Estimating the Risk of Attention Deficit Hyperactivity Disorder (ADHD) in Parents of Children with ADHD and the Association with Their Children's Disease Severity and Adherence to Medication

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is characterised by inattentiveness, hyperactivity, and impulsivity. Up to half of the affected children have a parent with ADHD. In this study, the risk of ADHD among parents of ADHD children was estimated. The associations between parental ADHD and child ADHD severity and medication adherence were determined.

METHODOLOGY

Parents of children and adolescents diagnosed with ADHD attending the University Kebangsaan Malaysia Medical Centre (UKMMC) were recruited between June to August 2022 and the administered Conners' Adult ADHD Rating Scale (CAARS) self-report short form, Vanderbilt ADHD Parent Rating Scale (performance section), and Medication Adherence Report Scale (MARS).

RESULTS

Forty-five children with ADHD were recruited and 15 out of 45 (33%) parents were detected to have ADHD. ADHD severity was worse in children with ADHD parents for total severity (mean of 34.67 vs. 29.13, p = 0.047) and difficult behaviours at home (mean of 7.87 vs. 6.27, p = 0.036). The children's academic performance and behavioural challenges at home and school were positively correlated with the parental ADHD scores for 'inattention' and 'problems with self-care' subscales.

CONCLUSIONS

A total of 33% of ADHD children had parents with ADHD. ADHD children with ADHD parents were more likely to have behavioural problems at home and more severe ADHD. However, no statistical significance was noted with medication adherence.

Self-Reported Adult ADHD Symptoms: Evidence Supporting Cautious Use in an Assessment-Seeking Sample

OBJECTIVE

Self-report symptom inventories are commonly used in adult ADHD assessment, and research indicates they should be interpreted with caution. This study investigated one self-report symptom inventory for adult ADHD in a clinical sample.

METHOD

Archival data were used to evaluate diagnostic utility of the Conners Adult ADHD Rating Scale-Self-Report: Long Version (CAARS-S:L) in a sample of 122 adults seeking ADHD assessment.

RESULTS

Overall, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) estimates for the ADHD Index and other CAARS-S:L scales demonstrated weak accuracy. Anxiety and depression were the most common diagnoses present when a false positive on the ADHD Index was observed. PPV and specificity for the ADHD Index were higher in males compared to females.

CONCLUSION

The CAARS-S:L may be useful for screening purposes in some cases, but should not be the main method used for diagnostic purposes. Clinical implications of findings are discussed.

Executive and Daily Life Functioning Influence the Relationship Between ADHD and Mood Symptoms in University Students

Objectives: Many studies have indicated a close relationship between ADHD and mood symptoms in university students. In the present study, we explore the role of daily functional impairments and executive functioning in the ADHD-mood relationship. Method: A total of 343 adults (126 males) filled out (a) the Conners' Adult ADHD Rating Scale, (b) the Depression Anxiety and Stress Scale, (c) the Weiss Functional Impairment Rating Scale, and (d) the Executive Function Index Scale. Results: The correlation between mood symptoms and ADHD was .48 (moderate correlation) and dropped to .15 (weak correlation) when controlling for functional problems and executive functioning. Hierarchical regression analyses showed that both functional impairments and executive functioning significantly explained 42% to 53% of the variance of mood symptoms. The addition of ADHD symptoms to the model slightly increased the explained mood variance by only 1%. Conclusion: These findings underline the role of experienced difficulties in triggering mood symptoms in ADHD symptomatology.

The association between the score of adult attention-deficit/hyperactivity traits and risky driving behaviors with alcohol intake and narcotics consumption among Iranian motorcyclists

BACKGROUND

Motorcycle drivers are among the most vulnerable road users, accounting for a large proportion of global traffic accidents. This study aimed to investigate the association between the score of adult attention-deficit/hyperactivity (ADHD) traits and risky driving behaviors (RDB) with alcohol intake (AI) and narcotics consumption (NC) among motorcyclists in Iran.

METHODS

This multi-center cross-sectional study encompassed 1747 motorcyclists from three cities in Iran. A random sampling method was applied in this study, and the required data was collected using three standard questionnaires on ADHD, substance abuse, and RDB. Independent sample t-test, covariance analysis, and quantile regression (QR) were used to analyze the data.

RESULTS

The results of t-test and analysis of covariance indicated that AI and NC were significantly associated with ADHD score and RDB among the motorcycle drivers. Additionally, the QR models showed that these effects were significant at all quantiles of ADHD and RDB, even for individuals who were at lower quantiles.

CONCLUSIONS

Considering the potential dangers of driving after AI and NC, appropriate measures should be adopted before certifying a driving license to screen ADHD as a predisposing factor for substance abuse and RDB. Furthermore, it is essential to equip traffic police with adequate diagnosis kits and establish heavy penalties for the offenders. In this regard, all interventions aimed to reduce traffic accidents among motorcycle drivers should be done considering the interrelationship between ADHD, RDB, and substance abuse.

Public perceptions of adult ADHD: Indications of stigma?

Stigmatization represents a major barrier to treatment seeking across mental disorders. Despite this, stigma research on individual mental disorders remains in its infancy. Attention-deficit hyperactivity disorder (ADHD) in adults also represents an under-researched area-being far less studied than its child counterpart. This study examined the current state of public perceptions towards adult ADHD. A simulation group consisting of 105 participants performed the Weiss Functional Impairment Rating Scale (WFIRS) and Conners' Adult ADHD Rating Scales (CAARS) as though they had ADHD. These scores were compared to a group consisting of 98 individuals with adult ADHD and a group of 117 healthy individuals both groups being instructed to complete the WFIRS and CAARS to the best of their abilities. Simulators were found to overestimate impairments in adult ADHD (to a large effect) in the domains of hyperactivity, DSM-IV hyperactivity-impulsivity, DSM-IV total, work, school, (to a medium effect) in family and social, and (to a negligible-small effect) in inattention, impulsivity, DSM-IV inattention, and life skills when compared to the ADHD group, and in all domains (to a large effect) when compared to the control group. Current and retrospective ADHD symptoms were found to be associated with more accurate perceptions in a number of domains. Evidence for the presence of perceptions considered to be stigmatizing was found, with largest effects present in the domains of hyperactivity, impulsivity, impairments at work, school, and engagement in risky behaviour.

Diagnostic Accuracy of the Conners' Adult ADHD Rating Scale in a Postsecondary Population

Objective: Clinicians frequently rely upon the results of self-report rating scales when making the diagnosis of ADHD; however, little research exists regarding the ability of self-report measures to accurately differentiate ADHD from other disorders. Method: This present study investigated the ability of the Conners' Adult ADHD Rating Scale (CAARS) to discriminate between 249 postsecondary students with carefully diagnosed ADHD and 507 clinical controls. Results: The overall discriminant validity of the CAARS was 69%, and it had an unacceptably high false positive and false negative rate. At lower prevalence rates, a high score on the CAARS has only a 22% chance of accurately identifying individuals with ADHD. Conclusion: Although the CAARS is an adequate screening measure, it should not be the main method by which a diagnosis is made, as it frequently misidentifies individuals with other psychological complaints as having ADHD. Implications for clinical practice are discussed.

Epigenome-wide Association Study of Attention-Deficit/Hyperactivity Disorder Symptoms in Adults

BACKGROUND

Previous studies have reported associations between attention-deficit/hyperactivity disorder symptoms and DNA methylation in children. We report the first epigenome-wide association study meta-analysis of adult attention-deficit/hyperactivity disorder symptoms, based on peripheral blood DNA methylation (Infinium HumanMethylation450K array) in three population-based adult cohorts.

METHODS

An epigenome-wide association study was performed in the Netherlands Twin Register (N = 2258, mean age 37 years), Dunedin Multidisciplinary Health and Development Study (N = 800, age 38 years), and Environmental Risk Longitudinal Twin Study (N = 1631, age 18 years), and results were combined through meta-analysis (total sample size N = 4689). Region-based analyses accounting for the correlation between nearby methylation sites were also performed.

RESULTS

One epigenome-wide significant differentially methylated position was detected in the Dunedin study, but meta-analysis did not detect differentially methylated positions that were robustly associated across cohorts. In region-based analyses, six significant differentially methylation regions (DMRs) were identified in the Netherlands Twin Register, 19 in the Dunedin study, and none in the Environmental Risk Longitudinal Twin Study. Of these DMRs, 92% were associated with methylation quantitative trait loci, and 68% showed moderate to large blood-brain correlations for DNA methylation levels. DMRs included six nonoverlapping DMRs (three in the Netherlands Twin Register, three in the Dunedin study) in the major histocompatibility complex, which were associated with expression of genes in the major histocompatibility complex, including C4A and C4B, previously implicated in schizophrenia.

CONCLUSIONS

Our findings point at new candidate loci involved in immune and neuronal functions that await further replication. Our work also illustrates the need for further research to examine to what extent epigenetic associations with psychiatric traits depend on characteristics such as age, comorbidities, exposures, and genetic background.

Evaluating the Psychometric Properties of the Conners Adult ADHD Rating Scales

Objective: Characterized by significant work-related impairments, difficulties with relationships, and higher rates of criminal behavior and substance abuse, ADHD is now understood as a disability that can persist throughout a lifetime. Differing opinions remain, however, regarding adult symptoms of ADHD, particularly with regard to gender differences. These issues add to the challenges of constructing a reliable and valid measure of ADHD for use with adults in research and practice. Method: We review the theoretical foundations of ADHD and psychometric properties of a major assessment device, the Conners' Adult ADHD Rating Scales (CAARS). Results: Results of the literature review found (a) a wide range of internal consistency estimates, with lowest values for the Diagnostic and Statistical Manual of Mental Disorders (DSM)-Hyperactive/Impulsive Symptoms subscale when completed by women, and (b) discriminant validity estimates in the same range as convergent validity estimates. Conclusion: These findings raise questions about the construct validity of the CAARS and suggest directions for future research.

A Double Dissociation Between Inattentive and Impulsive Traits, on Tasks of Visual Processing and Emotion Regulation

OBJECTIVE

To dissociate between inattentive and impulsive traits common in attention deficit hyperactivity disorder (ADHD) using a non-dichotomous measurment of these traits.

METHOD

120 university students who completed the Conner's adult ADHD rating scales (CAARS) were also tested on the Microgenesis task which requires visual attention and on the Cyber Cruiser task which requires emotion regulation.

RESULTS

Results show that a measure of inattention was specifically related to a measure of effortful visual processing condition. In addition, a measure of impulsivity was specifically related to the tendency to fail in refueling one's car on time, although this relation was opposite to the predicted direction. Furthermore, by using exploratory and confirmatory factor analyses, the CAARS' factor structure was confirmed to be relevant to an Israeli population.

CONCLUSION

The current experiment supports the idea that visual attention may play a part in inattentive symptoms, and that emotion regulation may play a part in impulsivity symptoms.

Retrospective assessment of childhood ADHD symptoms for diagnosis in adults: validity of a short 8-item version of the Wender-Utah Rating Scale

The Wender-Utah Rating Scale (WURS) is a widely used self-report instrument for retrospective assessment of childhood ADHD. However, many WURS items are not specific to ADHD. Here, we investigated the effect of excluding these items on the performance of the WURS in predicting adult ADHD based on previous diagnosis and current clinically significant symptoms. The study was conducted on a sample of adults (n = 1014; 48 % male) participating in a family-based investigation of ADHD. Participants completed the 61-item WURS questionnaire and the 66-item Conners Adult ADHD Rating Scale. Receiver operating characteristic (ROC) curves were used to compare the performance of the eight-item WURS (WURS-8) and the longer WURS-25 in predicting previous ADHD diagnosis and current clinically significant ADHD symptoms. WURS-8 and WURS-25 have approximately the same power to predict adult ADHD, based on either previous diagnosis or current symptoms (area under the ROC curves >0.8). WURS-8 performs at least as well as the longer WURS-25 in predicting adult ADHD. This 8-item questionnaire is thus a valid instrument and is especially useful for screening for ADHD in large epidemiological samples.

Specificity of the CAARS in Discriminating ADHD Symptoms in Adults From Other Axis I Symptoms

OBJECTIVE

In this study, we examined the sensitivity and specificity of the Conners' Adult ADHD Rating Scale-Self-Report: Long Version (CAARS) in 113 adult clinical archival records.

METHOD

Forty-five clients had requested evaluation for ADHD, suggesting problems with attention, and 68 requested other services. To examine the CAARS' ability to differentiate ADHD symptoms from other Axis I symptoms, it was compared with the Personality Assessment Inventory.

RESULTS

The two groups differed significantly on the weighted linear combination of the eight subscales of the CAARS, Wilks's Lambda = .565, F(7, 105) = 11.56, p < .0001, with higher mean scores found among those requesting evaluation of ADHD. z-tests revealed the eight CAARS subscales were more highly correlated with each other, based on the average intercorrelation, than the nine selected clinical scales of the Personality Assessment Inventory (PAI; Somatic Complaints [SOM], Mania [MAN], Paranoia [PAR], Schizophrenia [SCZ], Anxiety [ANX], Anxiety-Related Disorders [ARD], Depression [DEP], Borderline Features [BOR], and Antisocial Features [ANT]). Some unexpectedly high correlations were found between the CAARS and PAI clinical scales (MAN and SCZ).

CONCLUSION

The results of the present study were mixed, with some analyses yielding positive results with respect to the CAARS' sensitivity and others suggesting poor specificity.

An association between a dopamine transporter gene (SLC6A3) haplotype and ADHD symptom measures in nonclinical adults

Previous genetic studies have postulated that attention deficit hyperactivity disorder (ADHD) should be regarded as the extreme end of a set of behavioural traits that can be continuously measured in the general population. The current study adopted a quantitative trait approach to examine the relationship between dopamine gene variants and self-reported ADHD symptoms in 517 nonclinical adults. Although genetic associations with variants of both the dopamine transporter (DAT1; SLC6A3) and D4 receptor (DRD4) genes have been reliably reported in children, results in adults are less consistent. We probed two potentially functional variable number of tandem repeat (VNTR) polymorphisms in the 3'UTR and intron 8 of DAT1, the 10-repeat and 6-repeat alleles of which respectively form a haplotype (10/6 DAT1 haplotype) that is associated with childhood ADHD. We also genotyped the exon 3 VNTR of DRD4, the 7-repeat allele of which is also an established risk factor for childhood ADHD. Permutation analysis showed an influence of the 10/6 DAT1 haplotype on both CAARS-G and CAARS-H (DSM-IV ADHD Symptoms Total and ADHD Index respectively), such that ADHD symptom scores increased with each additional copy of the 10/6 DAT1 haplotype. This result survived corrections for multiple comparisons both at the level of genotype and phenotype. A nominal association with CAARS-G was also found for the 7-repeat allele of the DRD4 VNTR however this did not survive multiple comparison correction. Our results provide further support for the influence of variation in the 10/6 DAT1 haplotype and individual differences in ADHD symptoms in adults.

The effects of a Self-Alert Training (SAT) program in adults with ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD), a neuropsychiatric condition characterized by attention and impulsivity problems, is one of the most common behavioral disorders. The first line of treatment for ADHD is psychostimulant medication, but this has limited effectiveness, particularly in adults, and is often associated with adverse side-effects. Thus, it is imperative that new non-pharmaceutical approaches to treatment are developed. This study aims to evaluate the impact of a non-pharmacological Self-Alert Training (SAT) intervention on ADHD symptom prevalence, psychological and cognitive functioning, and on everyday functional impairment in adults with ADHD. Fifty-one adult participants with a current diagnosis of ADHD were randomized to either SAT or a Control Training (CT) program. They were assessed at baseline, immediately following the 5-week training period, and after 3-months using ADHD symptoms scales, as well as a series of neuropsychological tests and psychological questionnaires. Subjective ratings of everyday life attention and memory problems were also collected. The SAT group showed significant improvements in ADHD inattentive and impulsive symptoms, depressive symptoms and in self-efficacy ratings compared to the CT group at both post-training and at the 3-month assessment. Pre-post improvements in SAT participants on untrained cognitive tasks measuring selective attention and executive functions were also observed. Finally, the SAT group reported improved subjective ratings of everyday life attention at both assessment points. This pattern of results suggests that SAT may be beneficial in treating ADHD symptoms as well as psychological and cognitive impairments in adult ADHD. A large-scale randomized controlled trial (RCT) is needed.