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Adler, Lenard A. "Adult ADHD." Psychiatric Annals 47, no. 7 (July 1, 2018): 316. http://dx.doi.org/10.3928/00485713-20180605-02.
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QUIROS, GUILLERMO B., and MARCEL KINSBOURNE. "Adult ADHD." Annals of the New York Academy of Sciences 931, no. 1 (January 25, 2006): 140–47. http://dx.doi.org/10.1111/j.1749-6632.2001.tb05777.x.
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KINSBOURNE, MARCEL, GUILLERMO B. QUIROS, and DOLORES TOCCI RUFO. "Adult ADHD." Annals of the New York Academy of Sciences 931, no. 1 (January 25, 2006): 287–96. http://dx.doi.org/10.1111/j.1749-6632.2001.tb05785.x.
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Stein, Mark A. "Treating Adult ADHD with Stimulants." CNS Spectrums 13, S13 (2008): 8–11. http://dx.doi.org/10.1017/s1092852900026845.
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AbstractTreatment of attention-deficit/hyperactivity disorder (ADHD) may positively impact the neurobiology of adult patients with ADHD. Treatment may also minimize impairment from core symptoms and may alter the course of co-morbid disorders such as depression and substance use disorder. However, much of the information on stimulant use in adult ADHD comes from studies conducted in children, and it remains unclear whether there is a difference between children and adults when it comes to the side effects and tolerability of ADHD treatments. It is known that clinical presentation differs between adults and children, with adults demonstrating a higher percentage of mood disorders. Current treatments for adult ADHD include psychosocial therapies and pharmacologic therapies, the latter of which include the stimulants d-methylphenidate extended release (XR), OROS methylphenidate, lisdexamfetamine, and mixed amphetamine salts XR; and the nonstimulant atomoxetine, a selective norepinephrine reuptake inhibitor. There is need for additional study of treatment strategies for adult ADHD. Although all classes of ADHD medications are approved in adults, there are fewer approved formulations for adults than for children. Efficacy in adults is more subjective than in children, which may affect how efficacy rates for adult treatments are calculated. Adults also present a greater diversion risk than children. In addition, there are several new and emerging medication treatments worth considering.This Expert Roundtable Supplement represents part 2 of a 3-part supplement series on adult ADHD led by Lenard A. Adler, MD. In this activity, Thomas J. Spencer, MD, discusses the neurobiology and genetics of adult ADHD; Mark A. Stein, PhD, discusses stimulant therapy; and Jeffrey H. Newcorn, MD, reviews nonstimulants and psychosocial treatments.
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Rolland, B., D. Da Fonseca, M. Fatseas, and N. Simon. "Attention-deficit/hyperactivity disorder (ADHD) in adults: Specific clinical and therapeutic issues." European Psychiatry 30, S2 (November 2015): S27—S28. http://dx.doi.org/10.1016/j.eurpsy.2015.09.083.
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Attention-deficit/hyperactivity disorder (ADHD) was initially considered as a childhood psychiatric disorder. However, longitudinal observations have revealed that ADHD symptoms may persist in adulthood among approximately 50% of the patients . Adult ADHD is associated with impaired social outcome and frequent comorbidities such as mood disorders, personality disorders, and substance use disorders [2,3]. Correctly identifying and treating ADHD can significantly improve the global functioning and cognition of adult subjects, and reduce the intensity and frequency of the comorbid states [2,3]. Nonetheless, the clinical features of adult ADHD are clearly different from the youth form [1,2], and ADHD symptoms are easily mixed up in adults with symptoms of the comorbid conditions [2,3]. These clinical intricacies can make the diagnosis of ADHD difficult in adults. Moreover, the management of methylphenidate in adult subjects is also associated with specific risks and pitfalls, such as abuse and tampering behaviors, and additional safety risks . Put together, it appears crucial to identify and treat ADHD in adults, but the clinical and therapeutic complexities of adult ADHD require improved expertise and caution from adult psychiatrists and addiction specialists. In this thematic session of the 2015 French Psychiatry Congress, three French leading experts of adult ADHD will address the aforementioned clinical and therapeutic issues of the adulthood form of this disorder. David Da Fonseca, professor of child psychiatry in Marseille, will disentangle the clinical features of adult ADHD from the typical symptoms observed in the youth form. Mélina FATSEAS, associate professor of psychiatry and addiction medicine in Bordeaux, will specifically focus on the many and complex relationships observed between adult ADHD and substance use disorders. Last, Nicolas Simon, professor of addiction medicine and psychopharmacology in Marseille, will synthesize what are the very risks and issues with prescribing methylphenidate in adults.
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Spencer, Thomas J. "Pharmacology of Adult ADHD with Stimulants." CNS Spectrums 12, S6 (2007): 8–11. http://dx.doi.org/10.1017/s1092852900026018.
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AbstractAttention-deficit/hyperactivity disorder (ADHD) is a lifelong condition that begins in childhood and continues with adult manifestations related to the core symptoms. Approximately 50% to 75% of children with ADHD continue to meet criteria for the disorder as adolescents and adults. Adults with the disorder increasingly present to primary care physicians, psychiatrists, and other practitioners for diagnosis and treatment. Understanding the diagnosis of ADHD in adults requires knowledge of age-dependent decline of symptoms over time. Retrospective recall of symptoms and impairment are valid methods of diagnosing the disorder. ADHD is also a brain disorder with a strong neurobiologic basis, complex etiology, and genetic component. Genetic and environmental vulnerabilities give rise to abnormalities in the brain and subsequent behavioral and cognitive deficits, which may produce the symptoms associated with ADHD. Magnetic resonance imaging studies of ADHD have provided evidence that abnormalities in the brain are caused by the disorder itself rather than treatment of the disorder. Psychiatric comorbidity is common among patients with ADHD and tends to complicate treatment. Acute and long-term use of long-acting stimulant formulations (methylphenidate and amphetamine compounds) have shown robust efficacy and tolerability consistent with the treatment response established in children with ADHD. Non-stimulant medications have demonstrated efficacy as well, and may be preferred in patients with tic and substance use disorders.In this expert roundtable supplement, Timothy E. Wilens, MD, reviews the epidemiology and clinical presentation of adult ADHD. Next, Joseph Biederman, MD, provides an overview of recent advances in the neurobiology of ADHD. Thomas J. Spencer, MD, reviews stimulant treatment of adult ADHD, and Lenard A. Adler concludes with a discussion of non-stimulant trials in adult ADHD.
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Adler, Lenard A. "Non-Stimulant Trials of Adult ADHD." CNS Spectrums 12, S6 (2007): 11–13. http://dx.doi.org/10.1017/s109285290002602x.
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AbstractAttention-deficit/hyperactivity disorder (ADHD) is a lifelong condition that begins in childhood and continues with adult manifestations related to the core symptoms. Approximately 50% to 75% of children with ADHD continue to meet criteria for the disorder as adolescents and adults. Adults with the disorder increasingly present to primary care physicians, psychiatrists, and other practitioners for diagnosis and treatment. Understanding the diagnosis of ADHD in adults requires knowledge of age-dependent decline of symptoms over time. Retrospective recall of symptoms and impairment are valid methods of diagnosing the disorder. ADHD is also a brain disorder with a strong neurobiologic basis, complex etiology, and genetic component. Genetic and environmental vulnerabilities give rise to abnormalities in the brain and subsequent behavioral and cognitive deficits, which may produce the symptoms associated with ADHD. Magnetic resonance imaging studies of ADHD have provided evidence that abnormalities in the brain are caused by the disorder itself rather than treatment of the disorder. Psychiatric comorbidity is common among patients with ADHD and tends to complicate treatment. Acute and long-term use of long-acting stimulant formulations (methylphenidate and amphetamine compounds) have shown robust efficacy and tolerability consistent with the treatment response established in children with ADHD. Non-stimulant medications have demonstrated efficacy as well, and may be preferred in patients with tic and substance use disorders.In this expert roundtable supplement, Timothy E. Wilens, MD, reviews the epidemiology and clinical presentation of adult ADHD. Next, Joseph Biederman, MD, provides an overview of recent advances in the neurobiology of ADHD. Thomas J. Spencer, MD, reviews stimulant treatment of adult ADHD, and Lenard A. Adler concludes with a discussion of non-stimulant trials in adult ADHD.
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Edwin, Febin, and Joe McDonald. "Services for adults with attention-deficit hyperactivity disorder: national survey." Psychiatric Bulletin 31, no. 8 (August 2007): 286–88. http://dx.doi.org/10.1192/pb.bp.106.012237.
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Aims and MethodThe aim of the study was to obtain numbers of adult patients with attention-deficit hyperactivity disorder (ADHD) on consultant adult and adolescent psychiatrists' case-loads. A brief semi-structured confidential postal questionnaire was sent to 1947 consultant psychiatrists in England and Wales.ResultsThere were 1030 consultants who responded (52.9%), which clearly indicates that there is an increasing demand and need for a service, and the resources, to treat adult ADHD. Only 197 consultants offered a service for adults with ADHD. Adult ADHD is more commonly diagnosed in males (n=995, 73%), and the total number of patients with a diagnosis of adult ADHD was 1345. Most patients were aged 18–25 years (n=209, 54%). The most commonly prescribed stimulant medication was methylphenidate (n=251, 55%).Clinical ImplicationsThere is a clear need to improve services and funding for adults with ADHD. The study shows there are already services available for adult ADHD patients in some areas of the country. However, more research is needed to establish the prevalence of adult ADHD in England and Wales.
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Kooij, J. J. S., D. Bijlenga, L. Salerno, R. Jaeschke, I. Bitter, J. Balázs, J. Thome, et al. "Updated European Consensus Statement on diagnosis and treatment of adult ADHD." European Psychiatry 56, no. 1 (November 16, 2018): 14–34. http://dx.doi.org/10.1016/j.eurpsy.2018.11.001.
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AbstractBackground Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.
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Asherson, Philip, Wai Chen, Bridget Craddock, and Eric Taylor. "Adult attention-deficit hyperactivity disorder: recognition and treatment in general adult psychiatry." British Journal of Psychiatry 190, no. 1 (January 2007): 4–5. http://dx.doi.org/10.1192/bjp.bp.106.026484.
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SummaryAttention-deficit hyperactivity disorder (ADHD) is a common disorder affecting children and adults. Many young people treated with stimulants, as well as those in whom ADHD went unrecognised in childhood, need treatment as adults. Stimulants and atomoxetine effectively reduce ADHD symptoms at all ages and should be a standard treatment in general adult psychiatric practice.
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Stein, Mark A. "Medical Mimics and Differential Diagnosis in Adult ADHD." CNS Spectrums 13, S15 (October 2008): 14–16. http://dx.doi.org/10.1017/s1092852900003278.
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When performing a diagnostic evaluation for an adult patient with possible adult attention-deficit/hyperactivity disorder (ADHD), clinicians must pay particular attention to possible mimics. ADHD mimics are conditions responsible for the symptoms or impairments that superficially resemble, and may be confused with ADHD. These mimics may produce symptoms and impairments similar to those seen in adults with ADHD, but differ in etiology, course, or response to treatment of ADHD. When evaluating someone for ADHD, clinicians should first rule out the possibility of medical, psychiatric, and social mimics of ADHD.
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Adler, Lenard A. "Neurobiology, Pharmacology, and Emerging Treatment." CNS Spectrums 13, S13 (2008): 4. http://dx.doi.org/10.1017/s1092852900026821.
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AbstractTreatment of attention-deficit/hyperactivity disorder (ADHD) may positively impact the neurobiology of adult patients with ADHD. Treatment may also minimize impairment from core symptoms and may alter the course of co-morbid disorders such as depression and substance use disorder. However, much of the information on stimulant use in adult ADHD comes from studies conducted in children, and it remains unclear whether there is a difference between children and adults when it comes to the side effects and tolerability of ADHD treatments. It is known that clinical presentation differs between adults and children, with adults demonstrating a higher percentage of mood disorders. Current treatments for adult ADHD include psychosocial therapies and pharmacologic therapies, the latter of which include the stimulants d-methylphenidate extended release (XR), OROS methylphenidate, lisdexamfetamine, and mixed amphetamine salts XR; and the nonstimulant atomoxetine, a selective norepinephrine reuptake inhibitor. There is need for additional study of treatment strategies for adult ADHD. Although all classes of ADHD medications are approved in adults, there are fewer approved formulations for adults than for children. Efficacy in adults is more subjective than in children, which may affect how efficacy rates for adult treatments are calculated. Adults also present a greater diversion risk than children. In addition, there are several new and emerging medication treatments worth considering.This Expert Roundtable Supplement represents part 2 of a 3-part supplement series on adult ADHD led by Lenard A. Adler, MD. In this activity, Thomas J. Spencer, MD, discusses the neurobiology and genetics of adult ADHD; Mark A. Stein, PhD, discusses stimulant therapy; and Jeffrey H. Newcorn, MD, reviews nonstimulants and psychosocial treatments.
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Spencer, Thomas J. "Neurobiology and Genetics of ADHD in Adults." CNS Spectrums 13, S13 (2008): 5–7. http://dx.doi.org/10.1017/s1092852900026833.
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AbstractTreatment of attention-deficit/hyperactivity disorder (ADHD) may positively impact the neurobiology of adult patients with ADHD. Treatment may also minimize impairment from core symptoms and may alter the course of co-morbid disorders such as depression and substance use disorder. However, much of the information on stimulant use in adult ADHD comes from studies conducted in children, and it remains unclear whether there is a difference between children and adults when it comes to the side effects and tolerability of ADHD treatments. It is known that clinical presentation differs between adults and children, with adults demonstrating a higher percentage of mood disorders. Current treatments for adult ADHD include psychosocial therapies and pharmacologic therapies, the latter of which include the stimulants d-methylphenidate extended release (XR), OROS methylphenidate, lisdexamfetamine, and mixed amphetamine salts XR; and the nonstimulant atomoxetine, a selective norepinephrine reuptake inhibitor. There is need for additional study of treatment strategies for adult ADHD. Although all classes of ADHD medications are approved in adults, there are fewer approved formulations for adults than for children. Efficacy in adults is more subjective than in children, which may affect how efficacy rates for adult treatments are calculated. Adults also present a greater diversion risk than children. In addition, there are several new and emerging medication treatments worth considering.This Expert Roundtable Supplement represents part 2 of a 3-part supplement series on adult ADHD led by Lenard A. Adler, MD. In this activity, Thomas J. Spencer, MD, discusses the neurobiology and genetics of adult ADHD; Mark A. Stein, PhD, discusses stimulant therapy; and Jeffrey H. Newcorn, MD, reviews nonstimulants and psychosocial treatments.
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Newcorn, Jeffrey H. "Nonstimulants and Emerging Treatments in Adults with ADHD." CNS Spectrums 13, S13 (2008): 12–16. http://dx.doi.org/10.1017/s1092852900026857.
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AbstractTreatment of attention-deficit/hyperactivity disorder (ADHD) may positively impact the neurobiology of adult patients with ADHD. Treatment may also minimize impairment from core symptoms and may alter the course of co-morbid disorders such as depression and substance use disorder. However, much of the information on stimulant use in adult ADHD comes from studies conducted in children, and it remains unclear whether there is a difference between children and adults when it comes to the side effects and tolerability of ADHD treatments. It is known that clinical presentation differs between adults and children, with adults demonstrating a higher percentage of mood disorders. Current treatments for adult ADHD include psychosocial therapies and pharmacologic therapies, the latter of which include the stimulants d-methylphenidate extended release (XR), OROS methylphenidate, lisdexamfetamine, and mixed amphetamine salts XR; and the nonstimulant atomoxetine, a selective norepinephrine reuptake inhibitor. There is need for additional study of treatment strategies for adult ADHD. Although all classes of ADHD medications are approved in adults, there are fewer approved formulations for adults than for children. Efficacy in adults is more subjective than in children, which may affect how efficacy rates for adult treatments are calculated. Adults also present a greater diversion risk than children. In addition, there are several new and emerging medication treatments worth considering.This Expert Roundtable Supplement represents part 2 of a 3-part supplement series on adult ADHD led by Lenard A. Adler, MD. In this activity, Thomas J. Spencer, MD, discusses the neurobiology and genetics of adult ADHD; Mark A. Stein, PhD, discusses stimulant therapy; and Jeffrey H. Newcorn, MD, reviews nonstimulants and psychosocial treatments
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Ramsay, J. Russell, and Anthony L. Rostain. "Adult ADHD Research." Journal of Attention Disorders 11, no. 6 (May 10, 2007): 624–27. http://dx.doi.org/10.1177/1087054708314590.
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Sevilla Vicente, J., I. Basurte Villamor, A. Sedano Capdevila, M. Migoya Borja, R. Navarro Jímenez, and L. Serrano Marugan. "Adult ADHD diagnosis and binge eating disorder." European Psychiatry 41, S1 (April 2017): S485. http://dx.doi.org/10.1016/j.eurpsy.2017.01.578.
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The association between attention deficit hyperactivity disorder (ADHD) and eating disorders has not been yet clarified. The presence of ADHD was significantly correlated with more severe binge eating, bulimic behaviors, and depressive symptomatology. The aim of this work is to study the relationship between ADHD subtypes in adults and the risk of food addiction (binge eating disorder).The sample was collected on a specific program for adults with ADHD diagnosis in Madrid (Spain). In total, the sample was 110 patients, and we collected information about socio-demographic factors. All patients met DSM-5 criteria for ADHD in different subtypes. We used the conner's Adult ADHD rating scales and the Barrat impulsiveness scale. Also we used the Shorter Promise Questionnaire. This is a 16 scale self-report instrument to measure an individual's level of addictive tendency.The 36.4% were at high risk of developing a food addiction. For binge eating disorder (BE), no statistically significant differences were found by gender within patients with ADHD.Binge eating was significantly related to the impulsivity and emotional liability subscale of the CAARS (P < 0.05). The risk of develop BE in ADHD was 4.7 (CI 95% 1.8–12.07). Binge eating was significantly related to the total score on the Barrat scale (P < 0.05) Risk of 3,5 (CI 95% 1.5–7.9) and within the subtypes of impulsivity, motor impulsiveness was the one that was significantly related to BE (P < 0.001)There is a clear relationship between impulsiveness symptoms and BE in patients with ADHD. It's important to note that there are no gender differences within ADHA patients to develop a BE disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Matthies, Swantje, Chiharu Sadohara-Bannwarth, Sebastian Lehnhart, Jan Schulte-Maeter, and Alexandra Philipsen. "The Impact of Depressive Symptoms and Traumatic Experiences on Quality of Life in Adults With ADHD." Journal of Attention Disorders 22, no. 5 (September 2, 2016): 486–96. http://dx.doi.org/10.1177/1087054716654568.
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Objective: We assessed factors influencing quality of life (QoL) in adults with ADHD. Method: QoL, traumatic childhood experiences, and depression were assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Childhood Trauma Questionnaire (CTQ), and Beck Depression Inventory (BDI), respectively, in 60 adult ADHD outpatients and 60 age- and gender-matched controls. Results: Emotional neglect or abuse had occurred significantly more often during childhood in adults with ADHD. Depressive symptoms were rated significantly higher by ADHD patients. QoL was significantly lower in adults with ADHD, and the variables depression, ADHD symptom severity, and traumatic load, accounted for ~60% of variance in overall QoL. Conclusion: QoL is significantly reduced in adult ADHD patients. Depressive symptoms and traumatic childhood experiences influence QoL. Treatment for adult ADHD patients should take the high interdependence of depressive symptoms, childhood trauma, and QoL into consideration.
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Stein, Mark A. "Impairment Associated with Adult ADHD." CNS Spectrums 13, S12 (August 2008): 9–11. http://dx.doi.org/10.1017/s1092852900003187.
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Attention-deficit/hyperactivity disorder (ADHD) is present in 4% to 6% of adults in the United States. In the National Co-morbidity Survey Replication, a diagnosis of ADHD was associated with greater marital problems, unemployment, difficulties in the workplace, and frequent workplace absence. Despite these findings, the body of knowledge regarding impairment in adult ADHD is far from complete. Building upon our knowledge of impairment in adults with ADHD will result in a broader range of treatment outcomes which may be measured and targeted.
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Zwi, Morris, and Ann York. "Attention-deficit hyperactivity disorder in adults: validity unknown1." Advances in Psychiatric Treatment 10, no. 4 (July 2004): 248–56. http://dx.doi.org/10.1192/apt.10.4.248.
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Attention-deficit hyperactivity disorder (ADHD) is a commonly diagnosed childhood psychiatric disorder. Debate over its diagnostic validity, aetiology, presentation and treatment has extended from the clinical to the public domain. As children with ADHD diagnoses reach adulthood there is increasing interest in ‘adult ADHD’. Cohorts followed up show poorer outcomes as adults than do controls. Self-referred adults, sometimes relatives of children with ADHD, are also of interest regarding adult ADHD. Innovative work is being done examining issues of aetiology, treatment, outcomes and comorbidity in these groups, but heterogeneity among those diagnosed with ADHD and changes in classification systems and diagnostic criteria over time complicate comparison of research findings. The diagnostic validity of adult ADHD remains uncertain and needs further study.
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Adler, Lenard A., Lauren R. Lynch, David M. Shaw, Samantha P. Wallace, Katherine E. O’Donnell, Michael A. Ciranni, Alexis M. Briggie, and Stephen V. Faraone. "Effectiveness and Duration of Effect of Open-Label Lisdexamfetamine Dimesylate in Adults With ADHD." Journal of Attention Disorders 21, no. 2 (July 28, 2016): 149–57. http://dx.doi.org/10.1177/1087054713485421.
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Objectives: (a) Evaluate the efficacy and duration of effect of lisdexamfetamine dimesylate (LDX) in adult ADHD. (b) Assess the reliability and validity of the Adult ADHD Medication Smoothness of Effect Scale (AMSES) and Adult ADHD Medication Rebound Scale (AMRS). Method: Adults ( N = 40) with ADHD were treated with LDX for up to 12 weeks. The primary efficacy measure was the ADHD Rating Scale (ADHD-RS). The psychometric properties of the AMSES and AMRS are analyzed and compared with the ADHD-RS, ADHD Self-Report Scale (ASRS) v1.1 Symptom Checklist, and Time-Sensitive ADHD Symptom Scale (TASS). Results: ADHD-RS scores were significantly improved with LDX. The AMSES and AMRS had high internal consistency and were correlated with the ADHD-RS, ASRS v1.1 Symptom Checklist, and TASS. Conclusion: LDX is effective in treating adult ADHD and has a smooth drug effect throughout the day with limited symptom rebound. The AMSES and AMRS are valid and reliable measures.
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Wymbs, Brian T. "Investigating Self-Control Resource Depletion as a Situational Risk Factor for Aversive Interpartner Communication by Young Adults With ADHD." Journal of Attention Disorders 25, no. 2 (June 4, 2018): 199–208. http://dx.doi.org/10.1177/1087054718779228.
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Objective: Adults with attention-deficit hyperactivity disorder (ADHD) have more conflictual relations with their romantic partners than adults without ADHD. This study investigated whether adults with ADHD are differentially susceptible to conflict when self-control resources are depleted. Method: Heterosexual adult couples (20 including at least one adult with ADHD; 12 including no adults with ADHD) were randomly assigned to have resources temporarily depleted or not. Positive and negative communication was assessed during a subsequent problem-solving task with their partners. Results: Adults with ADHD whose self-control resources were depleted communicated less positively and more negatively with their romantic partners than adults without ADHD whose resources were depleted. Conclusion: Adults with ADHD appear to have a differential susceptibility to interpartner discord when their self-control resources have been depleted. Clinicians seeking to remediate discordant romantic relationships of adults with ADHD should consider evaluating how often their resources needed to manage their impulses are depleted.
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Ponte, A., H. Prata Ribeiro, L. Carvalhão Gil, and D. Pereira. "A crossroad in ADHD – adult-onset ADHD." European Psychiatry 41, S1 (April 2017): S334. http://dx.doi.org/10.1016/j.eurpsy.2017.02.281.
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IntroductionAttention-deficit/hyperactivity disorder (ADHD) is a common disorder characterized by inattention or hyperactivity–impulsivity, or both. For a long time, ADHD was thought of as a disorder of children which would sometimes persist into adulthood. DSM 5 uses as a criterion that several symptoms have to be present prior to age 12 years.ObjectivesTo discuss the findings of 3 recent cohorts that show the onset of ADHD in adulthood.MethodsA review of selected articles of interest using PubMed database.Results3 large, longitudinal, population studies from Brazil, New Zealand (NZ) and the United Kingdom (UK) show that we are at a crossroads in our understanding of ADHD. In each study, the prevalence of adult-onset ADHD (Brazil, 10.3%; UK, 5.5%; and NZ, 2.7%) was much larger than the prevalence of childhood-onset adult ADHD (UK, 2.6%; Brazil, 1.5%; and NZ, 0.3%). They all propose different conclusions that would result in a paradigmatic shift in ADHD: in Brazil, that child and adult ADHD are “distinct syndromes”; in the UK, “that adult ADHD is more complex than a straightforward continuation of the childhood disorder” and in NZ, that adult ADHD is “not a neurodevelopmental disorder”. Faraone et al., in an editorial in JAMA Psychiatry, propose that these findings might correlate to subthreshold child ADHD before it emerges as adolescent- or adult-onset ADHD.ConclusionsIt's an exciting time in ADHD research. These new data work as an incentive to study adult-onset ADHD and how it emerges. Future research will shape our understanding of adult ADHD.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Adler, Lenard A. "Epidemiology, Impairments, and Differential Diagnosis in Adult ADHD: Introduction." CNS Spectrums 13, S12 (August 2008): 4–5. http://dx.doi.org/10.1017/s1092852900003163.
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In the mid-1970s, attention-deficit/hyperactivity disorder (ADHD) was still believed to be a childhood disorder that disappeared with the onset of adolescence. At this time, Wender studied a cohort of adults presenting with ADHD-like symptoms, all of whom had been diagnosed with ADHD in childhood. Wender prescribed psycho-stimulants, which successfully produced a response in the adults, thus fostering research into adult ADHD.
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O'Donnell, James P., Kathleen K. McCann, and Steve Pluth. "Assessing Adult ADHD Using a Self-Report Symptom Checklist." Psychological Reports 88, no. 3 (June 2001): 871–81. http://dx.doi.org/10.2466/pr0.2001.88.3.871.
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The self-ratings of DSM-IV ADHD symptoms by adults reporting a previous ADHD diagnosis were contrasted with ratings by controls matched for age and sex. Adults previously diagnosed with ADHD endorsed significantly more symptoms of inattention and of hyperactivity–impulsivity. Specifically, 13 of the 18 DSM-IV ADHD symptoms were endorsed more frequently by the group previously diagnosed with ADHD than by the control group. Predictive power analysis showed that persons endorsing ADHD symptoms were highly likely to have reported a prior ADHD diagnosis. Finally, the data suggested that the DSM-IV diagnostic criteria of 6 symptoms of inattention or 6 symptoms of hyperactivity–impulsivity could be appropriately applied during adult ADHD assessment.
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Faraone, Stephen V., Michael J. Silverstein, Kevin Antshel, Joseph Biederman, David W. Goodman, Oren Mason, Andrew A. Nierenberg, Anthony Rostain, Mark A. Stein, and Lenard A. Adler. "The Adult ADHD Quality Measures Initiative." Journal of Attention Disorders 23, no. 10 (December 4, 2018): 1063–78. http://dx.doi.org/10.1177/1087054718804354.
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Objective: Quality measures (QMs; also known as Quality Indicators) quantify health care processes, outcomes, patient perceptions, and organizational structure and/or systems that are relevant to the provision of high-quality health care. We describe the first phase of a project that has as its ultimate goal the creation and validation of QMs for tracking the screening, diagnosis, treatment, and clinical follow-up of adults with ADHD. This will fill an important gap in the field of Adult ADHD because QMs for adult ADHD do not exist. Method: We followed the guidelines of the U.S. Agency for Healthcare Research and Quality (AHRQ) for the development of QMs. These guidelines call for two phases: (1) Identify Candidate QMs and (2) Assess Candidate QMs. This article describes the results of our Phase 1 activities. To generate QMs for adult ADHD, we took the following steps: (a) searched the clinical/research literature for adult ADHD QMs; (b) convened a multidisciplinary panel comprising clinical and research experts and had them brainstorm potential QMs in the areas of screening, diagnosis, treatment, follow-up, care coordination, and patient experience; (c) compared these QMs with existing guidelines for adult ADHD to see if any potential QMs had been missed, this led to a draft list of 46 QMs; (d) had 28 ADHD experts rate the importance, reliability, validity, feasibility, and usability of the QMs. Results: The literature review found several QMs for ADHD in youth but none for ADHD in adults. The brainstorming session generated 52 QMs. The survey showed that all of these QMs were highly rated but that there was sufficient variability in ratings to prioritize some QMs over others. Conclusion: Based on these results, we prioritized QMs to carry forward into the next phase of the project. This work fills an important gap for the clinical care of adult patients with ADHD and helps to set a precedent for mental health, which has lagged behind other areas of medicine in developing QMs.
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Mowlem, Florence D., Caroline Skirrow, Peter Reid, Stefanos Maltezos, Simrit K. Nijjar, Andrew Merwood, Edward Barker, Ruth Cooper, Jonna Kuntsi, and Philip Asherson. "Validation of the Mind Excessively Wandering Scale and the Relationship of Mind Wandering to Impairment in Adult ADHD." Journal of Attention Disorders 23, no. 6 (June 2, 2016): 624–34. http://dx.doi.org/10.1177/1087054716651927.
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Objective: This study investigates excessive mind wandering (MW) in adult ADHD using a new scale: the Mind Excessively Wandering Scale (MEWS). Method: Data from two studies of adult ADHD was used in assessing the psychometric properties of the MEWS. Case-control differences in MW, the association with ADHD symptoms, and the contribution to functional impairment were investigated. Results: The MEWS functioned well as a brief measure of excessive MW in adult ADHD, showing good internal consistency (α > .9), and high sensitivity (.9) and specificity (.9) for the ADHD diagnosis, comparable with that of existing ADHD symptom rating scales. Elevated levels of MW were found in adults with ADHD, which contributed to impairment independently of core ADHD symptom dimensions. Conclusion: Findings suggest excessive MW is a common co-occurring feature of adult ADHD that has specific implications for the functional impairments experienced. The MEWS has potential utility as a screening tool in clinical practice to assist diagnostic assessment.
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Rostain, Anthony L. "Adult ADHD and Depressive Disorders: Prevalence, Significance, and Clinical Presentation." CNS Spectrums 13, S8 (May 2008): 8–10. http://dx.doi.org/10.1017/s1092852900002959.
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Adult attention-deficit/hyperactivity disorder (ADHD) and the spectrum of depressive disorders have high overlapping prevalence rates. Rates of depression in adults with ADHD and rates of ADHD in depressed adults provide an important epidemiologic background for clinicians treating either or both of these populations. There is a distinctive phenomenology of ADHD and depression, and distinctive diagnostic issues that present with the coexistence of these two disorders.
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Skodzik, Timo, Heinz Holling, and Anya Pedersen. "Long-Term Memory Performance in Adult ADHD." Journal of Attention Disorders 21, no. 4 (July 28, 2016): 267–83. http://dx.doi.org/10.1177/1087054713510561.
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Objective: Memory problems are a frequently reported symptom in adult ADHD, and it is well-documented that adults with ADHD perform poorly on long-term memory tests. However, the cause of this effect is still controversial. The present meta-analysis examined underlying mechanisms that may lead to long-term memory impairments in adult ADHD. Method: We performed separate meta-analyses of measures of memory acquisition and long-term memory using both verbal and visual memory tests. In addition, the influence of potential moderator variables was examined. Results: Adults with ADHD performed significantly worse than controls on verbal but not on visual long-term memory and memory acquisition subtests. The long-term memory deficit was strongly statistically related to the memory acquisition deficit. In contrast, no retrieval problems were observable. Conclusion: Our results suggest that memory deficits in adult ADHD reflect a learning deficit induced at the stage of encoding. Implications for clinical and research settings are presented.
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Ramsay, Russell J., and Anthony L. Rostain. "A Cognitive Therapy Approach for Adult Attention Deficit/Hyperactivity Disorder." Journal of Cognitive Psychotherapy 17, no. 4 (October 2003): 319–34. http://dx.doi.org/10.1891/jcop.17.4.319.52537.
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While attention deficit/hyperactivity disorder (ADHD) is the most prevalent behavioral disorder of childhood, the past decade has seen a rise in the number of adults presenting for treatment with difficulties related to ADHD. Few treatments (particularly psychosocial treatments) offered to adult patients with ADHD, however, have been empirically tested, much less been grounded in an overarching treatment model that captures the complexity of the various neurobiological, developmental, and psychological issues germane to this clinical population. The purpose of this article is to introduce a cognitive therapy approach for treating adults with ADHD. To do so we will describe the nature of ADHD, discuss some of the clinical issues unique to this diagnosis, and outline a cognitive therapy approach for conceptualizing and treating adult ADHD, integrating a number of case examples.
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Filipe, C. N. "Adult ADHD: An Under-Diagnosed Condition." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70246-9.
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ADHD is a neurodevelopmental disorder that impairs executive functions, leads to maladaptive behavior and, in about 50%, has a livelong persistence. Nevertheless, adult ADHD is a very much under-diagnosed condition.We conducted a study aimed to identify ADHD in a special population of adults. Questionnaires were applied to the parents of children attending CADIn, a Clinical Centre for Developmental Disorders for evaluation or intervention (48% of their children were diagnosed as having ADHD and 22% were diagnosed as having Pervasive Developmental Disorder). We expected a higher incidence of ADHD in this population as well as a better awareness for the condition.We used the Adult ADHD Self-report Scale (ASRS-v1.1) and the questionnaires contained questions concerning degree of impairment, persistence of symptoms and comorbid psychiatric conditions. 114 parents were inquired, 29% fathers, 68% mothers 3% missed gender. 17% of the parents quoted above the cut-off-point for the ASRS-v1.1 screener and amongst those, 45% referred the ADHD symptoms as causing them severe impairment. Only 3 subjects had been previously diagnosed as ADHD. The prevalence of ADHD symptoms was similar for males and females. 56% of the ADHD population was diagnosed formerly as suffering from psychiatric disorder, compared to 35% of the total population. The more common diagnoses were depression (45%) and anxiety (30%).We conclude that ADHD is much under-diagnosed in the adult population. Considering its high heritability, a closer evaluation of the parents of children diagnosed with ADHD is suggested.
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Liebrenz, Michael, Alex Gamma, Iliyan Ivanov, Anna Buadze, and Dominique Eich. "Adult attention-deficit/hyperactivity disorder: Associations between subtype and lifetime substance use – a clinical study." F1000Research 4 (July 28, 2015): 407. http://dx.doi.org/10.12688/f1000research.6780.1.
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ADHD is the one of the most prevalent childhood disorders and has been associated with impairments persisting into adulthood. Specifically, childhood ADHD is an independent clinical risk factor for the development of later substance use disorders (SUD). Moreover, adults who meet diagnostic criteria for ADHD have shown high rates of comorbid SUDs. Few studies, however, have reported on the relationship between ADHD subtypes and SUD in adult samples. The purpose of this study was to characterize a clinical sample of adults with ADHD and to identify possible associations between ADHD subtypes, lifetime substance use, and if ADHD subtypes may be preferentially associated with specific substances of abuse. We recruited 413 adult ADHD patients, performed an evaluation of their ADHD and conducted an interview on their use of psychotropic substances. Complete data was obtained for 349 patients. Lifetime substance abuse or dependence was 26% and occasional use was 57% in this sample. The inattentive subtype was significantly less likely to abuse or be dependent on cocaine than the combined subtype. Our findings underscore the high rate of comorbidity between substance use and ADHD in adults. The more frequent abuse/dependence of cocaine by adult patients with hyperactive-impulsive symptoms should be kept in mind when treating this patient group.
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Liebrenz, Michael, Alex Gamma, Iliyan Ivanov, Anna Buadze, and Dominique Eich. "Adult attention-deficit/hyperactivity disorder: Associations between subtype and lifetime substance use – a clinical study." F1000Research 4 (October 19, 2016): 407. http://dx.doi.org/10.12688/f1000research.6780.2.
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ADHD is the one of the most prevalent childhood disorders and has been associated with impairments persisting into adulthood. Specifically, childhood ADHD is an independent clinical risk factor for the development of later substance use disorders (SUD). Moreover, adults who meet diagnostic criteria for ADHD have shown high rates of comorbid SUDs. Few studies, however, have reported on the relationship between ADHD subtypes and SUD in adult samples. The purpose of this study was to characterize a clinical sample of adults with ADHD and to identify possible associations between ADHD subtypes, lifetime substance use, and if ADHD subtypes may be preferentially associated with specific substances of abuse. We recruited 413 adult ADHD patients, performed an evaluation of their ADHD and conducted an interview on their use of psychotropic substances. Complete data was obtained for 349 patients. Lifetime substance abuse or dependence was 26% and occasional use was 57% in this sample. The inattentive subtype was significantly less likely to abuse or be dependent on cocaine than the combined subtype. Our findings underscore the high rate of comorbidity between substance use and ADHD in adults. The more frequent abuse/dependence of cocaine by adult patients with hyperactive-impulsive symptoms should be kept in mind when treating this patient group.
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Simon, Viktória, Pál Czobor, Sára Bálint, Ágnes Mészáros, and István Bitter. "Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis." British Journal of Psychiatry 194, no. 3 (March 2009): 204–11. http://dx.doi.org/10.1192/bjp.bp.107.048827.
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BackgroundIn spite of the growing literature about adult attention-deficit hyperactivity disorder (ADHD), relatively little is known about the prevalence and correlates of this disorder.AimsTo estimate the prevalence of adult ADHD and to identify its demographic correlates using meta-regression analysis.MethodWe used the MEDLINE, PsycLit and EMBASE databases as well as hand-searching to find relevant publications.ResultsThe 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.ConclusionsPrevalence 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.
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Bakare, Blessing, and Vesna Jordanova. "Psychometric Properties of a Brief Screening Measure for ADHD in Adults." International Journal of Psychological Research 13, no. 2 (August 19, 2020): 78–88. http://dx.doi.org/10.21500/20112084.4511.
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The use of screening tools is an effective and practical approach within the clinical diagnostic assessment of attention deficit hyperactivity disorder (ADHD) in adults. Existing screening measures for adult ADHD have focused on a younger population. Subsequently, the current study aimed to evaluate the utility and general usability of an adapted four-item screening tool for adult ADHD: a brief version of the Wender Utah Rating Scale (WURS-brief), within a middle-aged population. The sample consisted of 69 adults, aged between 30 and 63 (age M= 45, SD=6.95), who had been referred to a specialist adult ADHD outpatients clinic. Using factor analysis, the WURS-brief screening measure was compared to existing ADHD diagnostic tools that were used as reference measures within the analysis. The WURS-brief had respectable sensitivity when compared with existing diagnostic tools. This study highlights the importance of validating brief screening measures for middle-aged adults with ADHD within clinical settings and offers suggestions for future research.
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Ko, Chih-Hung, Tsyh-Jyi Hsieh, Peng-Wei Wang, Wei-Chen Lin, Cheng-Sheng Chen, and Ju-Yu Yen. "The Altered Brain Activation of Phonological Working Memory, Dual Tasking, and Distraction Among Participants With Adult ADHD and the Effect of the MAOA Polymorphism." Journal of Attention Disorders 22, no. 3 (March 16, 2015): 240–49. http://dx.doi.org/10.1177/1087054715572609.
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Objective: The present study aimed to reveal the brain correlates of phonological working memory (WM), dual tasking, and distraction in adult ADHD combined with the effect of polymorphisms of monoamine oxidase A ( MAOA rs1137070 Asp470Asp). Method: A total of 29 participants with adult ADHD and 21 controls were recruited. They completed 0-back and 2-back tasks, as wells as 2-back tasks with a dual-task effect or a distracting effect, during functional magnetic resonance imaging scanning. Results: The brain activation of WM in the bilateral inferior frontal lobe, pars opercularis, was higher among the adult ADHD group. The genotype of MAOA significantly interacted with the ADHD effect in the left inferior frontal lobe, pars opercularis. Adults with ADHD had higher activation in the left lingual area in response to the dual-tasking effect. Conclusion: The MAOA polymorphism moderated the altered activation in pars opercularis for WM among adults with ADHD. The higher lingual gyrus activation might indicate that higher attention resources are demanded to sustain the dual-task function of adults with ADHD.
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Biederman, Joseph. "Advances in the Neurobiology of ADHD." CNS Spectrums 12, S6 (2007): 6–7. http://dx.doi.org/10.1017/s1092852900026006.
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AbstractAttention-deficit/hyperactivity disorder (ADHD) is a lifelong condition that begins in childhood and continues with adult manifestations related to the core symptoms. Approximately 50% to 75% of children with ADHD continue to meet criteria for the disorder as adolescents and adults. Adults with the disorder increasingly present to primary care physicians, psychiatrists, and other practitioners for diagnosis and treatment. Understanding the diagnosis of ADHD in adults requires knowledge of age-dependent decline of symptoms over time. Retrospective recall of symptoms and impairment are valid methods of diagnosing the disorder. ADHD is also a brain disorder with a strong neurobiologic basis, complex etiology, and genetic component. Genetic and environmental vulnerabilities give rise to abnormalities in the brain and subsequent behavioral and cognitive deficits, which may produce the symptoms associated with ADHD. Magnetic resonance imaging studies of ADHD have provided evidence that abnormalities in the brain are caused by the disorder itself rather than treatment of the disorder. Psychiatric comorbidity is common among patients with ADHD and tends to complicate treatment. Acute and long-term use of long-acting stimulant formulations (methylphenidate and amphetamine compounds) have shown robust efficacy and tolerability consistent with the treatment response established in children with ADHD. Non-stimulant medications have demonstrated efficacy as well, and may be preferred in patients with tic and substance use disorders.In this expert roundtable supplement, Timothy E. Wilens, MD, reviews the epidemiology and clinical presentation of adult ADHD. Next, Joseph Biederman, MD, provides an overview of recent advances in the neurobiology of ADHD. Thomas J. Spencer, MD, reviews stimulant treatment of adult ADHD, and Lenard A. Adler concludes with a discussion of non-stimulant trials in adult ADHD.
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Silverstein, Michael J., Stephen V. Faraone, Terry L. Leon, Joseph Biederman, Thomas J. Spencer, and Lenard A. Adler. "The Relationship Between Executive Function Deficits and DSM-5-Defined ADHD Symptoms." Journal of Attention Disorders 24, no. 1 (October 8, 2018): 41–51. http://dx.doi.org/10.1177/1087054718804347.
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Objectives: To identify the relationship between the core Diagnostic and Statistical Manual of Mental Disorders (5th ed.) ADHD symptoms and executive function deficits (EFDs), to evaluate ADHD characteristics of those with executive dysfunction (ED), and to examine the predictive utility of the Adult ADHD Investigator Symptom Rating Scale (AISRS) in identifying those with adult ADHD and ED. Method: Two samples (referred and primary care practice) were pooled together for present analysis. Results: Final analysis included 297 respondents, 171 with adult ADHD. Spearman correlation coefficients and binary logistic regressions demonstrated that ADHD inattentive (IA) and hyperactive-impulsive (H-I) symptoms were moderately to strongly correlated with and highly predictive of EFDs. Receiver operating characteristic curve analysis showed that an AISRS DSM 18-item score of ⩾ 28 was most predictive of clinical ED. Conclusion: ADHD symptoms were strongly correlated with and predictive of EFDs, clinicians should screen adults with ADHD for EFDs and ADHD treatment providers should track EFD improvement in addition to DSM-5 ADHD symptoms.
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Snitselaar, Mark A., Marcel G. Smits, Kristiaan B. van der Heijden, and Jan Spijker. "Sleep and Circadian Rhythmicity in Adult ADHD and the Effect of Stimulants." Journal of Attention Disorders 21, no. 1 (July 28, 2016): 14–26. http://dx.doi.org/10.1177/1087054713479663.
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Objective: This review updates information on sleep and circadian rhythmicity in adult ADHD, especially circadian rhythmicity and the influence of stimulants. Method: Investigations into sleep, chronotype, and circadian rhythm in adult ADHD were searched in the Cochrane Library, Embase, Medline, and PsycInfo databases. Results: ADHD in adults is associated with longer objective sleep latency, irrespective of insomnia complaints. Sleep maintenance is disturbed and waking up time is delayed. Adult ADHD is associated with increased eveningness, delayed dim light melatonin onset (DLMO), and later waking up time. Stimulant treatment induces delay of nonparametric circadian parameters, whereas light therapy (LT) induces shifts toward morningness, which is associated with a reduction of ADHD symptoms. Conclusion: Adult ADHD is associated with delayed circadian rhythmicity and analogous sleep characteristics, which are typical of a delayed sleep phase disorder. Stimulants induce delay of circadian rhythmicity.
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Faraone, Stephen V. "Attention Deficit Hyperactivity Disorder in Adults." Current Directions in Psychological Science 9, no. 1 (February 2000): 33–36. http://dx.doi.org/10.1111/1467-8721.00055.
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The diagnosis of attention deficit hyperactivity disorder (ADHD) in adults has been a source of controversy, with some prominent researchers questioning its very existence and others suggesting it is an urgent clinical problem. This article reviews five domains of data addressing the validity of adult ADHD: clinical correlates, family history, treatment response, laboratory studies, and long-term outcome. It then shows how the debate over adult ADHD reflects a clash of theoretical paradigms and concludes by suggesting ways in which psychological science can collect the data needed to clarify the validity of adult ADHD.
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Ben-Sheetrit, Joseph, Miriam Peskin, Jeffrey H. Newcorn, Yaron Daniely, Liat Shbiro, Ann Rotem, Abraham Weizman, and Iris Manor. "Characterizing the Placebo Response in Adults With ADHD." Journal of Attention Disorders 24, no. 3 (June 21, 2018): 425–33. http://dx.doi.org/10.1177/1087054718780328.
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Objective: Several ADHD pharmacological trials reported high placebo response (PR) rates. This study aims to characterize the PR in adult ADHD. Method: A retrospective cohort analysis of the placebo arm (140 adults with ADHD, 18-55 yrs, M:F 46.4%-53.6%) of a 6-week randomized, multicenter, double-blind metadoxine study, using Conners’ Adult ADHD Rating Scale (CAARS) and the Adult ADHD Self-Report Scale (ASRS), was conducted. Results: Pre–post changes in placebo-treated adults were significant for both the CAARS and ASRS, F(2.9, 404.5) = 61.2, p < .00001, F(2.8, 383.0) = 43.1, p < .00001, respectively. Less than half of the participants had a PR which began early in treatment and persisted; almost 50% had a variable, inconsistent PR. Conclusion: In the current sample, PR in adult ADHD was prominent on both symptom scales and the investigator–rater instrument. Therefore, using investigator ratings as a primary endpoint does not necessarily attenuate PR. Of note, about half of the PR is variable, suggesting unreliable determination of efficacy.
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Barbaresi, William J., Amy L. Weaver, Robert G. Voigt, Jill M. Killian, and Slavica K. Katusic. "Comparing Methods to Determine Persistence of Childhood ADHD Into Adulthood: A Prospective, Population-Based Study." Journal of Attention Disorders 22, no. 6 (December 22, 2015): 571–80. http://dx.doi.org/10.1177/1087054715618791.
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Objective: To compare the rate of persistence of ADHD into adulthood as determined by a norm-referenced versus non-norm-referenced diagnostic interview, and by standardized questionnaires. Method: Adults from a birth cohort, including research-identified childhood ADHD cases ( N = 232; Mage = 27.0 years; 167 males, 65 females) and controls ( N = 335; Mage = 28.6 years; 210 males, 125 females), were administered the M.I.N.I. International Neuropsychiatric Interview, the Murphy–Barkley Symptoms Checklist (MB), and the Wender Utah Rating Scale (WURS) Results: Among the childhood ADHD cases, 29.3% fulfilled criteria for adult ADHD using a norm-referenced approach to M.I.N.I. scoring, versus 13.8% using published M.I.N.I. criteria. Among participants meeting norm-referenced diagnostic criteria, 41.8% and 69.1% were classified as adult ADHD using the MB and WURS, respectively. Conclusion: A non-norm-referenced approach resulted in a significant underestimate of the rate of adult ADHD. Reliance on either of two adult ADHD questionnaires would have further reduced this estimate.
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Sinha, A., O. Lewis, R. Kumar, S. L. H. Yeruva, and B. H. Curry. "Adult ADHD Medications and Their Cardiovascular Implications." Case Reports in Cardiology 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/2343691.
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Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobiological disorder exhibited by difficulty maintaining attention, as well as hyperactivity and impulsive behavior. Central nervous system (CNS) stimulants are the first line of treatment for ADHD. With the increase in number of adults on CNS stimulants, the question that arises is how well do we understand the long-term cardiovascular effects of these drugs. There has been increasing concern that adults with ADHD are at greater risk for developing adverse cardiovascular events such as sudden death, myocardial infarction, and stroke as compared to pediatric population. Cardiovascular response attributed to ADHD medication has mainly been observed in heart rate and blood pressure elevations, while less is known about the etiology of rare cardiovascular events like acute myocardial infarction (AMI), arrhythmia, and cardiomyopathy and its long-term sequelae. We present a unique case of AMI in an adult taking Adderall (mixed amphetamine salts) and briefly discuss the literature relevant to the cardiovascular safety of CNS stimulants for adult ADHD.
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Kirley, Aiveen, and Michael Fitzgerald. "Adult ADHD: a controversial diagnosis?" Irish Journal of Psychological Medicine 19, no. 3 (September 2002): 86–91. http://dx.doi.org/10.1017/s0790966700007138.
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AbstractAttention deficit hyperactivity disorder (ADHD) is characterised by inattention, hyperactivity and impulsivity with onset in children before the age of seven years. ADHD is the most common disorder presenting to child guidance clinics and has been shown to be a well-validated diagnosis. Current estimates of prevalence range from 1%5%. The concept of adult ADHD as a clinical entity is an emerging but controversial area in psychiatry. While childhood ADHD is accepted as a reliable and valid diagnosis, the validity of adult ADHD as a disorder is unclear. This paper reviews the likely presenting features of adult ADHD and common comorbid disorders. Guidelines for assessment and management are discussed and the evidence for validity of the diagnosis is critically examined.
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Bijlenga, D., J. Y. M. Tjon-Ka-Jie, F. Schuijers, and J. J. S. Kooij. "Atypical sensory profiles as core features of adult ADHD, irrespective of autistic symptoms." European Psychiatry 43 (June 2017): 51–57. http://dx.doi.org/10.1016/j.eurpsy.2017.02.481.
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AbstractBackground:Abnormal sensory sensitivity is a feature of autism-spectrum disorder (ASD), but is also reported in attention-deficit/hyperactivity disorder (ADHD). In many cases, ADHD and ASD are comorbid. This study investigated the prevalence of sensory hyper- and hyposensitivity among adults with ADHD, controlling for autistic symptoms.Method:One hundred and sixteen adults diagnosed with ADHD completed the Adolescent/Adult Sensory Profile-NL (AASP-NL) and the Autism-spectrum Quotient (AQ) questionnaires. Prevalences of hyper- and hyposensitivity and autism-spectrum symptoms were compared to norm values. Multivariate binary logistic regressions were used to determine the association of autistic symptoms, age, gender, ADHD subtype, self-reported severity of ADHD symptoms, comorbid disorders, and use of medication on the sensory hypo- and hypersensitivity in adults with ADHD.Results:Adults with ADHD had more autistic symptoms, and they had both more hyper- and hyposensitivity compared to norm groups. This was especially apparent in the Activity level and Auditory sensory modalities. Sensory hypo- and hypersensitivity were both related to an increased ADHD score, even showing a dose-response relationship, but not to any autistic symptom or comorbid disorder. As much as 43% of the females with ADHD reported sensory hypo- and/or hypersensitivity, compared to 22% of the men.Conclusions:Sensory hypo- and hypersensitivity may be viewed as key features of adult ADHD, especially in females, regardless of any autistic symptoms. Future research should be directed at the implications of this sensory dysregulation for the understanding of the pathophysiology of (female) ADHD, and on the usefulness of assessment of atypical sensory profiles in the diagnostic procedure of ADHD in adults.
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Lopez, Régis, Jean-Arthur Micoulaud-Franchi, Laura Camodeca, Marie Gachet, Isabelle Jaussent, and Yves Dauvilliers. "Association of Inattention, Hyperactivity, and Hypersomnolence in Two Clinic-Based Adult Cohorts." Journal of Attention Disorders 24, no. 4 (May 17, 2018): 555–64. http://dx.doi.org/10.1177/1087054718775826.
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Objective: To assess the relationship between excessive daytime sleepiness (EDS), inattention, and hyperactivity/impulsivity in adults with ADHD and central hypersomnia. Method: Drug-free adult patients with ADHD ( n = 100) or hypersomnia ( n = 100) were evaluated using a structured clinical interview and self-report questionnaires on ADHD symptoms and EDS. Results: In all, 61% of patients with hypersomnia had clinically significant ADHD symptoms with 25% having an ADHD diagnosis (with both childhood and adulthood ADHD symptoms) and 36% ADHD-like symptoms, without history of childhood ADHD. EDS was reported in 47% of patients with ADHD, among whom 22% had a hypersomnolence disorder. Conclusion: We confirmed the high frequency of ADHD and ADHD-like symptoms in central hypersomnia, and of EDS and hypersomnolence in ADHD in adults. The nature of the link between EDS, inattention, and hyperactivity appears to be complex that may involve either a cause–effect relationship or intrinsic features of a similar neurodevelopmental dysfunction.
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Asherson, Philip P. "Bridging the service divide." Advances in Psychiatric Treatment 10, no. 4 (July 2004): 257–59. http://dx.doi.org/10.1192/apt.10.4.257.
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Most child and adolescent mental health services recognise the existence of, and need for treatment in, attention-deficit hyperactivity disorder (ADHD). Many specialist multidisciplinary ADHD clinics have been developed in recent years, and many paediatricians have included the treatment of ADHD as an important part of their clinical activity. A good deal of the justification for this increase in therapeutic activity has been the demonstration that ADHD is indeed a predictor of adult mental health problems. General adult psychiatry, however, has not followed suit in identifying and treating substantial numbers of affected people. It is likely none the less that an increasing load in adult psychiatry will develop. A rising number of young people will enter adult life still receiving stimulant medication or other treatment for ADHD, and adult psychiatrists are likely to be consulted. Furthermore, an increasing number of adults are likely to recognise themselves as having been disabled by ADHD and therefore to seek assistance. In many cases, individuals with adult ADHD who require specific treatment for the condition will have been treated unsuccessfully for disorders with overlapping symptom profiles such as anxiety, depression, bipolar disorder and antisocial personality disorder.
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Asherson, P. "Continuity of ADHD Across the Lifespan." European Psychiatry 41, S1 (April 2017): S33. http://dx.doi.org/10.1016/j.eurpsy.2017.01.156.
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IntroductionFor many years ADHD was thought to be a childhood onset disorder that has limited impact 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 to those seen in children and adolescents. As a result, there has been a rapidly increasing awareness of ADHD in adults and an emergence of new clinical practice across the world. Despite this, 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.ObjectiveHere we address some of the key conceptual issues surrounding the continuity of ADHD across the lifespan, with a focus relevant to practicing health care professionals working with adult populations.ConclusionsWe conclude that ADHD should be recognised within adult mental health in the same way as other common adult mental health disorders. Failure to recognise and treat ADHD will be detrimental to the well being of many patients seeking help for common mental health problems.Disclosure of interestThe author declares that he has no competing interest.
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Manos, Michael J. "Recognizing & Treating Comorbid ADHD in Adults with Depression." CNS Spectrums 14, S9 (November 2009): 11–14. http://dx.doi.org/10.1017/s1092852900004107.
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The National Comorbidity Survey Replication by Kessler and colleagues found that of adult patients with major depressive disorder (MDD), 9.4% met Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised criteria for attention-deficit/hyperactivity disorder (ADHD). Among those with dysthymia, 22.6% also met criteria for ADHD. In addition, it is estimated that approximately a third of the United States population experiences MDD symptoms at any point in time. Kessler and colleagues also conducted a retrospective study on impairment of adults with ADHD and found that ADHD has a prevalence of ∼4.4% in the US adult population, which suggests that ∼9 million US adults may have ADHD.
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Notzon, Daniel P., Martina Pavlicova, Andrew Glass, John J. Mariani, Amy L. Mahony, Daniel J. Brooks, and Frances R. Levin. "ADHD Is Highly Prevalent in Patients Seeking Treatment for Cannabis Use Disorders." Journal of Attention Disorders 24, no. 11 (March 31, 2016): 1487–92. http://dx.doi.org/10.1177/1087054716640109.
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Objective: To estimate the prevalence of ADHD and determine an effective screening test for ADHD in a population-seeking treatment for cannabis use disorders. Method: The Conners Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV; CAADID) was used to generate sensitivity and specificity data for ADHD screening tests, which were then administered to 99 participants seeking treatment for cannabis use disorders to estimate ADHD prevalence. Results: The prevalence estimated from the Wender Utah Rating Scale (WURS) was 45% (sensitivity = 0.88, sensitivity of 0.75), from the Conners Adult ADHD Rating Scale (CAARS) 34% (sensitivity = 0.80, specificity = 0.91), from the WURS + CAARS 36% (sensitivity = 0.71, specificity = 0.95), and from the Adult ADHD Self-Report Scale (ASRS) 46% (sensitivity = 0.61, specificity = 0.86). Conclusion: The prevalence of ADHD in adults seeking treatment for cannabis use disorders is estimated to be between 34% and 46%. The WURS paired with the CAARS provides excellent sensitivity and specificity for the diagnosis of ADHD in this population.
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Adler, Lenard A. "Pharmacotherapy for Adult ADHD." Journal of Clinical Psychiatry 70, no. 5 (May 15, 2009): e12. http://dx.doi.org/10.4088/jcp.7129br5c.
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