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Ai W, Cunningham WA, Lai MC. Camouflaging, internalized stigma, and mental health in the general population. Int J Soc Psychiatry 2024:207640241260020. [PMID: 39129337 DOI: 10.1177/00207640241260020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
BACKGROUND Camouflaging, the strategies that some autistic people use to hide their differences, has been hypothesized to trigger mental health ramifications. Camouflaging might reflect ubiquitous impression management experiences that are not unique to autistic people and similarly impact the mental health of non-autistic people. AIMS We first examined whether individuals in the general population camouflage and manage impressions while experiencing mental health repercussions, and how gender and neurodivergent traits modified these associations. We then assessed how camouflaging and impression management arose from internalized stigma, and their inter-relationships in shaping mental health outcomes. METHODS Data were collected from 972 adults from a representative U.S. general population sample, with measures pertaining to camouflaging, impression management, mental health, internalized stigma, and neurodivergent traits. Multivariate hierarchical regression and moderated mediation analyses were used to address the two research aims. RESULTS Both camouflaging and self-presentation (a key component of impression management) were associated with mental health presentations in the general population, which overlapped with those previously reported in autistic people. These associations were more pronounced in women compared with men and were of different directions for individuals with higher autistic traits versus higher ADHD traits. Internalized stigma might be a key stressor that could elicit camouflaging and impression management through social anxiety, which in turn might lead to adverse mental health outcomes. CONCLUSIONS These findings advance the conceptual clarity and clinical relevance of camouflaging and impression management across social and neurodiverse groups in the general population. The ramifications of camouflaging and impression management underscore the need to alleviate internalized stigma for better mental health across human groups.
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Affiliation(s)
- Wei Ai
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Meng-Chuan Lai
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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Rivas-Vazquez RA, Diaz SG, Visser MM, Rivas-Vazquez AA. Adult ADHD: Underdiagnosis of a Treatable Condition. JOURNAL OF HEALTH SERVICE PSYCHOLOGY 2023; 49:11-19. [PMID: 36743427 PMCID: PMC9884156 DOI: 10.1007/s42843-023-00077-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Attention-deficit/hyperactivity disorder is a common neurodevelopmental disorder, well-characterized within the pediatric population and representing one of the most prevalent mental conditions among children and adolescents. Once diagnosed, pharmacologic and psychosocial therapies can reduce symptomatic expression and functional impairment. Traditionally thought to resolve by young adulthood, it is now recognized that ADHD persists into adulthood. Many of these individuals were never evaluated for ADHD as children and remain undiagnosed as adults, continuing to struggle with symptoms. It is common to develop compensatory strategies geared at mitigating the disruptive effects of ADHD. In this article, we provide an overview of adult ADHD, review changes to DSM-5 diagnostic criteria meant to facilitate diagnosis of ADHD during adulthood, and discuss various factors that serve as barriers to accurate detection of adult ADHD.
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Chauvin RJ, Buitelaar JK, Sprooten E, Oldehinkel M, Franke B, Hartman C, Heslenfeld DJ, Hoekstra PJ, Oosterlaan J, Beckmann CF, Mennes M. Task-generic and task-specific connectivity modulations in the ADHD brain: an integrated analysis across multiple tasks. Transl Psychiatry 2021; 11:159. [PMID: 33750765 PMCID: PMC7943764 DOI: 10.1038/s41398-021-01284-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 01/27/2021] [Accepted: 02/19/2021] [Indexed: 11/23/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is associated with altered functioning in multiple cognitive domains and neural networks. This paper offers an overarching biological perspective across these. We applied a novel strategy that extracts functional connectivity modulations in the brain across one (Psingle), two (Pmix) or three (Pall) cognitive tasks and compared the pattern of modulations between participants with ADHD (n-89), unaffected siblings (n = 93) and controls (n = 84; total N = 266; age range = 8-27 years). Participants with ADHD had significantly fewer Pall connections (modulated regardless of task), but significantly more task-specific (Psingle) connectivity modulations than the other groups. The amplitude of these Psingle modulations was significantly higher in ADHD. Unaffected siblings showed a similar degree of Pall connectivity modulation as controls but a similar degree of Psingle connectivity modulation as ADHD probands. Pall connections were strongly reproducible at the individual level in controls, but showed marked heterogeneity in both participants with ADHD and unaffected siblings. The pattern of reduced task-generic and increased task-specific connectivity modulations in ADHD may be interpreted as reflecting a less efficient functional brain architecture due to a reduction in the ability to generalise processing pathways across multiple cognitive domains. The higher amplitude of unique task-specific connectivity modulations in ADHD may index a more "effortful" coping strategy. Unaffected siblings displayed a task connectivity profile in between that of controls and ADHD probands, supporting an endophenotype view. Our approach provides a new perspective on the core neural underpinnings of ADHD.
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Affiliation(s)
- Roselyne J. Chauvin
- grid.10417.330000 0004 0444 9382Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.5590.90000000122931605Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands ,grid.4367.60000 0001 2355 7002Department of Neurology, Washington University School of Medicine, St Louis, USA
| | - Jan K. Buitelaar
- grid.10417.330000 0004 0444 9382Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.5590.90000000122931605Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Emma Sprooten
- grid.10417.330000 0004 0444 9382Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.5590.90000000122931605Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Marianne Oldehinkel
- grid.10417.330000 0004 0444 9382Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.5590.90000000122931605Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands ,grid.1002.30000 0004 1936 7857School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC Australia
| | - Barbara Franke
- grid.5590.90000000122931605Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Departments of Human Genetics and Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catharina Hartman
- grid.4494.d0000 0000 9558 4598University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Dirk J. Heslenfeld
- Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Emma Neuroscience Group at Emma Children’s Hospital, department of Pediatrics, Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Pieter J. Hoekstra
- grid.4494.d0000 0000 9558 4598University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Jaap Oosterlaan
- Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Emma Neuroscience Group at Emma Children’s Hospital, department of Pediatrics, Amsterdam Reproduction & Development, Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Clinical Neuropsychology section, Vrije Universiteit, Van der Boechortstraat 7, 1081 BT Amsterdam, The Netherlands
| | - Christian F. Beckmann
- grid.10417.330000 0004 0444 9382Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.5590.90000000122931605Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands ,grid.4991.50000 0004 1936 8948Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Maarten Mennes
- grid.5590.90000000122931605Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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Andersson Frondelius I, Ranjbar V, Danielsson L. Adolescents' experiences of being diagnosed with attention deficit hyperactivity disorder: a phenomenological study conducted in Sweden. BMJ Open 2019; 9:e031570. [PMID: 31455717 PMCID: PMC6720151 DOI: 10.1136/bmjopen-2019-031570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/02/2019] [Accepted: 08/06/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To explore adolescents' experiences of being diagnosed with Attention deficit hyperactivity disorder (ADHD). DESIGN Qualitative interview study, using a phenomenological framework and analysis. SETTING The children's clinic of a specialised out-care hospital located in a multicultural area of a Swedish city. PARTICIPANTS 13 adolescents, 7 boys and 6 girls between 14 and 19 years old, who had been diagnosed with ADHD. RESULTS The participants' experience of being diagnosed with ADHD was interpreted as a process of understanding oneself as being different, for better or worse, like many others. The participants sought acceptance and a sense of normality, while developing an understanding of both the positive and the negative sides of their ADHD traits. These two sides of a coin were inter-related parts of themselves and were shared by many others, which increased their acceptance. Three themes described phases of the process: struggling with vulnerability, responding to a label and manoeuvring social life. CONCLUSION The results add to previous research, illuminating that the adolescents tried to make sense of both the uniqueness and the vulnerability of the ADHD diagnosis. The findings can be useful for healthcare professionals, in reflecting on the complexity of ADHD and on the adolescents' expectations.
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Affiliation(s)
| | | | - Louise Danielsson
- Research Unit, Angered Hospital, Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Reinelt T, Petermann F. Zur Bedeutung auffälliger Exekutivfunktionen in der Diagnostik einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung. ACTA ACUST UNITED AC 2018. [DOI: 10.1024/1661-4747/a000359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Zusammenfassung. Defizite in Exekutivfunktionen und insbesondere in der Inhibitionsfähigkeit gelten verschiedenen Modellen zufolge als Kerndefizite einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS). Die Defizite sind sowohl auf einer Verhaltensebene als auch auf neurobiologischer Ebene belegt, finden aber bislang kaum Einzug in die klinische Diagnostik. Verschiedene Erhebungsverfahren werden vorgestellt und die Probleme im Bereich der klinischen Diagnostik skizziert. Viele Aufgaben messen nicht eine spezifische Exekutivfunktion, sondern umfassen immer auch andere kognitive Prozesse wie zum Beispiel Aufmerksamkeit oder Test- und Leistungsmotivation. Die Sensitivität vieler Aufgaben ist aufgrund der Heterogenität von ADHS durch verschiedene Entwicklungspfade oft nicht gewährleistet und Defizite in Exekutivfunktionen und der Inhibitionsfähigkeit sind auch nicht spezifisch für ADHS. Dennoch ist eine Diagnostik auffälliger Exekutivfunktionen und insbesondere von Defiziten in der Inhibitionsfähigkeit angebracht, da nur so Aussagen über zugrunde liegende Prozesse und Ursachen einer ADHS getroffen werden können, welche die Voraussetzung für gezielte Interventionen darstellen, wie zum Beispiel Inhibitionstrainings oder Neurofeedback.
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Affiliation(s)
- Tilman Reinelt
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
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Kerner auch Koerner J, Gust N, Petermann F. Developing ADHD in preschool: Testing the dual pathway model of temperament. APPLIED NEUROPSYCHOLOGY-CHILD 2017; 7:366-373. [DOI: 10.1080/21622965.2017.1347509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Julia Kerner auch Koerner
- Helmut-Schmidt-University, Hamburg, Germany and Center for Individual Development and Adaptive Education of Children at Risk (IDeA), Frankfurt, Germany
| | - Nicole Gust
- Center of Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany
| | - Franz Petermann
- Center of Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany
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Abstract
Zusammenfassung. Die Popularität des Resilienzbegriffes in der Forschung und Praxis begünstigt, dass dieser Begriff uneinheitlich verwendet wird. Dabei wird in der Regel das Ergebnis einer gesunden Entwicklung trotz widriger Umstände mit den zugrunde liegenden Mechanismen und Prozessen der Gesunderhaltung konfundiert. Ausgehend von einem Verständnis von Resilienz als einem Label für eine gesunde Entwicklung trotz widriger Umstände werden drei mögliche Entwicklungsverläufe von Resilienz vorgestellt: (1) Resilienz durch Resistenz, (2) Resilienz durch Kompensation und (3) Resilienz durch Restrukturieren. Die Bedeutung der unterschiedlichen Verläufe für die Gestaltung von Resilienzförderprogrammen wird für unterschiedliche Zielgruppen diskutiert.
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Affiliation(s)
- Tilman Reinelt
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Marc Schipper
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
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