Diagnosing ADHD in adults: limitations to DSM-IV and DSM-V proposals and challenges ahead

The Role of Age in Adult ADHD Quality Care: A Longitudinal Analysis of Electronic Health Record Data

OBJECTIVE

Several studies have shown that Adult ADHD presents differently in younger and older adults. We sought to assess the difference in care between these two groups using previously identified quality measures (QMs).

METHODS

Using electronic health record data, we matched a younger group of ADHD patients to an older group. We then assessed the achievement of the QMs using probit models with and without interaction terms.

RESULTS

The majority of QMs shown an increase in achievement for both groups over time. However, significant differences in quality of care between younger and older adult ADHD patients persisted. By the end of the study period, with the exception of three QMs, younger patients achieved the QMs more.

CONCLUSION

While, in general, the quality of care for adult ADHD increased from 2010 to 2020, there were still differences in care between younger and older adult ADHD patients.

How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

The persistence of attention-deficit/hyperactivity disorder (ADHD) into adulthood, particularly in women, is an unresolved question. Using a diverse, prospectively followed female sample (ADHD: n = 140; comparison: n = 88), we examined (a) informant (parent- vs. self-report) and (b) symptom threshold (DSM-IV cutoffs vs. a developmentally referenced criterion [DRC]) with respect to estimates of ADHD persistence into young adulthood (M = 19.6 years). We also ascertained the linkages of ADHD status (as measured by each informant and via the different symptom cutoffs) with impairment in key outcome domains. Informant diagnostic concordance was significant but small (κ = 0.22). Via parent report, more childhood-ascertained probands (44 %) than comparison participants (1 %) met full ADHD criteria in adulthood (p < 0.001, ϕ = 0.47); parallel results were found via self-report (22 % vs. 2 %; p < 0.001, ϕ = 0.28). As expected, DRC designations yielded higher persistence estimates than DSM cutoffs. With control of key covariates, parent-reported ADHD was independently associated with poor outcomes on eight of nine measures but self-reported ADHD was associated only with low math scores. Also, participants who met the DRC cutoff but not the higher DSM threshold showed similar impairment to DSM-diagnosed participants, far greater than that of participants who met neither cutoff. A lowered symptom threshold in adulthood compared to childhood appears justified.

EEG Differences Between the Combined and Inattentive Types of Attention-Deficit/Hyperactivity Disorder in Girls: A Further Investigation

This study further investigated electroencephalogram (EEG) differences between girls with the Combined and Inattentive types of attention-deficit/hyperactivity disorder (AD/HD). We selected subjects with widely separated scores on hyperactivity-impulsivity symptoms to behaviorally exaggerate diagnostic group differences. Twenty girls with AD/HD Combined type, 20 girls with AD/HD Inattentive type, and 20 controls (aged 7-12 years) had an eyes-closed resting EEG recorded from 19 electrodes. The EEG was fast Fourier transformed, and estimates for total power, absolute and relative power in the delta, theta, alpha, and beta frequency bands, and the theta/beta ratio were calculated and analyzed in 9 scalp regions. Girls of the Combined type, compared with girls of the Inattentive type, had elevated midline total power, elevated temporal absolute alpha activity, elevated posterior absolute beta activity, reduced right hemisphere relative delta and reduced left hemisphere relative alpha activity, and reduced theta/beta ratio in the left hemisphere. Although topographic differences were again found between the AD/HD types, significant global differences remain elusive in the EEGs of girls with the Combined and Inattentive types. Despite creating behaviorally exaggerated AD/HD type groups, girls' EEG activity failed to replicate differences found previously in mixed-sex groups. The EEG profiles of AD/HD types in girls are markedly different from those found in boys. This reinforces the notion that it is no longer appropriate to apply the male-based literature to all AD/HD groups; rather, the use of single-sex subject groups is necessary in EEG research of AD/HD.