The lived experiences of adults with attention-deficit/hyperactivity disorder: A rapid review of qualitative evidence

Patient, supporter and primary healthcare professional perspectives on health risks in over 16s with attention deficit hyperactivity disorder (ADHD) in England: a national survey study

BACKGROUND

Current research suggests that people with attention deficit hyperactivity disorder (ADHD) are at higher risk of physical and mental health disorders. This study aimed to explore these health risks in ADHD from the perspectives of multiple stakeholders.

METHODS

This study forms part of the 'Managing young people with ADHD in Primary care (MAP) study'. A survey developed by the study team was distributed to over 16 year olds with ADHD, their supporters, primary healthcare professionals and health commissioners across England, via social media and through patient/clinical networks (September-October 2022). This survey contained two questions on health risks. Question one asked about views on health risks in ADHD (free text). Question two asked about advice given (options list and free text). Descriptive statistics summarised responses to questions one and two, and qualitative analysis (reflexive thematic analysis) was used to explore free text responses from question one.

RESULTS

782 participants responded to the MAP survey. Of these, 206 healthcare professionals, 157 people with ADHD and 88 supporters answered question one. The most mentioned perceived risks were substance misuse, sleep disorders, weight management and smoking. More people with ADHD reported disordered eating as a health risk (n = 32) than healthcare professionals (n = 5). Generated themes included perceived health risks, impact of living with ADHD, lack of adequate healthcare, and need for ADHD awareness. In respect to advice given (question two), based on responses from 258 professionals, 162 people with ADHD and 100 supporters, the most common advice discussed in consultation was mental health (n = 149, n = 50 and n = 17 respectively). High numbers of respondents reported not giving/receiving advice on wider health (n = 38, n = 88 and n = 61 respectively).

CONCLUSIONS

Findings demonstrate that respondents perceived a range of physical and mental health risks posed by ADHD. These related to difficulties with activities of daily living, as well as healthcare interactions and the impact of core features of ADHD (e.g. impulsivity, emotional dysregulation). These risks are not currently explicitly addressed in United Kingdom national guidance on ADHD. More work is needed to examine and address the broader health outcomes of people with ADHD.

Problematic Use of Internet Associates with Poor Quality of Life via Psychological Distress in Invididuals with ADHD

Background

Problematic use of internet (PUI) may have negative impacts on psychological distress and quality of life (QoL). This situation might be more profound in people with attention-deficit/hyperactivity disorder (ADHD) due to poorer behavioral control and regulatory capacity. However, there is little evidence regarding mediated effects in the associations between PUI, psychological distress, and QoL in people with ADHD.

Aims

To investigate mediating effects of psychological distress in the associations of problematic smartphone use (PSPU), problematic use of social media (PUSM), and problematic gaming (PG) with QoL in individuals with ADHD.

Methods and Procedures

PUI behaviors of participants with ADHD (n = 99) were assessed using the Smartphone Application-Based Addiction Scale, Bergen Social Media Addiction Scale, and Internet Gaming Disorder-Short Form. Psychological distress was assessed using the Depression, Anxiety, Stress Scale and QoL using the Kid-KINDL.

Outcomes and Results

Psychological distress mediated the associations between PUI and different domains of QoL, except for self-esteem QoL. There were also positively direct effects between PG and physical QoL, PUSM and friends' QoL, and PSPU and physical QoL.

Conclusions and Implications

PUI may associate with poor QoL in people with ADHD via psychological distress. Programs on reducing PUI for people with ADHD are needed.

Cross-Cultural Adult ADHD Assessment in 42 Countries Using the Adult ADHD Self-Report Scale Screener

OBJECTIVE

We analyzed adult ADHD symptoms in a cross-cultural context, including investigating the occurrence and potential correlates of adult ADHD and psychometric examination of the Adult ADHD Self-Report Scale (ASRS) Screener.

METHOD

Our analysis is based on a large-scale research project involving 42 countries (International Sex Survey, N=72,627, 57% women, Mage=32.84; SDage=12.57).

RESULTS

The ASRS Screener demonstrated good reliability and validity, along with partial invariance across different languages, countries, and genders. The occurrence of being at risk for adult ADHD was relatively high (21.4% for women, 18.1% for men). The highest scores were obtained in the US, Canada, and other English-speaking Western countries, with significantly lower scores among East Asian and non-English-speaking European countries. Moreover, ADHD symptom severity and occurrence were especially high among gender-diverse individuals. Significant associations between adult ADHD symptoms and age, mental and sexual health, and socioeconomic status were observed.

CONCLUSIONS

Present results show significant cross-cultural variability in adult ADHD occurrence as well as highlight important factors related to adult ADHD. Moreover, the importance of further research on adult ADHD in previously understudied populations (non-Western countries) and minority groups (gender-diverse individuals) is stressed. Lastly, the present analysis is consistent with previous evidence showing low specificity of adult ADHD screening instruments and contributes to the current discussion on accurate adult ADHD screening and diagnosis.

Adult attention-deficit/hyperactivity symptoms and parental cognitions: a meta-analysis

Introduction

Attention-deficit/hyperactivity disorder (ADHD) symptoms in adults interfere with parental functioning. Dysfunctional parental cognitions may play a role in this impairment. Despite the importance of parental cognitions on parents and children's outcomes, up to now, no systematic review or meta-analysis of these findings is available. To fill this gap, this meta-analysis aimed to evaluate the relationship between adult ADHD symptoms and parental cognitions.

Methods

We conducted searches in Web of Science, PubMed, and ProQuest from January 2000 to June 2023. Studies were included if they provided data on the relationship between parental ADHD symptoms and parental cognitions by means of a row correlational coefficient, or means and standard deviation were reported for each study group. A random-effects model was used. Publication bias was assessed by funnel plot and Rosenthal's fail-safe N. Moderator analyses were conducted by means of subgroup analysis and meta-regression analyses.

Results

Fifteen published papers were included (N = 2851), and 51 effect sizes were analysed. The weighted mean effect size was small but significant (Fisher's Z = 0.186, k = 15, 95% CI [0.120 - 0.252], z = 5.539, p < 0.001), indicating that ADHD symptoms in adults are associated with more negative and less positive parental cognitions. The Fail-Safe N analysis suggested a robust effect. Tweedie's trim and fill results suggested that five studies were missing; after five missing studies had been imputed, the mean overall effect size dropped to 0.116 (0.080 - 0.152). There was significant heterogeneity among effect sizes. The methodology of the study was found to be a significant moderator. Meta-regression analyses revealed that the lower age of the parent and the child were related to more negative parental cognitions.

Discussion

Though the analysis might be inflated by publication bias, our results suggest a significant association between ADHD symptom level and dysfunctional parental cognitions. Biased negative perceptions of the parental role, the child and co-parenting may play a central mediator role between parental ADHD and parent and child outcomes. Given the familiar nature of ADHD, targeting dysfunctional parental cognitions in parent training programs is warranted.

Systematic review registration

osf.io/pnur7.

Silver linings of ADHD: a thematic analysis of adults' positive experiences with living with ADHD

OBJECTIVES

To identify and explore positive aspects of attention deficit hyperactivity disorder (ADHD) as reported by adults with the diagnosis.

DESIGN

The current study used a qualitative survey design including the written responses to an open-ended question on positive aspects of ADHD. The participants' responses were analysed using thematic analysis.

SETTING

The participants took part in trial of a self-guided internet-delivered intervention in Norway. As part of the intervention, the participants were asked to describe positive aspects of having ADHD.

PARTICIPANTS

The study included 50 help-seeking adults with an ADHD diagnosis.

RESULTS

The participants described a variety of positive aspects related to having ADHD. The participants' experiences were conceptualised and thematically organised into four main themes: (1) the dual impact of ADHD characteristics; (2) the unconventional mind; (3) the pursuit of new experiences and (4) resilience and growth.

CONCLUSIONS

Having ADHD was experienced as both challenging and beneficial, depending on the context and one's sociocultural environment. The findings provide arguments for putting a stronger emphasis on positive aspects of ADHD, alongside the challenges, in treatment settings.

TRIAL REGISTRATION NUMBER

NCT04511169.