Article

ADHD from a socio-economic perspective

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Abstract

Attention deficit hyperactivity disorder (ADHD) and related disorders affect children's ability to function in school and other environments. Awareness has increased in recent years that the same problems often persist in adulthood. Based on previous studies, we aimed to outline and discuss a descriptive model for calculation of the societal costs associated with ADHD and related disorders. Following a literature review including childhood and adult studies, long-term outcomes of ADHD and associated societal costs were outlined in a simple model. The literature concerning long-term consequences of ADHD and related disorders is scarce. There is some evidence regarding educational level, psychosocial problems, substance abuse, psychiatric problems and risky behaviour. The problems are likely to affect employment status, healthcare consumption, traffic and other accidents and criminality. A proposed model structure includes persisting problems in adulthood, possible undesirable outcomes (and their probabilities) and (lifetime) costs associated with these outcomes. Existing literature supports the conclusion that ADHD and related disorders are associated with a considerable societal burden. To estimate that burden with any accuracy, more detailed long-term data are needed.

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... Issues experienced by people with ADHD in childhood can lead to considerable cognitive and behavioural impairment [9,10], affecting social behaviour, school work and family life [11,12]. In adulthood, these issues are associated with higher rates of criminal behaviour, loss of work, addiction, suicidality and failed relationships [13]. While evidencebased treatments have been shown to help manage ADHD symptoms [14], untreated ADHD can have strong economic and social burdens [15]. ...
... Our findings also strongly overlapped with previous research. In a recent systematic review [13] considerable lack of accurate knowledge, issues with services and difficult communication between multiple stakeholders were also found to be barriers to access to care for ADHD. Semi structured interviews conducted with UK and Belgium clinicians [20] investigating decision making in the management of ADHD also reported issues around multidisciplinary communication and the lack of clear, operationalised guidelines and services. ...
Article
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Background: Attention Deficit Hyperactivity Disorder (ADHD) is underdiagnosed in many European countries and the process of accessing care and diagnosis is complex and variable. In many countries, general practitioners (GPs) refer on to secondary care where individuals receive an assessment and, if appropriate, a diagnosis and access to care. It is therefore essential that GPs have a clear understanding of the disorder and its care pathways. While previous studies have highlighted potential barriers in GPs' ADHD awareness, this qualitative study aims to further explore individual stakeholders' experiences. Methods: Semi-structured interviews explored the views of multiple stakeholders- GPs (n = 5), healthcare specialists (n = 5), patients (adults with ADHD n = 5) and parents (n = 5) with experience of the presentation and management of ADHD in primary care. These interviews were analysed using thematic analyses and following principles of grounded theory. Results: Stakeholders described ADHD assessment, diagnosis and treatment as an intricate process. Many factors affected this process such as complex pathways, lack of services, limited GP recognition and knowledge, and communicative difficulties between and within multiple stakeholders. Conclusion: This analysis underlines the significant impact that receiving (or not) a diagnosis can have, and further explores muddled ADHD care pathways, highlighting key issues around GP identification and the shortage of adult services. Implications for practice and future research are discussed, suggesting a strong need for more commissioned pathways and GP specific educational programs.
... Issues experienced by people with ADHD in childhood can lead to considerable cognitive and behavioural impairment [9, 10], affecting social behaviour, school work and family life [11,12]. In adulthood, these issues are associated with higher rates of criminal behaviour, loss of work, addiction, suicidality and failed relationships [13]. While evidence-based treatments have been shown to help manage ADHD symptoms [14], untreated ADHD can have strong economic and social burdens [15]. ...
... Our findings also strongly overlapped with previous research. In a recent systematic review [13] considerable lack of accurate knowledge, issues with services and difficult communication between multiple stakeholders were also found to be barriers to access to care for ADHD. Semi structured interviews conducted with UK and Belgium clinicians [20] investigating decision making in the management of ADHD also reported issues around multidisciplinary communication and the lack of clear, operationalised guidelines and services. ...
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Background: Attention Deficit Hyperactivity Disorder (ADHD) is underdiagnosed in many European countries and the process of accessing care and diagnosis is complex and variable. In many countries, general practitioners (GPs) refer on to secondary care where individuals receive an assessment and, if appropriate, a diagnosis and access to care. It is therefore essential that GPs have a clear understanding of the disorder and its care pathways. While previous studies have highlighted potential barriers in GPs’ ADHD awareness, this qualitative study aims to further explore individual stakeholders’ experiences. Methods: Semi-structured interviews explored the views of multiple stakeholders- GPs (n=5), healthcare specialists (n=5), patients (adults with ADHD n=5) and parents (n=5) with experience of the presentation and management of ADHD in primary care. These interviews were analysed using thematic analyses and following principles of grounded theory. Results: Stakeholders described ADHD assessment, diagnosis and treatment as an intricate process. Many factors affected this process such as complex pathways, lack of services, limited GP recognition and knowledge, and communicative difficulties between and within multiple stakeholders. Conclusion: This analysis underlines the significant impact that receiving (or not) a diagnosis can have, and further explores muddled ADHD care pathways, highlighting key issues around GP identification and the shortage of adult services. Implications for practice and future research are discussed, suggesting a strong need for more commissioned pathways and GP specific educational programs.
... Several studies have reported that individuals with ADHD diagnosed in childhood and young adulthood have difficulties completing their education [37], as well as entering and staying in the labor market [12,14,17,[37][38][39]. In this study, individuals were already employed when diagnosed with ADHD [14], which indicates that they might have been in better health, and had less debilitating ADHD symptoms or better responsiveness to treatment compared with ADHD patients on permanent DP [12]. ...
Article
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We compared labor market marginalization (LMM), conceptualized as days of unemployment, sickness absence and disability pension, across occupational branches (manufacturing, construction, trade, finance, health and social care, and education), among young employees with or without attention deficit hyperactivity disorder (ADHD) and examined whether sociodemographic and health-related factors explain these associations. All Swedish residents aged 19–29 years and employed between 1 January 2005 and 31 December 2011 were eligible. Individuals with a first ADHD diagnosis (n = 6030) were matched with ten controls and followed for five years. Zero-inflated negative binomial regression was used to model days of LMM with adjustments for sociodemographic and health-related factors. In total, 20% of those with ADHD and 59% of those without had no days of LMM during the follow-up. The median of those with LMM days with and without ADHD was 312 and 98 days. Having an ADHD diagnosis was associated with a higher incidence of LMM days (incident rate ratios (IRRs) 2.7–3.1) with no differences across occupational branches. Adjustments for sociodemographic and health-related factors explained most of the differences (IRRs: 1.4–1.7). In conclusion, young, employed adults with ADHD had a higher incidence of LMM days than those without, but there were no substantial differences between branches, even after adjusting for sociodemographic and health-related factors.
... These challenges include direct costs (e.g., purchasing stimulant medication), indirect costs (e.g., missed time at work), and intangible costs (e.g., marital tension) (Jo 2014). Previous investigations of the costs associated with raising a child with ADHD to families have focused predominately on direct expenses within the healthcare system and indirect costs related to parental productivity loss (e.g., Bernfort et al. 2008;Birnbaum et al. 2005;De Ridder and De Graeve 2006;Doshi et al. 2012;Gupte-Singh et al. 2017;Hakkaart-van Roijen et al. 2007;Matza et al. 2015;Meyers et al. 2010). Emerging studies on family burden related to raising children with autism spectrum disorders (ASD) have included other important domains (see Beecham 2014, for a review). ...
Article
The purpose of the study was to estimate the burden to families of raising a child with attention-deficit/hyperactivity disorder (ADHD). Data were drawn from a longitudinal sample recruited in western Pennsylvania. When participants were between 14 and 17 years old, parents completed a questionnaire assessing economic burden over the course of raising their children. Domains of economic burden to families included direct costs related to child’s behaviors (excluding treatment expenses) and indirect costs related to caregiver strain. On average, participants with ADHD incurred a total economic burden over the course of child development that was more than five times greater compared to youths without ADHD (ADHD = $15,036 per child, Control = $2,848 per child), and this difference remained significant after controlling for intellectual functioning, oppositional defiant symptoms, or conduct problems. Parents of participants with ADHD were more likely to have changed their job responsibilities or been fired and reported lower work efficiency. The current evaluation of economic burden to individual families extends previous estimates of annual societal cost of illness (COI) of ADHD. Our rough annual estimate of COI for ADHD in children and adolescents is $124.5 billion (2017 US Dollars). Findings underscore the need for interventions to reduce the costly dysfunctional outcomes in families of children with ADHD.
... Longitudinal studies have shown that it persists in 50 to 65% of cases to adulthood (Barkley, 1990;Biederman et al., 1996;Weiss, 1993). Addictions, as well as ADHD, are associated with occupational and interpersonal difficulties, increased crime, a greater propensity to have traffic accidents and poorer quality of life in general (Adler, 2008;Barkley, 2002;Bernfort, Nordfeldt, & Persson, 2008;Biederman et al., 1993;Fischer, Barkley, Smallish, & Fletcher, 2002;Goksøyr & Nøttestad, 2008;Harwood & Myers, 2004). ...
Article
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Existe una elevada comorbilidad entre el trastorno por deficit de atencion con hiperactividad (TDAH) y los trastornos por uso de sustancias. Se revisa la literatura sobre la prevalencia, caracteristicas clinicas y tratamiento de la comorbilidad del TDAH con la dependencia de sustancias depresoras del SNC. Las prevalencias encontradas presentan amplia variabilidad (4,5% a 58%). El TDAH se asocia a una mayor gravedad de la adiccion, menor edad de inicio del consumo y de la adiccion, mayor presencia de otros trastornos psicopatologicos y mayor cronicidad. En pacientes drogodependientes el diagnostico es un proceso complejo por el frecuente solapamiento de sintomas. Los instrumentos de cribado se deben utilizar con precaucion. El tratamiento farmacologico ha mostrado eficacia en la reduccion de los sintomas del TDAH y no hay consenso respecto a su influencia sobre el consumo. Sin embargo, los resultados se deben interpretar con cautela, porque las muestras son pequenas. Las intervenciones psicoeducativas son relevantes, pero no se han descrito, ni estudiado sistematicamente los resultados de este tipo de intervenciones.
... This seemingly supports previous studies' reports that ADHD shows chronic progression and that symptoms persist into adulthood in approximately 50% of individuals (2)(3)(4)(5)(6)(7). Compared to typical adults, those with ADHD have a higher rate of substance abuse, lower education levels, and lower occupational ability (8)(9)(10). In this regard, considering the chronic progression of ADHD and the socioeconomic costs of the disease itself, long-term continued treatment is essential. ...
Article
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We examined short- and long-term medication compliance among youth with attention-deficit hyperactivity disorder (ADHD), using data from the National Health Insurance database in Korea. Of the 5,699,202 6-14-year-old youth in 2008, we chose those with at least 1 medical claim containing an ICD-10 code for diagnosis of ADHD (F90.0) and no prescription for ADHD within the previous 365 days. We tracked the data every 6 months between 2008 and 2011, to determine treatment compliance among newly diagnosed, medicated patients. Further, we checked every 1 month of the 6 months after treatment commencement. Treatment continuity for each patient was calculated by sequentially counting the continuous prescriptions. For measuring compliance, we applied the medication possession ratio (MPR) as 0.6, 0.7, and 0.8, and the gap method as 15- and 30-days' intervals. There were 15,133 subjects; 11,934 (78.86%) were boys. Overall 6-month treatment compliance was 59.0%, 47.3%, 39.9%, 34.1%, 28.6%, and 23.1%. Monthly drop-out rates within the first 6 months were 20.6%, 6.5%, 4.7%, 3.7%, 3.0%, and 2.5%, respectively. When applying MPR more strictly or shorter gap days, treatment compliance lessened. This is the first nationwide report on 36-month treatment compliance of the whole population of 6-14-year-olds with ADHD. We found the beginning of the treatment, especially the first month, to be a critical period in pharmacotherapy. These results also suggest the importance of setting appropriate treatment adherence standards for patients with ADHD, considering the chronic course of ADHD.
... A consensus tends to be in a conclusion that multiple factors are important at the same time (Russell et al., 2016). Extensive reviews confirm this assumption by finding consistent correlations between socioeconomic factors and ADHD both in children and their families (Bernfort et al., 2008). ...
Article
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The review examines Attention Deficit Hyperactivity Disorder (ADHD in its Child and Adult form) and its various presentations (Hyperactive Impulsive, Inattentive, and Combined) with a particular focus on environmental (incl. social factors), lifestyles and comorbidities. It is argued that ADHD is best understood in a holistic and interactive context and a vast empirical literature is presented to illustrate the point: Environmental factors include stress in general as well as exposure to toxins (phthalates, bisphenol A). Social factors are illustrated by effects of social deprivation and seduction to unhealthy lifestyles. Maternal lifestyle during pregnancy is pointed out (particularly her exposure to nicotine, alcohol, caffeine, and drugs, even seemingly benign medications like acetaminophen), which all tend to be related to ADHD. Family environment is discussed with respect to protective effect of (mainly authoritative and autocratic) parenting styles. Societal factors include mainly economic and political issues: income inequality and poverty (low SES is an ADHD risk factor) and a growing moral dilemma between a humanistic effort to globally spread the knowledge of ADHD and the medicalization and commercialization of the disorder. The second part of the review is devoted to ADHD related lifestyles and resulting comorbidities (e.g., food addiction and obesity, substance abuse, electronic media dependencies and conduct and personality disorders). Although ADHD is a neurodevelopmental disorder, its assessment and treatment are also linked to environmental, behavioral and social factors and their interactions.
... Unmanaged and untreated ADHD results in long-term impairments in many domains [34]. In adulthood, these issues are associated with higher criminal behaviour rates, loss of work, addiction, suicidality and failed relationships [35] demonstrating that untreated ADHD can have substantial economic and social burdens [36]. There is, therefore, a strong need for early detection and diagnosis and gaining timely access to care is of great importance. ...
Chapter
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Despite ADHD impacting around 5% of children in the UK, a lot of healthcare professionals are ill-equipped to deal with this disorder, especially in primary care. Untreated and undiagnosed ADHD can strongly impact individuals throughout their lifetime. It is therefore vital that individuals access treatment and diagnosis at an early stage. The diagnosis pathway for ADHD is complex and varies across countries. However, in many countries, specialist services are responsible for ADHD diagnosis and treatment, following a referral from a primary care physician (PCP). Without such referral, individuals are often unable to access care. Previous studies have shown that PCPs are often ill-equipped to deal with individuals with ADHD, highlighting a lack of knowledge and training, directly impacting access to care. To increase PCPs' knowledge of ADHD, a novel online training program was developed. This innovative approach included co-production with PCPs throughout the development process and is the only online ADHD training to date tailored for PCPs that has been evaluated through a randomised control trial. This chapter first presents common ADHD pathways to care and the barriers to PCPs' understanding of ADHD. The chapter then looks at the development and evaluation of an online intervention aimed at increasing PCPs' confidence and understanding of ADHD.
... At an early age, disorders impair the educational and job opportunities of the young, also their choices when selecting partners and their general life, undesired pregnancies are another source of pressure (Bernfort, Nordfeldt & Persson, 2008). Individuals under 15 years of age represent up to 30% of the population of Latin America and the Caribbean, and more than 40% of the populations of some countries in the region of Guatemala and Belize as two countries in Europe and America (Bureau, 2007); 19% of the population in the region is between 15 to 24 years of age (United Nations World Youth Report [UNWYR], 2014). ...
Article
The purpose is to understand mental health in young women not in education, employment or training (NEET) through the meanings attributed to life experience. From a larger study that included women, fifteen early adult women participated in this study using an intensive intentional sampling strategy. We carefully selected only a few cases, seeking to characterize the object of study and to obtain in depth information based on the participants' subjective reality; they were females from Oviedo, Spain and Aguascalientes, Mexico. We found in young NEET women different emotional expressions of mental health related to the feelings of not being in the situation of not working or studying, such as sadness, loneliness, anxiety, stress, fear, frustration, and discomfort. These women experienced loneliness when felt they did not have friends, since they were isolated not going to school or work. These life stories allowed understanding, from the feminine subjective perspective, the emotional experience of NEET, which, according to the meanings they mentioned, are specific forms of distress and depression with repercussions for their mental health. These results demonstrate the relevance of new public policies on mental health, education and work to attend to the needs of this population.
... Ces chiffres indiquent que plus de 50 % des sujets TDA/H continuent à présenter une partie de la symptomatologie du trouble lorsqu'ils parviennent à l'âge adulte. Bernfort [20] pointe En association avec ces éléments cliniques, il est pertinent de proposer l'administration d'épreuves normées afin de déterminer le niveau d'un certain nombre de compétences. l'échelle de Weschler (WISC) est hétérogène entre les indices mais aussi à l'intérieur de ces derniers. ...
... Ayrıca çocuk ve ergenlerdeki ruhsal bozuklukların ekonomik maliyetinin yetiskinlerinkine yakın bir düzeyde olduğunu saptayan çalışmalar da vardır. 10,11 Özellikle ruhsal bozuklukların epidemiyolojisinin ve etiyolojisinin önemine vurgu yapan araştırmacılar 12 gençlikteki ruhsal bozuklukların yaygınlığının, risk etkenlerinin ve ilerleyici yapısının anlaşılması gerektiğini belirtmişlerdir. Ruhsal bozuklukların başlangıç yaşının çoğunlukla ergenlik dönemine denk gelmesi ve tedavi maliyetlerinin aile ve ülke ekonomilerine getirdiği yük dikkate alındığında, çocuk ve ergenlerde görülen ruhsal bozuklukların veya yatkınlıkların erken dönemde fark edilebilmesi önem taşımaktadır. ...
Article
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Ergenler için Psikolojik Bozukluklar Envanterinin revizyon çalışması-I: Psikolojik Bozukluklar Formu ÖZ Amaç: Bu çalışmanın amacı, özgün Ergenler için Psikolojik Bozukluklar Envanterinin (EPBE) maddelerinden yarar-lanılarak oluşturulan Ergenler için Psikolojik Bozukluklar Envanteri-Psikolojik Bozukluklar Formunun (EPBE-PBF) geçerlilik ve güvenilirlik çalışmalarının yapılmasıdır. Yöntem: Çalışma 15-22 (18.43±1.60) yaşları arasındaki 527’si kız (%64.9), 285’i erkek (%35.1) olmak üzere 812 kişilik lise ve üniversite öğrencilerinden oluşan bir örneklem grubuyla yapılmıştır. Test-tekrar test güvenilirliği için 52 öğrenciye uygulama yapılmıştır. Yakınsak geçerlilik kapsa-mında 127 kişilik bir örneklem grubuna ilk oturumda EPBE-PBF, ikinci oturumda Sürekli Kaygı Ölçeği (SKÖ), Kısa Belirti Ölçeği (KBÖ) ve Beck Depresyon Ölçeği (BDÖ) bir arada uygulanmıştır. Sonuçlar: Güvenilirlik analizinde, toplam ölçek için Cronbach alfa değerinin 0.78 ve alt ölçekler için 0.57-0.89 arasında olduğu saptanmış; her alt ölçek için madde-toplam korelasyonları 0.30'un üzerinde bulunmuştur. Test-tekrar test analizinde korelasyon katsa-yıları 0.53-0.90 arasındadır. Yakınsak geçerlilik analizlerinde elde edilen korelasyon katsayıları 0.37-0.79 arasın-dadır. EPBE-PBF, MMPI gibi profil indeksli bir ölçek olduğu için her alt ölçek, kendi içinde Varimax döndürmesine göre temel bileşenler analizine tabi tutulmuştur. Tartışma: Özgün çalışmadan sonra ikinci kez yapılmış olan geçerlilik ve güvenilirlik analizlerine göre EPBE-PBF’nin geçerli ve güvenilir bir ölçek olduğu görülmüştür. (Anadolu Psikiyatri Derg 2018; 19(Özel sayı.1):49-58) Anahtar sözcükler: Ergenler için Psikolojik Bozukluklar Envanteri-Psikolojik Bozukluklar Formu (EPBE-PBF), DSM-5, ergenlik, geçerlilik, güvenilirlik Revision study of Psychological Disorders Inventory for Adolescents-I: Psychological Disorders Form ABSTRACT Objective: The purpose of this study is to conduct validity and reliability studies of the Inventory of Psychological Disorders for Adolescents-Psychological Disorders Form (PDIA-PDF), which were created by using the original Inventory of Psychological Disorders for Adolescents (PDIA). Methods: The study consisted of a sample group of 812 high school and university students, including 527 female (64.9%) and 285 male (35.1%) aged 15-22 (18.43±1.60) years.Test-retest reliability was also examined in 52 participants. Furthermore, in the context of convergent validity, it were applied EPBE-PBF to a sample group of 127 persons in the first session. It were applied together State Trait Anxiety Inventory (STAI), Brief Symptom Inventory (BSI) and Beck Depression Inventory (BDI) in second session. Results: In the reliability study, the Cronbach’s alpha for the total scale was 0.78 and for sub-scales, it was between 0.57 and 0.89. It was also found that item-total correlations for each subscale were higher than 0.30. Correlation coefficient values for test-retest reliability were between 0.53 and 0.90. The Pearson’s corre-lation values varied between 0.37 and 0.79. As PDIA-PDF is an inventory with profile index such as MMPI, each subscale was subjected to confirmatory factor analysis in accordance with Varimax rotation in itself. Discussion: It is seen that PDIA-PDF is a valid and reliable scale according to the validity reliability analyzes performed secondly after the original study. (Anatolian Journal of Psychiatry 2018; 19(Special issue.1):49-58) Keywords: Psychological Disorders Inventory for Adolescents-Psychological Disorders Form (PDIA-PDF), DSM-5, adolescence, validity, reliability
... At an early age, disorders impair the educational and job opportunities of the young, also their choices when selecting partners and their general life, undesired pregnancies are another source of pressure (Bernfort, Nordfeldt & Persson, 2008). Individuals under 15 years of age represent up to 30% of the population of Latin America and the Caribbean, and more than 40% of the populations of some countries in the region of Guatemala and Belize as two countries in Europe and America (Bureau, 2007); 19% of the population in the region is between 15 to 24 years of age (United Nations World Youth Report [UNWYR], 2014). ...
Article
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Resumen The purpose is to understand mental health in young women not in education, employment or training (NEET) through the meanings attributed to life experience. From a larger study that included women, fifteen early adult women participated in this study using an intensive intentional sampling strategy. We carefully selected only a few cases, seeking to characterize the object of study and to obtain in depth information based on the participants´subjectiveparticipants´subjective reality; they were females from Oviedo, Spain and Aguascalientes, Mexico. We found in young NEET women different emotional expressions of mental health related to the feelings of not being in the situation of not working or studying, such as sadness, loneliness, anxiety, stress, fear, frustration, and discomfort. These women experienced loneliness when felt they did not have friends, since they were isolated not going to school or work. These life stories allowed understanding, from the feminine subjective perspective, the emotional experience of NEET, which, according to the meanings they mentioned, are specific forms of distress and depression with repercussions for their mental health. These results demonstrate the relevance of new public policies on mental health, education and work to attend to the needs of this population. Este artículo tiene como objetivo analizar la salud mental en las mujeres jóvenes que no estudian ni trabajan a través de los significados atribuidos a la experiencia de la vida. Fueron 15 mujeres jóvenes que participaron en el estudio que participaron en un estudio más amplío solo se eligieron a las mujeres, que fueron seleccionadas mediante una estrategia intensiva de muestreo intencional; fueron mujeres jóvenes de Oviedo, España y Aguascalientes, México. Los resultados sobre la salud mental, se encontró que en las jóvenes hay diferentes expresiones emocionales relacionados con el malestar por no estar trabajando o estudiando, tales como la tristeza, la soledad, la ansiedad, el estrés, el miedo, la frustración y malestar. Estas mujeres experimentan la soledad cuando ven que ya no tienen los mismos amigos por no ir a la escuela o al trabajo. Estas historias permitieron entender cómo desde la perspectiva subjetiva femenina, la importancia que han experimentado el ser "NiNi" que, de acuerdo con los significados que les dieron, son formas específicas de la ansiedad y la depresión con repercusiones en su salud mental. Los resultados sugieren crear nuevas políticas públicas de atención en salud mental, educación y trabajo. Palabras clave: adultos tempranos, mujeres, salud mental, México-España.
... As ADHD is characterized by impulsivity and inattention, it causes impairment across multiple domains [2]. It increases the risk of several negative outcomes such as poor education and substance abuse [3]. Although the ADHD etiology is complex, both heritable factors [4] and environmental and social influences [5] contribute to its causation. ...
Article
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Background: Socioeconomic status (SES) resources protect children and adults against the risk of medical and psychiatric conditions. According to the Minorities’ Diminished Returns theory, however, such protective effects are systemically weaker for the members of racial and ethnic minority groups compared to Whites. Aims: Using a national data set with 15 years of follow up, we compared Black and White youth for the effects of family SES at birth on the risk of Attention Deficit Hyperactivity Disorder (ADHD) at age 15. Methods: The Fragile Families and Child Wellbeing Study (FFCWS, 1998–2016) is a longitudinal prospective study of urban youth from birth to age 15. This analysis included 2006 youth who were either White (n = 360) or Black (n = 1646). The independent variable was family income, the dependent variable was ADHD at age 15. Child gender, maternal age, and family type at birth were covariates, and race was the focal moderator. We ran logistic regressions in the overall sample and specific to race. Results: In the overall sample, high family income at birth was not associated with the risk of ADHD at age 15, independent of all covariates. Despite this relationship, we found a significant interaction between race and family income at birth on subsequent risk of ADHD, indicating a stronger effect for Whites compared to Blacks. In stratified models, we found a marginally significant protective effect of family SES against the risk of ADHD for White youths. For African American youth, on the other hand, family SES was shown to have a marginally significant risk for ADHD. Conclusions: The health gain that follows family income is smaller for Black than White families, which is in line with the Minorities’ Diminished Returns. The solution to health disparities is not simply policies that aim to reduce the racial gap in SES, because various racial health disparities in the United States are not due to differential access to resources but rather the impact of these resources on health outcomes. Public policies, therefore, should go beyond equalizing access to resources and also address the structural racism and discrimination that impact Blacks’ lives. Policies should fight racism and should help Black families to overcome barriers in their lives so they can gain health from their SES and social mobility. As racism is multi-level, multi-level interventions are needed to tackle diminished returns of SES.
... Betroffene Kinder zeigen dabei vermehrt impulsive, hyperaktive oder aggressive Verhaltensweisen (Howell & Watson, 2009). Diese gehen vielfach mit schwerwiegenden Beeinträchtigungen für die betroffenen Kinder einher: Sie haben weniger Freunde (Mikami, 2010), schlechtere Beziehungen zu ihren Eltern (Burt, McGue, Krueger & Iacono, 2005), zeigen schlechtere Schulleistungen (Daley & Birchwood, 2010;Wirth, Reinelt, Gawrilow & Rauch, 2015), haben langfristig häufiger Gesundheitsprobleme (Bernfort, Nordfeldt & Persson, 2008;Kretschmer et al., 2014) und werden häufiger delinquent (Cohn, Van Domburgh, Vermeiren, Geluk & Doreleijers, 2012). ...
Article
Zusammenfassung. Externalisierende Verhaltensauffälligkeiten sind mit hohen gesellschaftlichen Kosten verbunden. Damit wirksame Präventions- und frühe Therapieprogramme entwickelt werden können, ist es notwendig, bereits in den ersten Lebensjahren Risiken für einen externalisierenden Entwicklungsverlauf zu identifizieren. In einer systematischen Literaturrecherche konnten aus 21 Publikationen zu 12 längsschnittlichen Geburtskohorten mit insgesamt 55 077 Kindern frühe Risiken bezogen auf eine elterliche Psychopathologie, einen niedrigen sozio-ökonomischen Status und ungünstige Eltern-Kind-Interaktionen identifiziert werden. Insbesondere eine mütterliche Depression, ein niedriger sozio-ökonomischer Status und ein harsches Erziehungsverhalten in den ersten Lebensjahren waren prädiktiv für externalisierende Verhaltensauffälligkeiten im Kindergarten und bei Schuleintritt. Implikationen für die klinische Praxis werden vorgestellt.
... The estimates of overall annual incremental health care costs associated with adult ADHD ranged from $16 to 50 billion (Doshi et al. 2012). Comorbid psychiatric disorders, such as depression and anxiety disorders (Hodgkins et al. 2011;Karlsdotter et al. 2016), and risky behavior leading to traffic accidents (Bernfort et al. 2008) appeared to be more prevalent among ADHD patients, resulting in higher medical costs. ...
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Objectives ADHD has a considerable economic impact. The aim of this study is to conduct a trial-based economic evaluation of mindfulness-based cognitive therapy (MBCT) added to treatment as usual (TAU) versus TAU in adults with ADHD. Methods A Dutch economic evaluation with a time horizon of 9 months was conducted from the societal perspective in the intention-to-treat (ITT) sample. Costs were assessed with a self-report questionnaire. Outcomes were expressed in quality adjusted life years (QALYs) and response rate. Bootstrap simulations were performed to estimate mean costs, QALYs, response rate, incremental cost-effectiveness ratios (ICERs), and associated uncertainty. Additional sensitivity analyses were done with imputed data, without extreme cost outliers, using the per protocol sample, and from a health care perspective. Results In the ITT sample, societal costs were €3572 for MBCT + TAU (n = 47; 95% CI 2416 to 4995) and €3389 for TAU (n = 49; 2327 to 4763). Average QALYs were 0.542 (0.522 to 0.563) per patient for MBCT + TAU and 0.534 (0.511 to 0.556) for TAU. In MBCT + TAU, more patients responded than in TAU (31% versus 6%; M bootstrapped difference 25%, 12 to 40%). ICERs were €21,963 per QALY gained and €389 per responder. At a threshold of €30,000 per QALY, the probability of MBCT being cost-effective was 51%. All sensitivity analyses showed more favorable results for MBCT + TAU. Conclusions In most analyses, MBCT was found to be more costly and effective, particularly in terms of disease-specific outcome, than TAU. If the threshold exceeds €30,000 per QALY and €1000 per responder, MBCT seemed cost-effective in treating adult ADHD.
... Moreover, there are some demographic features shown to be associated both with ADHD and injuries. Age, gender, educational level, smoking, marital status and economic status are among these factors [38][39][40][41][42][43]. ...
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Background: The aim of this study was to investigate the association between adult ADHD screening scores and hospitalization due to pedestrian injuries in a sample of Iranian pedestrians. Methods: Through a case-control study, a case population of 177 pedestrians injured by the vehicles in road traffic crashes were compared with 177 controls who lacked a record of intentional or unintentional injuries enrolled from various wards of Imam Reza University Hospital which is a specialty teaching hospital located in the same city with similar referral level. The cases and controls had an age range of 18-65 years and were matched on gender and age. ADHD symptom profile was assessed using the Persian Self-report Screening Version of the Conner's Adult ADHD Rating Scales (CAARS-S:SV). The association of ADHD screening score and pedestrian injuries was investigated using multiple binary logistic regression to investigate the independent effect of ADHD index score on belonging to case group. Both crude and adjusted odds ratios were reported. Results: Men comprised 86.4% of the study subjects. The crude odds ratios for all the four ADHD subscales to be associated with pedestrian injuries were 1.05, 1.08, and 1.04 for the subscales A (attention deficit), B (hyperactivity/impulsiveness) and ADHD index respectively. However, the association for subscale A was not statistically significant with a borderline p-value. The final multivariate analysis showed that variables associated with pedestrian injuries in the road traffic crashes were ADHD Index score (OR = 1.06, 95% CI: 1.01-1.12); economic status (including household income and expenditure capacity); educational level and total walking time per 24 h. Conclusions: Adult ADHD screening score can predict pedestrian injuries leading to hospitalization independently from sex, age, economic status, educational level and pedestrian exposure to traffic environment (average walking time).
... The main characteristics of ADHD are persistent and maturationally inconsistent patterns of inattention and/or hyperactivity disruptive of social and vocational activities (American Psychiatric Association, 2013, p. 59). In accordance with these characteristics, ADHD has been correlated with a wide array of personal, social, academic, and occupational problems across all age groups (Aduen et al., 2018; see also Barkley, 2015b;Bernfort et al., 2008;Brandt & Fischer, 2017;Loe & Feldman, 2007). ...
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Objectives The purpose of this theoretical analysis of current research on ADHD is to provide an account integrating executive functional profiles with its broader structural neurodevelopmental profile. Methods Comparative theoretical analyses between executive functional deficit disorder models of ADHD and results from default mode network fMRI data. This was followed by an analysis of the temporal profile of ADHD and phase synchronous neural assemblies. Results Comparative analyses suggest disparities within executive functional deficit disorder models and discontinuities between executive functional and structural profiles of ADHD. Analysis of the temporal signature of ADHD provides a potential avenue for integrating different profiles by means of anchoring executive functions within inherent diachronic neurocognitive organization. Conclusions The analyses provided suggest that executive functional deficits in ADHD arise from much broader idiosyncrasies, rooted within the inherent diachronic organization of neurocognitive function, and whose challenges must be understood in conjunction with socio cultural environmental factors.
... * Shuixia Guo guoshuixia75@163.com disorder, which not only has a negative impact on patients' own quality of life, but also an unquantifiable negative impact on their families (Bernfort et al., 2008;Sripada et al., 2014). Therefore, considerable attention should be paid to research on the pathogenesis of ADHD. ...
Article
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Aberration in the asymmetric nature of the human brain is associated with several mental disorders, including attention deficit/hyperactivity disorder (ADHD). In ADHD, these aberrations are thought to reflect key hemispheric differences in the functioning of attention, although the structural and functional bases of these defects are yet to be fully characterized. In this study, we applied a comprehensive meta-analysis to multimodal imaging datasets from 627 subjects (303 typically developing control [TDCs] and 324 patients with ADHD) with both resting-state functional and structural magnetic resonance imaging (MRI), from seven independent publicly available datasets of the ADHD-200 sample. We performed lateralization analysis and calculated the combined effects of ADHD on each of three cortical regional measures (grey matter volume - GMV, fractional amplitude of low frequency fluctuations at rest -fALFF, and regional homogeneity -ReHo). We found that compared with TDC, 68%,73% and 66% of regions showed statistically significant ADHD disorder effects on the asymmetry of GMV, fALFF, and ReHo, respectively, (false discovery rate corrected, q = 0.05). Forty-one percent (41%) of regions had both structural and functional abnormalities in asymmetry, located in the prefrontal, frontal, and subcortical cortices, and the cerebellum. Furthermore, brain asymmetry indices in these regions were higher in children with more severe ADHD symptoms, indicating a crucial pathoplastic role for asymmetry. Our findings highlight the functional asymmetry in ADHD which has (1) a strong structural basis, and thus is likely to be developmental in nature; and (2) is strongly linked to symptom burden and IQ and may carry a possible prognostic value for grading the severity of ADHD.
... While young people may be less susceptible to severe forms of the illness, suffering milder symptoms, lower morbidity, and better prognosis compared to adults (1, 2) they have experienced an upsurge in stress (3,4) precipitating loneliness, anxiety and depression in many (5)(6)(7)(8). As emotional symptoms in adolescence can become associated with many serious mental health outcomes including suicide, long-term physical health consequences, and significant healthcare burden (9)(10)(11), the effect of COVID-19 on young people's mental health could be more damaging in the longer run than the infection itself (12). Measuring early signs of mental health challenges such as worries and negative emotions in young people is thus an urgent priority for researchers (13,14) as well as policy-makers, including identifying those most vulnerable to mental health difficulties. ...
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The COVID-19 pandemic has posed unprecedented stress to young people. Despite recent speculative suggestions of poorer mental health in young people in India since the start of the pandemic, there have been no systematic efforts to measure these. Here we report on the content of worries of Indian adolescents and identify groups of young people who may be particularly vulnerable to negative emotions along with reporting on the impact of coronavirus on their lives. Three-hundred-and-ten young people from North India (51% male, 12–18 years) reported on their personal experiences of being infected by the coronavirus, the impact of the pandemic and its' restrictions across life domains, their top worries, social restrictions, and levels of negative affect and anhedonia. Findings showed that most participants had no personal experience (97.41%) or knew anyone (82.58%) with COVID-19, yet endorsed moderate-to-severe impact of COVID-19 on their academics, social life, and work. These impacts in turn associated with negative affect. Participants' top worries focused on academic attainments, social and recreational activities, and physical health. More females than males worried about academic attainment and physical health while more males worried about social and recreational activities. Thus, Indian adolescents report significant impact of the pandemic on various aspects of their life and are particularly worried about academic attainments, social and recreational activities and physical health. These findings call for a need to ensure provisions and access to digital education and medical care.
... Numerous studies have investigated the negative impact of ADHD in adults on educational attainment, employability, and productivity in the workplace, as well as on functional ability, self-esteem, and social functioning (Agarwal, Goldenberg, Perry, & IsHak, 2012;Bernfort, Nordfeldt, & Persson, 2008;Biederman et al., 2006;Fredriksen et al., 2014). One study involving a large manufacturing company found that ADHD was associated with a 4% to 5% reduction in work performance (p = .001), ...
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Objective: Investigate the association between diagnosis and outcomes in adults with symptoms of ADHD. Method: The Validate Attitudes and Lifestyle Issues in Depression, ADHD and Troubles with Eating (VALIDATE) study collected sociodemographic and clinical characteristics data, and responses from validated questionnaires on health-related quality of life (HRQoL), work productivity, functioning, and self-esteem. ADHD-diagnosed respondents ( n = 444) were matched with respondents with symptomatic ADHD ( n = 1,055) within the same sex-by-age group using propensity score matching. Effects of ADHD diagnosis on each outcome were adjusted for covariates that remained imbalanced after matching, using generalized mixed models. Results: After matching, symptomatic respondents ( n = 867) had worse outcomes than ADHD-diagnosed respondents ( n = 436), as measured by the Work Productivity and Activity Impairment: General Health questionnaire and Sheehan Disability Scale ( p < .001). ADHD-diagnosed respondents had better mean EuroQol five-dimensional five-level (EQ-5D-5L) scores and Rosenberg Self-Esteem Scale scores than symptomatic respondents ( p < .001). Conclusion: ADHD-diagnosed individuals are more likely to experience better functional performance, work-related productivity, HRQoL, and self-esteem than individuals with symptomatic ADHD.
... While young people may be less susceptible to severe forms of the illness, suffering milder symptoms, lower morbidity, and better prognosis compared to adults (1, 2) they have experienced an upsurge in stress (3,4) precipitating loneliness, anxiety and depression in many (5)(6)(7)(8). As emotional symptoms in adolescence can become associated with many serious mental health outcomes including suicide, long-term physical health consequences, and significant healthcare burden (9)(10)(11), the effect of COVID-19 on young people's mental health could be more damaging in the longer run than the infection itself (12). Measuring early signs of mental health challenges such as worries and negative emotions in young people is thus an urgent priority for researchers (13,14) as well as policy-makers, including identifying those most vulnerable to mental health difficulties. ...
... social services) should be explored further. Given the extensive societal costs related to NDDs [73,74], it is also important to conduct cost-effectiveness analyses. Finally, it is important to emphasise that there are limits to what we should expect from TRANSITION and similar interventions. ...
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Background: The support needs of people with neurodevelopmental disorders are not sufficiently met during the initial years of adulthood. Aim: To evaluate feasibility and preliminary effects of a novel programme designed to empower young adults with autism spectrum disorder (ASD) and/or attention deficit hyperactivity disorder (ADHD) to make progress within significant life domains (i.e. work, education, finance, housing/household management, health, leisure/participation in society, and relationships/social network). Material and Method: TRANSITION is a 24-week programme that combines group-based workshops with personalised support based on goal attainment scaling. The study enrolled 26 young adults (50% females; age 17–24 years) in the normative intellectual range, diagnosed with ASD (n = 8), ADHD (n = 4), or both (n = 14). The intervention was delivered by the regular staff of publicly funded psychiatric services in Stockholm, Sweden. Results: The programme was possible to implement with minor deviations from the manual. Participants and staff generally viewed the intervention positively, but also provided feedback to guide further improvement. There was a high degree of attendance throughout, with 21 participants (81%) completing the programme. All completers exceeded their predefined goal expectations within at least one domain. Conclusions: The TRANSITION-programme is a promising concept that deserves further evaluation.
... ADHD is a debilitating and impairing condition for children [3] and is known to increase the risk of poor outcomes throughout stages of life [4][5][6]. The economic impact of ADHD is estimated to be substantial [7]. In addition, between 30 and 70 % of those with a childhood diagnosis of ADHD will continue to experience clinically significant symptoms into adulthood [3]. ...
Article
This systematic review examines associations between parental socioeconomic disadvantage and childhood attention deficit/hyperactivity disorder (ADHD). Socioeconomic status (SES) was measured by parental income, education, occupation and marital status. Results were mixed by measure of SES with no one aspect being differentially related to ADHD. 42 studies were included in the review, of which 35 found a significant univariate association between socioeconomic disadvantage and ADHD. Meta-analyses of dimensions of SES and their association with ADHD indicate that children in families of low SES are on average 1.85-2.21 more likely to have ADHD than their peers in high SES families. In spite of substantial between-study heterogeneity, there is evidence for an association between socioeconomic disadvantage and risk of ADHD measured in different ways. This is likely mediated by factors linked to low SES such as parental mental health and maternal smoking during pregnancy.
Article
Aim. Attention deficit hyperactivity disorder (ADHD) in adulthood has been studied extensively in recent years. ADHD prevalence and persistence over the lifespan have been well documented, along with its adverse consequences on individual's life. This current review aims to examine research to date on the treatment and management of adult ADHD, with a particular focus on pharmacological treatment. Methods. A literature search was performed in MEDLINE, PubMed and Cochrane databases. Results. The diagnosis of adult ADHD is challenging because of its different clinical presentation in adulthood, and for the confounding effects of the frequent presence of comorbidities. There is a substantial agreement in considering a multimodal approach, combining medication, psychological and psychosocial interventions, as the most effective treatment of ADHD in adults as well in children. Stimulants are the most effective drug for ADHD treatment, but the presence and severity of comorbidities affect the treatment choice and outcomes. Conclusion. Despite the guidelines recommendations and the well documented safety and effectiveness of ADHD medications, adults affected by this disorder still suffer for the noticeable gap between research and clinical practice. The majority of drugs currently used in children are still not licensed for adults, and their availability varies among countries. This condition determines a considerable difficulty in the treatment of adults with ADHD, mostly in European countries.
Chapter
Introduction Young adults with attention-deficit hyperactivity disorder (ADHD) are at risk for experiencing numerous life difficulties as a consequence of impairments in the cognitive skills that undergird self-control, also known as the executive functions [1, 2]. Moreover, coming as they do during this period of life during which there are long-term effects of decisions made (e.g., education, career, relationships), the manner in which these life difficulties are managed may have lingering effects on one’s sense of self and one’s future. The aim of this chapter is to review how ADHD affects the experiences of young adults, roughly defined as 18- to 30-year-olds, who are enrolled in post-secondary educational programs. In particular, the current review will start with a discussion of the typical difficulties encountered by these students that might lead them to seek help. The components of a competent assessment of ADHD in young adults, as well as some areas of concern in their evaluation will be outlined. The chapter will conclude with an overview of the different treatments available to college and university students with ADHD, including discussions of the available outcome research on these approaches. Symptoms and functional impairments As a group, individuals with ADHD are less likely to attend college and are more likely to drop out of college than individuals without ADHD [3, 4]. Surveys have found that between 2% and 9% of college students fulfill diagnostic criteria for ADHD [5–7], although only about 1%of students formally identify themselves with ADHD [4]. Nevertheless, increasing numbers of students are arriving at college with learning disabilities associated with ADHD.
Book
Adult ADHD: Diagnostic Assessment and Treatment, Third Edition covers not only diagnostic assessment, but also comorbidity patterns as well as differential diagnosis of ADHD with for example bipolar disorder and borderline personality disorder. The symptom overlap and misdiagnosis of chronic fatigue syndrome in girls and women with the inattentive subtype of ADHD, ADD is explored. The chronic delayed sleep phase syndrome associated with ADHD based on disturbances in the circadian rhythm, and the possible consequences for general health (obesity, diabetes, cardiovascular diseases and cancer) are discussed. There are sections on ADHD and intelligence, criminality, sexuality, dyslexia and autism. Adult ADHD can be treated effectively but as yet the disorder is not always recognised by professionals and this book aims to help correct this. Diagnostic tools are included, such as the structured Diagnostic Interview for Adult ADHD (DIVA), and an ultra-short and somewhat longer screening tool, all based on the DSM-IV criteria for ADHD. Treatment options cover psychoeducation and motivation and individual and group coaching; long-acting stimulants and other new drugs for treating ADHD; use of melatonin to treat the delayed sleep-phase disorder. Useful information is included on the setting up and organisation of a department for adult ADHD with a multidisciplinary team. References, websites and useful international addresses have all been updated. Adult ADHD: Diagnostic Assessment and Treatment, Third Edition is intended for students, junior doctors/residents, psychologists, psychiatrists, other mental healthcare professionals and interested parties and provides a quick overview of the current state of the science and of the methods used in diagnosis and treatment.
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Objective: It has only recently been accepted that attention-deficit hyperactivity disorder (ADHD) persists into adulthood. Accordingly, less is known about adult diagnostic and treatment prevalence. We aimed to determine the lifetime prevalence of ADHD diagnosis and psychostimulant prescriptions for young adults in the province of Manitoba and to explore how diagnosis differs according to sociodemographic characteristics and age at diagnosis; and to investigate whether a socioeconomic gradient exists within young adults with a lifetime ADHD diagnosis, as well as the variables that moderate the gradient. Methods: Using the Manitoba Population Health Research Data Repository, our cross-sectional analysis used 24 fiscal years of data (1984/85 to 2008/09) and included all adults aged 18 to 29 during 2007/08 to 2008/09 in Manitoba (n = 207 544) who had a lifetime diagnosis of ADHD (n = 14 762). Regression analyses tested for differences in rates by sex, region, age, age at diagnosis, and socioeconomic status. Results: Lifetime prevalence for ADHD diagnosis (7.11%) and psychostimulant prescriptions (3.09%) differed according to sex, region, and age. In contrast to previous Manitoban research on childhood ADHD, the socioeconomic gradient for ADHD diagnosis was not found in young adulthood. When region was accounted for, a small negative gradient in the urban population and a positive gradient in the rural population were evident. People from the highest income quintile were significantly less likely to be diagnosed before age 18, compared with other income quintiles. Conclusions: Given the high lifetime prevalence of ADHD in Manitoban young adults and significant socioeconomic correlates for diagnosis, further investigation into the trajectory of this relatively unexplored population is recommended.
Chapter
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Introduction “The good that I would do, that I do not; that which I hate, that do I.” St. Paul “We know the good and recognize it, but we cannot do it.” Euripides Hippolytus Attention-deficit hyperactivity disorder (ADHD) affects an estimated 11% of the school-aged population in the United States [1]. It is a chronic condition that can have adverse effects extending beyond childhood into adolescence and adulthood [2]. Children, teens, and adults with ADHD struggle to manage domains of functioning that range across the lifespan from experiencing success in school to achieving fulfillment in work, from making friends in childhood to building social networks in adulthood, and from sustaining family trust and intimacy to contributing to community life [3, 4]. Though many people with ADHD “muddle through” in managing the affairs of life, evidence indicates that people diagnosed with ADHD are at higher risk for mental health problems and life adversity [5–8] and families of children with ADHD experience considerable emotional and financial stressors [9, 10]. These adverse outcomes make a strong case that ADHD is a public health concern requiring careful attention to appropriate independent and multimodal treatment approaches. The pervasiveness of symptoms in domains of daily functioning supports the need for ongoing treatment across settings, through the day, and over years. Research and clinical expertise have provided practical treatments for children and adults with ADHD, but despite successes, sustained application of interventions remains problematic. This chapter reviews pharmacotherapy treatment adherence for ADHD across the lifespan, overviews psychosocial intervention adherence, and provides suggestions to clinicians to improve treatment adherence over time. ADHD is a treatable neurocognitive condition Medical interventions To see a single daily dose of benzedrine produce a greater improvement in school performance than the combined efforts of a capable staff working in a most favorable setting would have been all but demoralizing to the teachers had not the improvement been so gratifying from a practical viewpoint. Charles Bradley, MD 1937 [11]. Since Bradley’s comments on the effects of medical treatment in children with “morbid defect of volition” [12], ADHD treatments are available through increasingly sophisticated modes of delivery. Successful intervention has been demonstrated in preschoolers, children, adolescents, and adults.
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Introduction Attention-deficit hyperactivity disorder (ADHD) and depressive spectrum disorders frequently co-occur. Adults presenting for treatment of depression experience increased rates of ADHD, while those with ADHD suffer with higher rates of depression than their non-ADHD peers. Unfortunately despite the commonness of their occurrence, ADHD in adults with depressive spectrum disorders is often overlooked and therefore not found or treated. Likewise, despite their well-documented increased risk, many adults with ADHD suffer with untreated depression. Adults with ADHD experience significant interpersonal difficulties in relationships with family, friends, colleagues, and themselves. Adults with ADHD are often variably effective, or at least inefficient, in modulating the outflow from their body, mouth, and mind; and may be unaware of how their behavior impacts others. Over the course of development these adults frequently “bump into the walls of life,” enduring repeated recriminations and assaults to their self-esteem, which are often experienced as both “stressed and stressful.” Although not explicitly included in the diagnostic criteria of the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1], adults with ADHD are frequently perceived as “impatient,” “hot tempered,” and “irritable” [2–4]. Living with ADHD is difficult; and can be disheartening to patients, their loved ones, and their colleagues. Researchers and clinicians from around the globe recognize that adults with ADHD suffer with a variety of depressive spectrum disorders. As clinicians it is crucial to keep both aspects in mind; namely, that many adults with ADHD exhibit frequent affective symptoms (i.e., low frustration tolerance, dysphoria, and excessive emotional reactivity) and that these behaviors may reflect either dejection resulting from their ADHD and/or as an aspect of a clinically significant depression [5–8]. The clinical challenge is to differentiate their affective dysregulation related to ADHD from depressive spectrum disorders such as major depression, dysthymia, seasonal affective disorder, recurrent brief depression as well as the depressive phase of bipolar disorder. Over the course of the past 20 years a variety of researchers have enhanced our understanding of the relationship between depression and ADHD and their work informs our clinical practice. In this chapter I will review these data, paying special attention to the overlap between ADHD in adults, depression, executive function deficits, and emotional dysregulation, and conclude by discussing data about the psychosocial and medical treatments of both conditions.
Chapter
Introduction Despite increased recognition that children with attention-deficit hyperactivity disorder (ADHD) commonly grow up to be adults with the same disorder, evidence-based guidelines on the treatment of adults with ADHD are lacking. Support groups (e.g., www.chadd.org and www.add.org) assist the newly diagnosed adult by providing education, an overview of treatment options, available resources, and peer support. Recently the World Health Organization supported the development of an easy to use screen tool for ADHD in adults. This tool has been validated [1] and is easy to access and use. Fortunately over the past several years, several organizations including the American Academy of Child and Adolescent Psychiatry, the Center for ADHD Advocacy, Canada, and the European Network Adult ADHD have published guidelines which provide clinicians with a thorough description of the clinical features of ADHD across the lifespan and outline principles for the assessment, diagnosis, and recognition of common comorbid disorders and treatment of ADHD. Once a reliable and valid diagnosis has been established the treatment of ADHD in adults relies on three foundations: psychoeducation, pharmacotherapy, and psychosocial treatments. It is important to set clear realistic treatment goals with the adult and identify specific symptoms and problematic areas of functioning as targets of treatment. Response-based rating scales such as the ADHD Rating Scale (ADHD-RS), the Conners’ Adult ADHD Rating Scale (CAARS), the Wender–Reimherr Adult ADHD Rating Scale, and the Brown Adult ADHD Rating Scale can be used to help assess symptoms and monitor outcome (for review see Adler and Cohen [2] and Murphey and Adler [3]). Additional therapies often complement the effects of medication. As with children, college students and adults returning to school may benefit from additional educational supports. Coaching and organization training appear useful but remain understudied [4, 5].
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Introduction Stimulants are among the most effective and most studied psychotropic medications in clinical use today. Over the past decade, with the increase in the diagnosis of attention-deficit hyperactivity disorder (ADHD), there has been a corresponding increase in the use of stimulants – the most commonly prescribed medications for this condition. This chapter explores contemporary issues of prescribing stimulants for children and adolescents with ADHD and examines specific areas in recent literature and clinical concerns that may persist. Stimulant preparations overview Two groups of stimulants are currently approved by the US Food and Drug Administration (FDA) for ADHD treatment of the pediatric population, methylphenidates (MPH) and amphetamines (AMPH). These medicines are available in both branded and generic formulations. Table 20.1 describes the names, preparations, strengths, and duration of behavioral effects of commonly available stimulants. Since April 2000, several stimulant formulations have been approved – including extended-release preparations of oral MPH, transdermal MPH, extended-release dexmethylphenidate (d-MPH), lisdexamfetamine, and an oral solution of dextroamphetamine sulfate. By and large, these longer-acting forms of MPH and AMPH circumvent the short duration of action of the immediate-release stimulants (e.g., 3–5 hours of efectiveness for ADHD). The stimulants are classified by the FDA and Drug Enforcement Agency (DEA) as Schedule II agents.
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Introduction Cigarette smoking is the leading preventable cause of death and disability in the United States. Annually, smoking leads to more than 400 000 premature deaths in the USA and nearly 5 million deaths worldwide [1]. In the USA alone, $150 billion in annual costs are attributable to smoking-related illnesses and lost worker productivity [2]. Several large-scale, epidemiological studies have reported that individuals who have psychiatric disorders are significantly more likely to smoke than individuals from the general population [3, 4]. The prevalence of smoking among individuals with a current psychiatric condition is nearly double that of individuals without current mental illness [4, 5]. While individuals who reported a psychiatric diagnosis in the past month make up approximately 30% of the US population, they consume an estimated 44.3% of all cigarettes [4]. The number of co-occurring psychiatric disorders in an individual is also associated with higher levels of nicotine dependence and greater withdrawal severity [4, 6]. Most population- and clinic-based studies of smoking/psychiatric illness comorbidity have excluded attention-deicit hyperactivity disorder (ADHD). This may be because ADHD is oten considered a disorder of childhood and is thus not included as a psychiatric condition category when studying samples of adults. However, in the few studies in which the disorder has been examined, ADHD shows comparable rates of comorbidity with cigarette smoking as other psychiatric disorders (approximately 40%) [7]. Moreover, recent evidence suggests that ADHD symptoms, even at levels below the threshold required to make a clinical diagnosis, are signiicantly associated with risk for smoking [8].
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Introduction and rationale The psychostimulants, primarily methylphenidate (MPH) and amphetamine (AMPH), are the most effective and frequently prescribed medications for attention-deficit hyperactivity disorder (ADHD). Hundreds of controlled clinical trials have established the utility of these medications in reducing the overactivity, impulsivity, and inattention characteristic of children with ADHD, leading to improvement in a wide variety of associated behaviors, including academic performance, social functioning, and disruptive behavior. The effect size of stimulant medication for treatment of core ADHD symptoms is considered to be large, making these medications among the most effective treatments in psychiatric practice. Moreover, the tolerability profile of stimulants is considered to be quite agreeable. Yet, despite their overall robust efficacy and reasonable tolerability profile, stimulant treatments have their limitations, as outlined below. Response. Some patients do not tolerate stimulant treatments well or do not achieve optimal symptom reduction with these medications. For example, in the Multimodal Treatment Study of Children with ADHD (i.e., MTA study), only 56% of patients had an optimal response (defined as a composite rating of “1” on a composite scale comprising symptoms of ADHD and oppositional defiant disorder [ODD]) to well-titrated medication treatment, primarily stimulants (and almost exclusively immediate-release formulations, since the MTA study was conducted in the mid to late 1990s), using all available compounds and formulations; approximately 20% of the patients did not respond to treatment with either stimulant class [1]. In addition, while the 14-month MTA findings [2] clearly established the relative superiority of assignment to the MTA medication algorithm over behavior interventions over the course of 1 year (i.e., relatively long-term improvement), findings from the 36- and 72-month follow-up assessments suggest that the superiority of intensive, carefully monitored medication management gradually dissipates when children are returned to community treatment. While this result does not contradict the findings of robust efficacy of acute stimulant treatment, it does suggest the importance of considering multiple perspectives regarding intervention [3, 4].
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Descriptive and clinical features Prevalence Although anxiety disorders and ADHD are distinct classes of disorders with different developmental trajectories across the lifespan, the disorders have very high rates of comorbidity and may share common symptom presentations [1–3]. Anxiety disorders can present very early in life, with several forms of anxiety disorders differentiating by age 2 years [4–7]. However, the prevalence of anxiety increases with age and many individuals diagnosed in youth will experience ongoing anxiety problems, often experiencing multiple anxiety disorders across the lifespan [8–10]. Among adults in the US population, 18.1% meet criteria for an anxiety disorder in any given year; nearly three-quarters of these individuals experienced their first episode by age 21 [9, 11]. The overall lifetime prevalence of 28.8% makes anxiety disorders one of the most commonly diagnosed classes of disorders [9, 11]. Within the population of individuals with anxiety disorders, nearly one-quarter experience clinically significant attention problems as a feature of their disorder [9, 12]. Individuals with anxiety disorders are also at double the risk for meeting full criteria for ADHD than the general population [3]. The lifetime prevalence of ADHD is lower; early age of onset is also characteristic, although later than the earliest onset anxiety disorders [4, 10, 13, 14]. The population-wide prevalence of ADHD in the United States is approximately 8% among youth ages 4 to 18 years [13, 14]. That number declines to 4.4% among adults [2]. The trend of declining diagnosis with age is in accordance with etiological theories describing ADHD as a neurobiological disorder characterized by a delayed developmental trajectory – as suggested by the finding of delayed cortical thickening in youth with ADHD vs. healthy controls [2, 15–17]. Continued symptom impairment during adulthood would then be associated with developmental differences, rather than delay [17].
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The NCLT model has a number of properties chief among them is the idea that multiple variables and life experiences interacted with a constitutionally provided core to produce an outcome that is sometimes adaptive and, as in the case of mental illness, sometimes not adaptive. In this regard it fit the Life Course Model of Disease which posits that there are differences in health patterns that result from broad social, economic, and environmental factors that underlie causes of persistent inequalities in health for a wide range of diseases and conditions across population groups. Both models support the idea that early experiences, as much as and perhaps to a greater extent than later experiences, facilitate the development of specific pathways and trajectories thereby significantly influencing an individual’s future health and development. NCLT extends the Life Course model to the treatment of mental illness conceptualized as emerging as a result of life course processes. Its focus is on the individual and how that individual adapts to the life course events that they interact with.
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Introduction Neuroimaging of attention-deficit hyperactivity disorder (ADHD) involves the application of increasingly sophisticated approaches to an intermittently moving target. The first imaging studies, which are reviewed elsewhere [1], used computed-axial tomography even before the diagnosis of attention deficit disorders with or without hyperactivity had been formulated in 1980 and did not detect differences when applied quantitatively [2]. The second generation of imaging studies harnessing positron emission tomography methods first detected substantial differences between individuals with ADHD and healthy controls [3], but the use of injected radioligands meant that this approach was mostly limited to studies of adults [1] with rare exceptions [4]. The widespread availability of high-resolution three-dimensional magnetic resonance imaging (MRI) by the early 1990s revolutionized ADHD structural imaging, as the technique could be applied to children and adolescents without entailing risks greater than those encountered in daily life. The designation as a minimal risk procedure was particularly important for the inclusion of healthy children as comparison subjects and for the conduct of longitudinal studies. The resulting profusion of investigations has become too voluminous to even enumerate. For example a PubMed search on March 16, 2013 with the abbreviated search terms MRI and ADHD returned 846 results.
Chapter
Introduction New diagnostic criteria for attention-deficit hyperactivity disorder (ADHD) have been introduced in the latest edition of the Diagnostic and Statistical Manual for Mental Disorders (fifth edition, DSM-5) that was published in May 2013 [1]. Various changes to DSM-IV were suggested by the committee chosen to revise the criteria which then led to exploration of various large-scale existing datasets to test out the results and discover the implications of many of these proposals. (Note – the author did not serve on this committee but did consult with it and provide datasets to it.) Many of the proposals for change were founded on a number of criticisms that were previously leveled at the extant DSM-IV diagnostic criteria [2–5]. Rather than just discuss the various changes that have occurred in the DSM-5 criteria for ADHD, this chapter places those changes in the context of the larger issues and criticisms they were intended to address. It also discusses several additional issues apparently not planned to be addressed as of this time, yet deserved to be acknowledged and possibly even corrected by clinicians utilizing DSM-5 criteria. At the outset, it should be understood that the problems with DSM-IV and the need for their correction in no way invalidate those criteria for use in the diagnosis of ADHD in children and adults. Since DSM-III [6], efforts have increased to make the criteria more empirically based, in part, using available scientific evidence as well as testing the proposed criteria in field trials [7, 8]. From a scientific standpoint, existing knowledge (criteria in this case) is always imperfect but can be further refined and made more accurate as a representation of material reality or a truth claim. This occurs through a Darwinian process of testing the existing information against reality and using the feedback (criticism) received in return from such testing to revise the knowledge base.
Chapter
The interaction and relationship between attention deficit hyperactivity disorder (ADHD) and substance use disorders (SUD) have long been recognized. Many hypotheses for this relationship have been advanced. However, it took contributions from many fields to shed light on this very prevalent problem, often starting in late childhood or early adolescence but continuing well into adulthood. These included contributions from epidemiology, genetics, neuroimaging, psychopharmacology, and of course long-term clinical follow-up to understand that SUD and substance abuse are significant complications of the lack of adequate treatment of ADHD, often dating from early childhood. There is also a bidirectional influence, esp. with the use of tobacco and alcohol during pregnancy increasing the risk for the development of ADHD in the fetus. That ADHD and SUD are public health issues is now well recognized and has resulted in formal clinical trials to elucidate the best treatment when both disorders co-occur or are concurrent/comorbid. This is particularly relevant as treatment of ADHD is often with medications with a risk of diversion and hence abuse. As such, clinical trials to understand the relative benefits versus risks are very important clinically. A review of the literature in these areas leads then to an attempt to translate research findings into evidence-based practice that maximizes benefits but minimizes risks. Practice guidelines in this respect are reviewed.
Chapter
ADHD is an established disorder with widespread development of clinical services for children and adolescents. Cross-sectional and longitudinal studies also demonstrate the continuity of symptoms and impairments into adult life in many cases. This chapter provides an overview of the key clinical concerns and impact of ADHD on adults and emphasizes the importance of ADHD to adult psychopathology. The range of impairments is broad. At one end of the spectrum are high functioning individuals who cope well in many aspects of their lives, but struggle with symptoms such as chronic disorganization, restlessness, inability to relax, irritability, and difficulty sleeping. On the other hand, some individuals with ADHD are among the most dysfunctional in society, having considerable difficulties maintaining themselves in employment, completing simple everyday tasks, developing relationships, controlling their temper and being drawn into antisocial behavior, and drug and alcohol abuse. The severity of the symptoms of ADHD in some cases explains the frequent difficulty non-specialists can have in distinguishing ADHD from other mental health problems such as bipolar and personality disorders. The overall conclusion is that ADHD is a distinct condition that often has serious consequences for adults as well as children and adolescents. Because ADHD in adults is a common source of personal and societal suffering, because it is highly treatable, because it compounds other disorders, and because services for adults with ADHD are limited, ADHD deserves the full attention of those working in adult mental health.
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Objective: This study evaluated the efficacy of an Integrated Brain, Body, and Social (IBBS) intervention for children with ADHD. Treatment consisted of computerized cognitive remediation training, physical exercises, and a behavior management strategy. Method: Ninety-two children aged 5 to 9 years with ADHD were randomly assigned to 15 weeks of IBBS or to treatment-as-usual. Primary outcome measures included blinded clinician ratings of ADHD symptoms and global clinical functioning. Secondary outcome measures consisted of parent and teacher ratings of ADHD and neurocognitive tests. Results: No significant treatment effects were found on any of our primary outcome measures. In terms of secondary outcome measures, the IBBS group showed significant improvement on a verbal working memory task; however, this result did not survive correction for multiple group comparisons. Conclusion: These results suggest that expanding cognitive training to multiple domains by means of two training modalities does not lead to generalized improvement of ADHD symptomatology.
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The abilities to stabilize the focus of attention, notice attention lapses, and return attention to an intended object following lapses are precursors for mindfulness. Individuals diagnosed with attention-deficit hyperactivity disorder (ADHD) are deficient in the attentional and self-control skills that characterize mindfulness. The present study assessed the relationship between mindfulness and ADHD in young adults using the Mindful Attention and Awareness Scale (MAAS), a computerized Go/No-Go task (the Test of Variables of Attention (TOVA)), the World Health Organization Adult Self-Report Scale (ASRS), a tool used as an adult ADHD screen, the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory-II (BDI-II). We recruited 151 adult volunteers (ages 18 to 40); 100 with confirmed ADHD diagnoses and 51 control participants. Overall, participants with prior diagnoses of ADHD scored lower on the MAAS than controls and ASRS scores were strongly negatively correlated MAAS scores. Attention performance index, response time, and response-time variability subscales of the TOVA were positively correlated with MAAS scores and negatively correlated with ASRS scores. Intrasubject response-time variability on the TOVA, a parameter associated with attention lapses, was also strongly negatively correlated with MAAS scores. Overall, participants’ self-reported mindfulness, as measured by the MAAS, was strongly related to self-reports on a clinical measure of attention disorders, anxiety, depression, and multiple indices of concentration and mind wandering on a standardized Go/No-Go task, the TOVA.
Article
Background: Models incorporating long-term outcomes (LTOs) are not available to assess the health economic impact of attention-deficit/hyperactivity disorder (ADHD). Objective: Develop a conceptual modelling framework capable of assessing long-term economic impact of ADHD therapies. Methods: Literature was reviewed; a conceptual structure for the long-term model was outlined with attention to disease characteristics and potential impact of treatment strategies. Results: The proposed model has four layers: i) multi-state short-term framework to differentiate between ADHD treatments; ii) multiple states being merged into three core health states associated with LTOs; iii) series of sub-models in which particular LTOs are depicted; iv) outcomes collected to be either used directly for economic analyses or translated into other relevant measures. Conclusions: This conceptual model provides a framework to assess relationships between short- and long-term outcomes of the disease and its treatment, and to estimate the economic impact of ADHD treatments throughout the course of the disease.
Article
Although Attention-Deficit/Hyperactivity Disorder shows (ADHD) male predominance, females are significantly impaired and exhibit additional comorbid disorders during adolescence. However, no empirical work has examined the influence of cyclical fluctuating steroids on ADHD symptoms in women. The present study examined estradiol (E2), progesterone (P4), and testosterone (T) associations with ADHD symptoms across the menstrual cycle in regularly-cycling young women (N=32), examining trait impulsivity as a moderator. Women completed a baseline measure of trait impulsivity, provided saliva samples each morning, and completed an ADHD symptom checklist every evening for 35days. Results indicated decreased levels of E2 in the context of increased levels of either P4 or T was associated with higher ADHD symptoms on the following day, particularly for those with high trait impulsivity. Phase analyses suggested both an early follicular and early luteal, or post-ovulatory, increase in ADHD symptoms. Therefore, ADHD symptoms may change across the menstrual cycle in response to endogenous steroid changes.
Chapter
Although the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD) were originally intended for children [1, 2], the criteria are the same for adults and can be reliably used to diagnose individuals who are currently experiencing symptoms of the disorder and have a history of these symptoms since early childhood [3, 4]. It is also necessary to document impairment in professional, academic, and personal settings and that the symptoms are due primarily to ADHD and not to another psychiatric condition or other environmental or personal circumstances. Rating scales can be quite helpful for documenting symptoms (ADHD symptom scales) or for more structured evaluations which can be used in fully establishing the diagnosis. A further utility of ADHD adult symptom scales can be in monitoring the response to treatment. There are several diagnostic interviews and symptom rating scales that can be used in the clinical evaluation of adults for ADHD (Tables 18.1 and 18.2), which are generally economical and effective in obtaining a large amount of data quickly, including symptom severity and response to treatment. Many of these measures include adult-specific prompts and probes designed to assess the impact and severity of ADHD symptoms using a semi-structured interview, which is particularly advantageous for clinicians who have limited experience in working with adult ADHD patients. There are also measures that assess ADHD-related impairments in executive function (EF), emotional regulation (ER), occupational, and quality-of-life domains.
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Background Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) frequently persist into adolescence and young adulthood. However, there are few clinical services that support those with these disorders through adulthood. Objective Our aim was to determine if clinical services meet the needs of people with ASD and ADHD, who are ‘at transition’ from childhood to adulthood. Design A longitudinal study of individuals with ASD and ADHD, the impact of services and treatments. Methods Our research methods included (1) interviewing > 180 affected individuals (and their families) with a confirmed diagnosis of ASD and/or ADHD, (2) screening for ASD and ADHD in approximately 1600 patients and (3) surveying general practitioner prescribing to 5651 ASD individuals across the UK. In addition, we tested the effectiveness of (1) new ASD diagnostic interview measures in 169 twins, 145 familes and 150 non-twins, (2) a magnetic resonance imaging-based diagnostic aid in 40 ASD individuals, (3) psychological treatments in 46 ASD individuals and (4) the feasability of e-learning in 28 clinicians. Setting NHS clinical services and prisons. Participants Focus – young people with ASD and ADHD as they ‘transition’ from childhood and adolescence into early adulthood. Interventions Testing the utility of diagnostic measures and services, web-based learning interventions, pharmacological prescribing and cognitive–behavioural treatments. Main outcome measures Symptom severity, service provision and met/unmet need. Results People with ASD and ADHD have very significant unmet needs as they transition through adolescence and young adulthood. A major contributor to this is the presence of associated mental health symptoms. However, these are mostly undiagnosed (and untreated) by clinical services. Furthermore, the largest determinant of service provision was age and not severity of symptoms. We provide new tools to help diagnose both the core disorders and their associated symptoms. We also provide proof of concept for the effectiveness of simple psychological interventions to treat obsessional symptoms, the potential to run treatment trials in prisons and training interventions. Limitations Our findings only apply to clinical service settings. Conclusions As individuals ‘transition’ their contact with treatment and support services reduces significantly. Needs-led services are required, which can both identify individuals with the ‘core symptoms’ of ASD and ADHD and treat their residual symptoms and associated conditions. Future work To test our new diagnostic measures and treatment approaches in larger controlled trials. Trial registration Current Controlled Trials ISRCTN87114880. Funding The National Institute for Health Research Programme Grants for Applied Research programme.
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The behavioural characteristics of ADHD do not exist in binary form (i.e. normal vs. abnormal); instead, they exist on a spectrum or continuum. This implies that some aspects of ADHD can be adaptive rather than impairing, or some adults may possess certain strengths or attributes that mediate and/or compensate for their ADHD-related deficits or impairments. More research is needed to clarify these observations. To explore and describe positive aspects of ADHD from the perspective of successful adults with ADHD. A phenomenological approach with open-ended interviews was used to collect data. The interviews were audio taped, transcribed verbatim and analysed using thematic content analysis. Six core themes (cognitive dynamism, courage, energy, humanity, resilience and transcendence) defined by 19 sub-themes were found. These themes were compared against attributes catalogued in the character strengths and virtues (CSV) handbook and classification for positive psychology. Two core themes (cognitive dynamism and energy) were not listed as virtues in the CSV, and neither were six sub-themes (divergent thinking, hyper-focus, nonconformist, adventurousness, self-acceptance and sublimation) listed as behavioural traits. We propose these constructs as positive aspects specific to ADHD, and the other constructs, as positive aspects relevant to people in general, with or without ADHD. This study offers insights into positive human qualities, attributes or aspects of ADHD that can support and sustain high functioning and flourishing in ADHD life. This study also addresses the question in the disability research about “how we might reconsider the behaviours associated with ADHD so that they are seen as valuable and worthy of conservation?”.
Article
There is insufficient data regarding the excess direct and indirect costs associated with attention deficit hyperactivity disorder (ADHD). Using the Danish National Patient Registry (2002–2016), we identified 83,613 people of any age with a diagnosis of ADHD or who were using central-acting medication against ADHD (primarily methylphenidate, with at least two prescriptions) and matched them to 334,446 control individuals. Additionally, 18,959 partners of patients aged ≥18 years with ADHD were identified, and compared with 74,032 control partners. Direct costs were based on data from the Danish Ministry of Health. Information about the use and costs of drugs were obtained from the Danish Medicines Agency. The frequencies of visits and hospitalizations, and costs of general practice were derived from data from the National Health Security. Indirect costs were obtained from Coherent Social Statistics. The average annual health care costs for people with ADHD and their partners were, respectively, €2636 and €477 higher than those of the matched controls. A greater percentage of people with ADHD and their partners compared with respective control subjects received social services (sick pay or disability pension). Those with ADHD had a lower income from employment than did controls for equivalent periods up to five years before the first diagnosis of ADHD. The additional direct and indirect annual costs (for those aged ≥18 years) including transfers of ADHD compared with controls were €23,072 for people with ADHD and €7,997 for their partners. ADHD has substantial socioeconomic consequences for individual patients, their partners and society.
Thesis
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In der dargestellten Arbeit wurden verschiedene Hypothesen im Hinblick auf die berufliche und gesundheitliche Belastung von Eltern mit Kindern, die an ADHS leiden, untersucht. So wurde zunächst der Fragestellung nachgegangen, in wieweit das von ADHS betroffene Kind in der Familie selbst zu einer erhöhten Belastung der Eltern am Arbeitsplatz und somit zu einer gesteigerten gesundheitlichen Einschränkung führt. Zudem untersuchten wir die Auswirkungen einer möglichen eigenen ADHS-Symptomatik in der Kindheit laut WURS auf die gesundheitliche Verfassung und die Leistungsfähigkeit am Arbeitsplatz. Schließlich wurde in der dritten Hypothese die Frage untersucht, in wieweit ein Effekt der Anzahl betroffener Kinder mit ADHS innerhalb einer Familie feststellbar ist. Entsprechend wurde eine vergleichende Untersuchung mit einer klinischen Stichprobe (n=91) und einer gesunden Vergleichsstichprobe (n=198) durchgeführt. Um die verschiedenen Einflussfaktoren verifizierbar zu machen, wurden verschiedene Untersuchungsinstrumente in Form von Fragebögen sowohl an die klinische Stichprobe als auch an die Vergleichsstichprobe (Familien, deren Kinder als gesund beschrieben wurden) verteilt. Zur allgemeinen Einschätzung von Verhaltensauffälligkeiten der Kinder in den jeweiligen Familien wurde die Child-Behavior-Checklist von den Eltern ausgefüllt. Zudem schätzten die Eltern über den Fremdbeurteilungsbogen für hyperkinetische Störungen die ADHS-Symptomatik ihrer Kinder ein. Darüber hinaus beurteilten die Eltern eine mögliche eigene ADHS-Symptomatik in der Kindheit über die retrospektiv ausgelegte Wender Utah Rating Scale. Der individuelle Gesundheitszustand der Väter und Mütter wurde über den „EQ-5D“ erfragt, während die Belastung am Arbeitsplatz mittels der Work Limitation Questionnaire ermittelt wurde. Schließlich füllten alle teilnehmenden Eltern einen sozioökonomischen Fragebogen aus, in dem Alter, Geschlecht, Familienstand, Schulabschluss und das Haushaltsnettoeinkommen berücksichtigt wurden. In zahlreichen, im Diskussionsteil bereits erwähnten Studien wurde eine Mehrbelastung der Eltern festgestellt. In der vorliegenden Arbeit wurden darüber hinaus die konkreten Auswirkungen dieser bereits festgestellten Mehrbelastung auf den Gesundheitszustand und das berufliche Umfeld untersucht. Die Untersuchung dieser Auswirkungen auf das alltägliche Leben der betroffenen Eltern geriet bislang kaum in den Fokus wissenschaftlicher Arbeiten. Um zukünftig betroffene Familien gezielter in unterschiedlichen Lebensbereichen unterstützen zu können ist es jedoch von eminenter Bedeutung, diese Auswirkungen zu kennen und besser zu verstehen. In den Ergebnissen konnte konkret gezeigt werden, dass bezüglich der Hypothese 1 die Anwesenheit eines ADHS-Kindes innerhalb einer Familie den Gesundheitszustand der Eltern laut Selbsturteil im EQ-5D signifikant beeinflusst. Im Rahmen der beruflichen Belastung war feststellbar, dass ein ADHS-Kind sich signifikant auf die physische Konstitution laut WLQ der Eltern auswirkt. Die Untersuchung der Hypothese II ergab, dass eine mögliche eigene ADHS-Symptomatik in der Kindheit sich auf unterschiedliche Dimensionen im beruflichen Umfeld auswirkt, jedoch nicht signifikant auf den individuellen Gesundheitszustand. Väter und Mütter, die selbst in ihrer Kindheit ADHS-Symptome angaben, geben eine signifikante Beeinträchtigung bezüglich der mentalen Fähigkeiten, des Zeitmanagements und der allgemeinen Arbeitsproduktivität laut Selbsteinschätzung im WLQ an. Eine physische Einschränkung am Arbeitsplatz laut WLQ war bei den Vätern signifikant feststellbar, nicht jedoch bei den Müttern. Die Ergebnisse der Hypothese III ergaben, dass bezüglich der Arbeitsfähigkeit bereits bei einem oder mehr Kindern mit ADHS die kognitiven Fähigkeiten der Eltern am Arbeitsplatz laut WLQ beeinträchtigt sind. Gleichermaßen wird die Arbeitsproduktivität bereits bei einem oder mehr von ADHS betroffenen Kindern signifikant beeinflusst. Auf die physische Konstitution der Eltern laut Selbsteinschätzung im WLQ haben ein oder auch mehrere von ADHS betroffene Kinder jedoch keinen signifikanten Einfluss. Die zeitliche Organisation der Eltern am Arbeitsplatz laut WLQ ist folglich bei einem Kind mit ADHS noch nicht signifikant beeinträchtigt, wohl aber, wenn mehr als ein Kind betroffen ist. Ebenso ist der Gesundheitszustand der Eltern laut EQ-5D erst ab zwei betroffenen Kindern in einer Familie durch diesen Umstand beeinflusst. Zusammenfassend lässt sich also feststellen, dass durch die Anwesenheit eines Kindes mit ADHS in einer Familie eher der Gesundheitszustand der Eltern signifikant beeinflusst wird, wohingegen die eigene ADHS-Symptomatik der Eltern in der Kindheit viel mehr zu einer signifikanten und mehrdimensionalen Beeinträchtigung am Arbeitsplatz führt. Diese Erkenntnis zeigt, dass die eigene ADHS-Symptomatik der Eltern in der Kindheit neben der Anwesenheit eines ADHS - Kindes nicht unerhebliche Auswirkungen auf die alltäglichen Aufgaben der Betroffenen hat. Die Erkenntnis dieser neuen Zusammenhänge sollte in zukünftigen Forschungsvorhaben berücksichtigt werden.
Chapter
ADHD is a clinically diagnosed neurobehavioral disorder where the affected individual experiences abnormalities of executive function. Impaired behavioral inhibition is a key element in ADHD, and some authors feel that inattention and hyperactivity follow. There is variability in the presence and magnitude of attention-deficit hyperactivity and impulsivity domains among affected children [1–3]. There is no pathognomonic diagnostic laboratory, imaging, or cognitive test to confirm the diagnosis [3]. It is generally accepted that a child presenting with symptoms of ADHD should initially undergo hearing and vision screening to address treatable problems mimicking ADHD [1–3] (moderate evidence).
Article
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Attention-deficit disorder with hyperactivity is believed, by some, to be a developmental antecedent (predisposing factor) to antisocial personality disorder and criminality. However, evidence supporting this association has not been consistent. We report on a prospective follow-up study of 103 males (ages 16 to 23 years), who were diagnosed as hyperactive (attention-deficit disorder with hyperactivity) between ages 6 and 12 years, and 100 normal controls. The official arrest records of all subjects who resided in New York State during the follow-up interval were obtained. Blind diagnoses (based on structured interviews with subjects and their parents) were made on 98% of the initial cohort at follow-up. Although other investigators have reported on the delinquent behavior of hyperactive children in a prospective design, to our knowledge, follow-up mental status has not been studied previously in relation to official arrest records. Significantly more probands than controls had been arrested (39% vs 20%), convicted (28% vs 11%), and incarcerated (9% vs 1%). The presence of an antisocial/conduct disorder in young adulthood almost completely accounted for the increased risk for criminal activities in the former hyperactive children whether or not it was accompanied by a substance use disorder. Continuing attention-deficit disorder with hyperactivity at follow-up, by itself, was not associated with arrest history. The findings support the view that childhood attention-deficit disorder with hyperactivity is a risk factor for later criminality, but that this relationship is almost exclusively mediated by the development of an antisocial disorder in early adulthood.
Article
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The paucity of data concerning the long-term natural history of attention-deficit hyperactivity disorder (ADHD), a common childhood psychiatric disorder, prompted a longitudinal study to investigate the adult sequelae of the childhood disorder. Prospective study, follow-up intervals ranging from 13 to 19 years (mean, 16 years), with blind systematic clinical assessments. Ninety-one white males (mean age, 26 years), representing 88% of a cohort systematically diagnosed as hyperactive in childhood, and 95 (95%) of comparison cases of similar race, gender, age, whose teachers had voiced no complaints about their school behavior in childhood. Probands had significantly higher rates than comparisons of ADHD symptoms (11% vs 1%), antisocial personality disorders (18% vs 2%), and drug abuse disorders (16% vs 4%). Significant comorbidity occurred between antisocial and drug disorders. Educational and occupational achievements were significantly compromised in the probands. These disadvantages were independent of psychiatric status. We did not find increased rates of affective or anxiety disorders in the probands. Childhood ADHD predicts specific adult psychiatric disorders, namely antisocial and drug abuse disorders. In the adolescent outcome of this cohort, we found that these disturbances were dependent on the continuation of ADHD symptoms. In contrast, in adulthood, antisocial and drug disorders appeared, in part, independent of sustained ADHD. In addition, regardless of psychiatric status, ADHD placed children at relative risk for educational and vocational disadvantage. The results do not support a relationship between childhood ADHD and adult mood or anxiety disorders.
Article
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Numerous studies have examined the adolescent and young adult fate of children with attention deficit hyperactivity disorder (ADHD). In marked contrast, relatively little is known about the adult outcome of these children. There have been only two controlled, prospective studies of psychiatric status into adulthood. The present study was conducted to gain further understanding of the natural course of this common childhood condition. This was a prospective follow-up of clinically diagnosed, white boys of average intelligence who were referred by teachers to a child psychiatric research clinic at an average age of 7.3 years. At a mean age of 24.1 years, 85 probands (82% of the childhood cohort) and 73 comparison subjects (94% of adolescent comparison subjects) were directly interviewed by trained clinicians who were blind to group status. Evaluations of the probands and comparison subjects indicated significantly higher prevalences of antisocial personality disorder (12% versus 3%) and nonalcohol substance abuse (12% versus 4%) in the probands, whereas mood disorders (4% versus 4%) and anxiety disorders (2% versus 7%) were not significantly different. At adult follow-up, ADHD was rare, occurring in only 4% of the probands (no comparison subjects). The results of the present study are consistent with the authors' previously reported major findings. They strongly suggest that children with ADHD are at significantly higher risk for a specific negative course marked by antisocial and substance-related disorders.
Article
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The relationships of attention deficit hyperactivity disorder (ADHD), conduct disorder, and gender to substance abuse were studied in a large population-based sample of adolescent twins. Structured interviews were administered to 626 pairs of 17-year-old twins (674 girls and 578 boys) and their mothers to generate lifetime psychiatric diagnoses, and computerized measures of current substance use were obtained. Hierarchical logit analyses were performed to assess the independent effects of ADHD, conduct disorder, and gender on current substance use, frequency of substance use, and DSM-III-R diagnoses of substance use disorders. Conduct disorder was found to increase the risk of substance use and abuse in adolescents regardless of gender. In contrast, independent of its association with conduct disorder, an ADHD diagnosis did not significantly increase the risk of substance use problems. This study found no significant gender differences in the effects of ADHD and conduct disorder on substance use and abuse, although there was some suggestion that girls with ADHD might be at slightly higher risk than boys for substance abuse. In addition, increased risk of substance abuse among adolescents with conduct disorder may be primarily confined to those with persistent conduct disorder.
Article
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This article reviews controlled, prospective follow-up studies of children with attention-deficit disorders (ADHD) into young adulthood and adulthood. In their late teens, those with ADHD as children, compared with non-ADHD comparisions, show relative deficits in academic and social functioning. In addition, about two-fifths of these children continue to experience ADHD symptoms, and a significant minority demonstrate pervasive antisocial behaviors, including drug abuse. Many of these same difficulties persist into adulthood. Compared with the comparisons, former ADHD probands complete less formal schooling, hold lower ranking occupational positions, and continue to exhibit poor social skills, antisocial personality, and symptoms of the childhood syndrome. On the other hand, as adults, nearly all former cases are gainfully employed, some in higher level positions, and a full two-thirds show no evidence of any mental disorder. Although relative deficits are seen in early to middle adolescence, young adulthood, and adulthood, childhood ADHD does not preclude achieving one's educational and vocational goals, and the majority of these children do not experience emotional or behavioral problems by their mid-twenties.
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Most prior literature examining the relations among attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance use and abuse suggests that CD fully account for the ADHD-substance abuse relation. This study sought to test an alternate theory that individuals with symptoms of both ADHD and CD are at a special risk for substance abuse. Relations between childhood ADHD and CD symptoms, and young adult tobacco, alcohol, marijuana, and hard drug use and dependence symptoms, were examined in a sample of 481 young adults. ADHD and CD symptoms interacted to predict marijuana dependence symptoms and hard drug use and dependence symptoms, such that individuals with high levels of both ADHD and CD had the highest levels of these outcomes.
Article
This article reviews controlled, prospective follow-up studies of children with attention-deficit disorder (ADHD) into young adulthood and adulthood. In their late teens, those with ADHD as children, compared with non-ADHD comparisions, show relative deficits in academic and social. functioning. In addition, about two-fifths of these children continue to experience ADHD symptoms, and a significant minority demonstrate pervasive antisocial behaviors, including drug abuse. Many of these same difficulties persist into adulthood. Compared with the comparisons, former ADHD probands complete less formal schooling, hold lower ranking occupational positions, and continue to exhibit poor social skills, antisocial personality, and symptoms of the childhood syndrome. On the other hand, as adults, nearly all former cases are gainfully employed, some in higher level positions, and a full two-thirds show no evidence of any mental disorder. Although relative deficits are seen in early to middle adolescence, young adulthood, and adulthood, childhood ADHD does not preclude achieving one's educational and vocational goals, and the majority of these children do not experience emotional or behavioral problems by their mid-twenties.
Article
What are the total direct healthcare costs for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and how do these costs compare to those for youth with asthma? We used eligibility and claims payment records to identify all continuously enrolled Medicaid youth with ADHD and asthma ages 7 to 20 from Pittsburgh and seven surrounding counties, in the 1994-1995 fiscal year. Payments for services were summed over claims by types of health-care services. We summed inpatient and outpatient days separately. We used multiple regressions to test for differences in costs and days between the two groups, adjusting for demographic factors. Distributions of total direct healthcare costs in youths who have ADHD are similar to those who have asthma (t=1.3, P=.17), but youths with ADHD have higher pharmaceutical costs than those with asthma (t=8.9, P<.001). Youths with ADHD had 0.32 more outpatient visits on average than those with asthma (chi-square=125, P<.001), but at least one less inpatient day (chi-square=92, P<.001). Direct healthcare costs for youths with ADHD are at least as high as healthcare costs for those with asthma. Services for youths with ADHD are distributed among general medical, mental health, and pharmaceuticals, so efforts to improve care will require coordination among mental health carve-outs, primary care providers, and pharmaceutical benefits managers.
Article
Objective: The paucity of data concerning the longterm natural history of attention-deficit hyperactivity disorder (ADHD), a common childhood psychiatric disorder, prompted a longitudinal study to investigate the adult sequelae of the childhood disorder.Design: Prospective study, follow-up intervals ranging from 13 to 19 years (mean, 16 years), with blind systematic clinical assessments.Subjects: Ninety-one white males (mean age, 26 years), representing 88% of a cohort systematically diagnosed as hyperactive in childhood, and 95 (95%) of comparison cases of similar race, gender, age, whose teachers had voiced no complaints about their school behavior in childhood.Results: Probands had significantly higher rates than comparisons of ADHD symptoms (11% vs 1%), antisocial personality disorders (18% vs 2%), and drug abuse disor- ders (16% vs 4%). Significant comorbidity occurred between antisocial and drug disorders. Educational and occupational achievements were significantly compromised in the probands. These disadvantages were independent of psychiatric status. We did not find increased rates of affective or anxiety disorders in the probands.Conclusions: Childhood ADHD predicts specific adult psychiatric disorders, namely antisocial and drug abuse disorders. In the adolescent outcome of this cohort, we found that these disturbances were dependent on the continuation of ADHD symptoms. In contrast, in adulthood, antisocial and drug disorders appeared, in part, independent of sustained ADHD. In addition, regardless of psychiatric status, ADHD placed children at relative risk for educational and vocational disadvantage. The results do not support a relationship between childhood ADHD and adult mood or anxiety disorders.
Book
Recent years have seen tremendous advances in understanding and treating Attention-Deficit/Hyperactivity Disorder (ADHD). Now in a revised and expanded third edition, this authoritative handbook brings the field up to date with current, practical information on nearly every aspect of the disorder. Drawing on his own and others' ongoing, influential research - and the wisdom gleaned from decades of front-line clinical experience - Russell A. Barkley provides insights and tools for professionals working with children, adolescents, or adults. Part I presents foundational knowledge about the nature and developmental course of ADHD and its neurological, genetic, and environmental underpinnings. The symptoms and subtypes of the disorder are discussed, as are associated cognitive and developmental challenges and psychiatric comorbidities. In Parts II and III, Barkley is joined by other leading experts who offer state-of-the-art guidelines for clinical management. Assessment instruments and procedures are described in detail, with expanded coverage of adult assessment. Treatment chapters then review the full array of available approaches - parent training programs, family-focused intervention for teens, school- and classroom-based approaches, psychological counseling, and pharmacotherapy - integrating findings from hundreds of new studies. The volume also addresses such developments as once-daily sustained delivery systems for stimulant medications and a new medication, atomoxetine. Of special note, a new chapter has been added on combined therapies. Chapters in the third edition now conclude with user-friendly Key Clinical Points. This comprehensive volume is intended for a broad range of professionals, including child and adult clinical psychologists and psychiatrists, school psychologists, and pediatricians. It serves as a scholarly yet accessible text for graduate-level courses. Note: Practitioners wishing to implement the assessment and treatment recommendations in the Handbook are advised to purchase the companion Workbook, which contains a complete set of forms, questionnaires, and handouts, in a large-size format with permission to photocopy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(jacket)
Article
The prevalence of childhood conduct disorder (CD) and attention-deficit hyperactivity disorder (ADHD) was studied in a sample of 100 adult maximum-security inmates. Inmate criminal and developmental history was obtained using interviews and records, and the Wender Utah Rating Scale (WURS) was administered to assess childhood ADHD. It was found that 63% of the sample met DSM-IV criteria for childhood CD, whereas 41% were either treated or assessed for childhood ADHD. Significant comorbidity was found between childhood CD and ADHD, but CD was the only significant predictor of adult criminality. CD and non-CD inmates differed significantly in juvenile and adult criminal behavior, age of first arrest, substance abuse, and violence. The WURS indicated significant validity in identifying childhood ADHD and CD as well as substance abuse and criminality. These findings are discussed in tenrs of methodological difficulties and the adult consequences of childhood disruptive behavior disorders.
Antisocial behaviour (conduct disorder) is the commonest psychiatric problem in childhood. An interview was developed to measure the direct and indirect costs arising from antisocial behaviour over a range of domains, including behaviours inside and outside the home. Data were collected for a pilot sample of 10 children aged 4–10 years who had been referred to child and adolescent mental health services. The average cost across the 10 families was £15,382 a year, ranging from £5411 to £40,896 per family. The greatest cost fell on the families themselves (average nearly £5000 per year) and the education authority (average nearly £5000 per year); and there were significant costs for the health service, social services and the Benefits Agency.
Much of the extensive body VLf research into attention deficit hyperactivity disorder (ADHD) has concentrated on understanding the aetiology of the disorder. This research has generated a number of very different conceptualizations of ADHD, ranging from purely medical descriptions to theories that incorporate a range of social and psychological factors. Although a large amount of research has been undertaken in this area, little is known about the individual experiences of those directly affected by the disorder and, in particular, how parents make sense of the variety of different aetiological models. The aim of this study was to investigate this issue. The mothers of nine boys, aged between 8 and 11 years, agreed to participate in the study. One father also participated. In-depth interviews, following a semi-structured format, were held with each participant. Interviews were transcribed verbatim and analysed using a grounded theory approach. Data analysis revealed that the key issue for parents was the discrepancy in the way in which parents understood the causes of ADHD, as compared with the ways in which others viewed the disorder. Parents reported that they believed ADHD to be a biologically based disorder, but that they felt others considered the disorder to be related to psychological and social factors. The implications of these differing perspectives were as follows: (i) parents battled with professionals and family members to encourage them to share their views of the condition; (ii) parents felt blamed by professionals and family members for their sons' difficulties; and (iii) parents reported experiencing significant emotional distress as a result of the differing views.
Article
Examined the prevalence of attention-deficit/hyperactivity disorder (ADHD) and conduct disorder among adults admitted to 2 chemical dependency treatment centers. It was hypothesized that ADHD alone or in combination with conduct disorder would be overrepresented in a population of patients with psychoactive substance use disorders. 201 Ss were selected randomly from 2 chemical dependency treatment centers. 48 (24%) of the Ss were found to meet DSM-IV criteria for ADHD. The prevalence of ADHD was 28% in men (30/106) and 19% in women (18/95). 79 participants (39%) met criteria for conduct disorder, and 34 of these individuals also had ADHD. Overall, individuals with ADHD (compared with those without ADHD) were more likely to have had more motor vehicle accidents. Women with ADHD (in comparison with women without ADHD) had a higher number of treatments for alcohol abuse. Ss with conduct disorder were younger, had a greater number of jobs as adults, and were more likely to repeat a grade in school, have a learning disability, be suspended or expelled from school, have an earlier age at onset of alcohol dependence, and have had a greater number of treatments for drug abuse. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Patterns of association between attention deficit hyperactivity disorder (ADHD) and substance-use disorders are considered. Recent investigations have found that up to 50% of individuals with continuing ADHD symptoms have a substance-use disorder. ADHD appears to represent an independent risk factor for substance abuse. We review clinical challenges posed by the diagnosis of ADHD in substance-abusing populations. Nicotine dependence is also substantially more common among adults with ADHD (40%) than in the general population (26%). While several classes of substances of abuse may ameliorate various symptoms of ADHD, individuals with ADHD may also be vulnerable to substance use because of poor judgment or impulsive behavior in social settings. Evidence is reviewed from genetic studies examining the role of the dopamine D2 (DRD2) gene in the etiology of ADHD. The presence of ADHD may affect the course of adolescent substance abuse in several ways: predicting earlier age of onset, longer duration of substance-use disorder, and progression of alcohol abuse to another drug-use disorder. Individuals with ADHD have been noted to have a shorter interval between the onsets of drug abuse and drug dependence. Such individuals are also at greater risk for treatment failure, as their disruptive behaviors interfere with treatment access and response. Lastly, we review advances in pharmacotherapeutic agents used for treating ADHD and consider the impact of these interventions on comorbid substance-use disorders. We suggest promising areas of focus for clinical research trials targeting the subpopulation of substance abusers with concurrent ADHD.
Article
Many children, adolescents, and adults with Attention Deficit Disorders report chronic difficulties with falling asleep, awakening and/or maintaining adequate daytime alertness. These problems may be due to a variety of factors, including environment, lifestyle, and psychiatric comorbidities. Impairments in sleep/arousal may also be related more directly to the underlying pathophysiology of ADD. This chapter describes clinical manifestations of sleep/arousal problems often associated with ADD and reviews behavioral and medication options for treatment.
Article
It is becoming increasingly recognized that one third to one half of children diagnosed as having attention deficit/hyperactivity disorder (ADHD) continue to exhibit symptoms of the disorder into adulthood. The nature of the clinical picture is not well understood by a substantial number of clinicians. The purpose of this study is to report on the demographic and clinical profile of 56 adults, age 19 to 65 years (48 men, eight women) who present with adult ADHD and meet DSM-III-R criteria for the disorder. Patients underwent a diagnostic work-up consisting of medical and psychiatric evaluation, a structured interview Schedule for Affective Disorders and Schizophrenia-Lifetime Version [SADS-L]), the Symptoms Checklist Revised (SCL-90R), Conners Attention Deficit Disorder With Hyperactivity (ADDH) scale, structured interview of ADDH, the Global Assessment of Functioning Scale (GAF), and, when available, information from parents was obtained. Ninety-one percent of our sample met the Utah Criteria for adult ADHD. The majority of the sample had additional DSM-III-R diagnoses and only seven had ADHD diagnosis alone. Fifty-three percent of the sample met the criteria for generalized anxiety disorder, 34% alcohol abuse or dependence, 30% drug abuse, 25% dysthymic disorder, and 25% cyclothymic disorder. These findings were similar to those reported in the literature.
Article
Among 547 adolescents with serious emotional disturbances, ages 12 to 18, this study assessed (1) prevalence of DSM-III substance use disorders (i.e., alcohol and marijuana abuse/dependence), and (2) comorbidity with DSM-III Axis I disorders. Factors of age, sex, state location, and type of treatment program also were examined. Data were analyzed by logistic regression. Significant factors (p less than 0.05) associated with severe alcohol or marijuana abuse/dependency diagnosis included (1) residential mental health treatment program, 2.37 Odds Ratio (OR); (2) conduct disorder diagnosis, 2.18 OR; (3) depression diagnosis, 1.75 OR; (4) states, 1.43 OR; (5) age, 1.29 OR; and (6) a depression x facility interaction, 1.91 OR.
Article
In a sample of 298 cocaine abusers seeking inpatient (n = 149) or outpatient (n = 149) treatment, rates of psychiatric disorders were determined by means of the Schedule for Affective Disorders and Research Diagnostic Criteria. Overall, 55.7% met current and 73.5% met lifetime criteria for a psychiatric disorder other than a substance use disorder. In common with previous reports from clinical samples of cocaine abusers, these overall rates were largely accounted for by major depression, minor bipolar conditions (eg, hypomania, cyclothymic personality), anxiety disorders, antisocial personality, and history of childhood attention deficit disorder. Affective disorders and alcoholism usually followed the onset of drug abuse, while anxiety disorders, antisocial personality, and attention deficit disorder typically preceded drug abuse.
Article
The objective of this paper is to present data from the Ontario Child Health Study on the prevalence of attention deficit disorder with hyperactivity (ADDH). The overall prevalence of ADDH was 9.0% in boys and 3.3% in girls. There were no significant differences in the prevalence of ADDH by age or urban-rural status, but the disorder was significantly more common in boys than in girls. The prevalence of various subtypes of ADDH was also explored: attention deficit with and without hyperactivity, situational vs pervasive ADDH, and ADDH with and without other disorders. The clinical implications of these findings are discussed.
Article
The goals of this investigation were to ascertain the significant differences, if any, among adolescent outcomes for hyperactive children and to examine the early life contributions of biological and psychological characteristics, family environments, social relationships, cognitive and academic status, and school behavior, along with hyperactivity, in explaining each of several outcomes. The subjects were classified on the basis of social system definitions of hyperactivity as well as on the basis of pervasive attention deficit disorder with hyperactivity (ADDH) based on parent and teacher ratings. Outcome measures at ages 17 and 18 included data on educational status, conduct problems, mental health disorders, and substance use. Regardless of the definition used, hyperactive children had significantly poorer educational outcomes and a greater extent of conduct disorders than their age peer controls. Regression analyses supported the inference that early biological factors, as well as the child's early health and temperament, predispose for adolescent mental health outcomes of depression, aggressive and nonaggressive conduct disorders, and hospitalization for psychological treatment. In contrast, familial, social, and cognitive factors had greater contributory potential in explaining educational outcomes, substance use, and conduct problems.
Article
In a controlled family study of clinically-referred children with attention deficit disorder (ADD), data were collected on first-degree relatives of 22 children with ADD and 20 normal children. Fourteen (64%) probands had associated diagnoses of conduct disorder (CD) or oppositional disorder (OPD). The data indicate two familial patterns. For children with associated CD/OPD, the rates of antisocial disorders (CD, OPD, antisocial personality disorder) in relatives were significantly higher than the rates of these disorders in relatives of probands without associated CD/OPD (46% versus 13%, p < 0.05) and in relatives of normal control subjects (46% versus 7%, p < 0.001). These findings suggest that ADD children with an associated CD/OPD may represent a meaningful subgroup with specific familial characteristics.
Article
Although attention deficit hyperactivity disorder is a common disorder of childhood, its status as a disorder in adults is not clear. The authors reasoned that if the adult diagnosis of the disorder is a valid clinical entity, it should be similar to the childhood disorder with regard to patterns of psychiatric and cognitive findings. Eighty-four adults with a clinical diagnosis of childhood-onset attention deficit hyperactivity disorder confirmed by structured interview who were referred for treatment were studied. Findings were compared with those from a preexisting study group of referred children with attention deficit hyperactivity disorder, nonreferred adult relatives of those children who also had attention deficit hyperactivity disorder, and adults without the disorder who were relatives of normal children. Subjects were evaluated with a comprehensive battery of psychiatric, cognitive, and psychosocial assessments. The referred and nonreferred adults with attention deficit hyperactivity disorder were similar to one another but more disturbed and impaired than the comparison subjects without the disorder. The pattern of psychopathology, cognition, and functioning among the adults with attention deficit hyperactivity disorder approximated the findings for children with the disorder. These results show that referred and nonreferred adults with attention deficit hyperactivity disorder have a pattern of demographic, psychosocial, psychiatric, and cognitive features that mirrors well-documented findings among children with the disorder. These findings further support the validity of the diagnosis for adults.
Article
To evaluate the motor vehicle driving knowledge, skills, and negative driving outcomes of older teens and young adults with attention deficit hyperactivity disorder (ADHD). A university medical center clinic for adult ADHD. A total of 25 young adults with ADHD and 23 young adults without ADHD 17 to 30 years old drawn from the community and equated for age, gender, and educational level. Structured interview, behavior ratings by self- and others, video test of driving knowledge, computer simulated driving test, and official motor vehicle records. ADHD young adults were cited more often for speeding, were more likely to have had their licenses suspended, were involved in more crashes, were more likely to have had crashes causing bodily injury, and were rated by themselves and others as using poorer driving habits. Official driving records corroborated these negative outcomes. Although no group differences in driving knowledge were evident, young adults with ADHD had more crashes, scrapes, and erratic steering during the computer-stimulated driving test than did the control subjects. Findings supported previous research suggesting that greater driving risks are associated with ADHD and suggested that ADHD does not interfere with driving knowledge so much as with actual performance (motor control) during vehicle operation.
Article
Treatment outcome in sexually abused preschool children was evaluated 6 and 12 months after treatment. Forty-three sexually abused preschool children and their parents were evaluated 6 and 12 months after completion of either Cognitive-Behavioral Therapy for Sexually Abused Preschoolers (CBT-SAP) or nondirective supportive therapy (NST). Parents completed the Child Behavior Checklist, Child Sexual Behavior inventory, and Weekly Behavior Report to measure a variety of symptoms in their children. Repeated-measures analyses indicated that there were significant group by time interactions on several outcome measures from the beginning of the study to the end of the 12-month follow-up period, with the CBT-SAP group exhibiting significantly more improvement over time than the NST group. Clinical findings also indicated the superior effectiveness of CBT-SAP over NST in reducing sexually inappropriate behavior. Findings support the superior efficacy of CBT-SAP over NST in maintaining symptom reduction in the year after treatment completion. The importance of using cognitive-behavioral interventions for sexually inappropriate behaviors and including nonoffending parents in the treatment of sexually abused preschool children is discussed.
Article
Little is known about the adult outcome of attention-deficit hyperactivity disorder (ADHD), a very prevalent childhood disorder that is known to affect deleteriously academic performance and other areas of child functioning. This study represents a third wave of evaluations that examine the long-term educational achievement and occupational rank of children with ADHD. This is a prospective follow-up of white boys of average intelligence whose ADHD was clinically diagnosed according to systematic criteria at an average age of 7 years. Follow-up intervals range from 15 to 21 years (mean, 17 years). At average age 24 years, 85 probands (representing 82% of the childhood cohort) and 73 controls (84%) were directly interviewed by trained clinicians who were blind to group membership. First, probands completed significantly less formal schooling than controls (about 2 years less, on average). Second, probands had lower-ranking occupational positions than controls. Finally, these disadvantages were not accounted for by adult mental status. The present study suggests that childhood ADHD predisposes to specific disadvantages and continues to affect important functional domains unrelated to current psychiatric diagnosis.
Article
Clinical observation suggests that adolescents with alcohol use disorders often have complex histories that include childhood maltreatment and other traumas. The aim of this study was to determine the relationships among adolescent alcohol use disorders and a broad range of traumas and adverse life events. The subjects were 132 adolescents with alcohol dependence, 51 adolescents with alcohol abuse, and 73 adolescents recruited from the community as a control group. Trauma history was assessed by a semistructured interview and other adverse life events by questionnaire. Traumatic events reflecting interpersonal violence had occurred in many of the adolescents with alcohol dependence and abuse and few of the control adolescents. Adolescents with alcohol abuse or dependence, compared with control subjects, were 6 to 12 times more likely to have a physical abuse history and 18 to 21 times more likely to have a sexual abuse history. Sexual abuse was more common in females, and victimization by other violent acts was more common in males. Many other adverse life events were also significantly more common in the alcohol use disorder groups than in the control group, including having a close friend die, arguments within the family, and legal difficulties. These results demonstrate that trauma and other adverse life events are strongly associated with alcohol use disorders in adolescents. Clinical screening of adolescents with alcohol use disorders for a range of traumatic events is recommended.
Article
To examine the relationship between attention deficit disorder with hyperactivity in childhood and criminality in adolescence and adulthood in 89 hyperactive and 87 normal control subjects. In this prospective study, adolescent follow-up intervals ranged from 13 to 21 years and adult follow-up ranged from 18 to 23 years. The official arrest records for all subjects were obtained. Hyperactive subjects had significantly higher juvenile (46% versus 11%) and adult (21% versus 1%) arrest rates. Juvenile and adult incarceration rates were also significantly higher. Childhood conduct problems predicted later criminality, and serious antisocial behavior in adolescence predicted adult criminality. Hyperactive children are at risk for both juvenile and adult criminality. The risk for becoming an adult offender is associated with conduct problems in childhood and serious antisocial behavior (repeat offending) in adolescence. Hyperactive children who do not have conduct problems are not at increased risk for later criminality.
Article
The goal of the research described in this article was to generate a grounded theory of how parents of children with attention deficit hyperactivity disorder (ADHD) coped with this chronic behavioral disorder. Interview data from 15 families with ADHD children (N = 59) were analyzed using the grounded theory method. Data analysis revealed that parents outlasted the disruption of ADHD through three subprocesses of "reinvesting": making sense, recasting biography, and relinquishing the "good ending." Findings suggest that there is a developmental trajectory of how parents adjust to the disorder over time and that there is a need for increased social and mental health services for all members of the family over the course of the disorder.
Article
To examine associations between attentional difficulties at age 13 and a range of adverse driving outcomes measured at 21 years. Data were gathered over the course of a 21-year longitudinal study of a birth cohort of 1,265 New Zealand children. Data collection included the following: (1) parent and teacher report measures of attentional difficulties (13 years); (2) measures of driving behavior, including involvement in an accident, drinking and driving, and traffic violations (18-21 years); and (3) measures of a range of potentially confounding individual, sociofamilial, and driving-related factors. Young people with high levels of attentional difficulties were at greater risk of involvement in a motor vehicle accident, drinking and driving, and traffic violations. These associations were largely explained by the personal characteristics (gender, conduct problems) and driving experience (length of time respondent held a license, distance driven) of young people with attentional difficulties. Even after adjustment for the effects of confounding factors, adolescent attentional difficulties placed young people at increased risk of an injury accident, driving without a license, and other traffic violations. Associations between adolescent attentional difficulties and subsequent driving risks largely reflect the effects of confounding factors correlated with attentional difficulties and driving outcomes. However, even after adjustment for confounding, adolescent attentional difficulties contributed to later injury accident risk and possibly also to risky driving behavior.
Article
This cross-sectional study sought to determine the prevalence of attention-deficit/hyperactivity disorder (ADHD) and conduct disorder among adults admitted to 2 chemical dependency treatment centers. It was hypothesized that ADHD alone or in combination with conduct disorder would be overrepresented in a population of patients with psychoactive substance use disorders. Two hundred one participants were selected randomly from 2 chemical dependency treatment centers. Standardized clinical interviews were conducted using the Structured Clinical Interview for DSM-IV, the Addiction Severity Index, and DSM-IV criteria for ADHD. Reliabilities for the diagnostic categories were established using the Cohen kappa, and the subgroups of individuals with and without ADHD and conduct disorder were compared. Forty-eight (24%) of the participants were found to meet DSM-IV criteria for ADHD. The prevalence of ADHD was 28% in men (30/106) and 19% in women (18/95; NS). Seventy-nine participants (39%) met criteria for conduct disorder, and 34 of these individuals also had ADHD. Overall, individuals with ADHD (compared with those without ADHD) were more likely to have had more motor vehicle accidents. Women with ADHD (in comparison with women without ADHD) had a higher number of treatments for alcohol abuse. Individuals with conduct disorder (in comparison with those without conduct disorder) were younger, had a greater number of jobs as adults, and were more likely to repeat a grade in school, have a learning disability, be suspended or expelled from school, have an earlier age at onset of alcohol dependence, and have had a greater number of treatments for drug abuse. They were more likely to have a lifetime history of abuse of and/or dependence on cocaine, stimulants, hallucinogens, and/or cannabis. A significant overrepresentation of ADHD exists among inpatients with psychoactive substance use disorders. Over two thirds of those with ADHD in this sample also met criteria for conduct disorder. Our sample had a very large overlap between ADHD and conduct disorder, and the major comorbidities identified here were attributable largely to the presence of conduct disorder. Individuals who manifest conduct disorder and/or ADHD represent a significant proportion of those seeking treatment for psychoactive substance use disorders. They appear to have greater comorbidity and may benefit from a treatment approach that addresses these comorbidities specifically through medical and behavioral therapies.
Article
Literature concerning the role of the Child Health Services in the identification of children with possible Attention Deficit Hyperactivity Disorder/Deficits in Attention, Motor Control and Perception (ADHD/DAMP) is summarized in order to establish a background for evaluation, discussion and conclusion.
Article
There is a need for controlled longitudinal studies in the field of attention disorders in the general population. In a community-based follow-up study, 55 of 61 subjects aged 22 years, who had attention-deficit/hyperactivity disorder (ADHD) with and without comorbid developmental coordination disorder (DCD) at initial workup at age 7 years, were compared, on a multitude of outcome variables, with 46 of 51 age-matched subjects without such diagnoses. None of the subjects had received stimulant treatment. Psychiatrists performing the follow-up study were blind to original diagnostic group status. In the ADHD/DCD group 58% had a poor outcome compared with 13% in the comparison group (p < .001). Remaining symptoms of ADHD, antisocial personality disorder, alcohol abuse, criminal offending, reading disorders, and low educational level were overrepresented in the ADHD/DCD groups. The combination of ADHD and DCD appeared to carry a particularly gloomy outlook. Childhood ADHD and DCD appears to be a most important predictor of poor psychosocial functioning in early adulthood. It would seem appropriate to screen for such disorders in schools and clinics so that therapies may be started early.
Article
A shortage of data exists on medical care use by persons with attention-deficit/hyperactivity disorder (ADHD). To compare medical care use and costs among persons with and without ADHD. Population-based cohort study conducted in Rochester, Minn. All children born in 1976-1982 were followed up through 1995, using school and medical records to identify those with ADHD. The 4880 birth cohort members (mean age, 7. 3 years) still residing in Rochester in 1987 were followed up in medical facility-linked billing databases until death, emigration, or December 31, 1995. Clinical diagnoses, likelihood and frequency of inpatient and outpatient hospitalizations, emergency department (ED) visits, and total medical costs (including ambulatory care), compared among individuals with and without ADHD. Among the 4119 birth cohort members who remained in the area through 1995 (mean age, 15.3 years), 7.5% (n = 309) had met criteria for ADHD. Compared with persons without ADHD, those with ADHD were more likely to have diagnoses in multiple categories, including major injuries (59% vs 49%; P<.001) and asthma (22% vs 13%; P<.001). The proportion with any hospital inpatient, hospital outpatient, or ED admission was higher for persons with ADHD vs those without ADHD (26% vs 18% [P<. 001], 41% vs 33% [P =.006], and 81% vs 74% [P =.005], respectively). The 9-year median costs for persons with ADHD compared with those without ADHD were more than double ($4306 vs $1944; P<.001), even for the subset with no hospital or ED admissions (eg, median 1987 costs, $128 vs $65; P<.001). The differences between individuals with and without ADHD were similar for males and females and across all age groups. In our cohort, compared with persons without ADHD, those with ADHD exhibited substantially greater use of medical care in multiple care delivery settings.
Article
Many children, adolescents, and adults with Attention Deficit Disorders report chronic difficulties with falling asleep, awakening and/or maintaining adequate daytime alertness. These problems may be due to a variety of factors, including environment, lifestyle, and psychiatric comorbidities. Impairments in sleep/arousal may also be related more directly to the underlying pathophysiology of ADD. This chapter describes clinical manifestations of sleep/arousal problems often associated with ADD and reviews behavioral and medication options for treatment.