Functional Impairments in Adults With Self-Reports of Diagnosed ADHD
Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Yawkey Center for Outpatient Care, Boston, MA 02114, USA. The Journal of Clinical Psychiatry
(Impact Factor: 5.5).
04/2006; 67(4):524-40. DOI: 10.4088/JCP.v67n0403
The objective of this study was to evaluate functional impairments in a nonreferred sample of adults identifying themselves as having been diagnosed with attention-deficit/hyperactivity disorder (ADHD) by a clinician in their community.
We completed a survey in April and May 2003 of a community sample of 500 adults who reported having received a diagnosis of ADHD in the community and 501 gender- and age-matched comparisons from a national sample representative of the U.S. population.
Adults with self-reports of diagnosed ADHD in the community were significantly less likely to have graduated high school (83% vs. 93% of controls; p < or = .001) or obtain a college degree (19% vs. 26%; p < .01), were less likely to be currently employed (52% vs. 72%; p < or = .001), and had significantly more mean job changes over 10 years (5.4 vs. 3.4 jobs; p < or = .001). They also were significantly more likely to have been arrested (37% vs. 18% of controls; p < or = .001) or divorced (28% vs. 15%; p < or = .001) and were significantly less satisfied (p < or = .001) with their family, social, and professional lives.
Adults who reported having received a diagnosis of ADHD in the community had significant impairment in multiple domains of functioning compared with age- and gender-matched controls without this diagnosis, highly consistent with findings derived from carefully diagnosed referred samples.
Available from: J. Russell Ramsay
- "Numerous cross-sectional and longitudinal studies have established ADHD as one of the more impairing disorders encountered in outpatient behavioral health care. Converging evidence indicates that individuals with ADHD are more likely than non-clinical controls to experience difficulties in educational settings, the workplace, relationships with employers, co-workers, and partners, parenting, as well as being at higher risk of co-existing psychiatric diagnoses, including emerging findings of increased risk of suicide (when ADHD co-exists with depression and substance abuse; Barbaresi et al., 2013; Barkley et al., 2008; Biederman et al., 2006; Brook, Brook, Zhang, Seltzer, & Finch, 2013; Faraone et al., 2015; Galéra et al., 2012; Harpin, Mazzone, Raynaud, Kahle, & Hodgkins, 2013; Klein et al., 2012; Nigg, 2013). In addition to these life domains, it stands to reason that a diagnosis of ADHD is associated with risk of low self-esteem, low life satisfaction, greater likelihood of physical health problems and injuries, problematic technology use, financial problems, and legal issues. "
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ABSTRACT: Contemporary models of attention-deficit/hyperactivity disorder (ADHD) provide frameworks for understanding this condition that move beyond the diagnostic symptom criteria. ADHD is currently viewed as a developmental syndrome of impaired self-regulatory processes that underlie the common symptoms and functional problems. Most clinic-referred adults with ADHD report chronic difficulties executing their intended plans despite recognizing the negative consequences for not doing so. Seeing as the psychosocial treatments for adult ADHD intervene at the level of life impairments and functioning, it is important that interventions directly target these implementation problems. The goal of this article is to discuss the case of a young woman with ADHD who has difficulties engaging in the various tasks she needs to perform to pursue her post-college goals. In particular, a cognitive-behavioral therapy approach that emphasizes implementation strategies designed to help adults with ADHD follow through on their plans is illustrated.
- "While 30e50% of children diagnosed with ADHD exhibit symptomatic improvement throughout development (Biederman, Mick, & Faraone, 2000), others show persistent ADHD behavior into adulthood (Faraone, Biederman, & Mick, 2006). Adult ADHD has a substantial impact on the public health system as it has been associated with impairments in multiple domains including family functioning, work, and leisure time (Biederman et al., 2006; Kessler et al., 2006). Few behavioral, environmental, and neurocognitive factors were found to predict clinical outcome (Biederman, Petty, Clarke, Lomedico, & Faraone, 2011; Kessler et al., 2005; van Lieshout, Luman, Buitelaar, Rommelse, & Oosterlaan, 2013). "
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One neurodevelopmental theory hypothesizes remission of attention-deficit/hyperactivity disorder (ADHD) to result from improved prefrontal top-down control, while ADHD, independent of the current diagnosis, is characterized by stable non-cortical deficits (Halperin & Schulz, 2006). We tested this theory using resting state functional MRI (fMRI) data in a large sample of adolescents with remitting ADHD, persistent ADHD, and healthy controls.
Participants in this follow-up study were 100 healthy controls and 129 adolescents with ADHD combined type at baseline (mean age at baseline 11.8 years; at follow-up 17.5 years). Diagnostic information was collected twice and augmented with magnetic resonance imaging (MRI) scanning at follow-up. We used resting state functional connectivity (RSFC) of the executive control network to investigate whether improved prefrontal top-down control was related to a developmental decrease in ADHD symptoms. In addition, we tested whether non-cortical RSFC, i.e., cerebellar and striatal RSFC, was aberrant in persistent and/or remittent ADHD compared to controls.
Higher connectivity within frontal regions (anterior cingulate cortex) of the executive control network was related to decreases in ADHD symptoms. This association was driven by change in hyperactive/impulsive symptoms and not by change in inattention. Participants with remitting ADHD showed stronger RSFC than controls within this network, while persistent ADHD cases exhibited RSFC strengths intermediate to remittent ADHD cases and controls. Cerebellar and subcortical RSFC did not differ between participants with ADHD and controls.
In line with the neurodevelopmental theory, symptom recovery in ADHD was related to stronger integration of prefrontal regions in the executive control network. The pattern of RSFC strength across remittent ADHD, persistent ADHD, and healthy controls potentially reflects the presence of compensatory neural mechanisms that aid symptomatic remission.
Available from: Nora Bunford
- "Compared to those without ADHD, men and women with ADHD report being less satisfied in their romantic relationships as well as discord in such relationships (e.g., Babinski et al. 2010; Barkley et al. 2008), including intimate partner violence (Wymbs et al. 2012, in press). Finally, when married, individuals with ADHD are more likely to divorce than individuals without ADHD (e.g., Biederman et al. 2006; Fargason and Ford 1994; Kessler et al. 2006; Murphy and Barkley 1996). Similar problems also exist for individuals who exhibit ED. "
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