The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication

Columbia University, New York, New York, United States
American Journal of Psychiatry (Impact Factor: 12.3). 05/2006; 163(4):716-23. DOI: 10.1176/appi.ajp.163.4.716
Source: PubMed


Despite growing interest in adult attention deficit hyperactivity disorder (ADHD), little is known about its prevalence or correlates.
A screen for adult ADHD was included in a probability subsample (N=3,199) of 18-44-year-old respondents in the National Comorbidity Survey Replication, a nationally representative household survey that used a lay-administered diagnostic interview to assess a wide range of DSM-IV disorders. Blinded clinical follow-up interviews of adult ADHD were carried out with 154 respondents, oversampling those with positive screen results. Multiple imputation was used to estimate prevalence and correlates of clinician-assessed adult ADHD.
The estimated prevalence of current adult ADHD was 4.4%. Significant correlates included being male, previously married, unemployed, and non-Hispanic white. Adult ADHD was highly comorbid with many other DSM-IV disorders assessed in the survey and was associated with substantial role impairment. The majority of cases were untreated, although many individuals had obtained treatment for other comorbid mental and substance-related disorders.
Efforts are needed to increase the detection and treatment of adult ADHD. Research is needed to determine whether effective treatment would reduce the onset, persistence, and severity of disorders that co-occur with adult ADHD.

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Available from: Tevfik Bedirhan Ustun, Oct 25, 2015
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    • "Twenty-one percent of children raised in institutions met criteria for attention deficit hyperactivity disorder (ADHD) by age 4½ years, even if they later lived in a foster care family (Zeanah et al. 2009); at 12 years the rate of ADHD was 19.3% (Humphreys et al. 2015). High rates of ADHD have also been observed in other studies of children reared in institutions (Kreppner et al. 2001; Stevens et al. 2008) and they are markedly higher than in never institutionalized children , where the prevalence of ADHD is estimated to be between 3% and 10% (Kessler et al. 2006; Spencer et al. 2007). Indeed, symptoms of ADHD are so common among previously institutionalized children, that some have argued that they represent one type of deprivation-specific behavior patterns (Kreppner et al. 2001; Rutter et al. 2010). "
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    ABSTRACT: Background: Young children raised in institutions are exposed to extreme psychosocial deprivation that is associated with elevated risk for psychopathology and other adverse developmental outcomes. The prevalence of attention deficit hyperactivity disorder (ADHD) is particularly high in previously institutionalized children, yet the mechanisms underlying this association are poorly understood. We investigated whether deficits in executive functioning (EF) explain the link between institutionalization and ADHD. Method: A sample of 136 children (aged 6-30 months) was recruited from institutions in Bucharest, Romania, and 72 never institutionalized community children matched for age and gender were recruited through general practitioners' offices. At 8 years of age, children's performance on a number of EF components (working memory, response inhibition and planning) was evaluated. Teachers completed the Health and Behavior Questionnaire, which assesses two core features of ADHD, inattention and impulsivity. Results: Children with history of institutionalization had higher inattention and impulsivity than community controls, and exhibited worse performance on working memory, response inhibition and planning tasks. Lower performances on working memory and response inhibition, but not planning, partially mediated the association between early institutionalization and inattention and impulsivity symptom scales at age 8 years. Conclusions: Institutionalization was associated with decreased EF performance and increased ADHD symptoms. Deficits in working memory and response inhibition were specific mechanisms leading to ADHD in previously institutionalized children. These findings suggest that interventions that foster the development of EF might reduce risk for psychiatric problems in children exposed to early deprivation.
    Psychological Medicine 10/2015; DOI:10.1017/S0033291715002020 · 5.94 Impact Factor
    • "This is 2–4 times higher than the estimated DSM-IV rate of ADHD in the general adult population (2.5–4.3%) (Fayyad et al., 2007; Kessler et al., 2006; Simon et al., 2009). Despite the high level of ADHD within the PD group, none of the patients had an existing current diagnosis of ADHD prior to the research study. "
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    ABSTRACT: This study examines the rate of attention-deficit-hyperactivity disorder (ADHD) and associated functional impairments in mentally disordered offenders (MDOs). One hundred and thirty-one male MDOs with a primary diagnosis of either severe mental illness (SMI) or personality disorder (PD) completed screening questionnaires for ADHD. If positive, they were invited for a comprehensive diagnostic interview. Additional data pertaining to self-rated impairments, and objective records of critical incidents and episodes of seclusion were obtained from patient records. Twenty-six patients screened positive (7 with SMI, 19 with PD). On further assessment, no SMI patients met criteria for ADHD. Four PD patients met criteria for persistent 'syndromatic' ADHD, whereas six met 'symptomatic' ADHD criteria, giving overall prevalence estimates of 8.6% and 12.9% respectively. Greater functional impairments were self-reported by the PD+ADHD screener positive group, compared with screener negative peers, with large effect sizes. A significant but small effect was found for spending longer in seclusion. Compared with population norms, a high rate of ADHD and associated impairments are present in MDO's with a primary diagnosis of PD. These individuals have complex needs and both pharmacological and non-pharmacological interventions are required for their rehabilitation.
    09/2015; DOI:10.1016/j.psychres.2015.09.024
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    • "Most notably, 66% of fathers in this study were above the clinical cutoff for ADHD, compared with 4.4% of adult males in epidemiological studies (Kessler et al., 2006). Rates of clinically significant depressive (33%) and ASPD (12%) symptoms in the current sample were also consistent with other samples of parents of children with ADHD (Chronis et al., 2003; Johnston & Mash, 2001), and were elevated compared with epidemiological rates of 8.2% and 1%, respectively (Kessler et al., 2006; Lenzenweger, Lane, Loranger, & Kessler, 2007). Unlike the epidemiological studies described above, the current study did not utilize diagnostic interviews, though it is unlikely that this methodological difference entirely accounts for the elevated rates of psychopathology in the current study. "
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    ABSTRACT: Objective: Parental psychopathology and parenting quality robustly predict negative outcomes among children with ADHD. Little research has investigated associations between paternal ADHD symptoms and parenting, though there is clear evidence linking maternal ADHD symptoms with both suboptimal parenting and child conduct problems, and considerable research supporting fathers' significant contributions to their children's development. Method: This cross-sectional study examined psychopathology and parenting in a sample of fathers (N = 102) and their 5- to 12-year-old children with previously diagnosed ADHD. Results: Results suggested that paternal antisocial personality disorder (ASPD) symptoms (rather than ADHD symptoms) were robustly associated with child conduct problems, with an indirect effect through paternal negative parenting. Conclusion: This study suggests that negative parenting may be a potential mechanism by which paternal ASPD is associated with child conduct problems, and demonstrates the importance of considering co-occurring psychopathology in research examining adult ADHD, parenting, and child outcomes.
    Journal of Attention Disorders 09/2015; DOI:10.1177/1087054715604361 · 3.78 Impact Factor
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