Distinguishing symptoms of ADHD from other psychiatric disorders in the adult primary care setting

Self-reported attention and hyperactivity symptoms among adults with epilepsy

BACKGROUND

 Patients with epilepsy (PWE) frequently have comorbid psychiatric disorders, the most common of which are depression and anxiety. Attention deficit disorder with hyperactivity (ADHD) is also more frequent among PWE, though that condition has been scarcely studied among the adult PWE population.

OBJECTIVE

 This study aimed to compare the presence of ADHD symptoms between adult PWE and the general population.

METHODS

 This was an observational case-control study. Ninety-five adult PWE from a tertiary center in southern Brazil were compared with 100 healthy controls. All subjects were submitted to three structured scales: 1) the World Health Organization Adult ADHD Self-Report Scale version 1.1 (ASRS); 2) the Hospital Anxiety and Depression Scale (HADS); and 3) the Adverse Events Profile (AEP). Dichotomic variables were analyzed through chi-square test and Fisher's exact test, as appropriate, and non-parametric variables were analyzed through the Mann-Whitney U test.

RESULTS

 Medians and interquartile ranges (IR) were: 1) ASRS: 26.00 (IR: 18 to 38) among PWE versus 17.00 (IR: 11 to 24) among controls, p < 0.001; 2) HADS: 14.00 (IR: 8 to 21) among PWE versus 11.00 (IR: 8 to 16) among controls, p = 0.007; 3) AEP: 3800 (IR: 31 to 49) among PWE versus 33.00 (IR: 23 to 43) among controls, p = 0.001.

CONCLUSION

 PWE showed a higher burden of symptoms of ADHD, depression, and anxiety when compared with controls, which replicates in the Brazilian population the findings of current literature that point toward a higher prevalence of such disorders among PWE.

Daily life impairments associated with childhood/adolescent attention-deficit/hyperactivity disorder as recalled by adults: results from the European Lifetime Impairment Survey

INTRODUCTION

The Lifetime Impairment Survey, conducted in Europe, assessed impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD) in childhood, and experiences of ADHD diagnosis and treatment, as recalled by adults.

METHODS

Adults with ADHD and without ADHD (control group) were invited to participate in an internet-based survey and report on their childhood experiences. History of ADHD diagnosis was self-reported. Groups were compared using impairment and symptom scales.

RESULTS

Overall, 588 adults with ADHD and 736 without ADHD participated. Mean (standard deviation [SD]) age at diagnosis of ADHD was 20.0 (12.6) years (median 18.0) following consultation with 3.8 (5.1) doctors (median 2) over 44.6 (69.3) months (median 17.0). A total of 64.1% (377/588) of adults with ADHD reported frustration or difficulties during the diagnostic process. The ADHD group had a higher mean (SD) score versus control for general (3.3 [1.2] vs 2.1 [1.2]; p < 0.001) and school impairment (2.8 [0.7] vs 2.3 [0.6]; p < 0.001) but not home impairment (2.1 [0.5] for both groups). Discussion The survey demonstrated that ADHD had a negative impact on all aspects of childhood investigated, as recalled by adults.

CONCLUSIONS

These data provide insights into childhood impairments and identify areas for improvement in the management and treatment of ADHD.

A quick test of cognitive speed for comparing processing speed to differentiate adult psychiatric referrals with and without attention-deficit/hyperactivity disorders

OBJECTIVE

This retrospective study used A Quick Test of Cognitive Speed (AQT) to compare processing speed and efficiency measures by adults with attention-deficit/hyperactivity disorder (ADHD) or non-ADHD psychiatric disorders and healthy controls.

METHOD

Color, form, and color-form combination naming tests were administered to 104 adults, ages 17-55 years, referred for psychiatric evaluation of possible ADHD. Thirty healthy adults were controls. Psychiatric intake procedures identified 64 adults with ADHD (ICD-10 and DSM-IV criteria) and 40 with mild psychiatric disorders without ADHD. The study was conducted from 2008 through 2010.

RESULTS

At intake, color, form, and color-form combination naming times (seconds) were longer and overhead [color-form combination - (color + form)] was larger for patients with ADHD than for non-ADHD patients and controls. In the ADHD group, color and form measures were in the normal range. Color-form combination was in the slower-than-normal speed (60-70 seconds) and overhead, a processing-efficiency measure, in the atypical range (> 10 seconds). In the non-ADHD patient and control groups, all AQT measures were in the normal range. Analysis of variance with post hoc analysis of log-normal values for color, form, and color-form combination and time for overhead indicated significant (Bonferroni P < .01) mean differences between the ADHD and other groups, but not between the non-ADHD and control groups. When using fail criteria for either color-form combination or overhead, the sensitivity for the ADHD group was 89%.

CONCLUSIONS

RESULTS support AQT as a possible complement to psychiatric intake procedures to differentiate adults with ADHD from those with mild psychiatric disorders, and they suggest that a controlled prospective study might be productive.