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

Attention-Deficit/Hyperactivity Disorder Diagnoses in Finland During the COVID-19 Pandemic

Importance

Several reports suggest an increase in attention-deficit/hyperactivity disorder (ADHD) symptoms during the COVID-19 pandemic. This nationwide study assessed new ADHD diagnoses and ADHD prevalence before and during the pandemic.

Objective

To investigate trends in new ADHD diagnoses, prevalence, and ADHD medication use from 2015 to 2022 in Finland.

Design, Setting, and Participants

This longitudinal cohort study comprised the entire Finnish population. ADHD diagnoses and medication use were obtained from nationwide registers and assessed at 3 time points: in 2015 and before (2020) and after (2022) the pandemic. Data were analyzed from January 2015 to June 2022.

Main outcomes and Measures

New ADHD diagnoses, ADHD lifetime prevalence, and ADHD medication use.

Results

The cohort comprised 5 572 420 individuals (2 819 645 women [50.6%]). Lifetime prevalence of ADHD increased by 2.7-fold during 2015 to 2022; prevalence was 1.02% in 2015 (95% CI, 1.01%-1.03%), 1.80% in 2020 (95% CI, 1.79%-1.81%), and 2.76% in 2022 (95% CI, 2.75%-2.77%). Young men aged 13 to 20 years had the highest lifetime prevalence of 11.68% (95% CI, 11.56%-11.81%) in 2022. New ADHD diagnoses doubled during the pandemic, from 238 per 100 000 in 2020 to 477 per 100 000 in 2022. The pandemic-associated incremental increase in new diagnoses was 18.60% (95% CI, 16.47%-20.49%; 9482 per 50 897 cases). Young women aged 13 to 20 years had a 2.6-fold increase in new diagnoses during the pandemic, from 577 per 100 000 in 2020 to 1488 per 100 000 in 2022, and women aged 21 to 30 years had a 3.0-fold increase, from 361 per 100 000 to 1100 per 100 000. New diagnoses increased by 2.9-fold among those older than 55 years (from 5 per 100 000 to 13 per 100 000 in women and from 5 per 100 000 to 14 per 100 000 in men). Boys younger than 13 years had the highest absolute rate of new ADHD diagnoses in 2022 (1745 per 100 000), but boys and young men younger than 21 years did not show a significant incremental increase in new diagnoses. Lifetime prevalence of ADHD medication purchases was 0.57% (95% CI, 0.56%-0.58%) in 2015 (31 771 [55.62%] of those with ADHD diagnosis), 1.15% (95% CI, 1.14%-1.16%) in 2020 (64 034 [63.83%]), and 1.69% (95% CI 1.68%-1.70%) in 2022 (92 557 [61.43%]), respectively.

Conclusions and Relevance

In this nationwide cohort study, new ADHD diagnoses and ADHD prevalence showed significant increase in Finland during the pandemic. ADHD medication use did not increase in relation to ADHD diagnoses. These results highlight potential adverse outcomes of pandemic-associated changes in living conditions.

Treatments for ADHD in adults in jails, prisons and correctional settings: a scoping review of the literature

BACKGROUND

Attention-Deficit / Hyperactivity Disorder (ADHD) is prevalent at a higher rate in correctional settings than in the general population. Treatment of ADHD in this environment is challenging as stimulants, the most common treatment for ADHD, require cautious prescribing in the context of frequent substance use disorders (SUD) and diversion in the institutional setting. In addition, both pharmacological and non-pharmacological treatment approaches require significant staff resources. The aim of this scoping review is to map and summarize all literature addressing treatment of ADHD specifically in correctional settings, synthesize the evidence supporting various approaches, and highlight areas for future research. Due to the limited number of primary research studies addressing this question directly, we chose a scoping review methodology that would allow us to explore what kinds of studies and literature exist and include all types of articles directly related to our question.

RESULTS

Five-hundred sixty-five relevant articles were screened. Thirty-two articles were included in the final review. Eleven of the articles reported primary research. Five of these articles were based on three randomized controlled trials. Among randomized controlled trials on the effect of stimulants, inclusion criteria, outcome measures and effectiveness varied widely. Non-male and non-white populations were under-represented. Among review articles and recommendations opinion was inconsistent, with some recommending stimulants as first-line treatment and others recommending they be avoided altogether. The effect of non-stimulant medications was examined in 2 small studies. The only non-pharmacological treatment examined was dialectical behavior therapy, and only feasibility was reported. Four articles provided practice recommendations from consensus or expert opinion. Two of these recommended stimulants as first-line treatment, and two recommended stimulants as treatment of last resort.

CONCLUSIONS

We found a diverse but shallow literature addressing our research question. Primary research in the corrections setting is limited and varies in inclusion criteria, outcomes studied, and effectiveness. Recommendations on treatment are inconsistent. Future research should address methods of diagnosis, the role of non-stimulants, non-pharmacological interventions, non-male and non-white people who are incarcerated (PWAI), and effects of treatment method on patients, staff and other PWAI. Better research and guidance on treating ADHD has potential to improve health of PWAI, the institutional environment, and resource utilization.

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.

Association of ADHD symptoms in adolescence and mortality in Northern Finland Birth Cohort 1986

BACKGROUND

Diagnosis of attention deficit hyperactive disorder (ADHD) has been associated with increased risk of mortality in large register samples. However, there is less known about the association between symptoms of ADHD in adolescents and risk of mortality in general population samples.

METHODS

The Northern Finland Birth Cohort 1986 (n = 9432 at recruitment in early pregnancy) linked to nationwide register data for deaths was utilized to study the association between parent-rated ADHD symptoms assessed using Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire and mortality until age 33 years. Cox-regression analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) was used to study the association between SWAN inattentive, hyperactive, and combined symptom scores and risk of death.

RESULTS

Sixty-three (0.9%) of the 6685 participants died during the follow-up. Higher SWAN inattentive (crude HR = 2.30, 95% CI 1.46-3.63), SWAN hyperactive (crude HR = 2.43, 95% CI 1.29-4.56), and SWAN combined (crude HR = 2.69, 95% CI 1.57-4.61) scores were associated with increased risk of death. After adjustments for sex, family structure, and lifetime parental psychiatric disorder, these associations persisted. Further adjustment for frequent alcohol intoxication, cannabis, and other substance use in adolescence attenuated these to below statistical significance.

CONCLUSIONS

These results extend previous findings on the risk of mortality in adolescents who have symptoms of ADHD. Further research with larger samples are needed to determine whether the association between ADHD symptoms and mortality is independent of adolescent substance use.

A Review of Canadian Diagnosed ADHD Prevalence and Incidence Estimates Published in the Past Decade

(1) Background: ADHD is recognized as one of the most common neurodevelopmental disorders. The worldwide prevalence of ADHD is estimated at 5.3%; however, estimates vary as a function of a number of factors, including diagnostic methods, age, sex and geographical location. A review of studies is needed to clarify the epidemiology of ADHD in Canada. (2) Methods: A search strategy was created in PubMed and adapted for MEDLINE and PsycINFO. Papers were included if they examined diagnosed ADHD prevalence and/or incidence rates in any region of Canada, age group and gender. A snowball technique was used to identify additional papers from reference lists, and experts in the field were consulted. (3) Results: Ten papers included in this review reported on prevalence, and one reported on incidence. One study provided an overall prevalence estimate across provinces for adults of 2.9%, and one study provided an overall estimate across five provinces for children and youth of 8.6%. Across age groups (1 to 24 years), incidence estimates ranged from 0.4% to 1.2%, depending on province. Estimates varied by age, gender, province, region and time. (4) Conclusions: The overall Canadian ADHD prevalence estimate is similar to worldwide estimates for adults. Most studies reported on prevalence rather than incidence. Differences in estimates across provinces may reflect the varying number of practitioners available to diagnose and prescribe medication for ADHD across provinces. To achieve a more comprehensive understanding of the epidemiology of ADHD in Canada, a study is needed that includes all provinces and territories, and that considers estimates in relation to age, gender, ethnicity, geographical region, socioeconomic status and access to mental healthcare coverage. Incidence rates need further examination to be determined.

Adverse Childhood Experiences (ACEs) and Health Histories Among Clients in a First Nations-Led Treatment for Substance Use

First Nations adults continue to experience significant health disparities compared to non-First Nations adults in Canada. Ongoing difficulties associated with intergenerational trauma among First Nations peoples may be examined using the adverse childhood experiences (ACEs) model, which measures various forms of abuse, neglect, and household dysfunction. We examined prevalence rates of ACEs and physical and mental health outcomes within a predominately First Nation sample of clients seeking substance use treatment from a First Nations-led treatment facility. The prevalence of ACEs was higher than national averages and previous data collected with broader Indigenous samples in Canada. Descriptive analyses of ACEs and health outcomes for those seeking First Nations-led substance use treatment showed these participants had more chronic health difficulties co-morbid with clinical levels of problematic substance use. To improve ongoing best-treatment options for those seeking substance use treatment, continued assessment and promotion of broader aspects of health and wellbeing are required, including the balance of physical, emotional, spiritual, and mental health and wellbeing across a lifespan.

Attention-deficit/hyperactivity disorder and physical multimorbidity: A population-based study

Background:

There has been little research on the association of attention-deficit/hyperactivity disorder (ADHD) with co-occurring physical diseases. The aim of this study was to examine the association between possible ADHD and physical multimorbidity (i.e. = 2 physical diseases) among adults in the English general population.

Methods:

Data were analyzed from 7274 individuals aged = 18 years that came from the Adult Psychiatric Morbidity Survey 2007. ADHD symptoms were assessed with the Adult Self-Report Scale (ASRS) Screener. Information was also obtained on 20 self-reported doctor/other health professional diagnosed physical health conditions present in the past 12 months. Multivariable logistic regression and mediation analyses were conducted to assess the associations.

Results:

There was a monotonic relation between the number of physical diseases and possible ADHD (ASRS score = 14). Compared to those with no diseases, individuals with = 5 diseases had over 3 times higher odds for possible ADHD (odds ratio [OR]: 3.30, 95% confidence interval [CI]: 2.48–4.37). This association was observed in all age groups. Stressful life events (% mediated 10.3–24.3%), disordered eating (6.8%), depression (12.8%), and anxiety (24.8%) were significant mediators in the association between possible ADHD and physical multimorbidity.

Conclusion:

Adults that screen positive for ADHD are at an increased risk for multimorbidity and several factors are important in this association. As many adults with ADHD remain undiagnosed, the results of this study highlight the importance of detecting adult ADHD as it may confer an increased risk for poorer health outcomes, including physical multimorbidity.

Risk of Alcohol Abuse in Humans with Attention-deficit/Hyperactivity Disorder Symptoms

The relationship between attention-deficit/hyperactivity disorder (ADHD) and the risk of alcohol abuse is widely studied. Even though this topic has been of interest for several years, it is heavily debated. We studied various papers and conducted a systematic review using PubMed as the main source of data collection. We found that several studies put forward the concept of a positive association between alcohol abuse and ADHD symptoms, but a minority of them also showed opposing and contradictory results. We discovered that this inconsistency observed in studies could be a result of a biased approach in studies and a subjective attempt in interpretations. These biases could be studied in terms of sample size involved in the analysis, age at which studies are conducted among other statistical parameters. We believe that the deviations in the outcomes prove that the studies may be incomplete and that a standardized method of interpretation is required. Therefore, this paper recommends the need for further research to explore the connection between alcohol abuse in patients showing ADHD symptoms.

Temporal Trends in the Prevalence and Incidence of Diagnosed ADHD in Children and Young Adults between 1999 and 2012 in Canada: A Data Linkage Study

OBJECTIVE

There is a need for the routine monitoring of treated attention-deficit hyperactivity disorder (ADHD) for timely policy making. The objective is to report and assess over a decade the prevalence and incidence of diagnosed ADHD in Canada.

METHODS

Administrative linked patient data from the provinces of Manitoba, Ontario, Quebec, and Nova Scotia were obtained from the same sources as the Canadian Chronic Diseases Surveillance Systems to assess the prevalence and incidence of a primary physician diagnosis of ADHD ( ICD-9 and ICD-10 codes: 314, F90.x) for consultations in outpatient and inpatient settings (Med-Echo in Quebec, the Canadian Institute of Health Information Discharge Abstract Database in the 3 other provinces, plus the Ontario Mental Health Reporting System). Dates of service, diagnosis, and physician specialty were retained. The estimates were presented in yearly brackets between 1999-2000 and 2011-2012 by age and sex groups.

RESULTS

The prevalence of ADHD between 1999 and 2012 increased in all provinces and for all groups. The prevalence was approximately 3 times higher in boys than in girls, and the highest prevalence was observed in the 10- to 14-year age group. The incidence increased between 1999 and 2012 in Manitoba, Quebec, and Nova Scotia but remained stable in Ontario. Incident cases were more frequently diagnosed by general practitioners followed by either psychiatrists or paediatricians depending on the province.

CONCLUSION

The prevalence and incidence of diagnosed ADHD did not increase similarly across all provinces in Canada between 1999 and 2012. Over half of cases were diagnosed by a general practitioner.

[Impulsivity in adolescents with attention deficit hyperactivity disorder]

AIM

To study impulsivity in adolescents with attention deficit hyperactivity disorder (ADHD) and evaluate the efficacy of noophen in dosage 500 mg daily for 45 days in the treatment of this disorder.

MATERIAL AND METHODS

The results of the clinical, psychological and psycho-physiological study of 60 adolescents with ADHD, aged 12 to 15 years, have been analyzed. A comparative analysis of the clinical picture of the disease and the data of psychophysiological examination of ADHD predominantly hyperactive (ADHD-H) and the combined type of the disease are presented as well. The study shows significantly higher levels of anxiety and impulsivity in children with ADHD-H. The efficacy of noophen in the treatment of this group of patients has been evaluated.

RESULTS AND CONCLUSION

The high clinical efficacy of noophen is shown. After treatment, the improvement has been obtained in 63.3% of patients.