Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder

OBJECTIVE

Although attention deficit hyperactivity disorder is a common disorder of childhood, its status as a disorder in adults is not clear. The authors reasoned that if the adult diagnosis of the disorder is a valid clinical entity, it should be similar to the childhood disorder with regard to patterns of psychiatric and cognitive findings.

METHODS

Eighty-four adults with a clinical diagnosis of childhood-onset attention deficit hyperactivity disorder confirmed by structured interview who were referred for treatment were studied. Findings were compared with those from a preexisting study group of referred children with attention deficit hyperactivity disorder, nonreferred adult relatives of those children who also had attention deficit hyperactivity disorder, and adults without the disorder who were relatives of normal children. Subjects were evaluated with a comprehensive battery of psychiatric, cognitive, and psychosocial assessments.

RESULTS

The referred and nonreferred adults with attention deficit hyperactivity disorder were similar to one another but more disturbed and impaired than the comparison subjects without the disorder. The pattern of psychopathology, cognition, and functioning among the adults with attention deficit hyperactivity disorder approximated the findings for children with the disorder.

CONCLUSIONS

These results show that referred and nonreferred adults with attention deficit hyperactivity disorder have a pattern of demographic, psychosocial, psychiatric, and cognitive features that mirrors well-documented findings among children with the disorder. These findings further support the validity of the diagnosis for adults.

Markedly decreased expression of class I histocompatibility antigens, protein, and mRNA in human small-cell lung cancer

We have found markedly deficient expression of the class I major histocompatibility antigens HLA-A,B,C and beta 2m on human small-cell lung cancer (SCLC) lines and fresh tumor samples. The deficit of HLA-A,B,C and beta 2-microglobulin (beta 2m) antigen expression was demonstrated with both radiobinding assays and indirect immunofluorescence assays. Immunoprecipitation of metabolically labeled cells with antibodies to class I antigens showed most SCLC lines to have synthesized almost no beta 2m and HLA-A,B,C proteins. Northern blot analysis, using human HLA-A,B, and beta 2m cDNA probes, showed that almost all SCLC lines tested had markedly decreased amounts of HLA and beta 2m mRNA, but both gene products could be induced with interferon treatment of SCLC lines. We conclude that human SCLC, in contrast to other lung cancer types, is characterized by greatly reduced transcription of HLA-A,B,C and beta 2m genes, which suggests the existence of a mechanism for evading the host immune response to the tumor and of an E1a-like product in this type of tumor cell.

Convergence of the Child Behavior Checklist with structured interview-based psychiatric diagnoses of ADHD children with and without comorbidity

We evaluated the convergence of CBCL scales with the diagnosis of ADHD and comorbid disorders in 133 ADHD and 118 normal control boys, aged 6-17 years old. We evaluated the strength of association between each CBCL scale and structured-interview derived diagnoses with Total Predictive Value (TPV) and the odds-ratio (OR). Excellent convergence was found between the CBCL Attention Problems scale with the diagnosis of ADHD, between the Delinquent Behavior scale and the diagnosis of CD, and between the Anxiety/Depression scale and the diagnoses of Anxiety Disorders. These findings indicate that the CBCL could serve as a rapid and useful screening instrument to identify comorbid and non-comorbid cases of ADHD.

Mechanisms of bone erosion in gout: a quantitative analysis using plain radiography and computed tomography

OBJECTIVE

The underlying basis of bone erosion in gout remains speculative. The aim of this study was to understand the mechanisms of bone erosion in gout using non-invasive imaging techniques.

METHODS

Paired plain radiographs and computed tomography (CT) scans of 798 individual hand and wrist joints from 20 patients with gout were analysed. Radiographs were scored for erosion (0-5) using the Sharp/van der Heijde method. CT scans were scored for the presence and diameter of bone erosions and tophi. The presence of intraosseous tophus (tophus visualised within bone) was recorded. The relationships between radiographic erosion, CT erosion and tophus scores were analysed.

RESULTS

With increasing radiographic erosion scores, the percentage of joints with intraosseous tophus increased (p<0.001). For those joints with a radiographic erosion score of 4 or 5, 96/98 (98%) had CT evidence of intraosseous tophus. There was a significant relationship between the radiographic erosion scores and intraosseous tophus size (p<0.001). For those joints with CT erosion, 194/237 (81.8%) had visible intraosseous tophus. Of the joints with CT erosions greater than 5 mm, 106/112 (94.6%) had visible intraosseous tophus and all (56/56) erosions greater than 7.5 mm had intraosseous tophus. There was a strong correlation between CT erosion diameter and intraosseous tophus diameter (r = 0.93, p<0.001). Intraosseous tophi were larger than non-intraosseous tophi, but had similar density and calcification.

CONCLUSION

There is a strong relationship between bone erosion and the presence of intraosseous tophus. These results strongly implicate tophus infiltration into bone as the dominant mechanism for the development of bone erosion and joint damage in gout.

Development and application of surface plasmon resonance-based biosensors for the detection of cell-ligand interactions

Surface plasmon resonance (SPR)-based biosensors were investigated with a view to providing a portable, inexpensive alternative to existing technologies for "real-time" biomolecular interaction analysis of whole cell-ligand interactions. A fiber optic SPR-based (FOSPR) biosensor, employing wavelength-dependent SPR, was constructed to enable continuous real-time data acquisition. In addition, a commercially available integrated angle-dependent SPR-based refractometer (ISPR) was modified to facilitate biosensing applications. Solid-phase detection of whole red blood cells (RBCs) using affinity-captured blood group specific antibodies was demonstrated using the BIACORE 1000, BIACORE Probe, FOSPR, and ISPR sensors. Nonspecific binding of RBCs to the hydrogel-based biointerface was negligible. However, the background noise level of the FOSPR-based biosensor was approximately 25-fold higher than that of the widely used BIACORE 1000 system while that of the ISPR-based biosensor was over 100-fold higher. Nevertheless, the FOSPR biosensor was suitable for the analysis of macromolecular analytes contained in crude matrices.

Increasing the tolerance of DCD hearts to warm ischemia by pharmacological postconditioning

Donation after circulatory death (DCD) offers a potential additional source of cardiac allografts. We used a porcine asphyxia model to evaluate viability of DCD hearts subjected to warm ischemic times (WIT) of 20–40 min prior to flushing with Celsior (C) solution. We then assessed potential benefits of supplementing C with erythropoietin, glyceryl trinitrate and zoniporide (Cs), a combination that we have shown previously to activate ischemic postconditioning pathways. Hearts flushed with C/Cs were assessed for functional, biochemical and metabolic recovery on an ex vivo working heart apparatus. Hearts exposed to 20-min WIT showed full recovery of functional and metabolic profiles compared with control hearts (no WIT). Hearts subjected to 30- or 40-min WIT prior to C solution showed partial and no recovery, respectively. Hearts exposed to 30-min WIT and Cs solution displayed complete recovery, while hearts exposed to 40-min WIT and Cs solution demonstrated partial recovery. We conclude that DCD hearts flushed with C solution demonstrate complete recovery up to 20-min WIT after which there is rapid loss of viability. Cs extends the limit of WIT tolerability to 30 min. DCD hearts with ≤30-min WIT may be suitable for transplantation and warrant assessment in a transplant model.

Normothermic ex vivo perfusion provides superior organ preservation and enables viability assessment of hearts from DCD donors

The shortage of donors in cardiac transplantation may be alleviated by the use of allografts from donation after circulatory death (DCD) donors. We have previously shown that hearts exposed to 30 min warm ischemic time and then flushed with Celsior supplemented with agents that activate ischemic postconditioning pathways, show complete recovery on a blood-perfused ex vivo working heart apparatus. In this study, these findings were assessed in a porcine orthotopic heart transplant model. DCD hearts were preserved with either normothermic ex vivo perfusion (NEVP) using a clinically approved device, or with standard cold storage (CS) for 4 h. Orthotopic transplantation into recipient animals was subsequently undertaken. Five of six hearts preserved with NEVP demonstrated favorable lactate profiles during NEVP and all five could be weaned off cardiopulmonary bypass posttransplant, compared with 0 of 3 hearts preserved with CS (p < 0.05, Fisher's exact test). In conclusion, DCD hearts flushed with supplemented Celsior solution and preserved with NEVP display viability before and after transplantation. Viability studies of human DCD hearts using NEVP are warranted.

Serotoninergic mechanisms in hypertension. Focus on the effects of ketanserin

Aggregating platelets release serotonin, which induces contraction of most vascular smooth muscle by activation of S2-serotoninergic receptors. Serotonin released in the circulation may contribute to the increase in peripheral resistance of hypertension as the responsiveness of blood vessels from hypertensive animals and humans to the vasoconstrictor action of the monoamine is augmented. The data obtained with the new antihypertensive agent ketanserin may favor that interpretation. Ketanserin is a selective S2-serotoninergic antagonist with additional alpha 1-adrenergic blocking properties. In humans, it has a terminal half-life of 12 to 25 hours and is eliminated predominantly by the liver. The hemodynamic profile of ketanserin is that of a vasodilator drug with actions on both resistance and capacitance vessels. On short-term intravenous administration, it lowers blood pressure in hypertensive patients with minimal reflex changes in cardiovascular function. When given orally long term to hypertensive patients, ketanserin causes a sustained reduction in arterial blood pressure, comparable to that obtained with either beta-adrenergic blockers or diuretics. Several studies have shown a greater efficacy in older (greater than 60 years of age) than in younger patients independent of starting pressure. Side effects mainly consist of dizziness, somnolence, and dry mouth, but they are usually not severe. The mechanism underlying the antihypertensive effect of ketanserin is unclear. It cannot be attributed to either S2-serotoninergic or alpha 1-adrenergic blockade alone, but an interaction between the two effects appears to be required.

Molecular immunobiology of macrophages: recent progress

Macrophage molecules involved in adhesion, signalling, secretion and interactions with pathogens and T-helper lymphocytes have been cloned and defined using monoclonal antibodies and genetic disruption. Studies of the regulation of macrophage differentiation and activation by cytokines have yielded insights into the heterogeneity of their functions in natural and acquired immunity, including immunity to infections by mycobacteria and HIV.

High-grade MRI bone oedema is common within the surgical field in rheumatoid arthritis patients undergoing joint replacement and is associated with osteitis in subchondral bone

OBJECTIVES

MRI bone oedema has been observed in early and advanced RA and may represent a cellular infiltrate (osteitis) in subchondral bone. We studied MRI scans from RA patients undergoing surgery, seeking to identify regions of bone oedema and examine its histopathological equivalent in resected bone.

METHODS

Preoperative contrast-enhanced MRI scans were obtained in 11 RA patients scheduled for orthopaedic surgery to the hands/wrists or feet. In 9, MRI scans were scored by 2 readers for bone oedema (RAMRIS system). Its distribution with respect to surgical site was investigated. In 4 patients, 7 bone samples were examined for a cellular infiltrate, and this was compared with MRI bone oedema, scored for spatial extent and intensity.

RESULTS

Inter-reader intraclass correlation coefficients for bone oedema were 0.51 (all sites) and 0.98 (bone samples for histology). Bone oedema was observed at 60% of surgical sites vs 38% of non-surgical sites. High-grade bone oedema (score >/=50% maximum) was strongly associated with the surgical field (OR 9.3 (3.5 to 24.2), p<0.0001). Bone oedema scores correlated with pain (r = 0.67, p = 0.048) and CRP (r = 0.86, p = 0.01). In 4 of the 7 bone samples, there was concordance between bone oedema and subchondral osteitis. In 3, there was no MRI bone oedema, and osteitis was "slight".

CONCLUSION

High-grade MRI bone oedema was common within the field of intended surgery and associated with pain. There was concordance between the presence and severity of MRI bone oedema and osteitis on histology, with an MRI threshold effect due to differences in image resolution.

Cellular characterisation of magnetic resonance imaging bone oedema in rheumatoid arthritis; implications for pathogenesis of erosive disease

OBJECTIVES

Magnetic resonance imaging (MRI) bone oedema is an important predictor of bone erosion in rheumatoid arthritis (RA). This study aimed to determine the cellular components of MRI bone oedema, and clarify the relationship between bone erosion and MRI bone oedema.

METHODS

Twenty-eight bones from 11 patients with RA undergoing orthopaedic surgery were analysed by quantitative and semi-quantitative immunohistochemistry. Pre-operative contrast-enhanced MRI scans were analysed for bone oedema.

RESULTS

The density of osteoclasts was higher in those samples with MRI bone oedema than those without MRI bone oedema (p = 0.01). Other cells identified within bone marrow included macrophages and plasma cells, and these were more numerous in samples with MRI bone oedema (p = 0.02 and 0.05 respectively). B cells were present in lower numbers, but B cell aggregates were identified in some samples with MRI bone oedema. There was a trend to increased RANKL expression in samples with MRI bone oedema (p = 0.09). Expression of RANKL correlated with the number of osteoclasts (r = 0.592, p = 0.004).

CONCLUSIONS

The increased number of osteoclasts and RANKL expression in samples with MRI bone oedema supports the hypothesis that bone erosion in RA occurs through activation of local bone resorption mechanisms within subchondral bone as well as through synovial invasion into bone.

Convergent and criterion-related validity of the Behavior Assessment System for Children-Parent Rating Scale

Examined aspects of the validity of the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1992) Parent Rating Scale (BASC-PRS) in 156 children with cross-setting disruptive behavior. The BASC-PRS is a recently published multidimensional measure composed of conceptually derived scales created for use in conjunction with psychiatric and educational classification systems. Convergent validity was assessed through correlations of BASC-PRS scale scores with scale scores on the Child Behavior Checklist/4-18 (CBCL/4-18; Achenbach, 1991b). Criterion-related validity was evaluated as the ability of BASC-PRS and CBCL/4-18 scales to predict membership in diagnostic groupings (no diagnosis, attention deficit hyperactivity disorder [ADHD] only, and ADHD with a comorbid externalizing disorder) derived via structured interviews based on the third, revised edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987). Results showed the validity of the BASC-PRS to be comparable to that of the CBCL/4-18. Given its conceptually derived scales, the BASC-PRS may prove to be a useful-tool for assessing childhood disruptive behavior.

Adherence of bacteria to intraocular lenses: a prospective study

AIMS

The study was designed to investigate the bacterial flora of the operating field during routine cataract surgery and the source of intraocular lens contamination during the surgery.

METHODS

The normal flora of the external eye and fornices of 17 patients undergoing selective cataract surgery was determined preoperatively. Swabs taken from the eyelid surface and lashes showed coagulase negative staphylococci (CNS) in 90%, Propionibacterium acnes in 62%, Corynebacterium sp in 18%, and Peptostreptococcus in 3% of the patients. The lower fornices of 70% had CNS, 47% P acnes, 6% Staphylococcus aureus, 6% Corynebacterium sp, and 6% Candida.

RESULTS

A sterile PMMA intraocular lens was touched on the upper bulbar conjunctiva immediately before the surgery. Eighty two per cent of lenses grew CNS, 18% P acnes, 18% Bacillus sp, 12% S aureus, and 6% Corynebacterium sp. A second sterile PMMA intraocular lens was left on the drape and near the eye during surgery. Forty seven per cent of these cultured CNS, 12% Corynebacterium sp, and 6% Bacillus sp. A high count of bacteria in the operating field, especially CNS and P acnes can contribute to postoperative inflammation and endophthalmitis.

CONCLUSION

Special measures are needed before and during the surgery to reduce the chance of intraocular inoculation of these bacteria. Use of proper culture media and techniques are necessary to identify these organisms, especially anaerobes, in postoperative inflammation.

Vascular access type and risk of mortality in a national prospective cohort of haemodialysis patients

BACKGROUND

Central venous catheters (CVC) are a potential source of bacteraemia and have been associated with increased mortality in haemodialysis patients. We aimed to investigate the relationships between haemodialysis vascular access, taking into account changes in vascular access type during patients' lives, and cause specific mortality risk in a national cohort of dialysis patients.

METHODS

Prospective cohort study including all patients receiving haemodialysis in Scotland at annual cross sectional surveys in 2009, 2010 and 2011. Data were collected through the Scottish Renal Registry and by a structured review of case records following death. Cox proportional hazards regression and multivariable logistic regression were used to model survival and risk of death from septicaemia respectively.

RESULTS

Of a cohort of 2666 patients, 873 (32%) died during follow-up. After case-mix adjustment, patients using only tunnelled CVC during follow-up had a higher risk of all cause mortality across all strata of prior renal replacement therapy exposure [adjusted hazard ratio (HR): 1.83-2.08]. Case-mix adjusted risks of cardiovascular death (adjusted HR: 2.20-2.95) and infection-related death (adjusted HR: 3.10-3.63) were also higher in this group. Patients using tunnelled CVCs during follow-up and prior to death had 6.9-fold higher odds of death from septicaemia compared with those using only arteriovenous fistulae or grafts.

CONCLUSION

Compared with an arteriovenous fistula or graft, sustained use of tunnelled CVCs for vascular access is associated with higher risks of all-cause, cardiovascular and infection-related mortality.

Psychiatric comorbidity in attention deficit disorder: impact on the interpretation of Child Behavior Checklist results

Studies have investigated associations between the Child Behavior Checklist (CBCL) and clinical diagnoses without assessing the impact of comorbidity on these results. This study evaluates associations between parental reports from the CBCL and a structured diagnostic interview in children with attention deficit disorder with hyperactivity (ADDH) stratified by the presence (ADDH+) or absence (ADDH-) of psychiatric comorbidity. Interview-defined ADDH children scored significantly worse on all scales of the CBCL compared with scores from interview-defined non-ill comparisons. However, these findings were accounted for by the subgroup of children with ADDH+. The results indicate a good correspondence between CBCL-based ratings and interview-defined diagnoses. These findings also suggest that the CBCL may be a good screening instrument, not only for ADDH but also for comorbid psychiatric disorders.

A naturalistic study of 24-hour electrocardiographic recordings and echocardiographic findings in children and adolescents treated with desipramine

OBJECTIVE

Recent studies assessing cardiovascular effects of desipramine (DMI) in pediatric patients consistently have found small, clinically benign, but statistically significant, increases in heart rate and electrocardiographic (ECG) conduction parameters. However, single, routine ECG recordings cannot fully assess potential infrequent rhythm disturbances.

METHOD

We analyzed data from 24-hour ECG monitoring, two-dimensional Doppler echocardiography, and expert clinical cardiac examination of DMI-treated patients. Subjects were 71 children (N = 35) and adolescents (N = 36) receiving long-term treatment (means +/- SD = 1.5 +/- 1.2 years, median = 1.0 year) with DMI (means +/- SD = 3.5 +/- 1.6 mg/kg).

RESULTS

Compared with previous observations in untreated healthy children. DMI-treated patients had significantly lower rates of sinus pauses and junctional rhythm, but significantly higher rates of single or paired premature atrial contractions and runs of supraventricular tachycardia. There was an association between DMI serum levels and paired premature atrial contractions, but no other associations were detected.

CONCLUSIONS

These findings support the impression from previous ECG studies that DMI-associated cardiac effects in pediatric patients are quite benign. Nevertheless, it remains to be ascertained whether even minor cardiac abnormalities may predict later, evidently rare, adverse cardiovascular effects that may include sudden death.

Diagnoses of attention-deficit hyperactivity disorder from parent reports predict diagnoses based on teacher reports

OBJECTIVE

For DSM-III attention deficit disorder (ADD), it was previously reported that, when a parent report leads to a diagnosis of ADD, it is highly likely that the teacher report will also be positive. This report seeks to generalize that finding to DSM-III-R attention-deficit hyperactivity disorder (ADHD).

METHOD

In a population of 34 children meeting clinical criteria for DSM-III-R ADHD, parents and teachers independently responded to questions about individual ADHD symptoms.

RESULTS

Correlations between parents and teachers for individual symptoms were low to moderate; however, there was a 77% probability that the teacher report would result in a positive diagnosis given a positive parent diagnosis. This probability increased to 88% if "broad" teacher diagnoses of ADHD, defined by 35% of the 14 DSM-III-R symptoms, were included.

CONCLUSIONS

In clinically-referred children, a clinical diagnosis of ADHD based on parent report is likely to be corroborated by a teacher report.

Determinants of folic acid knowledge and use among antenatal women

BACKGROUND

Although recommendations on folic acid use were issued by health authorities in a number of countries in the early 1990s, uptake of peri-conceptional folic acid is still disappointingly low. Regardless of food fortification policies, folic acid promotion will probably be required in most countries to optimize folate levels among women of child-bearing age. The aim of this study was to examine folic acid knowledge and use, and their determinants among antenatal women in the east of Ireland in 1997.

METHODS

Three hundred antenatal women attending their initial booking appointment in three Dublin maternity hospitals were surveyed. An interviewer-administered questionnaire was used with questions on folic acid knowledge and use, and demographic and obstetric questions. A univariate analysis of data was undertaken followed by a multivariate analysis using logistic regression to determine factors predicting knowledge and use of folic acid.

RESULTS

Seventy-six per cent of respondents had heard of folic acid, 16 per cent had taken it before pregnancy and 51 per cent during pregnancy. Women who had planned their pregnancy, were married and were relatively affluent were significantly more likely to have heard of folic acid, to know that it could prevent neural tube defects and to have taken it peri-conceptionally. Less affluent women tended to use their general practitioner (GP) more as a source of information and advice than those who were better off. In multivariate analysis, marriage and planned pregnancy were important predictors of folic acid knowledge whereas planned pregnancy advice given before pregnancy and relative affluence were predictive of peri-conceptional use.

CONCLUSIONS

Many women know of folic acid but do not take it peri-conceptionally. Women may associate folic acid with pregnancy and less with pre-pregnancy. Greater emphasis on peri-conceptional use should improve folic acid uptake. Focusing on less affluent women for folic acid promotion by GPs and other primary care professionals is also important.

In vitro development of human monoclonal antibody-secreting plasmacytomas

A polyclonal human lymphoblastoid cell line transformed in vitro with Epstein-Barr virus produced specific anti-Rhesus D antibody. It was repeatedly enriched by rosetting procedures and subsequently cloned. The cloning conditions employed a combination of mouse macrophage feeder layers, antimycoplasma agents, and low density passage. Formal evidence of monoclonality was obtained in one case which was of human IgG1 isotype and was secreted at the level of 15-20 micrograms/ml. All clones showed long-term stability in culture after 10 months of continuous passage. Both polyclonal and monoclonal cell lines possessed antigens characteristic of highly differentiated B cells, yet they also expressed Epstein-Barr virus nuclear antigen (EBNA). This study exemplifies a simple method for obtaining monoclonal antibody secreting plasmacytomas of human origin.

Norovirus foodborne outbreaks associated with the consumption of oysters from the Etang de Thau, France, December 2002

In January 2003, the Institut de Veille Sanitaire received notification of clusters of gastroenteritis (GE) thought to be associated with consumption of oysters harvested from Etang de Thau in the south of France. At the same time Italy reported an outbreak (200+ cases) associated with oysters from the Etang de Thau. An investigation was carried out to determine the source and vehicle of the outbreaks. Descriptive analysis of reported clusters in France, microbiological analysis of stool and oyster samples, genotyping of noroviruses and an environmental investigation of the Etang de Thau were carried out. A retrospective cohort study was also undertaken among those attending a number of family meals in Paris. Thirteen family clusters in four districts of France (69 cases) could be attributed to the consumption of Thau oysters based on descriptive evidence. Oysters distributed at an office in Paris and consumed at fourteen family meals between 19 and 24 December led to a further outbreak. In this outbreak the attack rate was 21/36 (58%) for Thau oyster consumers and 0/22 for non-consumers (p=0.00002). Noroviruses (genogroups I and II) were found in stool samples from four clusters and oysters from three clusters (including Paris). Environmental investigations revealed heavy rainfall, an overflow of a water purification station and faecal contamination of the Etang de Thau in December. Oysters from the Etang de Thau were responsible for a number of clusters of norovirus GE in winter 2002 in France and also in Italy. High Escherichia Coli levels in Thau water and shellfish led to an official request, mid-December, for oyster purification before distribution. This was not possible, due to lack of purification facilities. This investigation has contributed to a change in the way that shellfish harvesting areas are classified in France.

DNA fingerprinting transforms the art of cell authentication

The increasing diversity of new cell cultures is seriously stretching the capabilities of traditional methods of identification. DNA fingerprinting is set to play an important role in increasing confidence in the authenticity of cultures in research and industry.

Is adult attention deficit hyperactivity disorder a valid diagnosis in the presence of high IQ?

BACKGROUND

Because the diagnosis of attention deficit hyperactivity disorder (ADHD) in higher education settings is rapidly becoming a contentious issue, particularly among patients with high IQs, we sought to assess the validity of diagnosing ADHD in high-IQ adults and to further characterize the clinical features associated with their ADHD.

METHOD

We operationalized high IQ as having a full-scale IQ120. We identified 53 adults with a high IQ who did not have ADHD and 64 adults with a high IQ who met diagnostic criteria for ADHD. Groups did not differ on IQ, socio-economic status or gender.

RESULTS

High-IQ adults with ADHD reported a lower quality of life, had poorer familial and occupational functioning, and had more functional impairments, including more speeding tickets, accidents and arrests. Major depressive disorder, obsessive-compulsive disorder and generalized anxiety disorder diagnoses were higher in high-IQ adults with ADHD. All other psychiatric co-morbidities, including antisocial personality disorder and substance abuse, did not differ between the two high-IQ groups. ADHD was more prevalent in first-degree relatives of adults with ADHD relative to controls.

CONCLUSIONS

Our data suggest that adults with ADHD and a high IQ display patterns of functional impairments, familiality and psychiatric co-morbidities that parallel those found in the average-IQ adult ADHD population.