Externalising disorders - research Flashcards
Thapar (2018)
gene studies suggest ADHD is a trait along a continuum
persistent ADHD is associated with higher genetic loading
however…
common gene variants are only weakly predictive
Kibby (2018)
The term “processing speed” (PS) encompasses many components including perceptual, cognitive and output speed. Despite evidence for reduced PS in Attention-Deficit/Hyperactivity Disorder (ADHD), little is known about which component(s) is most impacted in ADHD, or how it may vary by subtypes. Participants included 151 children, ages 8–12 years, with ADHD Predominantly Inattentive Type, ADHD Combined Type and typically developing controls using DSM-IV criteria. All children completed four measures of processing speed: Symbol Search, Coding, Decision Speed, and simple reaction time. We found children with ADHD-PI and ADHD-C had slower perceptual and psychomotor/incidental learning speed than controls and that ADHD-PI had slower decision speed than controls. The subtypes did not differ on any of these measures. Mean reaction time was intact in ADHD. Hence, at a very basic output level, children with ADHD do not have impaired speed overall, but as task demands increase their processing speed becomes less efficient than controls’. Further, perceptual and psychomotor speed were related to inattention, and psychomotor speed/incidental learning was related to hyperactivity/impulsivity. Thus, inattention may contribute to less efficient performance and worse attention to detail on tasks with a higher perceptual and/or psychomotor load; whereas hyperactivity/impulsivity may affect psychomotor speed/incidental learning, possibly via greater inaccuracy and/or reduced learning efficiency. Decision speed was not related to either dimension. Results suggest that PS deficits are primarily linked to the inattention dimension of ADHD but not exclusively. Findings also suggest PS is not a singular process but rather a multifaceted system that is differentially impacted in ADHD.
Salvi et al. (2019)
Introduction. Attention Deficit Hyperactivity Disorder (ADHD) is an early onset clinical condition characterized by attention difficulties, hyperactivity and impulsivity which can persist across the lifespan, significantly influencing the evolutionary course and facilitating the rise of psychiatric comorbidities. The presence of different ADHD subtypes in adults is a heterogeneity factor to be recognized in order to orient prognosis and treatment, as indicated by studies that described differences in the characterization of different subtypes in relation to both severity and comorbidities. Materials and methods. In the present study we evaluated the socio-demographic and clinical characteristics of a sample of adults with ADHD and the characteristics associated with the different disorder subtypes. We described 60 patients aged between 18 and 65 years (mean age 34.1) with primary diagnosis of ADHD consecutively admitted to the Regional Centre for diagnosis and treatment of ADHD in adults in Milan. Results. We observed high severity of symptoms and low quality of life, in particular in the “life outlook” dimension. The subtypes distribution was the following: 18.3% inattentive subtype, 8.3% hyperactive/impulsive subtype and 70% combined subtype. The hyperactive/impulsive subtype showed a significantly higher frequency in females, while the inattentive subtype was more frequent in males. Patients with the hyperactive/impulsive subtype showed worse quality of life and more frequent anxiety disorders. Conclusions. Considering the different clinical profiles among various subtypes, these data add relevance to subtypes classification of adult ADHD.
Bralten et al. (2013)
Objective: Because multiple genes with small effect sizes are assumed to play a role in attention-deficit/hyperactivity disorder (ADHD) etiology, considering multiple variants within the same analysis likely increases the total explained phenotypic variance, thereby boosting the power of genetic studies. This study investigated whether pathway-based analysis could bring scientists closer to unraveling the biology of ADHD. Method: The pathway was described as a predefined gene selection based on a well-established database or literature data. Common genetic variants in pathways involved in dopamine/norepinephrine and serotonin neurotransmission and genes involved in neuritic outgrowth were investigated in cases from the International Multicentre ADHD Genetics (IMAGE) study. Multivariable analysis was performed to combine the effects of single genetic variants within the pathway genes. Phenotypes were DSM-IV symptom counts for inattention and hyperactivity/impulsivity (n = 871) and symptom severity measured with the Conners Parent (n = 930) and Teacher (n = 916) Rating Scales. Results: Summing genetic effects of common genetic variants within the pathways showed a significant association with hyperactive/impulsive symptoms (p(empirical) = .007) but not with inattentive symptoms (p(empirical) = .73). Analysis of parent-rated Conners hyperactive/impulsive symptom scores validated this result (P-empirical = .0018). Teacher-rated Conners scores were not associated. Post hoc analyses showed a significant contribution of all pathways to the hyperactive/impulsive symptom domain (dopamine/norepinephrine, p(empirical) = .0004; serotonin,. P-empirical = .0149; neuritic outgrowth, p(empirical) = .0452). Conclusion: The present analysis shows an association between common variants in 3 genetic pathways and the hyperactive/impulsive component of ADHD. This study demonstrates that pathway-based association analyses, using quantitative measurements of ADHD symptom domains, can increase the power of genetic analyses to identify biological risk factors involved in this disorder.
Riley et al. (2008)
Objective: The purpose of this study was to evaluate whether preschool children with attention-deficit/hyperactivity disorder predominantly hyperactive-impulsive type (ADHD-HI) and ADHD combined type (ADHD-C) have different levels of functional impairment in four domains: externalizing (oppositional and disruptive) behaviors, internalizing (anxious) behaviors, social skills, and preacademic functioning. Methods: The subjects were 102 children 3 to 5 years of age, meeting DSM-IV criteria for ADHD. Children with ADHD-C versus ADHD-HI were compared across at least two measures for each of the four functional domains. oppositional and anxious behaviors were assessed on the Conners Parent and Teacher Rating Scales. In addition, off-task and disruptive behaviors were assessed by direct observation in the preschool setting. Social skills were assessed on the parent and teacher versions of the Social Skills Rating System and preacademic skills were assessed on the letter word identification, passage comprehension, and applied problems. subtests of the Woodcock-Johnson III Tests of Achievement and the initial sound fluency subtest of the Dynamic indicators of Basic Early Literacy Skills 5th Edition. Results: There were no significant differences between the groups on rating scale T scores for parent-reported oppositional symptoms (ADHD-C vs ADHD-HI; 66.7 +/- 13.5 vs 65.7 +/- 11.7; p = .73); parent-reported anxious symptoms (53.5 +/- 11.1 vs 53.2 +/- 9.7; p = .90); teacher-reported oppositional symptoms (70.9 +/- 15.6 vs 75.5 +/- 14.7; p = .17); or teacher reported anxious symptoms (59.2 +/- 11.6 vs 58.5 +/- 12.2; p = .77). No statistically significant differences were found between the groups when examining off-task and/or disruptive behavior during structured and free play observations at school. No significant differences between the subtypes were found for social skills or preacademic functioning. Conclusions: Across the four areas of functioning assessed in this study, preschool children with ADHD-HI and those with ADHD-C demonstrated similar levels of functioning. This study, in combination with data from longitudinal studies demonstrating that most children with ADHD-HI are later diagnosed with ADHD-C, suggests that ADHD-HI may represent an earlier form of ADHD-C as opposed to a distinct subtype.
Bluschke (2018)
It is far from conclusive what distinguishes the inattentive (ADD) and the combined (ADHD-C) subtype of ADHD on the neuronal level. Theoretical considerations suggest that especially interval timing processes may dissociate these subtypes from each other. Combining high-density EEG recordings with source localization analyses, we examine whether there are ADHD-subtype specific modulations of neurophysiological processes subserving interval timing in matched groups of ADD (n = 16), ADHD-C (n = 16) and controls (n = 16). Patients with ADD and ADHD-C show deficits in interval timing, which was correlated with the degree of inattention in ADD patients. Compared to healthy controls, patients with ADHD-C display a somewhat weaker, yet consistent response preparation process (contingent negative variation, CNV). In patients with ADD, the early CNV is interrupted, indicating an oscillatory disruption of the interval timing process. This is associated with activations in the supplemental motor areas and the middle frontal gyrus. Patients with ADD display adequate feedback learning mechanisms (feedback-related negativity, FRN), which is not the case in patients with ADHD-C. The results suggest that altered pacemaker-accumulation processes in medial frontal structures distinguish the ADD from the ADHD-C subtype. Particularly in patients with ADD phasic interruptions of preparatory neurophysiological processes are evident, making this a possible diagnostic feature.
Oie et al. (2014)
The aim of the present study was to investigate the ability of children with attention deficit/hyperactivity disorder-combined subtype (ADHD-C) and predominantly inattentive subtype (ADHD-PI) to direct their attention and to exert cognitive control in a forced attention dichotic listening (DL) task. Twenty-nine, medication-naive participants with ADHD-C, 42 with ADHD-PI, and 40 matched healthy controls (HC) between 9 and 16 years were assessed. In the DL task, two different auditory stimuli (syllables) are presented simultaneously, one in each ear. The participants are asked to report the syllable they hear on each trial with no instruction on focus of attention or to explicitly focus attention and to report either the right- or left-ear syllable. The DL procedure is presumed to reflect different cognitive processes: perception (nonforced condition/NF), attention (forced-right condition/FR), and cognitive control (forced-left condition/FL). As expected, all three groups had normal perception and attention. The children and adolescents with ADHD-PI showed a significant right-ear advantage also during the FL condition, while the children and adolescents in the ADHD-C group showed a no-ear advantage and the HC showed a significant left-ear advantage in the FL condition. This suggests that the ADHD subtypes differ in degree of cognitive control impairment. Our results may have implications for further conceptualization, diagnostics, and treatment of ADHD subtypes.
Polanczyk et al. (2007)
Objective: The worldwide prevalence estimates of attention deficit hyperactivity disorder (ADHD)/hyperkinetic disorder (HD) are highly heterogeneous. Presently, the reasons for this discrepancy remain poorly understood. The purpose of this study was to determine the possible causes of the varied worldwide estimates of the disorder and to compute its worldwide-pooled prevalence. Method: The authors searched MEDLINE and PsycINFO databases from January 1978 to December 2005 and reviewed textbooks and reference lists of the studies selected. Authors of relevant articles from North America, South America, Europe, Africa, Asia, Oceania, and the Middle East and ADHD/HD experts were contacted. Surveys were included if they reported point prevalence of ADHD/HD for subjects 18 years of age or younger from the general population or schools according to DSM or ICD criteria. Results: The literature search generated 9,105 records, and 303 full-text articles were reviewed. One hundred and two studies comprising 171,756 subjects from all world regions were included. The ADHD/HD worldwide-pooled prevalence was 5.29%. This estimate was associated with significant variability. In the multivariate metaregression model, diagnostic criteria, source of information, requirement of impairment for diagnosis, and geographic origin of the studies were significantly associated with ADHD/HD prevalence rates. Geographic location was associated with significant variability only between estimates from North America and both Africa and the Middle East. No significant differences were found between Europe and North America. Conclusions: Our findings suggest that geographic location plays a limited role in the reasons for the large variability of ADHD/HD prevalence estimates worldwide. Instead, this variability seems to be explained primarily by the methodological characteristics of studies.
Sayal et al. (2018)
Attention-deficit hyperactivity disorder (ADHD) is a common childhood behavioural disorder. Systematic reviews indicate that the community prevalence globally is between 2% and 7%, with an average of around 5%. At least a further 5% of children have substantial difficulties with overactivity, inattention, and impulsivity that are just under the threshold to meet full diagnostic criteria for ADHD. Estimates of the administrative prevalence (clinically diagnosed or recorded) vary worldwide, and have been increasing over time. However, ADHD is still relatively under-recognised and underdiagnosed in most countries, particularly in girls and older children. ADHD often persists into adulthood and is a risk factor for other mental health disorders and negative outcomes, including educational underachievement, difficulties with employment and relationships, and criminality. The timely recognition and treatment of children with ADHD-type difficulties provides an opportunity to improve long-term outcomes. This Review includes a systematic review of the community and administrative prevalence of ADHD in children and adolescents, an overview of barriers to accessing care, a description of associated costs, and a discussion of evidence-based pathways for the delivery of clinical care, including a focus on key issues for two specific age groups—younger children (aged ≤6 years) and adolescents requiring transition of care from child to adult services.
Thomas et al. (2015)
METHODS: Medline, PsycINFO, CINAHL, Embase, and Web of Science were searched for studies with point prevalence estimates of ADHD. We included studies of children that used the diagnostic criteria from DSM-III, DSM-III-R and DSM-IV in any language. Data were extracted on sampling procedure, sample characteristics, assessors, measures, and whether full or partial criteria were met.
RESULTS: The 175 eligible studies included 179 ADHD prevalence estimates with an overall pooled estimate of 7.2% (95% confidence interval: 6.7 to 7.8), and no statistically significant difference between DSM editions. In multivariable analyses, prevalence estimates for ADHD were lower when using the revised third edition of the DSM compared with the fourth edition (P = .03) and when studies were conducted in Europe compared with North America (P = .04). Few studies used population sampling with random selection. Most were from single towns or regions, thus limiting generalizability.
CONCLUSIONS: Our review provides a benchmark prevalence estimate for ADHD. If population estimates of ADHD diagnoses exceed our estimate, then overdiagnosis may have occurred for some children. If fewer, then underdiagnosis may have occurred.
Willcutt (2012)
This article describes a comprehensive meta-analysis that was conducted to estimate the prevalence of attention-deficit/hyperactivity disorder (ADHD), as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). A systematic literature review identified 86 studies of children and adolescents (N = 163,688 individuals) and 11 studies of adults (N = 14,112 individuals) that met inclusion criteria for the meta-analysis, more than half of which were published after the only previous meta-analysis of the prevalence of ADHD was completed. Although prevalence estimates reported by individual studies varied widely, pooled results suggest that the prevalence of DSM-IV ADHD is similar, whether ADHD is defined by parent ratings, teacher ratings, or a best estimate diagnostic procedure in children and adolescents (5.9–7.1 %), or by self-report measures in young adults (5.0 %). Analyses of diagnostic subtypes indicated that the predominantly inattentive type is the most common subtype in the population, but individuals with the combined type are more likely to be referred for clinical services. Additional research is needed to determine the etiology of the higher prevalence of ADHD in males than females and to clarify whether the prevalence of ADHD varies as a function of socioeconomic status or ethnicity. Finally, there were no significant prevalent differences between countries or regions of the world after controlling for differences in the diagnostic algorithms used to define ADHD. These results provide important support for the diagnostic validity of ADHD, and argue against the hypothesis that ADHD is a cultural construct that is restricted to the United States or any other specific culture.
Simon et al. (2009)
Method
We used the MEDLINE, PsycLit and EMBASE databases as well as hand-searching to find relevant publications.
Results
The pooled prevalence of adult ADHD was 2.5% (95% CI 2.1–3.1). Gender and mean age, interacting with each other, were significantly related to prevalence of ADHD. Metaregression analysis indicated that the proportion of participants with ADHD decreased with age when men and women were equally represented in the sample.
Conclusions
Prevalence of ADHD in adults declines with age in the general population. We think, however, that the unclear validity of DSM–IV diagnostic criteria for this condition can lead to reduced prevalence rates by underestimation of the prevalence of adult ADHD.
Polanczyk et al. (2014)
Methods: We updated the two most comprehensive systematic reviews on ADHD prevalence available in the literature. Meta-regression analyses were conducted to test the effect of year of study in the context of both methodological variables that determined variability in ADHD prevalence (diagnostic criteria, impairment criterion and source of information), and the geographical location of studies.
Results: We identified 154 original studies and included 135 in the multivariate analysis. Methodological procedures investigated were significantly associated with heterogeneity of studies. Geographical location and year of study were not associated with variability in ADHD prevalence estimates.
Conclusions: Confirming previous findings, variability in ADHD prevalence estimates is mostly explained by methodological characteristics of the studies. In the past three decades, there has been no evidence to suggest an increase in the number of children in the community who meet criteria for ADHD when standardized diagnostic procedures are followed.
Barkley (2003)
This paper provides a brief overview of the nature of attention-deficit/hyperactivity disorder (ADHD) in children and the current criteria used in its clinical diagnosis. While the disorder continues to be viewed as one of inattention and/or hyperactive-impulsive behavior, theories of ADHD are beginning to focus more on poor inhibition and deficient executive functioning (self-regulation) as being central to the disorder. Problems have been identified by research pertaining to the clinical diagnostic criteria outlined in the DSM-IV that, at present, remain unresolved. Clinicians should be aware of these problems and the adjustments that need to be made to them when dealing with special populations that were not represented in the field trials used to develop these criteria.
Li et al. (2018)
Despite many studies reporting a variety of alterations in brain networks in patients with attention deficit hyperactivity disorder (ADHD), alterations in hemispheric anatomical networks are still unclear. In this study, we investigated topology alterations in hemispheric white matter in patients with ADHD and the relationship between these alterations and clinical features of the illness. Weighted hemispheric brain anatomical networks were first constructed for each of 40 right-handed patients with ADHD and 53 matched normal controls. Then, graph theoretical approaches were utilized to compute hemispheric topological properties. The small-world property was preserved in the hemispheric network. Furthermore, a significant group-by-hemisphere interaction was revealed in global efficiency, local efficiency and characteristic path length, attributed to the significantly reduced hemispheric asymmetry of global and local integration in patients with ADHD compared with normal controls. Specifically, reduced asymmetric regional efficiency was found in three regions. Finally, we found that the abnormal asymmetry of hemispheric brain anatomical network topology and regional efficiency were both associated with clinical features (the Adult ADHD Self-Report Scale and Wechsler Adult Intelligence Scale) in patients. Our findings provide new insights into the lateralized nature of hemispheric dysconnectivity and highlight the potential for using brain network measures of hemispheric asymmetry as neural biomarkers for ADHD and its clinical features.
Dorr and Armstrong (2019)
Objective: To better understand current issues with adult ADHD assessment contributing to adult ADHD being under recognized and undertreated. Method: This study examined the relationship between symptoms, impairment, and executive functioning (EF) in a college sample. Results: Among individuals screening negative for ADHD, those higher in EF experienced significantly less impairment than those lower in EF. Executive functioning was shown to have a negative relationship with impairment while ADHD symptomology was shown to have a positive relationship with impairment. In addition, impairment was significantly predicted by ADHD symptom level and EF, and there was a significant interaction between EF and ADHD symptom level in predicting impairment. However, high EF did not significantly protect against impairment in individuals reporting a significant level of ADHD symptoms. Conclusion: Further research is needed to clarify the relationships between these variables in emerging adult college students.
Tamm et al. (2019)
Reaction time variability (RTV) is a ubiquitous phenomenon in Attention-Deficit/Hyperactivity Disorder (ADHD). Few studies have examined RTV in relation to functional outcomes such as social impairment in children with ADHD. In this exploratory study, we investigated whether RTV is associated with social functioning in children at risk for ADHD. Specifically, we explored the association between RTV (tau derived from correct go trials of a Stop-Signal task) and social functioning in 198 children ages 7-12 years referred for an ADHD evaluation. Social functioning measures included child and/or parent ratings of social competence, aggression, social problems, and impairment in relationships. In regression analyses that also included Oppositional Defiant Disorder symptoms and sex, higher RTV was significantly associated with lower ratings of social competence, and higher proactive/reactive aggression ratings on the child self-report measures. RTV was not significantly associated with parent report of social functioning or relationship impairment. This study provides preliminary evidence that RTV may be associated with social functioning in children at risk for ADHD. We propose that lapses of attention affecting cognitive control may also negatively impact social information processing thereby affecting social functioning. Replication is warranted and longitudinal studies are needed to investigate whether RTV predicts social dysfunction in ADHD.
Larsson (2019)
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Lin and Gau (2019)
Methods
We followed up 53 individuals diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) ADHD during childhood (mean age 12.77 years at time 1, 19.81 years at time 2) and 50 non-ADHD controls (mean age 12.80 years at time 1, 19.36 years at time 2) with repeated psychiatric interviews at two time points to confirm ADHD and other psychiatric diagnoses. Neuropsychological functions with high- and low-executive demands, measured by the Cambridge Neuropsychological Testing Automated Battery (CANTAB) at two time points, were compared.
Results
Both groups showed improvements in all neuropsychological tasks except reaction time in the ADHD group. Despite having a greater improvement in spatial working memory (SWM) than controls, individuals with ADHD still performed worse in various neuropsychological tasks than controls at follow-up. Better baseline intra-dimension/extra-dimension shift and parental occupation predicted fewer ADHD symptoms at follow-up independent of baseline ADHD symptoms. The degree of ADHD symptom reduction was not significantly linearly correlated to the magnitude of neuropsychological function improvement.
Conclusion
Individuals with ADHD and controls had parallel developments in neuropsychological functioning, except a catch-up in SWM in ADHD. Almost all neuropsychological functions herein were still impaired in ADHD at late adolescence/young adulthood. There may be a threshold (i.e. non-linear) relationship between neuropsychological functioning and ADHD symptoms.
Brocki et al. (2017)
Objective: The role of heterogeneous self-regulation deficits in ADHD has long been emphasized. Yet, longitudinal studies examining distinct self-regulation processes as prospective predictors of developmental change in ADHD symptoms spanning wide developmental periods are scarce. The aim of the current study was to examine affective and cognitive self-regulation as predictors of developmental change in ADHD symptoms from preschool to adolescence in a sample with one third of the children being at risk for developing an ADHD and/or ODD diagnosis. Method: At 5 years laboratory measures for hot and cool executive function (EF) and parental and teacher ratings were used for regulation of positive and negative emotionality. Symptoms of ADHD and ODD were measured at 5 and 13 years using parental and teacher ratings based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV). Results: Converging developmental paths in hyperactivity/impulsivity across time were found for those high versus low in early cognitive self-regulation, whereas the development of inattention symptoms diverged across time for those high versus low in early affective self-regulation. Conclusion: These results support the idea that different aspects of self-regulation are important for developmental change in the two separate ADHD symptom domains from preschool to adolescence.
Willcutt (2019)
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Lapalme et al. (2017)
The developmental course of attention-deficit/hyperactivity disorder (ADHD) symptoms (inattention, hyperactivity, impulsivity) from childhood to adolescence was described and compared based on parent and teacher report as a function of co-occurring conduct disorder/oppositional defiant disorder (CD/ODD) over 6 years. The moderating effect of gender was investigated. Participants were 291 children (6–13 years old; 79 girls) with ADHD: 91 with ADHD only and 200 with ADHD+CD/ODD. At study entry, boys and girls in the ADHD+CD/ODD group presented significantly more hyperactivity symptoms based on parent report and more impulsivity symptoms based on teacher report than did those in the ADHD-only group. ADHD symptoms, however, diminished on average over time in both groups, according to both parent and teacher report. However, as children in the ADHD+CD/ODD group, particularly girls, presented more symptoms at study entry, they tended to remain above the diagnostic threshold 6 years later. This suggests an association exists between co-occurring CD/ODD and ADHD persistence.
Faraone and Larsson (2019)
Decades of research show that genes play an vital role in the etiology of attention deficit hyperactivity disorder (ADHD) and its comorbidity with other disorders. Family, twin, and adoption studies show that ADHD runs in families. ADHD’s high heritability of 74% motivated the search for ADHD susceptibility genes. Genetic linkage studies show that the effects of DNA risk variants on ADHD must, individually, be very small. Genome-wide association studies (GWAS) have implicated several genetic loci at the genome-wide level of statistical significance. These studies also show that about a third of ADHD’s heritability is due to a polygenic component comprising many common variants each having small effects. From studies of copy number variants we have also learned that the rare insertions or deletions account for part of ADHD’s heritability. These findings have implicated new biological pathways that may eventually have implications for treatment development.
Attention deficit hyperactivity disorder (ADHD) is a childhood-onset condition with impairing symptoms of inattention, impulsivity, and hyperactivity. Decades of research have documented and replicated key facts about the disorder (for a review, see ref. [1]). It occurs in about 5% of children with little geographic or cross-cultural variation in prevalence and often co-occurs with other conditions, including mood, anxiety, conduct, learning, and substance use disorders. Longitudinal studies show that two-thirds of ADHD youth will continue to have impairing symptoms of ADHD in adulthood. People with ADHD are at risk for a wide range of functional impairments: school failure, peer rejection, injuries due to accidents, criminal behavior, occupational failure, divorce, suicide, and premature death. Although many details of ADHD’s pathophysiology are unknown, neuropsychological and neuroimaging studies implicate brain circuits regulating executive functioning, reward processing, timing, and temporal information processing.
This article reviews data about the role that genes play in the etiology of ADHD from two perspectives. Family, twin, and adoption studies provide a firm foundation for asserting that genes are involved in the etiology of ADHD. The view from molecular genetics provides a basis for understanding mechanisms whereby genes affect biological pathways that lead to ADHD.
Quiroga et al. (2016)
Objective: The aim of this study was to assess for the first time the criterion validity of the semi-structured Diagnostic Interview for ADHD in adults (DIVA 2.0), and its concurrent validity in comparison with the Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID) and other ADHD severity scales, following the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria. Method: A transversal study was performed on 40 out-patients with ADHD to check the criteria and concurrent validity of the DIVA 2.0 compared with the CAADID. Results: The DIVA 2.0 interview showed a diagnostic accuracy of 100% when compared with the diagnoses obtained with the CAADID interview. The concurrent validity demonstrated good correlations with three self-reported rating scales: the Wender Utah Rating Scale (WURS; r = .544, p < .0001), the ADHD-Rating Scale (r = .720, p < .0001), and Sheehan’s Dysfunction Inventory (r = .674, p < .0001). Conclusion: The DIVA 2.0 is a reliable tool for assessing and diagnosing Adult ADHD and is the only one that offers free online access for clinical and research purposes.
Asherson et al. (2016)
For many years, attention-deficit hyperactivity disorder (ADHD) was thought to be a childhood-onset disorder that has a limited effect on adult psychopathology. However, the symptoms and impairments that define ADHD often affect the adult population, with similar responses to drugs such as methylphenidate, dexamphetamine, and atomoxetine, and psychosocial interventions, to those seen in children and adolescents. As a result, awareness of ADHD in adults has rapidly increased and new clinical practice has emerged across the world. Despite this progress, treatment of adult ADHD in Europe and many other regions of the world is not yet common practice, and diagnostic services are often unavailable or restricted to a few specialist centres. This situation is remarkable given the strong evidence base for safe and effective treatments. Here we address some of the key conceptual issues surrounding the diagnosis of ADHD relevant to practising health-care professionals working with adult populations. We conclude that ADHD should be recognised in the same way as other common adult mental health disorders, and that failure to recognise and treat ADHD is detrimental to the wellbeing of many patients seeking help for common mental health problems.
Salvi et al. (2019)
Introduction. Attention Deficit Hyperactivity Disorder (ADHD) is an early onset clinical condition characterized by attention difficulties, hyperactivity and impulsivity which can persist across the lifespan, significantly influencing the evolutionary course and facilitating the rise of psychiatric comorbidities. The presence of different ADHD subtypes in adults is a heterogeneity factor to be recognized in order to orient prognosis and treatment, as indicated by studies that described differences in the characterization of different subtypes in relation to both severity and comorbidities. Materials and methods. In the present study we evaluated the socio-demographic and clinical characteristics of a sample of adults with ADHD and the characteristics associated with the different disorder subtypes. We described 60 patients aged between 18 and 65 years (mean age 34.1) with primary diagnosis of ADHD consecutively admitted to the Regional Centre for diagnosis and treatment of ADHD in adults in Milan. Results. We observed high severity of symptoms and low quality of life, in particular in the “life outlook” dimension. The subtypes distribution was the following: 18.3% inattentive subtype, 8.3% hyperactive/impulsive subtype and 70% combined subtype. The hyperactive/impulsive subtype showed a significantly higher frequency in females, while the inattentive subtype was more frequent in males. Patients with the hyperactive/impulsive subtype showed worse quality of life and more frequent anxiety disorders. Conclusions. Considering the different clinical profiles among various subtypes, these data add relevance to subtypes classification of adult ADHD.
Abecassis et al. (2017)
Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder that persists into adulthood for many individuals. Research on the disorder, however, has largely focused on childhood or on adulthood but spanning a very broad age range. Emerging adulthood, conceptualized as the period between 18 and 29 years of age, has been identified as a distinct developmental stage. To date, there is relatively little research focused specifically on ADHD in that period of life. In the present paper, we provide an overview of the characteristics of ADHD in emerging adults. The prevalence of ADHD in this stage of life appears to be slightly higher than typically found in studies with adult samples of broader age range. ADHD in emerging adults is associated with a variety of negative outcomes such as poorer academic and occupational functioning, psychiatric comorbidities, alcohol and substance use, as well as stimulant misuse. Studies using neuropsychological tests have generally reported average to high average intellectual functioning, variable performance on measures of attention, and generally intact scores on most measures of executive functions. In contrast, a small number of studies indicate the presence of subjective executive dysfunction. Methodological limitations that likely contribute to heterogeneity in the literature are discussed.
Fruchter et al. (2019)
Objective: To assess the functioning of young adults with ADHD in a military setting. Method: In all, 14,655 young adults with ADHD (mean age at first examination 17.8 +/- 0.7) attending mandatory service in the Israeli military were compared with matched controls on several functioning domains. Results: Young adults with ADHD had more sessions with mental health care professionals, physician appointments, sick days, and disqualifications of professions than controls (p < .001). Young adults with ADHD were also less medically fit for combat service (odds ratio [OR] = 0.75, 95% confidence interval [CI] = [0.72, 0.79]), more medically unfit for military service in general (OR = 1.26, 95% CI = [1.13, 1.40]), and had higher rates of overweight and obesity (p < .001). In addition, they were more likely to be diagnosed with a personality disorder (OR = 1.29, 95% CI = [1.07, 1.53]) or with minor affective and anxiety disorders (OR = 1.33, 95% CI = [1.06, 1.67]) than matched controls. Conclusion: These results support a negative effect of ADHD on the functioning of young adults in a military setting.
Thorell et al. (2019)
Purpose and aim: The overall aim of the present study was to examine quality of life in attention deficit hyperactivity disorder (ADHD) patients age >= 60 years. First, we compared older adults with ADHD to both healthy controls of the same age and younger adults with ADHD. Second, we examined executive functioning as a possible underlying factor for quality of life among older adults with ADHD. Methods: The study included 158 participants in three groups: (1) older adults (60-75 years of age) with ADHD (n = 42), (2) healthy controls of the same age (n = 58), and (3) younger adults (age 18-45 years of age) with ADHD (n = 56). The patients with ADHD were clinically-referred. Quality of life was examined through self-ratings and executive functioning was examined using both self-ratings and tests. Results: Older adults with ADHD differed significantly from controls the same age on all aspects of quality of life, with large effect sizes. However, they showed similar levels of quality of life compared to younger adults with ADHD. The exception was psychological health, for which older adults displayed better quality of life compared to younger adults with ADHD. Executive deficits measured through self-ratings, especially working memory, were related to quality of life, sometimes also beyond the influence of ADHD symptom levels. Conclusions: Older adults with ADHD show serious impairments in quality of life, that are comparable to the levels found for younger adults. Impairments may increase further as these individuals grow older and clinics need to meet the needs of this increasingly larger group of patients.
