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Faraone SV, Bellgrove MA, Brikell I, Cortese S, Hartman CA, Hollis C, Newcorn JH, Philipsen A, Polanczyk GV, Rubia K, Sibley MH, Buitelaar JK. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2024; 10:11. [PMID: 38388701 DOI: 10.1038/s41572-024-00495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD; also known as hyperkinetic disorder) is a common neurodevelopmental condition that affects children and adults worldwide. ADHD has a predominantly genetic aetiology that involves common and rare genetic variants. Some environmental correlates of the disorder have been discovered but causation has been difficult to establish. The heterogeneity of the condition is evident in the diverse presentation of symptoms and levels of impairment, the numerous co-occurring mental and physical conditions, the various domains of neurocognitive impairment, and extensive minor structural and functional brain differences. The diagnosis of ADHD is reliable and valid when evaluated with standard diagnostic criteria. Curative treatments for ADHD do not exist but evidence-based treatments substantially reduce symptoms and/or functional impairment. Medications are effective for core symptoms and are usually well tolerated. Some non-pharmacological treatments are valuable, especially for improving adaptive functioning. Clinical and neurobiological research is ongoing and could lead to the creation of personalized diagnostic and therapeutic approaches for this disorder.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Mark A Bellgrove
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
| | - Catharina A Hartman
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Chris Hollis
- National Institute for Health and Care Research (NIHR) MindTech MedTech Co-operative and NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK
- Department of Child & Adolescent Psychiatry, Transcampus Professor KCL-Dresden, Technical University, Dresden, Germany
| | | | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, Netherlands
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
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Ginapp CM, Greenberg NR, MacDonald-Gagnon G, Angarita GA, Bold KW, Potenza MN. "Dysregulated not deficit": A qualitative study on symptomatology of ADHD in young adults. PLoS One 2023; 18:e0292721. [PMID: 37824501 PMCID: PMC10569543 DOI: 10.1371/journal.pone.0292721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is a common condition that often persists into adulthood, although data suggest that the current diagnostic criteria may not represent how the condition presents in adults. We aimed to use qualitative methods to better understand ADHD symptomatology in young adults, especially regarding attentional and emotional dysregulation. METHODS Nine focus groups involving young adults (aged 18-35 years; N = 43; 84% female; 86% US and Canada) with diagnoses of ADHD were conducted. Participants were asked about their perceptions of the current diagnostic criteria and how their symptoms have presented and changed over time. Data were analyzed using an interpretive phenomenological analysis framework. RESULTS Most participants reported that the diagnostic criteria did not accurately capture their experiences with ADHD. They reported struggling with attention dysregulation, including hyperfocusing, and emotional dysregulation, including rejection-sensitive dysphoria. Many participants believed that their changing environments and behavioral adaptations influenced how their symptoms presented into adulthood. CONCLUSION Current diagnostic criteria for ADHD may not capture the range of symptoms present in young adults. More research is needed to characterize attentional and emotional dysregulation in this population.
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Affiliation(s)
- Callie M. Ginapp
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Norman R. Greenberg
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Grace MacDonald-Gagnon
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Gustavo A. Angarita
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- Connecticut Mental Health Center, New Haven, Connecticut, United States of America
| | - Krysten W. Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale Cancer Center, New Haven, Connecticut, United States of America
| | - Marc N. Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- Connecticut Mental Health Center, New Haven, Connecticut, United States of America
- Yale Cancer Center, New Haven, Connecticut, United States of America
- Connecticut Council on Problem Gambling, Wethersfield, Connecticut, United States of America
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Neuroscience, Yale University, New Haven, Connecticut, United States of America
- Wu Tsai Institute, Yale University, New Haven, Connecticut, United States of America
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Im DS, Tamarelli CM. Attention Deficit Hyperactivity Disorder in Medical Learners and Physicians and a Potentially Helpful Educational Tool. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:435-442. [PMID: 37131931 PMCID: PMC10149068 DOI: 10.2147/amep.s398196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/08/2023] [Indexed: 05/04/2023]
Abstract
Purpose Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by functionally impairing levels of inattention and/or hyperactive-impulsive behavior. It affects 3% to 5% of adults. This perspective piece aims to highlight the occurrence of ADHD in medical learners and physicians, including its reported prevalence in these groups, why reported rates may reflect underestimates, consequences of untreated symptoms, and a potentially helpful innovative educational tool to assist these individuals with a critical aspect of medical training and practice. Results Despite recent attention being paid to concerning levels of depression, anxiety, and burnout in medical learners and physicians, comparatively little attention has been devoted to the occurrence of ADHD in these groups. Reported rates of ADHD in medical learners and physicians, though low compared to rates of other mental health conditions and compared to rates of ADHD in the general population, may represent underestimates for a variety of reasons. The consequences of untreated ADHD symptoms are likely numerous and significant for these groups. Research has shown that about half of adults with ADHD discontinue prescribed treatment (stimulant medication) over time due to lack of perceived effectiveness, highlighting the need for durable, effective interventions to help medical learners and physicians with ADHD during and after their training. An innovative educational tool to assist medical learners and physicians with ADHD with a critical facet of their training and practice - the reading of scientific articles - is proposed, including a description of the tool, rationale for its design, practical considerations around implementation, and proposed directions for future research. Conclusion Untreated ADHD in medical learners and physicians may have numerous and significant consequences that can adversely impact training, practice, and ultimately patient care. These challenges warrant proper support for medical learners and physicians with ADHD via evidence-based treatments, program-based accommodations, and innovative educational tools.
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Affiliation(s)
- David S Im
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Correspondence: David S Im, University of Michigan Hospital, Department of Psychiatry, University of Michigan Medical School, 1500 East Medical Center Drive, UH 9C 9150, Ann Arbor, MI, 48109-5120, USA, Tel +1 734 764-0227, Fax +1 734 936 9983, Email
| | - Carrie M Tamarelli
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Krtek A, Malinakova K, Rudnicka RK, Pesoutova M, Zovincova V, Meier Z, Tavel P, Trnka R. Ambivalent bonds, positive and negative emotions, and expectations in teachers’ perceptions of relationship with their students with ADHD. Int J Qual Stud Health Well-being 2022; 17:2088456. [PMID: 35711126 PMCID: PMC9225763 DOI: 10.1080/17482631.2022.2088456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A growing body of research has been focusing recently on the life and well-being of students with attention-deficit/hyperactivity disorder (ADHD) and also on the well-being of their teachers. However, there is a need for in-depth, qualitative insights into ADHD issues from the teachers’ perspectives. Therefore, the main aim of this qualitative study was to use thematic analysis to explore how teachers perceive the relationship with students with ADHD and the factors that influence the quality of this relationship. Sixteen teachers working with adolescent ADHD students were interviewed for this purpose. The results indicate that the quality of the teacher-ADHD student relationship is associated with the ADHD students related behaviours, ambivalent emotions of the teacher, the teacher’s beliefs about ADHD and the beliefs about the determinants of the behaviour of the students with ADHD and the teacher’s approaches and methods of work in the classroom. Furthermore, the results suggest that increasing the quality of the teachers’ well-being is associated with knowledge of ADHD determinants, regulation of ambivalent emotions, empathy, teachers’ ability to perceive positive qualities and the potentials of the students with ADHD and their motivation to teach ADHD students.
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Affiliation(s)
- Arnost Krtek
- Sts Cyril and Methodius Faculty of Theology, Olomouc University Social Health Institute, Palacký University, Olomouc, Czech Republic
| | - Klara Malinakova
- Sts Cyril and Methodius Faculty of Theology, Olomouc University Social Health Institute, Palacký University, Olomouc, Czech Republic
| | - Ruzena Krtkova Rudnicka
- Sts Cyril and Methodius Faculty of Theology, Olomouc University Social Health Institute, Palacký University, Olomouc, Czech Republic
| | - Marketa Pesoutova
- Sts Cyril and Methodius Faculty of Theology, Olomouc University Social Health Institute, Palacký University, Olomouc, Czech Republic
| | - Vendula Zovincova
- Sts Cyril and Methodius Faculty of Theology, Olomouc University Social Health Institute, Palacký University, Olomouc, Czech Republic
| | - Zdenek Meier
- Sts Cyril and Methodius Faculty of Theology, Olomouc University Social Health Institute, Palacký University, Olomouc, Czech Republic
| | - Peter Tavel
- Sts Cyril and Methodius Faculty of Theology, Olomouc University Social Health Institute, Palacký University, Olomouc, Czech Republic
| | - Radek Trnka
- Sts Cyril and Methodius Faculty of Theology, Olomouc University Social Health Institute, Palacký University, Olomouc, Czech Republic
- The Department of Science and Research, Prague College of Psychosocial Studies, Prague, Czech Republic
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Chronis-Tuscano A. ADHD in girls and women: a call to action - reflections on Hinshaw et al. (2021). J Child Psychol Psychiatry 2022; 63:497-499. [PMID: 35040136 DOI: 10.1111/jcpp.13574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
This is a commentary on Hinshaw, Nguyen, O'Grady & Rosenthal's 'ADHD in Girls and Women: Underrepresentation, Longitudinal Processes, and Key Directions', which reviews the empirical literature on female-specific impairments, mechanisms and developmental pathways. Having conducted one of the most prominent and informative longitudinal investigations of girls with and without ADHD, Hinshaw et al. (2021) provide a compelling synthesis of their findings, highlighting research and clinical priorities. In this commentary, I highlight the pernicious effects of unrecognized and untreated ADHD in girls and women, challenges of making an accurate differential diagnosis and the need to raise awareness among health professionals, educators and parents about the clinical presentation of girls with ADHD in order to achieve earlier identification and intervention that can interrupt the developmental trajectory to widespread impairment, comorbidity and, in some cases, devastating outcomes.
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Gascon A, Gamache D, St-Laurent D, Stipanicic A. Do we over-diagnose ADHD in North America? A critical review and clinical recommendations. J Clin Psychol 2022; 78:2363-2380. [PMID: 35322417 DOI: 10.1002/jclp.23348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 11/09/2022]
Abstract
There has been a marked increase in the prevalence of attention-deficit/hyperactivity disorder (ADHD) in the last 25 years in North America. Some see this trend as positive and believe that it reflects a better identification of ADHD and even think that the disorder is still under-diagnosed. Others, however, contend that ADHD is over-diagnosed. To help mental health clinicians to maintain an informed and nuanced perspective on this debate, this critical review aims to (1) summarize empirical results on factors that might contribute to increase the number of ADHD diagnoses and (2) propose clinical recommendations coherent with these findings to improve clinical practices for ADHD assessment and treatment. We conclude that artifactual factors such as current formulation of diagnostic criteria, clinical practices, and inordinate focus on performance, which is rampant in North America, likely contribute to inflated prevalence rates.
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Affiliation(s)
- Abigaëlle Gascon
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Center for Interdisciplinary Studies on Child Development and the Family, Trois-Rivières, Quebec, Canada
| | - Dominick Gamache
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,CERVO Brain Research Centre, Quebec City, Quebec, Canada.,Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse, Montreal, Quebec, Canada
| | - Diane St-Laurent
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Center for Interdisciplinary Studies on Child Development and the Family, Trois-Rivières, Quebec, Canada
| | - Annie Stipanicic
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Center for Interdisciplinary Studies on Child Development and the Family, Trois-Rivières, Quebec, Canada.,University Institute for Intellectual Disability and Autism Spectrum Disorder, Trois-Rivières, Quebec, Canada
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Ginapp CM, Macdonald-Gagnon G, Angarita GA, Bold KW, Potenza MN. The lived experiences of adults with attention-deficit/hyperactivity disorder: A rapid review of qualitative evidence. Front Psychiatry 2022; 13:949321. [PMID: 36032220 PMCID: PMC9403235 DOI: 10.3389/fpsyt.2022.949321] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/27/2022] [Indexed: 12/04/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common condition that frequently persists into adulthood, although research and diagnostic criteria are focused on how the condition presents in children. We aimed to review qualitative research on lived experiences of adults with ADHD to characterize potential ADHD symptomatology in adulthood and provide perspectives on how needs might be better met. We searched three databases for qualitative studies on ADHD. Studies (n = 35) in English that included data on the lived experiences of adults with ADHD were included. These studies covered experiences of receiving a diagnosis as an adult, symptomatology of adult ADHD, skills used to adapt to these symptoms, relationships between ADHD and substance use, patients' self-perceptions, and participants' experiences interacting with society. Many of the ADHD symptoms reported in these studies had overlap with other psychiatric conditions and may contribute to misdiagnosis and delays in diagnosis. Understanding symptomatology of ADHD in adults may inform future diagnostic criteria and guide interventions to improve quality of life.
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Affiliation(s)
- Callie M Ginapp
- Yale School of Medicine, Yale University, New Haven, CT, United States
| | | | - Gustavo A Angarita
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Connecticut Mental Health Center, New Haven, CT, United States
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Connecticut Mental Health Center, New Haven, CT, United States.,Connecticut Council on Problem Gambling, Wethersfield, CT, United States.,Child Study Center, Yale School of Medicine, New Haven, CT, United States.,Department of Neuroscience, Yale University, New Haven, CT, United States.,Wu Tsai Institute, Yale University, New Haven, CT, United States
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Lefler EK, Flory K, Canu WH, Willcutt EG, Hartung CM. Unique considerations in the assessment of ADHD in college students. J Clin Exp Neuropsychol 2021; 43:352-369. [PMID: 34078248 DOI: 10.1080/13803395.2021.1936462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Evidence-based practice in psychology (EBPP) has long focused on treatment, but evidence-based psychological assessment (EBPA) is also crucial given the important role of accurate and reliable diagnostic practices in treatment planning. In terms of the diagnosis of attention-deficit/hyperactivity disorder (ADHD), EBPA practices are well-established for children, and more recently for adults, but for college students in particular there are special considerations that warrant attention. College students with symptoms of ADHD have some challenges that are unique, and thus the assessment and diagnosis of ADHD in these students is unique. The aim of this review is not to cover all EBPA strategies for diagnosing ADHD in emerging adult college students; rather, we will focus on the unique considerations at play in college ADHD assessment. These include (a) conceptual matters such as the appropriateness of the DSM-5 criteria for college students, the limitations of our understanding of ADHD this population because of a lack of diversity in research studies, and the issue of late-identified ADHD; and (b) practical matters, such as specific documentation needs, how to gather and interpret self- and other-report of symptoms, how to assess impairment, and alternate explanations for ADHD-like symptoms in college students.
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Affiliation(s)
- Elizabeth K Lefler
- Department of Psychology, University of Northern Iowa, Cedar Falls, IA, USA
| | - Kate Flory
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Will H Canu
- Department of Psychology, Appalachian State University, Boone, NC, USA
| | - Erik G Willcutt
- Deparment of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
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Sibley MH, Ortiz M, Graziano P, Dick A, Estrada E. Metacognitive and motivation deficits, exposure to trauma, and high parental demands characterize adolescents with late-onset ADHD. Eur Child Adolesc Psychiatry 2020; 29:537-548. [PMID: 31388765 DOI: 10.1007/s00787-019-01382-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Abstract
The objective of this study is to evaluate support for three hypotheses about the etiology of adolescent-onset ADHD symptoms: (1) a "cool" cognitive load hypothesis, (2) a "hot" rewards processing hypothesis, and (3) a trauma exposure hypothesis. Participants (N = 50) were drawn from two public high schools in a culturally diverse metropolitan area. A detailed procedure for identifying and confirming late-onset ADHD cases is described. Adolescents with late-onset ADHD (n = 15) were identified and compared to childhood-onset (n = 17) and non-ADHD classmates (n = 18). Adolescents and parents completed measures of neurocognition, rewards' processing, clinical profile, and environmental demands. Late-onset cases were clinically and neurocognitively indistinguishable from childhood-onset cases; however, they experienced higher demands from parents (d = 1.09). Compared to the non-ADHD group, late-onset cases showed significant deficits in metacognition (d = 1.25) and academic motivation (d = 0.80), as well as a pronounced history of multiple trauma exposure (OR 11.82). At 1-year follow-up, ADHD persisted in 67.7% of late-onset cases. Late-onset cases (26.7%) were more likely than childhood-onset cases (0.0%) to transfer to alternative schools by 1-year follow-up. Multiple factors may contribute to adolescent-onset ADHD. Adolescents with metacognition and motivation deficits may be at greatest risk for the late-onset ADHD phenotype, particularly in highly demanding environments. Exposure to traumatic stress may play a key role in the exacerbation of existing deficits or onset of new symptoms. Late-onset ADHD was persistent in most cases and associated with higher risk for school disengagement than childhood-onset ADHD. Further work is needed to better understand the etiologies of late-onset ADHD symptoms.
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Affiliation(s)
- Margaret H Sibley
- Florida International University, Miami, USA. .,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Center for Child Health, Behavior, and Development, Seattle Children's Hospital, 2001 8th Ave., Suite 400, Seattle, WA, 98121, USA.
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