of-sample prediction in NTR participants (N = 258, cases = 14.3%) and in a clinical sample (N = 145, cases = 51%) did not perform well (range misclassification was [0.40, 0.57]). The results highlighted connections between omics levels, with the strongest connections between non-transmitted PGSs, CpGs, and amino acid levels and show that multi-omics designs considering interrelated omics levels can help unravel the complex biology underlying ADHD.

Attention-deficit/hyperactivity disorder symptoms and subsequent cardiometabolic disorders in adults: investigating underlying mechanisms using a longitudinal twin study

BACKGROUND

Emerging research suggests that attention-deficit/hyperactivity disorder (ADHD) increases the risk for cardiovascular (CVDs) and metabolic disorders (i.e., cardiometabolic disorders) in adulthood. Yet, available studies are scarce and have mainly been focused on individuals receiving clinical ADHD diagnoses. We aimed to investigate the prospective associations of ADHD symptoms in young and mid-adulthood with subsequent cardiometabolic disorders and the underlying mechanisms.

METHODS

We studied 10,394 twins from the Swedish Twin Registry (STR), born between 1958 and 1985 without previous medical history of cardiometabolic disorders. They provided self-assessment of ADHD symptoms (score range 0-36) via a validated, DSM-IV-based scale in a web-based questionnaire/telephone interview within the Study of Twin Adults: Genes and Environment (STAGE), in 2005-2006 (aged 19-47 years), and were followed until the end of 2018 (33-59 years) to identify incident clinical diagnoses/medication prescriptions for cardiometabolic disorders acquired from Swedish national registers. We used Cox regression models to investigate the associations between ADHD symptoms score and cardiometabolic outcomes, with and without adjustment for relevant covariates, and a co-twin control design to study familial confounding.

RESULTS

A one-unit increase in the level of ADHD symptoms was associated with a 2% increase in the rate of CVDs (hazard ratio [HR] = 1.02, 95% confidence interval 1.01-1.04) and a 3% increase in the rate of metabolic disorders (HR = 1.03, 1.02-1.05), after adjusting for birth year and sex. The associations were no longer significant after adjusting for educational attainment, lifestyle factors, and comorbid psychiatric disorders. The associations remained significant after adjusting for familial factors shared by dizygotic twin pairs but became nonsignificant after adjusting for factors shared by monozygotic twin pairs. However, the strength of the associations attenuated significantly in monozygotic twins compared to dizygotic twins for CVDs only, suggesting genetic confounding.

CONCLUSIONS

ADHD symptom score is associated with a higher risk for cardiometabolic disorders, which may be explained by lower educational attainment, adverse lifestyle factors, and psychiatric comorbidities. Moreover, the associations appear to be partly confounded by shared genetic factors, especially for CVDs. Further research is needed to investigate the identified associations at the level of individual cardiometabolic disorders and to follow-up participants until a more advanced older age.

The prevalence of SCT in China, its comorbidity with ADHD and its association with life events and parental-rearing behaviors

Although sluggish cognitive tempo (SCT) symptoms are often observed in children with attention deficit hyperactivity disorder (ADHD), an increasing number of studies have highlighted its uniqueness. Nevertheless, no national survey on SCT among children and adolescents has been conducted in China. Hence, this research aims to study SCT in China and to evaluate the differences between SCT and ADHD symptoms by comparing their risk factors in terms of life events (LE) and parental rearing behaviors (PRB). This cross-sectional study used data from a survey on 71,929 children and adolescents in 5 province-level regions in China to study the incidence and demographic information of SCT in the Chinese population. Subsequently, the study investigated the comorbidity of ADHD and SCT, and conducted three logistic regressions on the LE and PRB scores to predict whether participants develop symptoms of ADHD or SCT, or neither symptom. 6658 participants were allocated into the SCT group, and the weighted point prevalence of SCT was 9.78%. 36.34% of participants with ADHD (n = 676) were found to demonstrate SCT symptoms, whereas no statistically significant difference was observed in its comorbidity to the three ADHD subtypes (χ2 = 1.668, p > 0.05, Δ = 2). The regression results on the presence or absence of ADHD revealed paternal excessive-interference and rejection, and maternal favoring were associated with ADHD diagnosis, whereas paternal punishment and favoring and maternal emotional warmth was related to the absence of ADHD symptoms. Academic stress and maternal excessive-interference were associated with SCT symptoms, and maternal emotional warmth associated with SCT absence. Concerning the presence of ADHD-only or SCT-only symptoms, LE adaptation was found to relate to SCT-only symptoms, while PRB paternal rejection and maternal favoring were associated with ADHD-only symptoms. While evidencing the high prevalence of SCT in China, our findings supported that although ADHD and SCT were highly comorbid, they may be considered two independent disorders with different risk factors. Specifically, participants with SCT symptoms are more vulnerable to stress from LE and tend to face more maladjustment than ADHD and normally-developing participants, and maternal rearing behaviours are the key factors to SCT symptoms. SCT brings global challenges in its diagnosis and treatment, and the challenge is more severe in a mentally stressful environment. Therefore, stress management and SCT etiology studies are recommended.

Magnitude, relationship and determinants of attention deficit hyperactivity disorder and depression among University of Gondar undergraduate students, Northwest Ethiopia, 2022: Non-recursive structural equation modeling

BACKGROUND

Up to 80% of adults with attention deficit hyperactivity disorder (ADHD) may have a concomitant psychiatric disorder. ADHD and depression, combined with the demands of University life, can pose serious challenges for students. However, there are limited studies conducted on this topic in our country. Therefore, the current study assessed the magnitude, relationship, and determinants of ADHD and depressive symptoms among students at the University of Gondar.

METHOD

An institution-based cross-sectional study was employed among 1514 undergraduate students at the University of Gondar from June 1-20, 2022. A stratified, simple random sampling technique was applied. Structural equation modeling was employed. The degree of relationship was interpreted based on the adjusted regression coefficient with 95% confidence interval (CI) and p-value (<0.05).

RESULT

In our study, 37.6% [CI: 35.2-40.1%] and 20.01% [CI: 18.1-22.1%] of the participants had depressive and ADHD symptoms, respectively. Chronic illness [β = 0.19, CI; 0.09, 0.30], alcohol use [β = 0.10, CI; 0.03, 0.17], social support [β = -0.23, CI; -0.29, -0.17], problematic internet use (PIU) [β = 0.23, CI; 0.18, 0.27], and insomnia [β = 0.24, CI; 0.17, 0.30] had a direct relationship with depressive symptoms. Mother education level [β = -0.09, CI; -0.13, -0.06], birth order [β = -0.09, CI; -0.11, -0.07], chat chewing [β = 0.18, CI; 0.06, 0.30], and depressive symptoms [β = 0.73, CI; 0.62, 0.86] had a direct relationship with ADHD. Chronic illness [β = 0.14, CI; 0.06, 0.22], PIU [β = 0.16, CI; 0.13, 0.21], social support [β = -0.16, CI; -0.22, -0.12], and insomnia [β = 0.17, CI; 0.13, 0.23] had an indirect effect on ADHD.

CONCLUSION AND RECOMMENDATION

The prevalence of ADHD and depressive symptoms was high. Chronic disease, alcohol use, social support, PIU, and insomnia had a direct effect on depressive symptoms and an indirect effect on ADHD. Mother education, birth order, chat chewing, and depressive symptoms had a direct effect on ADHD. Our study provided useful clues for clinical treatment and school-based interventions that aim to improve college students' mental well-being. It is better to design school-based intervention and prevention programs to achieve timely diagnosis and treatment of these disorders among university students.

Associations between blood leukocyte DNA methylation and sustained attention in mid-to-late childhood

Aims: To identify associations between DNA methylation (DNAm) across the epigenome and symptoms related to attention-deficit/hyperactivity disorder in a population of Hispanic children. Materials & methods: Among 517 participants in the ELEMENT study aged 9-18 years, we conducted an epigenome-wide association study examining associations between blood leukocyte DNAm and performance on the Conners' continuous performance test (CPT3). Results: DNAm at loci in or near ZNF814, ELF4 and OR6K6 and functional enrichment for gene pathways pertaining to ferroptosis, inflammation, immune response and neurotransmission were significantly related to CPT3 scores. Conclusion: DNAm was associated with CPT3 performance. Further analysis is warranted to understand how these genes and enriched pathways contribute to attention-deficit/hyperactivity disorder.

Selfcare Strategies Shown to Be Useful in Daily Life for Adults Diagnosed with Attention Deficit Hyperactivity Disorder - A Systematic Review

Adults with ADHD experience a wide range of difficulties in daily life, and RNs and other healthcare professionals need to know how to support them. The aim was to conduct a systematic review of which selfcare strategies adults with ADHD use and need in order to manage daily life. A literature review based on the PRISMA model was performed, and seven articles with a qualitative design were found. Data were analyzed with thematic analysis. The analysis generated one major theme Enabling ways to manage the consequences of disability in daily life based on three subthemes; Establishing ways of acting to help yourself, Finding encouraging and helping relationships, and Using external aids for managing daily life. Professionals may benefit from knowing about these selfcare strategies when meeting people with ADHD.

Association between cumulative psychosocial adversity in the family and ADHD and autism: a family-based cohort study

Cumulative exposure to psychosocial adversity at an early age has been shown to be a risk factor for attention-deficit hyperactivity disorder (ADHD) and autism that often co-occur. However, it is not clear if this association reflects a causal effect or familial confounding. We aimed to assess whether cumulative psychosocial adversity in the family increases the risk for ADHD and autism in offspring while accounting for unmeasured familial confounding. We used a population-based cohort of 1,877,901 individuals born in Sweden between 1990 and 2009. Participants were followed from the age of 3 until 2013, with a median follow up time of 13.8 years. We created a cumulative index based on 7 psychosocial adversity factors. We used Cox regression to estimate the hazard ratios (HRs) relating neurodevelopmental conditions to cumulative psychosocial adversity. To address familial confounding, the analyses were repeated in groups of relatives of different kinship: siblings and half-siblings and cousins. A dose-response relationship was observed between cumulative exposure to psychosocial adversity and ADHD at a general population level (covariate adjusted HRs (aHRs) with 95% confidence intervals ranged from 1.55 [one adversity; 1.53-1.58] to 2.65 [ ≥ 4 adversities; 1.98-3.54]). No clear dose-response relation was seen for autism (aHRs ranged from 1.04 [.59-1.84] to 1.37 [1.30-1.45]). HRs of ADHD and autism decreased with increasing level of kinship in the analysis of relatives. Cumulative exposure to psychosocial adversity was associated with both ADHD and autism in the general population, these associations were partly explained by unmeasured familial confounding between relatives. This highlights the need for using family-based designs in studies of psychosocial adversity and ADHD and autism.

Perceived Social Support on the Relationship Between ADD/ADHD and Both Anxious and Depressive Symptoms Among Canadian Adults

OBJECTIVE

The primary goal of the present research was to examine whether the relationships that social support demonstrates with both anxiety and depression varied between adults with and without ADD/ADHD in a Canadian sample.

METHOD

Data were obtained from the 2012 Canadian Community Health Survey-Mental Health (N ≥ 16,354). Presence of social support, diagnosis of generalized anxiety disorder (GAD), and experience of major depressive episodes (MDEs) were estimated in the self-report ADD/ADHD and non-ADD/ADHD groups.

RESULTS

Although social support was negatively associated with having GAD or experiencing an MDE, and self-report ADD/ADHD was positively associated with these outcomes. Presence of self-report ADD/ADHD did not significantly modify the relationships between social support and GAD or MDE.

CONCLUSION

Social support may be a protective factor against symptoms of anxiety and depression in the general Canadian population, for adults with and without ADHD.

Shared grey matter correlates of reading and attention

Disorders of reading (developmental dyslexia) and attention (ADHD) have a high rate of comorbidity (25-40%), yet little is known about the neural underpinnings of this phenomenon. The current study investigated the shared and unique neural correlates of reading and attention in 330 typically developing children ages 8-18 from the Philadelphia Neurodevelopmental Cohort. Multiple regression analyses were used to identify regions of the brain where grey matter (GM) volume was associated with reading or attention scores (p < 0.001, cluster FDR p < 0.05). Better attention scores correlated with increased GM in the precuneus and higher reading scores were associated with greater thalamic GM. An exploratory conjunction analysis (p < 0.05, k > 239) found that GM in the caudate and precuneus correlated with both reading and attention scores. These results are consistent with a recent meta-analysis which identified GM reductions in the caudate in both dyslexia and ADHD and reveal potential shared neural correlates of reading and attention.

The role of self-compassion in the mental health of adults with ADHD

OBJECTIVE

Evidence suggests that the poorer mental health associated with attention deficit hyperactivity Disorder (ADHD) is partially explained by adverse psychosocial correlates of the condition. As recent studies show that self-compassion is negatively associated with ADHD, this study investigates if levels of self-compassion may explain the mental health outcomes in people with ADHD compared to people without ADHD.

METHOD

A total of 543 adults with ADHD (62.72% female, 18-67 years), and 313 adults without ADHD (66.45% female, 18-82 years) completed questionnaires online to measure levels of self-compassion and mental health. A Structural Equation Model assessed the mediating effect of self-compassion on the relationships between ADHD and well-being (psychological, emotional, and social), and ADHD and ill-being (depression, anxiety, and stress).

RESULTS

Findings suggest that low self-compassion contributes to poorer mental health in adults with ADHD compared to adults without ADHD.

CONCLUSIONS

Thus, self-compassion may be a potential target to improve mental health in this population.

PUBLIC HEALTH SIGNIFICANCE

This study shows that self-compassion is an important factor in the mental health of adults with ADHD and provides preliminary evidence for the use of self-compassion interventions to improve mental health outcomes in adults with ADHD.

Stress and work-related mental illness among working adults with ADHD: a qualitative study

BACKGROUND

Though many adults with ADHD underperform professionally, are more stressed, and have more days of sickness absence compared to adults without ADHD, few studies have explored the experience of working as an adult with ADHD. This study explores the general experience of working with ADHD, including stress and work-related mental illness.

METHODS

Semi-structured telephone interviews were conducted with 20 working adults with ADHD. Interview topics included how the ADHD diagnosis and/or symptoms of ADHD may have affected participants on the job, how work may have affected participants' well-being, and the need for support and accommodation. Qualitative content analysis was used to explore verbatim transcripts from the interviews.

RESULTS

The analysis yielded three themes that describe some of the challenges of working with ADHD: Working and living with ADHD, Needs, and Special abilities, with a total of eight subcategories. Subcategories were Specific challenges; Relationships and cooperation; Negative consequences; Planning, prioritization, organization, and structure; Support, interventions, accommodations, and aids; Openness, understanding, and acceptance; Strategies; Strengths and qualities.

CONCLUSION

Further knowledge about the challenges of working with ADHD is needed in workplaces; where organizational support is lacking, much in terms of accommodations and aids is up to the employee, and the disclosure of diagnoses may be associated with great dilemma.

Associations between inattention and impulsivity ADHD symptoms and disordered eating risk in a community sample of young adults

BACKGROUND

Symptoms of attention deficit hyperactivity disorder (ADHD) and trait impulsivity have been associated with disordered eating but are seldom assessed in community studies, or longitudinally and little is known about the mediating mechanisms.

METHODS

We tested associations between ADHD symptoms and disordered eating cross-sectionally and between trait impulsivity and disordered eating longitudinally. We utilised data from a normative cohort of young adults (642 participants: 65% female, M_age = 23 years). Participants were classified as high risk or low risk for disordered eating using the SCOFF instrument. In the first two steps of both cross-sectional and longitudinal hierarchical logistic regression models, demographics and covariates were entered. For the cross-sectional regression, Adult ADHD self-report scale (ASRS) scores, separated into inattentive and hyperactive/impulsive symptoms, were entered in the third step. In a separate longitudinal model, Barratt impulsivity scale subscales (attentional, motor and non-planning impulsivity) were entered in the third step. Depression, as assessed by the moods and feelings questionnaire (MFQ), was examined as a mediator.

RESULTS

Cross-sectionally, sex, MFQ score and inattentive symptoms predicted disordered eating risk (model R² = 20%). Longitudinally, sex, MFQ score and attentional impulsivity predicted disordered eating risk (model R² = 16%). The relationship between inattentive symptoms and the disordered eating risk was partially mediated by MFQ score, whereas the relationship between attentional impulsivity and the disordered eating risk was fully mediated by MFQ scores.

CONCLUSIONS

These data highlight (1) a specific role for inattentive symptoms of ADHD and (2) the importance of both depression and impulsivity in predicting eating disorder risk.

Gender-based differences in prevalence and effects of ADHD in adults: A systematic review

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that starts from childhood and lasts through adulthood. Historically thought as male dominant disorder, researches now emphasized that ADHD also effects females equally. Despite the ascending research on gender differences of ADHD, there is little known about its differences in prevalence and effects and there is a dearth of reviews that can draw a firm conclusion especially in adults. Data from the available medical literature published in English language literature of all time was reviewed systematically and tabulated to evaluate the gender-based differences in prevalence and effects of ADHD in adults. The studies revealed gender differences in adult ADHD in prevalence, and effects. Results showed that males have more prevalence as compared to females but females too have a significant presence of disorder. Females were more impaired as compared to men in most of the effects of ADHD like social functioning, time perception, stress tackling and mood disorder. Males were more impaired in working memory and educational functioning as compared to females. The review shows sufficient evidence of gender differences in adult ADHD in prevalence, and effects, that similarity across genders should not be assumed. It is concluded that there are plenty of conflicting evidence regarding gender differences in many areas of adult ADHD research, and to remove such discrepancies, the existing research is the need for more studies on gender differences and similarities in functioning of adults with ADHD.

Do cognitive load and ADHD traits affect the tendency to prioritise social information in scenes?

We report two experiments investigating the effect of working memory (WM) load on selective attention. Experiment 1 was a modified version of Lavie et al. and confirmed that increasing memory load disrupted performance in the classic flanker task. Experiment 2 used the same manipulation of WM load to probe attention during the viewing of complex scenes while also investigating individual differences in attention deficit hyperactivity disorder (ADHD) traits. In the image-viewing task, we measured the degree to which fixations targeted each of two crucial objects: (1) a social object (a person in the scene) and (2) a non-social object of higher or lower physical salience. We compared the extent to which increasing WM load would change the pattern of viewing of the physically salient and socially salient objects. If attending to the social item requires greater default voluntary top-down resources, then the viewing of social objects should show stronger modulation by WM load compared with viewing of physically salient objects. The results showed that the social object was fixated to a greater degree than the other object (regardless of physical salience). Increased salience drew fixations away from the background leading to slightly increased fixations on the non-social object, without changing fixations on the social object. Increased levels of ADHD-like traits were associated with fewer fixations on the social object, but only in the high-salient, low-load condition. Importantly, WM load did not affect the number of fixations on the social object. Such findings suggest rather surprisingly that attending to a social area in complex stimuli is not dependent on the availability of voluntary top-down resources.

Attention-deficit/hyperactivity disorder symptoms, perceived stress, and suicidal ideation during the COVID-19 pandemic

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) symptoms have been linked to suicidal behavior. However, little is known about the mechanisms involved in this association. This study examined ADHD symptoms and suicidal ideation during the COVID-19 pandemic and the role of self-perceived stress in this association.

METHOD

Data were analyzed from an online sample of 1,452 Japanese individuals aged 18 to 89 obtained in February 2021. Information was collected on past-year suicidal ideation. ADHD symptoms were assessed with the Adult ADHD Self-Report Scale (ASRS) Screener while stress was measured with the Perceived Stress Scale (PSS-14). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-9), while the Generalized Anxiety Disorder scale (GAD-7) was used to assess anxiety symptoms. Logistic regression was used to examine associations.

RESULTS

Fifty-one (3.5%) individuals had ADHD symptoms, while more than one in ten (11.7%) of the respondents reported past-year suicidal ideation. In an analysis adjusted for sociodemographic factors, ADHD symptoms were associated with eight times higher odds for past-year suicidal ideation. However, adjusting the analysis for mental health variables (anxiety and depressive symptoms) attenuated the association which became non-significant (odds ratio [OR]: 1.96, 95% confidence interval [CI]: 0.92-4.18). In contrast, in an analysis adjusted for mental health, individuals with ADHD symptoms and stress had significantly higher odds for suicidal ideation (OR: 3.72, 95%CI: 1.43-9.67) whereas, ADHD symptoms without stress were not linked to suicidal ideation (OR: 1.25, 95%CI: 0.38-4.18).

CONCLUSIONS

Self-perceived stress is important in the association between ADHD symptoms and suicidal ideation among individuals in Japan during the COVID-19 pandemic. Detecting and managing stress and its effects in individuals with ADHD/ADHD symptoms should be a therapeutic focus for improving health-related outcomes in this population both during the COVID-19 pandemic and beyond.

Dependent Stress Mediates the Relation Between ADHD Symptoms and Depression

Objective: Depression and attention-deficit hyperactivity disorder (ADHD) are prevalent and highly comorbid. ADHD symptoms are associated with specific dependent (i.e., self-generated) stressors in children, and there is a strong link between dependent stress and depression. Despite continued comorbidity of ADHD and depressive symptoms into adulthood, it is unknown whether stress generation mediates the relation between ADHD and subsequent depressive symptoms in emerging adulthood, a period of heightened stress. Method: We tested this mediation model in a semester-long longitudinal study of 224 college students (aged 18-23 years). We additionally tested whether this model differed between inattentive versus hyperactive/impulsive ADHD symptoms given evidence that they vary in their relations to stress and depression. Results: Dependent stress mediated the association between total ADHD symptoms at baseline and later depressive symptoms; these effects were equivalent for inattentive versus hyperactive/impulsive ADHD symptoms. Conclusion: These findings suggest stress generation as a mechanism for increased depression in individuals with ADHD symptoms.

Inflammation, Anxiety, and Stress in Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and serious neurodevelopmental disorder characterized by symptoms of inattention and/or hyperactivity/impulsivity. Chronic and childhood stress is involved in ADHD development, and ADHD is highly comorbid with anxiety. Similarly, inflammatory diseases and a pro-inflammatory state have been associated with ADHD. However, while several works have studied the relationship between peripheral inflammation and stress in affective disorders such as depression or bipolar disorder, fewer have explored this association in ADHD. In this narrative review we synthetize evidence showing an interplay between stress, anxiety, and immune dysregulation in ADHD, and we discuss the implications of a potential disrupted neuroendocrine stress response in ADHD. Moreover, we highlight confounding factors and limitations of existing studies on this topic and critically debate multidirectional hypotheses that either suggest inflammation, stress, or anxiety as a cause in ADHD pathophysiology or inflammation as a consequence of this disease. Untangling these relationships will have diagnostic, therapeutic and prognostic implications for ADHD patients.

Adult attention-deficit hyperactivity disorder symptoms and psychological distress, hazardous drinking, and problem gambling: A population-based study

Recognition of ADHD in the adult population is relatively recent. Epidemiological research examining the mental health impact of ADHD in adulthood is thus limited. The objective of this study was to examine whether adult ADHD symptoms are associated with psychological distress, hazardous drinking, and problem gambling, after controlling for traumatic brain injury and sociodemographic characteristics. We analyzed data from a population-based survey administered in 2015 and 2016 to adults aged 18 years and over in Ontario, Canada (N = 3,817). Logistic regression was used to construct unadjusted and multivariable models for each of the three focal relationships. In the unadjusted models, ADHD symptoms were significantly related to psychological distress (OR = 9.3; 95% CI:6.1, 14.0) and hazardous drinking (OR = 2.1; 95% CI: 1.3, 3.4), but not to problem gambling (OR = 1.5; 0.5, 4.3). After adjustment, ADHD symptoms were significantly related to psychological distress (OR = 7.1; 95% CI: 4.6, 11.1), but not hazardous drinking (OR = 1.4; 95% CI: 0.8, 2.5) or problem gambling (OR = 0.6; 95% CI: 0.2, 2.5). This study further highlights the importance of clinicians assessing for concomitant ADHD and psychological distress in adults.

Mapping relationships between ADHD genetic liability, stressful life events, and ADHD symptoms in healthy adults

Attention-deficit/hyperactivity disorder (ADHD) symptoms are continuously distributed in the general population, where both genetic and environmental factors play roles. Stressful life events (SLEs) have been associated with ADHD diagnosis, but the relationship between ADHD genetic liability, SLEs, and ADHD symptoms in healthy individuals is less clear. Using a sample of 1,531 healthy adults (average age 26.9 years; 55.8% female), we investigated relationships between ADHD polygenic risk scores (ADHD-PRSs), SLEs, and ADHD symptoms in a general population sample. Confirming earlier findings in an overlapping sample, all SLE-measures assessed (lifetime SLEs, recent SLEs, and childhood trauma (CT)) were significantly correlated with total ADHD, inattention (IA), and hyperactivity-impulsivity (HI) scores (r² range = .08-.15; all p < .005). ADHD-PRSs was associated with HI (R²_best-fit  = .37%), lifetime SLEs (R²_best-fit  = .56%), and CT (R²_best-fit  = .40%). Mediation analyses showed that lifetime SLEs partially mediated the association between ADHD-PRSs and HI (indirect effect: β = 68.6, bias corrected accelerated 95% confident interval (BCa95%CI) [11.9, 131.0], p = .016, proportion mediated (P_M ) =19.5%), with strongest effects contributed by CT (β = 34.4, BCa95%CI [0.4, 76.5], p = .040, P_M  = 9.8%). On the other hand, HI partially mediated the association between the ADHD-PRSs and lifetime SLEs (β = 42.9, BCa95%CI [7.3, 83.9], p = .014, P_M  = 18.8%). Our study observed a complex relationship of genetic and environmental risk factors contributing to ADHD symptoms in the healthy adult population.

Telomere Length and ADHD Symptoms in Young Adults

Objective: Previous research examining telomeres in individuals with neuropsychiatric disorders shows that greater illness, symptoms, or cognitive impairment are linked with shorter telomeres. However, the relationships of telomere length and neuropsychological processes or psychiatric symptoms are not understood in individuals with Attention Deficit/Hyperactivity Disorder (ADHD). Method: 390 young adults with and without ADHD completed a multi-informant diagnostic assessment and neuropsychological testing battery. Participant DNA was isolated from saliva samples, and telomere length was determined using qPCR. Results: Linear regression models demonstrated the only significant association to survive correction for multiple testing was for childhood hyperactivity-impulsivity symptoms and longer telomere length. Conclusion: Contrary to expectations, longer telomere length in young adults was associated only with childhood ADHD symptoms, particularly hyperactivity-impulsivity, in this sample. These findings are an important demonstration that the neuropsychological deficits and symptoms experienced by individuals diagnosed with ADHD during adulthood may not be negatively associated with telomere length.

A single episode of stress during adolescence impairs short-term memory and increases risk behaviour in an animal model of attention-deficit/hyperactivity disorder

Adolescence is a period of increased sensitivity to stress and vulnerability to the manifestation of psychiatric disorders, such as attention-deficit/hyperactivity disorder (ADHD). Nevertheless, the relationship between stress during adolescence and ADHD is still unclear. Knowing that stress can have long-term consequences, the aim of this study was to evaluate the impact of a single episode of restraint stress during adolescence on locomotion, risk behaviour and short-term memory in adult spontaneously hypertensive rats (SHR), a validated animal model of ADHD. A single episode of stress during adolescence increased risk behaviour and impaired short-term recognition memory, but did not alter locomotion in adult SHR. These findings show that stress during adolescence, even acute, may lead to long-term behavioural consequences in an animal model of ADHD.

Eating behaviors, depression, and anxiety levels of pre bariatric surgery patients with obesity comorbid with or without Attention deficit and hyperactivity disorder: ADHD or Major Depression? Which is more related with eating behaviors?

OBJECTIVE

A high rate of attention deficit and hyperactivity disorder (ADHD) has been reported in patients undergoing obesity treatment. It is controversial whether ADHD solely or its comorbid disorders account for eating behaviors associated with obesity.

METHODS

After presurgery psychiatric assessment, 100 severely obese patients (50 with ADHD and 50 without ADHD) were administered Adult Attention Deficit Hyperactivity Disorder Self-Report Scale(ASRS), Wender Utah Rating Scale(WURS), Three-Factor Eating Questionnaire(TFEQ), and Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI).

RESULTS

Patients with obesity and ADHD had significantly greater emotional eating, susceptibility to hunger, depression, and anxiety but less restraint of eating scores than those without ADHD. Disinhibition of eating scores and presence of Binge Eating Disorder(BED) did not differ significantly between ADHD and non-ADHD groups. Obese patients with major depression had significantly higher ASRS, WURS, TFEQ, BAI scores, disinhibition of eating control, emotional eating, susceptibility to hunger, and diagnosis of BED than nondepressed ones.

CONCLUSIONS

Major depression and anxiety disorder have associations with disinhibition of eating control, emotional eating, susceptibility to hunger and BED, ADHD. Disinhibition of eating and BED did not differ according to the presence of ADHD; thus, depression was associated with eating control on more constructs than ADHD in our study.

Do borderline personality disorder and attention-deficit/hyperactivity disorder co-aggregate in families? A population-based study of 2 million Swedes

Large-scale family studies on the co-occurrence of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are lacking. Thus, we aimed to estimate the co-occurrence and familial co-aggregation of clinically ascertained ADHD and BPD diagnoses using the entire Swedish population. In a register-based cohort design we included individuals born in Sweden 1979-2001, and identified their diagnoses during 1997-2013; in total, 2,113,902 individuals were included in the analyses. We obtained clinical diagnoses of ADHD and BPD from inpatient and outpatient care. Individuals with an ADHD diagnosis had an adjusted (for birth year, sex, and birth order) odds ratio (aOR) of 19.4 (95% confidence interval [95% CI] = 18.6-20.4) of also having a BPD diagnosis, compared to individuals not diagnosed with ADHD. Having a sibling with ADHD also increased the risk for BPD (monozygotic twins, aOR = 11.2, 95% CI = 3.0-42.2; full siblings, aOR = 2.8, 95% CI = 2.6-3.1; maternal half-siblings, aOR = 1.4, 95% CI = 1.2-1.7; paternal half-siblings, aOR = 1.5, 95% CI = 1.3-1.7). Cousins also had an increased risk. The strength of the association between ADHD and BPD was similar in females and males, and full siblings showed similar increased risks regardless of sex. Among both males and females, ADHD and BPD co-occur within individuals and co-aggregate in relatives; the pattern suggests shared genetic factors and no robust evidence for etiologic sex differences was found. Clinicians should be aware of increased risks for BPD in individuals with ADHD and their relatives, and vice versa.

Association Between Hyperactivity Symptoms and Somatic Complaints: Mediating and Moderating Mechanisms in Childhood Trauma and Life Events Among Chinese Male Adolescents

Background: Prior research has found that attention deficit/hyperactivity disorder (ADHD) - particularly hyperactivity symptoms - is associated with various somatic complaints. The present study further tests the relationship between hyperactivity symptoms and somatic complaints in Chinese male adolescents and explores the underlying moderating and mediating mechanisms. Methods: Our sample included 1,586 males (age = 12-16) recruited as part of an epidemiological study of child and adolescent mental disorders from April to July, 2014. Hyperactivity symptoms and somatic complaints were assessed with Achenbach's Child Behavior Checklist (CBCL), and the Childhood Trauma Questionnaire Short Form (CTQ-SF) and Adolescent Life Events Scale (ASLEC) were used to assess exposure to childhood trauma and recent life events. Results: Adolescents with hyperactivity symptoms experienced more emotional abuse, physical abuse, life events, and reported more somatic complaints symptoms (p < 0.0083 or p < 0.05). Linear regression analysis showed that hyperactivity, total childhood trauma score/emotional abuse and sexual abuse and ASLEC score significantly predicted somatic complaints (all p < 0.05). Emotional abuse and life events mediated the relationship between hyperactivity symptoms and somatic complaints. Furthermore, childhood trauma moderated the path between hyperactivity symptoms and ASLEC in the moderation mediation model for predicting somatic complaints (p < 0.05). Conclusions: Hyperactivity symptoms had a significant impact on somatic complaints among Chinese male adolescents. Furthermore, childhood trauma and life events affected the relationship between hyperactivity symptoms and somatic complaints. Interventions for somatic complaints in male adolescents with hyperactivity symptoms should thus consider history of childhood trauma and life events.

Symptoms and level of functioning related to comorbidity in children and adolescents with ADHD: a cross-sectional registry study

BACKGROUND

It is well known that a wide range of psychiatric disorders co-occur with attention deficit hyperactivity disorder. In this study we aimed to examine the associations of psychiatric comorbidity in ADHD with symptom severity and level of functioning.

METHODS

We used data from the Swedish National Quality Registry for ADHD Treatment Follow-up and identified comorbid diagnoses in a sample of 3246 Swedish children and adolescents with ADHD. We investigated the association of comorbidity with symptom severity and level of function by multiple linear regressions.

RESULTS

Autism spectrum disorder, anxiety and affective disorders, oppositional defiant disorder or conduct disorder, learning disorders, and multiple comorbid disorders associate to lower levels of functioning compared to ADHD only. Multiple comorbidity, autism spectrum disorder, oppositional defiant or conduct disorders and tic disorders relate to ADHD symptom severity.

CONCLUSIONS

Comorbidity subgroups with ADHD differ in functional impairment and ADHD symptoms severity. Information on comorbidity profiles could be used for treatment planning more adapted to the individual. Especially those who have autism spectrum disorders and multiple comorbid disorders are at risk of severe ADHD symptoms and low level of functioning.

Adult attention-deficit/hyperactivity disorder prevalence among commercial divers in South Africa

INTRODUCTION

Adult attention-deficit/hyperactivity disorder (ADHD) is associated with increased chance of workplace accidents, psychiatric comorbidities, other risky behaviours and sophisticated psychopharmacological treatment. These factors all contribute to a potentially complex risk profile within the commercial diving context. In order to make informed decisions regarding ADHD and commercial diving, further description of this condition among commercial divers is required. This paper reports on a study that aimed to determine the prevalence of adult ADHD among commercial divers.

METHODS

The study used a self-reporting survey-type questionnaire to determine likely diagnosis, based on Diagnostic and Statistical Manual of Mental Disorders, 5th ed. criteria, in a group of 245 commercial divers in South Africa.

RESULTS

Fourteen cases (5.7% of the sample) met criteria for ADHD. The majority of the cases presented with combined type, and reflected mild forms of ADHD. Adult ADHD did not appear to occur in significantly different proportions across the biographical variables of age, education or diving qualification.

CONLCUSION

Based on this small survey, adult ADHD may be over-represented in commercial diving in South Africa, compared to general workplace populations. However, ADHD may not necessarily be a contra-indication to commercial diving.

Epigenome-wide association study of attention-deficit/hyperactivity disorder in adults

Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable neurodevelopmental disorder that often persists into adulthood. There is growing evidence that epigenetic dysregulation participates in ADHD. Given that only a limited number of epigenome-wide association studies (EWASs) of ADHD have been conducted so far and they have mainly focused on pediatric and population-based samples, we performed an EWAS in a clinical sample of adults with ADHD. We report one CpG site and four regions differentially methylated between patients and controls, which are located in or near genes previously involved in autoimmune diseases, cancer or neuroticism. Our sensitivity analyses indicate that smoking status is not responsible for these results and that polygenic risk burden for ADHD does not greatly impact the signatures identified. Additionally, we show an overlap of our EWAS findings with genetic signatures previously described for ADHD and with epigenetic signatures for smoking behavior and maternal smoking. These findings support a role of DNA methylation in ADHD and emphasize the need for additional efforts in larger samples to clarify the role of epigenetic mechanisms on ADHD across the lifespan.

German validation of the Conners Adult ADHD Rating Scales (CAARS) II: Reliability, validity, diagnostic sensitivity and specificity

Background

The German version of the Conners Adult ADHD Rating Scales (CAARS) has proven to show very high model fit in confirmative factor analyses with the established factors inattention/memory problems, hyperactivity/restlessness, impulsivity/emotional lability, and problems with self-concept in both large healthy control and ADHD patient samples. This study now presents data on the psychometric properties of the German CAARS-self-report (CAARS-S) and observer-report (CAARS-O) questionnaires.

Methods

CAARS-S/O and questions on sociodemographic variables were filled out by 466 patients with ADHD, 847 healthy control subjects that already participated in two prior studies, and a total of 896 observer data sets were available. Cronbach's-alpha was calculated to obtain internal reliability coefficients. Pearson correlations were performed to assess test-retest reliability, and concurrent, criterion, and discriminant validity. Receiver Operating Characteristics (ROC-analyses) were used to establish sensitivity and specificity for all subscales.

Results

Coefficient alphas ranged from .74 to .95, and test-retest reliability from .85 to .92 for the CAARS-S, and from .65 to .85 for the CAARS-O. All CAARS subscales, except problems with self-concept correlated significantly with the Barrett Impulsiveness Scale (BIS), but not with the Wender Utah Rating Scale (WURS). Criterion validity was established with ADHD subtype and diagnosis based on DSM-IV criteria. Sensitivity and specificity were high for all four subscales.

Conclusion

The reported results confirm our previous study and show that the German CAARS-S/O do indeed represent a reliable and cross-culturally valid measure of current ADHD symptoms in adults.

Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in young adults: A qualitative review of the utility of assessment measures and recommendations for improving the diagnostic process

Objective: Identify assessment measures that augment the clinical interview and improve the diagnostic accuracy of adult ADHD assessment.Method: The sometimes limited research literatures concerning the diagnostic efficacies of the clinical interview, standard and novel ADHD behavior rating scales, performance and symptom validity testing, and cognitive tests are critically reviewed.Results: Based on this qualitative review, both clinical interviews alone and ADHD behavior rating scales alone have adequate sensitivity but poor specificity in diagnosing ADHD. Response validity and symptom validity tests have reasonably good sensitivity and very good specificity in detecting invalid symptom presentation. Cognitive test batteries have inadequate sensitivity and specificity in identifying ADHD. Using cognitive tests in conjunction with behavior rating scales significantly improves the specificity of an assessment battery. Executive function behavior rating scales and functional impairment rating scales are unlikely to improve the diagnostic accuracy of ADHD assessment.Conclusions: Based on this review, key clinical interview questions, behavior rating scales, symptom validity tests, and cognitive tests that have promise to enhance current assessment practices are recommended. These are the authors' personal opinions, not consensus standards, or guidelines promulgated by any organization. These measures are incorporated in a practical, somewhat abbreviated, battery that has the potential to improve clinicians' ability to diagnose adult ADHD.

Association of Genetic and Environmental Risks for Attention-Deficit/Hyperactivity Disorder With Hypomanic Symptoms in Youths

IMPORTANCE

Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder are highly comorbid, with significantly associated symptoms. The mechanisms that account for their co-occurrence are not known.

OBJECTIVE

To examine the degree to which genetic and environmental risk factors for ADHD traits, across childhood and adolescence, are associated with adolescent hypomanic symptoms.

DESIGN, SETTING, AND PARTICIPANTS

This study used data on 13 532 twin pairs from the Child and Adolescent Twin Study in Sweden, a prospective, longitudinal twin study. Their parents provided ADHD data when children were 9 or 12 years of age. Of those who reached 15 years of age, 3784 participated. Of those who reached 18 years of age, 3013 participated. The study was performed from December 20, 2017, to December 5, 2018. Data analysis was performed at the Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden, from March 1, 2018, to October 31, 2018.

MAIN OUTCOMES AND MEASURES

Attention-deficit/hyperactivity disorder traits and hypomanic symptoms were assessed using parent-rated instruments. Associations between ADHD and adolescent hypomanic symptoms across childhood and adolescence were investigated using generalized estimating equations. Multivariate twin models were used to examine the extent to which genetic and environmental risk factors for ADHD were associated with hypomania.

RESULTS

Among 3784 15-year-old twin pairs and 3013 18-year-old twin pairs, ADHD and hypomanic symptoms were significantly associated (age 15 years: β = 0.30; 95% CI, 0.24-0.34; P < .001; age 18 years: β = 0.19; 95% CI, 0.16-0.22; P < .001), especially for the hyperactivity-impulsivity ADHD symptom domain (age 15 years: β = 0.53; 95% CI, 0.46-0.60; P < .001; age 18 years: β = 0.36; 95% CI, 0.30-0.42; P < .001) compared with the inattention domain (age 15 years: β = 0.40; 95% CI, 0.34-0.47; P < .001; age 18 years: β = 0.24; 95% CI, 0.19-0.29; P < .001). Between 13% and 29% of the genetic risk factors for hypomania were also associated with ADHD, with higher estimates detected for symptoms of hyperactivity-impulsivity (10%-25%) compared with inattention (6%-16%). Environmental factors played a negligible role in the associations. Genetic factors unique to adolescent hypomania were associated with 25% to 42% of its variance, suggesting some etiologic distinction between these forms of psychopathology.

CONCLUSIONS AND RELEVANCE

More than a quarter of the genetic risk factors for adolescent hypomanic traits were also associated with ADHD symptoms in childhood and adolescence, with hypomania-specific genetic risk factors detected. These findings suggest that ADHD and hypomanic symptoms are associated with shared genetic factors, which should be the focus of further research.

Probabilities of ADD/ADHD and Related Substance Use Among Canadian Adults

Objective: The aim of this study was to estimate the prevalence and probabilities of comorbidities between self-reported ADD/ADHD and smoking, alcohol binge drinking, and substance use disorders (SUDs) from a national Canadian sample. Method: Data were taken from the Public Use Microdata File of the 2012 Canadian Community Health Survey-Mental Health (N = 17 311). The prevalence of (a) smoking, (b) alcohol binge drinking, and (c) SUDs was estimated among those with an ADD/ADHD diagnosis versus those without an ADD/ADHD diagnosis. Results: After controlling for potential socioeconomic and mental health covariates, self-reported ADD/ADHD acted as a significant predictor for group membership in the heaviest smoking, heaviest drinking, and heaviest drug usage categories. Conclusion: Individuals self-reporting a diagnosis of ADD/ADHD were found to have a significantly higher likelihood of engaging in smoking and alcohol binge drinking, and were more likely to meet criteria for SUDs than individuals not reporting an ADD/ADHD diagnosis.

Comorbidity of Adult ADHD and Its Subtypes With Substance Use Disorder in a Large Population-Based Epidemiological Study

Objective: The objective of the study is to explore the role and possible substance preference in ADHD and subtypes in substance use disorder (SUD). Method: Using self-report data on ADHD Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) symptoms and SUD (alcohol, illicit drugs, and nicotine) in 18,167 Swedish twins, aged 20 to 45 years, we obtained odds ratios (OR) from mixed effect logistic regression, controlling for age, sex, education, and nonindependence of twin data. Results: Increased ADHD symptoms were significantly associated with increased odds for all SUD. ORs ranged between 1.33 for regular nicotine (95% confidence interval [CI] = [1.12, 1.59]); 2.54 for multiple drug use (95% CI = [2.00, 3.23]), and 3.58 for alcohol dependence (95% CI = [2.86, 4.49]). Conclusion: ADHD symptoms and subtypes in the population are associated with increased risks for all SUD outcomes, with no difference between ADHD subtypes, no substance preference, and no sex differences for the comorbidity. Clinicians need to consider ADHD evaluation and treatment as part of management of SUD in adults.

Adult ADHD in the South African workplace: the usefulness of a self-report screening measure and preliminary prevalence estimates

In the South African context, resource constraints often preclude the comprehensive assessment of large numbers of people for the likelihood of Adult Attention-Deficit/Hyperactivity Disorder (ADHD). Primary screening through a self-report measure may be useful to stream at-risk individuals towards diagnostic assessment services, as well as being useful in population and workplace based research. The present study set out, first, to investigate the usefulness of a self-report ADHD scale to identify at-risk individuals, and, second, to provide preliminary prevalence estimates for Adult ADHD, guided by Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria, in a South African workplace sample. Workers in full-time skilled employment ( N = 1,917), aged 18–44, completed a self-report Adult ADHD scale, and participated in an interview with a psychologist. Their scale data, using three different scoring and interpretation systems, were subjected to statistical analysis. Favourable internal reliability and positive predictive validity were found. Different interpretation systems provided different prevalence estimations: using DSM-5 criteria, a total prevalence estimate of 3.3 % was calculated (attention deficit subtype = 0.9%, hyperactivity-impulsivity subtype = 1.0%, and combined subtype = 1.4%). The positive predictive validity found with this sample suggests that this scale can be used constructively in research or screening contexts to identify at-risk individuals. Furthermore, preliminary prevalence estimates for Adult ADHD, guided by DSM-5 criteria, are now available for a South African workplace sample.

Adverse family life events during pregnancy and ADHD symptoms in five-year-old offspring

BACKGROUND

Prenatal exposure to maternal adverse life events has been associated with offspring ADHD, but the role of familial confounding is unclear. We aimed to clarify if adverse life events during pregnancy are related to ADHD symptoms in offspring, taking shared familial factors into account.

METHOD

Data were collected on 34,751 children (including 6,427 siblings) participating in the population-based Norwegian Mother and Child Cohort Study. During pregnancy, mothers reported whether they had experienced specific life events. We assessed ADHD symptoms in five-year-old children with the Conners' Parent Rating Scale-Revised: short form. We modeled the associations between life events and mean ADHD scores with ordinary linear regression in the full cohort, and with fixed-effect linear regression in sibling comparisons to adjust for familial confounding.

RESULTS

Children exposed to adverse life events had higher ADHD scores at age 5, with the strongest effect observed for financial problems (mean differences 0.10 [95% CI: 0.09, 0.11] in adjusted model), and the weakest for having lost someone close (0.02 [95% CI 0.01, 0.04] in adjusted model). Comparing exposure-discordant siblings resulted in attenuated estimates that were no longer statistically significant (e.g. mean difference for financial problems -0.03 [95% CI -0.07, 0.02]). ADHD scores increased if the mother had experienced the event as painful or difficult, and with the number of events, whereas sibling-comparison analyses resulted in estimates attenuated toward the null.

CONCLUSIONS

These results suggest that the association between adverse life events during pregnancy and offspring ADHD symptoms is largely explained by familial factors.

Maternal ADHD Symptoms and Parenting Stress: The Roles of Parenting Self-Efficacy Beliefs and Neuroticism

OBJECTIVE

ADHD symptoms in adults are consistently related to stress in a variety of domains, although whether the link between ADHD symptoms and stress is direct, or accounted for or moderated by other variables, is little studied. We used a cross-sectional design to examine whether parenting self-efficacy accounts for the relation between maternal ADHD symptoms and parenting stress, and whether levels of maternal neuroticism moderate this relation.

METHOD

A nonclinical sample of mothers of 120, six- to 12-year-old children completed surveys online.

RESULTS

Maternal ADHD symptoms were associated with parenting stress, but this relation was accounted for by parenting self-efficacy beliefs. Neuroticism did not moderate the relations among these variables. Covariate analyses indicated that although parenting self-efficacy beliefs remain a robust predictor of parenting stress, the relation between maternal ADHD symptoms and parenting stress can be better accounted for by other variables.

CONCLUSION

The results highlight the importance of self-efficacy beliefs and demonstrate that ADHD symptoms are not sufficient to understand the experience of parenting.

Attention-deficit/hyperactivity disorder symptoms and perceived mental health discrimination in adults in the general population

BACKGROUND

The experience of discrimination is common in individuals with mental health problems and has been associated with a range of negative outcomes. As yet, however, there has been an absence of research on this phenomenon in adults with attention-deficit/hyperactivity disorder (ADHD). The current study examined the association between ADHD symptoms and mental health discrimination in the general adult population.

METHODS

The analytic sample comprised 7274 individuals aged 18 and above residing in private households in England that were drawn from the Adult Psychiatric Morbidity Survey, 2007. Information on ADHD was obtained with the Adult ADHD Self-Report Scale (ASRS) Screener. A single-item question was used to assess mental health discrimination experienced in the previous 12 months. Logistic regression analysis was used to examine associations.

RESULTS

The prevalence of discrimination increased as ADHD symptoms increased but was especially elevated in those with the most severe ADHD symptoms (ASRS score 18-24). In a multivariable logistic regression analysis that was adjusted for a variety of covariates including common mental disorders, ADHD symptoms (ASRS ≥ 14) were associated with almost 3 times higher odds for experiencing mental health discrimination (odds ratio: 2.81, 95% confidence interval: 1.49-5.31).

CONCLUSION

ADHD symptoms are associated with higher odds for experiencing mental health discrimination and this association is especially elevated in those with the most severe ADHD symptoms. Interventions to inform the general public about ADHD may be important for reducing the stigma and discrimination associated with this disorder in adults.

Cross-Cultural and Gender Differences in ADHD Among Young Adults

OBJECTIVE

This study explored the effect of cultural and gender differences in ADHD among Spanish, African American, Hispanic American, and European American young adults.

METHOD

Structural equivalence between the four groups was examined by Tucker's phi coefficient. A MANCOVA was carried out with cultural groups and gender as factors and age as covariate.

RESULTS

Structural equivalence was observed across all groups, and no differential item functioning was found. No significant effect was found for gender, although, with the exception of the Hispanic group, males scored higher than females. Furthermore, small, though significant, cultural differences were found. The lowest levels of ADHD were observed in the European American group and the highest in the Hispanic American group. ADHD symptoms, notably inattention, showed some decline with age.

CONCLUSION

Findings extend existing data and suggest a relationship between culture and the development of ADHD, which might be mediated by parenting style.

Recent developments in the genetics of attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is a developmental psychiatric disorder that affects children and adults. ADHD is one of the psychiatric disorders with the strongest genetic basis according to familial, twin, and single nucleotide polymorphisms (SNP)-based epidemiological studies. In this review, we provide an update of recent insights into the genetic basis of ADHD. We discuss recent progress from genome-wide association studies (GWAS) looking at common variants as well as rare copy number variations. New analysis of gene groups, so-called functional ontologies, provide some insight into the gene networks afflicted, pointing to the role of neurodevelopmentally expressed gene networks. Bioinformatic methods, such as functional enrichment analysis and protein-protein network analysis, are used to highlight biological processes of likely relevance to the etiology of ADHD. Additionally, copy number variations seem to map on important pathways implicated in synaptic signaling and neurodevelopment. While some candidate gene associations of, for example, neurotransmitter receptors and signaling, have been replicated, they do not seem to explain significant variance in recent GWAS. We discuss insights from recent case-control SNP-GWAS that have presented the first whole-genome significant SNP in ADHD.

Attention deficit hyperactivity disorder symptoms and disordered eating in the English general population

OBJECTIVE

Attention deficit hyperactivity disorder (ADHD) symptoms and eating problems often coexist, but many of the previous studies have not taken into account key variables which may be important in this association. Thus, the goal of this study was to assess the association between ADHD symptoms and disordered eating, while taking into account of a variety of factors.

METHOD

This study used cross-sectional, nationally representative data from 7,403 people aged ≥16 years from England who participated in the 2007 Adult Psychiatric Morbidity Survey (APMS). ADHD symptoms were assessed with the Adult ADHD Self-Report Scale (ASRS) Screener. Questions from the five-item SCOFF screening instrument were used to identify possible ED. Multivariable logistic regression analyses were conducted.

RESULTS

The prevalence of possible eating disorder (ED) was much higher among those with ADHD symptoms (ASRS score ≥14) compared to those without ADHD symptoms (19.2 vs. 5.7%). ADHD symptoms were associated with possible ED (odds ratio [OR] = 3.48; 95% confidence interval [CI] = 2.56-4.72) after adjustment for age, sex, and ethnicity. After further adjustment for alcohol dependence, drug use, intelligence quotient, stressful life events, perceived stress, impulsivity, depression, anxiety disorder, and borderline personality disorder (BPD) traits, the OR was attenuated to 1.32 (95% CI = 0.82-2.13). Anxiety and BPD were the factors that led to the largest degree of attenuation.

DISCUSSION

A high prevalence of disordered eating in individuals with ADHD was observed. Factors such as co-existing anxiety and BPD traits may be particularly important in this association. Future research should focus on the factors involved in the association between ADHD symptoms and disordered eating behavior.

Associations between attention-deficit/hyperactivity disorder and autoimmune diseases are modified by sex: a population-based cross-sectional study

Several studies have demonstrated associations between neuropsychiatric disorders, such as attention-deficit/hyperactivity disorder (ADHD), and the immune system, including autoimmune diseases. Since ADHD and many autoimmune diseases show sex-specific properties, such associations may also differ by sex. Using Norwegian national registries, we performed a cross-sectional study based on a cohort of 2,500,118 individuals to investigate whether ADHD is associated with common autoimmune diseases. Associations between ADHD and autoimmune diseases in females and males were investigated with logistic regression and effect modification by sex was evaluated. Several subanalyses were performed. The strongest association was found between ADHD and psoriasis in females, adjusted odds ratio (adjOR) = 1.57 (95% confidence interval: 1.46-1.68) and males, adjOR = 1.31 (1.23-1.40); p value for interaction < 0.0001. Furthermore, among females, ADHD was associated with Crohn's disease, adjOR = 1.44 (1.16-1.79) and ulcerative colitis, adjOR = 1.28 (1.06-1.54). In contrast, males with ADHD had lower odds of Crohn's disease, adjOR = 0.71 (0.54-0.92), in addition to a trend for lower odds of ulcerative colitis, adjOR = 0.86 (0.71-1.03); p values for interaction < 0.0001 and 0.0023, respectively. In a group of females where information on smoking and body mass index was available, adjustment for these potential mediators did not substantially alter the associations. Our findings support previously reported associations between ADHD and diseases of the immune system. The associations differ by sex, suggesting that sex-specific immune-mediated neurodevelopmental processes may be involved in the etiology of ADHD.

Gender differences in psychiatric comorbidity: a population-based study of 40 000 adults with attention deficit hyperactivity disorder

OBJECTIVE

We aimed at determining whether gender modified associations between ADHD and psychiatric comorbidities in adults.

METHOD

We identified adults with ADHD by linking Norwegian national registries and compared them with the remaining adult population (born 1967-1997, ADHD and bipolar during 2004-2015, other psychiatric disorders 2008-2015). Prevalence differences (PDs) and prevalence ratios (PRs) of psychiatric disorders were determined by Poisson regression. Interaction by gender was evaluated on additive (PDs) and multiplicative (PRs) scales. Proportions of psychiatric disorders attributable to ADHD were calculated.

RESULTS

We identified 40 103 adults with ADHD (44% women) and 1 661 103 adults (49% women) in the remaining population. PDs associated with ADHD were significantly larger in women than in men for anxiety, depression, bipolar and personality disorders, for example depression in women: 24.4 (95% CI, 23.8-24.9) vs. in men: 13.1 (12.8-13.4). PDs were significantly larger in men for schizophrenia and substance use disorder (SUD), for example SUD in men: 23.0 (22.5-23.5) vs. in women: 13.7 (13.3-14.0). Between 5.6 and 16.5% of psychiatric disorders in the population were attributable to ADHD.

CONCLUSION

The association between ADHD and psychiatric comorbidities differed significantly among men and women. Clinicians treating adults with ADHD should be aware of these frequent and gender-specific comorbidities, such that early treatment can be offered.

Prevalence and Correlates of Self-Reported ADD/ADHD in a Large National Sample of Canadian Adults

OBJECTIVE

The objective of this study was to examine the prevalence and correlates of self-reported attention deficit disorder (ADD)/ADHD in Canadian adults.

METHOD

Prevalence of self-reported ADD/ADHD was examined in a large national sample of Canadians ( n = 16,957). Demographic variables, lifetime, and current psychiatric comorbidities were then compared in a group of adults with self-reported ADD/ADHD ( n = 488) and an age- and gender-matched control group ( n = 488).

RESULTS

The prevalence of self-reported ADD/ADHD was 2.9%. Significantly higher lifetime and current prevalence rates of major depressive disorder, bipolar I and II disorders, generalized anxiety disorder, and substance use disorders were observed in the ADD/ADHD group compared with the control group. Within the ADD/ADHD group, lifetime and 12-month prevalence rates of major depressive disorder and generalized anxiety disorder were significantly higher in women, whereas lifetime and current rates of some substance use disorders were significantly higher in men.

CONCLUSION

In a national sample of Canadian adults, self-reported ADD/ADHD was associated with significant psychiatric comorbidity. Gender differences were also noted.

Associations Between Core Symptoms of Attention Deficit Hyperactivity Disorder and Both Binge and Restrictive Eating

INTRODUCTION

It is unclear whether core symptoms of attention deficit hyperactivity disorder (ADHD) relate to specific types of disordered eating and little is known about the mediating mechanisms. We investigated associations between core symptoms of ADHD and binge/disinhibited eating and restrictive eating behavior and assessed whether negative mood and/or deficits in awareness and reliance on internal hunger/satiety cues mediate these relationships.

METHODS

In two independent studies, we used a dimensional approach to study ADHD and disordered eating. In Study 1, a community-based sample of 237 adults (72.6% female, 18-60 years [M = 26.8, SE = 0.6]) completed an online questionnaire, assessing eating attitudes/behaviors, negative mood, awareness, and reliance on internal hunger/satiety cues and ADHD symptomatology. In Study 2, 142 students (80.3% female, 18-32 years [M = 19.3, SE = 0.1]) were recruited to complete the same questionnaires and complete tasks assessing interoceptive sensitivity and impulsivity in the laboratory.

RESULTS

In each study, core symptoms of ADHD correlated positively with both binge/disinhibited and restrictive eating and negative mood mediated the relationships. Deficits in awareness and reliance on internal hunger/satiety signals also mediated the association between inattentive symptoms of ADHD and disordered eating, especially binge/disinhibited eating. The results from both studies demonstrated that inattentive symptoms of ADHD were also directly related to binge/disinhibited eating behavior, while accounting for the indirect pathways of association via negative mood and awareness and reliance on internal hunger/satiety signals.

CONCLUSION

This research provides evidence that core symptoms of ADHD are associated with both binge/disinhibited eating and restrictive eating behavior. Further investigation of the role of inattentive symptoms of ADHD in disordered eating may be helpful in developing novel treatments for both ADHD and binge eating.

Low hedonic tone and attention-deficit hyperactivity disorder: risk factors for treatment resistance in depressed adults

BACKGROUND

The burdens imposed by treatment-resistant depression (TRD) necessitate the identification of predictive factors that may improve patient treatment and outcomes. Because depression and attention-deficit hyperactivity disorder (ADHD) are frequently comorbid and share a complex relationship, we hypothesized that ADHD may be a predictive factor for the diagnosis of TRD. This exploratory study aimed to determine the percentage of undetected ADHD in those with TRD and evaluate factors associated with treatment resistance and undetected ADHD in depressed patients.

SUBJECTS AND METHODS

Adults referred (n=160) for psychiatric consultation completed a structured interview (MINI Plus, Mini International Neuropsychiatric Interview Plus) to assess the presence of psychiatric disorders.

RESULTS

TRD was significantly associated with the number of diagnoses (P<0.001), past (P<0.001) and present medications (P<0.001), chronic anhedonia (P=0.013), and suicide ideation (P=0.008). Undetected ADHD was present in 34% of TRD patients. The number of referral diagnoses (P<0.001), failed medications (P=0.002), and past selective serotonin reuptake inhibitor failures (P=0.035) were predictive of undetected ADHD in TRD.

CONCLUSION

Undetected ADHD may be more prevalent among TRD patients than previously thought. In addition, TRD patients are more likely to present with psychiatric comorbidity than non-TRD patients. Screening patients with depression for the presence of ADHD and chronic anhedonia/low hedonic tone may help identify patients with TRD and undetected ADHD and improve treatment outcomes.

Genetic and environmental aspects in the association between attention-deficit hyperactivity disorder symptoms and binge-eating behavior in adults: a twin study

BACKGROUND

Prior research demonstrated that attention-deficit hyperactivity disorder (ADHD) is associated with binge-eating behavior, binge-eating disorder (BED), and bulimia nervosa (BN). The aim of this study was to investigate these associations in an adult twin population, and to determine the extent to which ADHD symptoms and binge-eating behavior share genetic and environmental factors.

METHODS

We used self-reports of current ADHD symptoms and lifetime binge-eating behavior and associated characteristics from a sample of over 18 000 adult twins aged 20-46 years, from the population-based Swedish Twin Registry. Mixed-effects logistic regression was used to examine the association between ADHD and lifetime binge-eating behavior, BED, and BN. Structural equation modeling was used in 13 773 female twins to determine the relative contribution of genetic and environmental factors to the association between ADHD symptoms and binge-eating behavior in female adult twins.

RESULTS

ADHD symptoms were significantly associated with lifetime binge-eating behavior, BED, and BN. The heritability estimate for current ADHD symptoms was 0.42 [95% confidence interval (CI) 0.41-0.44], and for lifetime binge-eating behavior 0.65 (95% CI 0.54-0.74). The genetic correlation was estimated as 0.35 (95% CI 0.25-0.46) and the covariance between ADHD and binge-eating behavior was primarily explained by genetic factors (91%). Non-shared environmental factors explained the remaining part of the covariance.

CONCLUSIONS

The association between adult ADHD symptoms and binge-eating behavior in females is largely explained by shared genetic risk factors.