The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys

Co-Producing Resources to Help Improve Access to Primary Care for Young People With Attention Deficit Hyperactivity Disorder

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder resulting in negative long-term outcomes if untreated. Pathways to healthcare in the United Kingdom are complex, especially for those aged 16-25 transitioning between child and adult mental health services. We aimed to co-produce evidence-informed resources to improve accessibility of primary care for young people with ADHD.

METHODS

We utilised co-production principles from the National Institute for Health and Care Research and findings from recent research to create evidence-informed resources which collate experiences of multiple stakeholders. Lived experience advisors (young people aged 16-25 with ADHD and their supporters) and healthcare professionals were recruited through previous research engagement and local collaborations. Research partners engaged in workshops or individual meetings to agree priorities, content, and language/visual appearance for outputs.

RESULTS

Lived experience advisors (7), healthcare professionals (5), and researchers (3) co-produced a downloadable resource for young people and their supporters. The resource identifies key stages on ADHD healthcare pathways, common barriers, and top tips recommended by people with lived experience, and verified by healthcare professionals. Key messages for primary care professionals were co-produced.

CONCLUSION

Co-produced resources can help address barriers to accessing ADHD treatment and support via stretched NHS services. Collaborative working also highlighted the need for national policy change to alleviate pressures faced by healthcare professionals and patients.

PATIENT AND PUBLIC CONTRIBUTION

Two research advisory groups (RAGs) of healthcare professionals and lived experience advisors informed research methods and presentation of results. RAG members participated in co-production workshops, contributed to authorship, and disseminated outputs.

C. G. Jung's Concept of "Manic Mood" From 1904: An Early Contribution to the Disorder of the Adult Form of ADHD?

BACKGROUND

Adult ADHD has increasingly become a focus in adult psychiatry. Despite well-established diagnostic criteria and specific therapeutic approaches, contemporary discussions often dismiss ADHD as a "fad." This study examines Carl Gustav Jung's 1904 concept of "manic mood" and its potential alignment with the modern understanding of ADHD in adults.

OBJECTIVE

The aim of this paper is to investigate and discuss whether Jung's concept of "manic mood" can be considered part of the intellectual history of adult ADHD.

METHOD

Jung's concept of "manic mood" is analyzed and presented using the literary-historical method of "close reading," placing the analysis within the context of the early 20th-century discussion of "chronic-manic concepts." This analysis is compared with the current diagnostic criteria for adult ADHD.

RESULTS AND CONCLUSION

Jung's concept of "manic mood," described in 1904, has clear parallels to diagnostic criteria used for adult ADHD. It is conceivable that the patients presented by Jung would be diagnosed with adult ADHD today. Jung's work fits into the discussion of "chronic-manic concepts" of the early 20th century and thus makes a relevant original contribution to the nosological-diagnostic classification of forms in the spectrum of ADHD-affective disorders-personality disorders. The parallel between Jung's disease construct of "manic mood" and the current view of ADHD supports our hypothesis that the adult form of ADHD represents a consistent disease phenomenon and should therefore not be degraded as a "fad."

ADHD and Alcohol Use Disorder: Optimizing Screening and Treatment in Co-occurring Conditions

Attention deficit hyperactivity disorder (ADHD) is notably overrepresented in substance use treatment centers, with an estimated prevalence of 21-23% when screening practices are implemented. Many adults in these settings receive an ADHD diagnosis for the first time, highlighting the frequent underdiagnosis of ADHD among individuals seeking treatment for alcohol and substance use issues. Additionally, those entering treatment programs represent only a small fraction of the broader population with problematic alcohol use. This review explores the research on the prevalence and treatment of co-occurring ADHD and substance use disorders (SUD), with a particular emphasis on alcohol use disorders (AUD) as the most common SUD. It also provides clinical guidelines for the screening and diagnosis of ADHD in patients with active alcohol and substance use and offers recommendations to enhance screening practices and improve access to treatment for individuals with co-occurring ADHD and AUD.

REIMAGINE: A central nervous system basket trial showing safety and efficacy of vafidemstat on aggression in different psychiatric disorders

AIM

Vafidemstat is a brain-penetrant, orally bioavailable, small molecule irreversible inhibitor of the histone lysine-specific demethylase KDM1A (also known as LSD1), which corrects memory deficits and behavior alterations including aggression and social interaction deficits in preclinical models.

METHODS

Here, we report the results of REIMAGINE, a phase IIa, single-center, open-label, one-arm basket trial that evaluated the safety and efficacy of vafidemstat on aggression in adult patients with borderline personality disorder (BPD), attention-deficit/hyperactivity disorder (ADHD), and autistic spectrum disorder (ASD). Participants received 1.2 mg/day of vafidemstat for 8 weeks.

RESULTS

Vafidemstat was shown to be safe and well tolerated, and no drug-related clinically significant adverse events were observed. Furthermore, all neuropsychiatric scales assessed showed notable efficacy signals, whether assessing agitation/aggression (Clinical Global Impression for Severity [CGI-S] and Clinical Global Impression for Improvement [CGI-I] and Neuropsychiatric Inventory [NPI] questionnaire for Agitation-Aggression [NPI-AA]), overall patient functioning (total NPI), or disease-specific features (Attention-Deficit/Hyperactivity Disorder Rating Scale [ADHD-RS] and Borderline Personality Disorder Checklist [BPDCL]). Statistically significant improvements were observed in the aggregated data (all participants) and for each of the three disease groups independently. Changes were evident within the first 2 weeks of treatment.

CONCLUSION

In summary, the REIMAGINE study supports that vafidemstat is safe, well tolerated, and causes a significant and consistent reduction in agitation/aggression and nonaggression features in BPD, ADHD, and ASD. These data support continuing the development of vafidemstat as a new treatment option for these psychiatric disorders.

Is adult attention deficit hyperactivity disorder associated with non-suicidal self-injury and/or suicidal behaviors? A study on the role of borderline personality disorder comorbidity

Although several studies have suggested an association between attention deficit hyperactivity disorder (ADHD) and non-suicidal self-injury (NSSI) as well as suicidal attempts (SA), few have considered the confounding impact of a comorbid borderline personality disorder (BPD). In the present study, we conducted a retrospective analysis on 147 ADHD patients to assess the role played by BPD in the association between ADHD and lifetime history/number of NSSI and SA. BPD was considered both categorically and dimensionally. Overall, ADHD symptoms were positively associated with a higher lifetime history/number of NSSI and SA. This association was maintained after further adjustment on comorbid BPD status, but not after adjustment on BPD symptoms. While being only exploratory, these results add evidence on the complex links between ADHD and NSSI/SA and suggest a potential role played by BPD symptoms in this association.

The relationship between attention deficit hyperactivity disorder emotion regulation difficulties and sleep quality in adults: a cross sectional study

OBJECTIVE

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that begins in childhood and often persists into adulthood, characterized by difficulties with attention, impulsivity, and hyperactivity. This study aims to explore the relationship between ADHD, emotion regulation difficulties, and sleep quality in adults.

METHODS

Thirty-nine adults with ADHD were compared to thirty-seven healthy controls. Participants completed the Wender Utah Rating Scale (WURS), Pittsburgh Sleep Quality Index (PSQI), and the Difficulties in Emotion Regulation Scale (DERS).

RESULTS

Participants were categorized based on their WURS scores those with a score of 36 or higher (ADHD group) and those with a score below 36 (non ADHD group). Comparisons of the PSQI and DERS scores between groups revealed that the group with ADHD had significantly higher total and subscale DERS scores compared to the group without ADHD. However, no significant differences were observed between the groups in terms of PSQI total and subscale scores. When the relationship between emotion regulation difficulties and sleep quality of participants diagnosed with attention deficit and hyperactivity disorder (ADHD) was examined, a correlation was found between DERS total and subscale scores and PSQI total and subscale scores.

CONCLUSION

The findings suggest that adults with ADHD have more difficulties in emotion regulation than those without ADHD. Although no difference in sleep quality was found in our study between adults with ADHD and those without ADHD, the correlation between PSQI and DERS suggests that developing emotion regulation strategies with a transdiagnostic approach may help improve sleep quality.

[Substance Use Disorder as a Comorbidity in Patients with Attention Deficit Hyperactivity Disorder]

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder manifested by inattention and/or hyperactivity and impulsivity. It is a disorder that begins in childhood but can persist into adulthood. It is associated with the emergence of various comorbidities, including, very often, the development of substance use disorders (SUD). When present simultaneously, they contribute to more severe presentations of both conditions and makes treatment more complex and challenging. Despite being different conditions, they have potentially common etiological pathways. The main aims of this article were to study the correlation between ADHD and SUD, particularly concerning the prevalence of this association, etiology and what are the best diagnostic and treatment strategies. We conclude that SUD is one of the most common comorbidities among ADHD patients, with genetic factors, neuroanatomical and neurophysiological impairments correlating both conditions. Patients with ADHD and SUD have an earlier onset of SUD, heavier abuse and worse outcomes. Special attention to this disorder is recommended in patients with ADHD. Furthermore, an active search for ADHD in patients with SUD is highly recommended, which can be carried out in the first place with self-reported scales. The appropriate treatment seems to involve a combination of pharmacological and non-pharmacological approaches, with strategies targeting both conditions.

Subthreshold Autism and ADHD: A Brief Narrative Review for Frontline Clinicians

Background: Epidemiological studies have shown that neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) are more prevalent in the general childhood population, compared to cases that are formally diagnosed in clinical cohorts. This suggests that many children and youths have NDD which are never diagnosed clinically, causing impairments in some domains of their daily life. There is increasing recognition of the concept of a "subthreshold" condition, sometimes used to describe the presence of potentially impairing variations in the neurodevelopmental profile that do not meet criteria for a diagnosis. The aim of this narrative review is to appraise the published literature about common themes regarding subthreshold conditions in relation to autism and ADHD, identifying any practical lessons that may be applicable to frontline neurodevelopmental clinicians. Methods: We searched electronic databases including PMC and PubMed using various combinations of keywords, including "Subthreshold", "subclinical", "neurodevelopmental", "childhood", "ADHD" and "ASD". Results: The identified themes include definitions, prevalence, assessment tools, lifetime impairments, NDD classification models, management, raising public awareness, and future research directions. Conclusions: The authors propose that a "subthreshold condition" should be recorded when NDDs do not meet current diagnostic criteria if there is evidence of significant, persisting impairment in at least one setting.

Bias by gender: exploring gender-based differences in the endorsement of ADHD symptoms and impairment among adult patients

Background

Research on adult attention-deficit/hyperactivity disorder (ADHD) remains limited, particularly regarding the experiences of women.

Methods

This exploratory study investigates patient responses to the Diagnostic Interview for ADHD in Adults (DIVA-5), which assesses current (adult) and retrospective (childhood) ADHD symptoms based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). We focused on overall endorsement rates of ADHD symptoms, impairments, and specific examples of both, with particular attention to gender differences. Using descriptive statistics and chi-square tests, we analysed existing DIVA-5 data from 2,257 adult patients diagnosed with ADHD at mental health clinics affiliated with the Parnassia Groep in the Netherlands.

Results

Our findings indicate that ADHD manifests similarly across men and women, though subtle differences in symptom and impairment patterns emerged. Women more frequently endorsed several inattentive and hyperactive/impulsive symptoms in adulthood, whereas men reported higher endorsement rates of several childhood symptoms. Regarding impairments, gender-specific patterns were observed in areas such as self-esteem and social relationships.

Conclusion

While these differences were small, they highlight the need for further investigation into gendered ADHD manifestations. Additionally, we discuss potential measurement limitations and propose recommendations for refining the DIVA-5 and advancing research on gender differences in ADHD.

The Role of Empathy in ADHD Children: Neuropsychological Assessment and Possible Rehabilitation Suggestions-A Narrative Review

Background and Objectives: Theory of mind (ToM) deficits in children with ADHD are closely related to social difficulties and problems in interpersonal interactions. Evidence suggests that these cognitive deficits negatively affect the ability to understand and respond to others' emotions and intentions, thus contributing to social isolation and a lower quality of life. However, the findings across studies vary, indicating that ADHD subtype and comorbidities, such as anxiety and mood disorders, can significantly influence sociocognitive deficits, modulating the extent of social problems. Materials and Methods: This review examines the relationship among ADHD, ToM, and empathy, analyzing studies comparing children with ADHD with peers with typical development or other neurodevelopmental conditions. A search in PubMed, Scopus, and the Cochrane Library prior to January 10, without time restrictions, using "ADHD", "Cognitive Empathy", and "Theory of Mind" identified relevant studies assessing these abilities through neuropsychological tests or questionnaires. Results: Of the initial 243 studies, 23 studies met the inclusion criteria. Children with ADHD exhibited significant impairments in ToM and empathy, affecting social cognition and interpersonal understanding. Various assessment tools revealed difficulties in understanding beliefs, emotions, and intentions, with executive function deficits playing a crucial role in shaping these social challenges. Conclusions: This review highlights the need for targeted therapeutic interventions that not only address cognitive deficits but consider emotional and metacognitive aspects, such as emotion regulation and self-awareness. Future research should focus on integrating executive function training with approaches that develop metacognitive and emotional skills, thus providing more comprehensive support.

The impact of physical activity on inhibitory control of adult ADHD: a systematic review and meta-analysis

Objective

We aimed to Investigate physical activity's effects on inhibitory control in adult attention deficit hyperactivity disorder (ADHD).The benefits of physical activity on the inhibitory control of adult ADHD were explored in the hope of providing some suggestions for approaches to treating adult ADHD.

Methods

We searched the databases PubMed, Web of Science, CNKI and Wanfang for randomised controlled trials (RCTs) of the effect of physical activity on inhibitory control in adults with ADHD, using PRISMA guidelines. We used used the Cochrane Bias Risk Assessment Criteria to assess the methodological quality of the included studies. Finally, we performed a heterogeneity analysis and a potential publication bias analysis using Revman 5.4.

Results

A total of eight articles, 14 studies, and 373 experimental subjects were included in the systematic review and meta-analysis. The meta-analysis results showed that both acute exercise (standard mean deviation (SMD) = -0.65, 95% confidence interval (CI) = -1.10,-0.2, P = 0.005) and chronic exercise (SMD = -1.77, 95% CI = -2.84, -0.69, P = 0.0001) have a positive effect on the inhibitory control of adult ADHD. Pilates (SMD = -2.22, 95% CI = -2.97, -1.47, P < 0.0001), Tai Chi (SMD = -2.20, 95% CI = -6.25, -1.8, P = 0.25), cycling (SMD = -0.67, 95% CI = -1.27, -0.08, P = 0.03), vibration training (SMD = -0.67, 95% CI = -1.39, -0.05, P = 0.07), yoga (SMD = 0.01, 95% CI = -0.50, -0.48, P = 0.97), and other different exercise styles have significant differences in their effects on adult ADHD inhibitory control.

Conclusions

Physical activity has a beneficial effect on inhibitory control in adults with ADHD. However, more research is needed to examine the beneficial effects of different types of physical activity, intervention modalities, and dose-response effects of intensity.

Registration

This review was registered with INPLASY (registration number: 202490109).

The Role of Physical Activity in ADHD Management: Diagnostic, Digital and Non-Digital Interventions, and Lifespan Considerations

Background: Attention Deficit Hyperactivity Disorder (ADHD) has been described as a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity affecting cognitive, emotional, and social functioning. While pharmacological and behavioral treatments remain primary, physical activity (PA) (digital and non-digital versions) has emerged as a great complementary intervention due to its potential impact on executive functions, emotional regulation, and neurobiological markers. Objectives: This study aimed to assess the effects of PA on ADHD symptoms, executive function, and emotional regulation, exploring its potential impact and new practical applications in digital and non-digital treatment. Methods: This narrative review assessed 132 studies published between 1 January 2010 and January 2025, ensuring the inclusion of the most recent and relevant findings. The review was conducted in Scopus, PubMed, and Web of Science, using a predefined combination of terms related to ADHD, physical activity, executive function, neuroplasticity, and emotional regulation. Results: Regular PA improves executive functions, attention, inhibitory control, and cognitive flexibility in ADHD. Aerobic exercise enhances sustained attention, high-intensity training improves impulse control, and coordinative activities boost cognitive flexibility. Non-digital and digital innovations, such as exergaming and wearable fitness trackers, offer promising solutions to improve adherence to PA regimens, reinforcing their role as a key intervention in ADHD management. Conclusions: PA could be a valuable complementary intervention for ADHD through a hybrid approach that may improve cognitive and emotional functioning while addressing comorbidities.

Attention Deficit/Hyperactivity Disorder in Adults: Position of Portuguese Experts on Diagnosis and Treatment

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists into adulthood, affecting approximately 1.5% - 3% of the adult population in Portugal. Untreated ADHD in adults is associated with increased risks of substance abuse, criminality, poor academic and professional performance. Less than 20% of adults with ADHD are properly diagnosed and treated due to overlapping symptoms with other psychopathological comorbidities, lack of awareness, and prejudice surrounding this disorder. This position paper results from expert meetings involving six Portuguese experts in managing adult ADHD. It aims to guide diagnostic and treatment strategies, as well as address the main barriers and limitations in managing these patients within the Portuguese context, specifically regarding diagnosis and treatment. Furthermore, it seeks to clarify and demystify associated misconceptions, increase medical awareness, and promote discussion for the development of guidelines to improve the diagnosis, treatment, and quality of life of adults with ADHD in Portugal.

Impaired health-related quality of life, and depressive symptoms in a cohort of healthy adults with symptoms of attention deficit/hyperactivity disorder

BACKGROUND

Attention deficit/hyperactivity disorder (ADHD) prevalence has increased in the last 10 years, most likely due to increased recognition by clinicians. Even so, an issue with under-diagnostics may persist. Historically ADHD has been described as a male-dominant disorder. However, recent evidence shows that ADHD prevalence is similar between the sexes, but that the related impairment or symptomatology might vary. This study estimated the prevalence of undiagnosed ADHD symptoms (pADHD) and explored the sex-stratified symptomatology and associations with self-perceived health-related quality of life (HRQL) and experience of depressive symptoms.

METHODS

This was done in a unique cohort of 50,937 healthy blood donors - individuals who successfully maintain regular commitments despite potential ADHD symptoms. ADHD symptoms were estimated using the Adult ADHD Self-Report Scale (ASRS), health-related quality of life (HRQL) measured using mental and physical component scores (MCS/PCS) estimated based on a 12-item Short-Form Health Survey (SF-12) with a higher score indicating better HRQL, and depressive symptoms were measured using Major Depression Inventory (MDI) with higher score indicating more depressive symptoms.

RESULTS

In total, 3% were classified with pADHD (sex ratio 1:1). pADHD was associated with reduced MCS and PCS, and increased MDI score. Males scored on average higher on inattentive symptoms compared to females, whereas females scored on average higher on hyperactive-impulsive symptoms. Individuals scoring high on the combined inattentive and hyperactive-impulsive ADHD symptom presentation were most likely to be impaired in terms of higher MDI scores and lower PCS when compared to non-ADHD controls.

CONCLUSIONS

In conclusion, ADHD symptoms are common in this seemingly healthy and undiagnosed population. Symptom presentations differ between sexes and the type of presentation seems to impact the association with depressive symptoms and level of reduced HRQL.

Symptoms of ADHD and Other Common Mental Disorders Influence Academic Success in South African Undergraduates

OBJECTIVE

ADHD symptoms are highly prevalent among university students. These symptoms, particularly the inattentive cluster, predispose students to poorer academic performance and worse academic adjustment. Moreover, ADHD symptoms are often comorbid with other common mental disorders; this comorbidity also leads to poor outcomes. South African students often have fewer resources to successfully transition to university. Hence, our longitudinal study used data from a sample of South African first-year undergraduate students to investigate (a) associations between ADHD symptoms and academic performance/adjustment, (b) separate influences of the inattentive and hyperactivity-impulsivity clusters on academic performance/adjustment, and (c) the influence of the combination of ADHD and psychiatric comorbidities on academic performance/adjustment.

METHOD

We collected data three times through the first semester of 2023. Predictors within our regression models included sociodemographic variables, psychological variables (self-reported symptoms of ADHD, depression, anxiety, and risky alcohol use), and high school academic performance. Outcomes were first-semester GPA and self-reported academic adjustment (magnitude of change across the semester and overall adjustment at the end of the semester).

RESULTS

Analyses showed that, unlike academic performance (N = 506), magnitude of change in academic adjustment (N = 180) was significantly predicted by ADHD symptoms and the combination of ADHD (p = .02), depression (p < .001), and anxiety symptoms (p = .01). Inattentive ADHD symptoms predicted both academic performance and magnitude of change in academic adjustment.

CONCLUSIONS

Our findings suggest that the presence of ADHD symptoms (both with and without other common mental disorders) is associated with a smaller magnitude of academic adjustment, and that the presence of inattentive symptoms of ADHD is associated with both poorer academic performance and smaller magnitude of academic adjustment. These findings are significant in informing future interventions targeting the academic outcomes of first-year university students.

Comprehending self-compassion manifestations and their relationships among adults diagnosed with ADHD: A foundation for recovery-based interventions

Background

Enhancing self-compassion (SC) was found to enhance Quality of Life (QoL). There is a need to comprehend SC manifestations among adults with attention deficit hyperactivity disorder (ADHD) who experience low QoL to provide a foundation for Recovery-based interventions aiming to enhance SC and QoL among adults with ADHD.

Objective

To explore SC manifestations and their relationships with ADHD symptoms and ADHD related QoL.

Methods

A cross-sectional survey used self-rated questionnaires for ADHD symptoms, QoL and SC among 32 adults with ADHD, recruited by a volunteer community sampling.

Results

Moderate overall SC was noted. Negative SC means were found to be higher than the positive SC means. The positive SC subscale common humanity had the lowest mean while the negative SC subscale overidentification had the highest mean. Overall SC level was found to significantly contribute to ADHD symptoms in predicting QoL variance. Overidentification was found to be a significant partial mediator between ADHD symptoms and QoL.

Conclusion

Recovery-based interventions aiming to decrease the tendency of adults with ADHD to overidentify with their negative thoughts and feelings and to enhance their realization that their difficulties are shared by others, may have the potential to enhance SC and QoL.

Digital health interventions with healthcare information and self-management resources for young people with ADHD: a mixed-methods systematic review and narrative synthesis

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental condition. Young people face challenges accessing ADHD healthcare in the UK, especially when transitioning between child and adult services. Digital health interventions (DHIs), as an adjunct to usual care, could improve access to healthcare information and condition-management support for this underserved group. This systematic review aimed to identify and synthesise evidence on DHIs suitable for young people aged 16-25 with ADHD, focussing on UK healthcare settings. We searched MEDLINE, Embase, PsycINFO, IEE Xplore, ACM Digital Library, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials, Scopus, Web of Science Core Collection, ProQuest Dissertations & Theses Global from inception to December 2023 for studies about DHIs for ADHD which provided healthcare and self-management information, and which included at least one participant aged 16-25 years. Studies were grouped by intervention type (healthcare & self-management information, symptom monitoring, and management tools), appraised using the Quality Assessment with Diverse Studies (QuADS) tool. A narrative synthesis was conducted. Nineteen papers representing 15 interventions and comprising 2651 participants were identified. Research studies spanned intervention development, feasibility/usability, pilots exploring preliminary effectiveness, and trials. QuADS scores ranged from 13 to 34 out of 39. Preliminary evidence of feasibility and acceptability was strongest for co-produced interventions. Limited evidence of effectiveness was found, except for psychoeducation DHIs which may be effective in reducing ADHD symptoms. Future research should build on this emerging evidence-base, emphasising co-produced DHIs tailored to young people with ADHD.

Assessment of learning and memory impairments in adults with predominately inattentive versus combined presentation attention-deficit/hyperactivity disorder

This cross-sectional study compared adults diagnosed with Attention-Deficit/Hyperactivity Disorder-Inattentive (ADHD-I) and ADHD-Combined (ADHD-C) presentations with a non-ADHD group on verbal and visual learning and delayed recall using the Rey Auditory Verbal Learning Test (RAVLT) and Brief Visuospatial Memory Test-Revised (BVMT-R), respectively. Data from 380 predominately college student adult outpatients were used, with 155 who met criteria for ADHD-I, 165 who met criteria for ADHD-C, and 60 who did not meet criteria for ADHD but were diagnosed with a primary depressive or anxiety disorder or received no diagnosis. Each patient was administered the RAVLT and BVMT-R as part of a comprehensive neuropsychological evaluation. Significant main effects of study group were found, such that patients with ADHD-C demonstrated worse learning and delayed recall of both verbal and visual information than patients with ADHD-I and the non-ADHD group. Patients with ADHD-I performed comparably to the non-ADHD group, apart from visual learning and delayed recall. Notably, more patients in the ADHD groups had possible or probable learning and memory impairment compared to the non-ADHD group. Findings were consistent with previous research indicating that those with ADHD exhibit poorer verbal and visual learning and delayed recall than those without ADHD.

Maternal Hyperandrogenemia and the Long-Term Neuropsychological, Sex Developmental, and Metabolic Effects on Offspring

Maternal hormonal and metabolic disorders, such as diabetes and obesity, can adversely affect the intrauterine environment, resulting in suboptimal fetal growth and an elevated risk of cardiovascular and metabolic diseases in the later life of the offspring. In this review, we examine the long-term impact of elevated maternal androgen levels during pregnancy on offspring. Maternal hyperandrogenemia is linked to various neurodevelopmental disorders, including attention-deficit/hyperactivity disorder, autism spectrum disorder, and anxiety-like behaviors, mediated by alterations in key brain regions responsible for emotion and cognition. Furthermore, children born to mothers with hyperandrogenemia exhibit heightened risk of metabolic and cardiovascular dysfunctions, such as obesity, insulin resistance, and hypertension, which can manifest early in life. Prenatal exposure to androgens has also been linked to reduced birth weights and altered fetal growth, potentially due to impaired placental function. Additionally, maternal testosterone levels influence offspring sex ratios, often favoring male births, though exceptions occur in certain conditions, such as congenital adrenal hyperplasia. The findings of this review underscore the need for healthcare professionals to monitor maternal serum androgen profiles during pregnancy. Further research is needed to determine underlying mechanisms and potential interventions to mitigate these risks.

The Transition to Adulthood: A Qualitative Study of Autism Spectrum Disorder From Military and Veteran Parents and Military-Dependent Young Adults

INTRODUCTION

Given the unique experiences of military service members and their families, military-dependent young adults (18-25 years old) with autism spectrum disorder (ASD) and their military or veteran families experience unique barriers to accessing quality mental health care during the transition to adulthood. In fact, developing services to address ASD challenges for military families is a burgeoning area of interest for the department of defense. However, there is a limited knowledge on the specific needs of military families as the young adult's transition outside of high school and lose supports.

MATERIALS AND METHODS

The present study conducted 3 focus groups with 16 military and veteran parents, and 3 focus groups with 10 military-dependent young adults to evaluate the needs of military-dependent young adults (17-25 years old) with ASD and military/veteran parents with a young adult with ASD.

RESULTS

Parents reported several key topics, including barriers to services (e.g., permanent change of station, recently moving to a state and lacking awareness of the available resources), defining adulthood in terms working in a cohesive family structure, and therapy recommendations for parents and young adults with ASD transitioning to adulthood. Young adults provided key information, including describing experiences with having a parent in the military, difficulty accessing services during the transition to adulthood, and recommendations on therapy for military-dependent young adults with ASD.

CONCLUSION

Military and veteran families with autistic dependents lack access to important mental-health resources. When developing programs for military families and military-dependent autistic young adults, mental health providers should consider the frequent relocations, lack of access to important transition resources, and common military values. The presence of advocates at military bases should be encouraged to help military families navigate autism services in their local community.

Association of exercise and ADHD symptoms: Analysis within an adult general population sample

Given the limitations associated with existing treatments for Attention Deficit/Hyperactive disorder (ADHD), Physical Activity (PA) has been considered as an adjunct therapeutic option. Previous research has generally found that PA reduces ADHD symptoms in children. However, much less research has explored the same effects in adults, and especially females, with ADHD. This cross-sectional study investigated the relationship between PA and ADHD in adults, and whether any relationship was moderated by proxy diagnostic ADHD group, as well as exploring the roles of motivation and forms of exercise. 268 participants completed an online survey measuring proxy ADHD diagnosis; ADHD symptomatology; PA level; forms of exercise performed, and motivation for exercise. In contrast to previous research performed with child participants (which frequently found significant negative correlations), there was no significant relationship between PA level and total ADHD symptomatology in adults, but there was a significant negative correlation between PA level and inattentive ADHD symptomatology. The strength of relationship between PA level and ADHD symptomatology did not differ based on ADHD proxy diagnostic grouping; PA level based on motivation type; or PA level based on total forms of exercise performed. However, it may be that clear relationships between PA and ADHD symptomatology are not easily identifiable in adult populations when only broad, nonspecific variables/measures are used (e.g., only measuring ADHD symptoms as a continuous total score, rather than considering inattentive/hyperactive symptoms separately). Therefore, greater differentiation between ADHD symptoms and subject characteristics (such as gender) might be required to better establish potential relationships and effects in this area, and better inform any potential PA based treatments.

Prevalence of ADHD Among Nonpsychotic Patients of Day-Care Centers and Comparison of Psychiatric Comorbidities Among Persons With and Without ADHD: A Pilot Study

Background/Objectives: Adults with ADHD are more likely to develop other mental disorders. There are few data on the prevalence of ADHD among nonpsychotic patients treated with psychotherapy in day-care centers. This paper aims to assess persons with ADHD in this specific population and to compare psychiatric comorbidities in groups with and without ADHD. Methods: A total of 152 persons (men and women aged 18-58 years [M = 33; SD = 9.56]) were diagnosed according to the Mini International Neuropsychiatric Interview 5.0. (MINI). Personality disorders were assessed with SCID-II. ADHD was diagnosed according to a structured diagnostic history, DSM-IV-TR criteria, as well as CAARS and ASRS questionnaires. Results: A total of 47 persons (31%) met the criteria for ADHD in adults. Individuals with and those without ADHD did not differ in terms of education, employment, earnings, functioning on the labor market, satisfaction with their material status, being in a relationship, and divorce rate. Patients with ADHD more often had comorbidities such as major depression (34%) and personality disorders (31.9%), while for those without ADHD, anxiety disorders (58.1%) were predominant. The prevalence of personality disorders was higher in the group with ADHD and approached statistical significance (χ2 [1, N = 152] = 18.496; p = 0.06). Borderline and passive-aggressive personality disorders were also more frequent in this group. Conclusions: The prevalence of ADHD among patients treated in the day-care psychiatric center was much higher than in general population. In the group with ADHD, there was a higher prevalence of personality disorders, mainly borderline and passive-aggressive types. As only a small sample was analyzed in this single-center study, the presented findings need replication in similar settings.

Efficacy of internet-based cognitive behavioral therapy for medicated adults with attention-deficit/hyperactivity disorder (ADHD): A randomized controlled trial

BACKGROUND

Cognitive behavioral therapy (CBT) is an effective treatment for adults with attention-deficit/hyperactivity disorder (ADHD), but its use is limited by poor accessibility and time constraints-barriers that internet-based CBT (iCBT) may help overcome. This trial aimed to explore the short- and long-term efficacy of iCBT in medicated adults with ADHD.

METHODS

Eighty-six adults with ADHD were randomized into two groups: the iCBT combined with medication group (iCBT+M, n = 43) and the medication-only group (n = 43). The iCBT+M group received 12 weeks of iCBT with ongoing medication, while the medication-only group continued with medication alone. The primary outcome was the change in ADHD symptoms. Secondary outcomes included emotional symptoms, executive function, quality of life, and global functioning. Outcomes were assessed at baseline, post-treatment (T1), 6-month (T2), and 12-month follow-up (T3). Mixed linear models were used to assess the differences in outcomes between the two groups at each follow-up point.

RESULTS

Compared to the medication-only group, the iCBT+M group showed greater improvements in ADHD symptoms (d = 0.50 at T1/T2, 0.59 at T3), executive function (d = 0.87 at T1, 0.49 at T2, 0.25 at T3), quality of life (d = -0.74 at T1, -0.59 at T2, -0.28 at T3), global functioning (d = 0.66 at T1, 0.85 at T2, 0.42 at T3), and anxiety (d = 0.43 at T1).

CONCLUSION

iCBT interventions may benefit medicated adults with ADHD by improving core symptoms, executive function, quality of life, and overall functioning, with effects sustained for 12 months.

Retrospective assessment of ICD-10/DSM-5 criteria of childhood ADHD from descriptions of academic and social behaviors in German primary school reports

BACKGROUND

The diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adolescence and adulthood is particularly challenging because retrospective confirmation of previous childhood ADHD is mandatory. Therefore, collecting valid diagnostic information about behavior at school is important. Primary school reports often contain descriptions of academic performance and social behaviors associated with ADHD criteria. Yet, there is no systematic approach available how to assess such reports quantitatively, and therefore, there is also no study on how valid such an approach could predict an ADHD diagnosis.

METHODS

We examined primary school reports from Germany (ADHD: n = 1197, typically developing controls: n = 656) for semantic references to ICD-10/DSM-5 main and sub-criteria of ADHD. Descriptions were assessed on a quantitative scale (blinded clinical expert rating) for disorder-associated behaviors (symptoms scale) as well as for desired, adaptive behaviors (competencies scale) according to these criteria. The scores of these developed scales have been summarized to summary scores. Scores were analyzed using linear mixed models, and sensitivity and specificity were estimated using receiver operating characteristics (ROC).

RESULTS

Ratings showed highly significant differences between school reports of children with and without ADHD. For the summary scores, both symptoms and competencies scales showed high diagnostic accuracy (ROC area under the curve at least 0.96) with best discrimination when combining both into an integrated index (sensitivity and specificity > 0.97).

CONCLUSIONS

Our findings suggest that systematic quantitative analysis of primary school reports should be further explored to construct a valid instrument for retrospective assessment of childhood ADHD criteria to aid the diagnostic process in adolescents and adults.

Validity of the Italian Version of DIVA-5: Semi-Structured Diagnostic Interview for Adult ADHD Based on the DSM-5 Criteria

Introduction: In 2019, an updated version of the Diagnostic Interview for ADHD in Adults (DIVA-5) was developed based on DSM-5 criteria, currently validated in Korean and Farsi. The aim of this study is to validate the DIVA-5 Italian version. Methods: 132 subjects in the Adult ADHD Screening Center of AUSL-Modena, who agreed to participate in this study, were selected. Socio-demographic and clinical variables were collected. DIVA-5, Barkley Adult ADHD Rating Scale (BAARS), and Adult ADHD Self Rating Scale (ASRS-v1.1) were administered. We assessed the internal consistency of the DIVA-5 Italian version and its concurrent validity with ASRS-v1.1 and BAARS-IV. An exploratory factor analysis (EFA) was conducted to evaluate the construct validity, and a multiple linear regression to evaluate the predictive validity. Results: Our analysis indicated good internal consistence of the DIVA-5 Italian version (Cronbach's alpha and Kuder coefficients ranged between 0.61 and 0.78). The EFA showed five factors representing specific variance. The correlation between the corresponding ADHD dimensions of DIVA-5 and BAARS was found to be statistically significant (Spearman's coefficient ranged between 0.61 and 0.47, p = 0.000), while the correlation between the DIVA-5 dimensions and ASRS-v1.1 was statistically significant for all the dimensions except child hyperactivity/impulsivity. The multiple linear regression showed a positive association of the DIVA-5 score with the "job" variable and a negative association with "drug therapy". DIVA-5 showed greater sensitivity for inattention in adulthood and greater specificity for hyperactivity/impulsivity in childhood. Conclusions: Our results confirm that the DIVA-5 Italian version represents a valid and reliable tool to diagnose adult ADHD.

Digital Surveillance of Mental Health Care Services in Saudi Arabia: Cross-Sectional Study of National e-Referral System Data

Background

Mental illness affects an estimated 25% of the global population, with treatment gaps persisting worldwide. The COVID-19 pandemic has exacerbated these challenges, leading to a significant increase in mental health issues globally. In Saudi Arabia, the lifetime prevalence of mental disorders is estimated at 34.2%, yet 86.1% of those with a 12-month mental disorder report no service use. To address these challenges, digital health solutions, particularly electronic referral (e-referral) systems, have emerged as powerful tools to improve care coordination and access. Saudi Arabia has pioneered the nationwide Saudi Medical Appointments and Referrals Centre (SMARC), a centralized e-referral system using artificial intelligence and predictive analytics.

objectives

This study aims to analyze Saudi Arabia's novel nationwide e-referral system for mental health services, using SMARC platform data to examine referral patterns, and service accessibility. This study also aims to demonstrate how digital health technology can inform and improve mental health care delivery and policy making.

Methods

This retrospective, cross-sectional study used secondary data from SMARC on 10,033 psychiatric e-referrals in Saudi Arabia during 2020-2021. Referrals were assessed by patient sociodemographic variables, geographic data, and e-referral characteristics including date, type, bed type, and reason for e-referral. Descriptive statistical analyses identified referral patterns, while regression modeling determined predictors of external referrals to other regions.

Results

Analysis of 10,033 psychiatric e-referrals revealed that 58.99% (n=5918) were for patients aged 18-44 years, 63.93% (n=6414) were for men, and 87.10% (n=8739) were for Saudi nationals. The Western Business Unit generated 45.17% (n=4532) of all e-referral requests. Emergency cases were the most common type of referral overall, followed by routine inpatient and routine outpatient department referrals. However, in the Northern Business Unit, routine inpatient referrals were most frequent. Two-thirds of requests were for ward beds, while critical beds were rarely requested. "Unavailable subspecialty" was the primary reason for referrals across all regions. The utilization of the mental health e-referral system varied across regions, with the Northern Border and Albaha regions showing the highest rates, while Madinah, Eastern, and Riyadh regions demonstrated lower use. Temporal analysis showed almost similar monthly patterns in 2020 and 2021. There was an overall increase in referrals in 2021 compared with 2020.

Conclusions

This pioneering study of mental health e-referrals in Saudi Arabia demonstrates how digital health transformation, particularly through an e-referral system, has significantly enhanced access to mental health services nationwide in Saudi Arabia. The success of this digital initiative demonstrates how digital health solutions can transform health care access, particularly in mental health services, offering a valuable model for other health care systems.

Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study

BACKGROUND

Nearly 3% of adults have attention-deficit and hyperactivity disorder (ADHD), although in the UK, most are undiagnosed. Adults with ADHD on average experience poorer educational and employment outcomes, worse physical and mental health and are more likely to die prematurely. No studies have yet used mortality data to examine the life expectancy deficit experienced by adults with diagnosed ADHD in the UK or worldwide.

AIMS

This study used the life-table method to calculate the life-expectancy deficit for people with diagnosed ADHD using data from UK primary care.

METHOD

A matched cohort study using prospectively collected primary care data (792 general practices, 9 561 450 people contributing eligible person-time from 2000-2019). We identified 30 039 people aged 18+ with diagnosed ADHD, plus a comparison group of 300 390 participants matched (1:10) by age, sex and primary care practice. We used Poisson regression to estimate age-specific mortality rates, and life tables to estimate life expectancy for people aged 18+ with diagnosed ADHD.

RESULTS

Around 0.32% of adults in the cohort had an ADHD diagnosis, ~1 in 9 of all adults with ADHD. Diagnoses of common physical and mental health conditions were more common in adults with diagnosed ADHD than the comparison group. The apparent reduction in life expectancy for adults with diagnosed ADHD relative to the general population was 6.78 years (95% CI: 4.50 to 9.11) for males, and 8.64 years (95% CI: 6.55 to 10.91) for females.

CONCLUSIONS

Adults with diagnosed ADHD are living shorter lives than they should. We believe that this is likely caused by modifiable risk factors and unmet support and treatment needs in terms of both ADHD and co-occurring mental and physical health conditions. This study included data from adults with diagnosed ADHD; the results may not generalise to the entire population of adults with ADHD, the vast majority of whom are undiagnosed.

Unraveling the insomnia puzzle: sleep reactivity, attention deficit hyperactivity symptoms, and insomnia severity in ADHD Patients

Introduction

Insomnia is the most common sleep problem among adults with attention deficit hyperactivity disorder (ADHD). The severity of insomnia can exacerbate the symptoms of ADHD. Identifying the predictive factors that contribute to insomnia severity may be crucial in treating insomnia among adults with ADHD. One potential factor contributing to insomnia is sleep reactivity, which refers to the tendency to experience insomnia triggered by stress. This phenomenon, also known as vulnerability to stress-related insomnia, reflects the extent to which individuals are prone to developing insomnia in response to stressful situations. To date, sleep reactivity in adults with ADHD has not been studied. This study aimed to investigate the relationship between sleep reactivity, attention deficit hyperactivity symptoms, and the severity of insomnia in adults with ADHD.

Methods

This study included 61 adults with ADHD with no comorbid psychiatric or medical diseases and 61 adult healthy controls (HCs) matched for age, sex, body mass index, and years of education. All participants completed the sociodemographic data form, Ford Insomnia Response to Stress Test (FIRST), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Adult ADHD Self-Report Scale (ASRS), and Wender Utah Rating Scale (WURS).

Results

Sleep reactivity, insomnia severity, and poor sleep quality were higher in adults with ADHD compared to HCs. Higher sleep reactivity was associated with worse sleep outcomes in both groups, whereas higher sleep reactivity was associated with severe ADHD symptoms in the HCs group. In the ADHD group, insomnia severity was predicted by higher sleep reactivity, ASRS, and being female (R2 = 0.32, F (6, 61) = 4.36, p = 0.001), not age, ADHD medication use, and WURS.

Conclusion

Our findings suggest that higher sleep reactivity, increased ADHD symptoms, and being female may predict the severity of insomnia in adults with ADHD.

Bidirectional association between allergic rhinitis and attention-deficit/hyperactivity disorder: A systematic review and meta-analysis

BACKGROUND

This meta-epidemiological study seeks to further investigate the reciprocal relationship between allergic rhinitis (AR) and attention-deficit/hyperactivity disorder (ADHD).

METHODS

A comprehensive search of the databases was conducted up to March 3, 2024. We performed a synthesis and meta-analysis of odds ratios and their corresponding 95 % confidence intervals using Stata 14.0. Funnel plot analysis and Egger's regression test were utilized to assess potential publication bias.

RESULTS

Eighteen articles involving 4,289,444 participants were included. AR patients had an increased risk of developing ADHD (OR: 1.83; 95 % CI: 1.37-2.43), while ADHD patients were also more likely to have AR (OR: 1.38; 95 % CI: 1.11-1.72). Subgroup analysis indicated a predisposition of AR patients to autism spectrum disorder (OR: 1.34; 95 % CI: 0.86-1.0) and a higher risk of ADHD in cohort studies (OR: 1.90; 95 % CI: 1.26-2.88). Female AR patients were more likely to develop ADHD than males (OR: 1.86; 95 % CI: 1.43-2.43), and children aged ≤8 years with AR were at greater risk for ADHD compared to older children (OR: 1.75; 95 % CI: 1.14-2.69).

CONCLUSIONS

This meta-analysis confirms a bidirectional association between AR and ADHD, indicating that they are mutually independent risk factors.

"I Found Comfort in Exercising": Exploring Experiences With Exercise for Adults With Attention-Deficit/Hyperactivity Disorder

Little is known about how adults with attention-deficit/hyperactivity disorder (ADHD) experience exercise, resulting in a lack of recommendations for supporting this population. We aimed to explore how adults with ADHD experience exercise as a management tool before and after diagnosis and how and why individuals experience issues related to exercise dependence. Fifteen active adults with a diagnosis of ADHD participated in semistructured interviews. Three overarching themes were identified: (a) exercise as a necessity for ADHD, reflecting the need to exercise before a formal ADHD diagnosis, and use of exercise as a management tool postdiagnosis; (b) goals and achievements to live by, reflecting how exercise patterns revolved around a need to make progress toward targets; and (c) activity or exercise: a roller coaster journey, covering the ups and downs of exercise journeys. This article highlights the importance of exercise for adults to manage ADHD and how this can be encouraged and supported.

Single-cell Technology in Stem Cell Research

Single-cell technology (SCT), which enables the examination of the fundamental units comprising biological organs, tissues, and cells, has emerged as a powerful tool, particularly in the field of biology, with a profound impact on stem cell research. This innovative technology opens new pathways for acquiring cell-specific data and gaining insights into the molecular pathways governing organ function and biology. SCT is not only frequently used to explore rare and diverse cell types, including stem cells, but it also unveils the intricacies of cellular diversity and dynamics. This perspective, crucial for advancing stem cell research, facilitates non-invasive analyses of molecular dynamics and cellular functions over time. Despite numerous investigations into potential stem cell therapies for genetic disorders, degenerative conditions, and severe injuries, the number of approved stem cell-based treatments remains limited. This limitation is attributed to the various heterogeneities present among stem cell sources, hindering their widespread clinical utilization. Furthermore, stem cell research is intimately connected with cutting-edge technologies, such as microfluidic organoids, CRISPR technology, and cell/tissue engineering. Each strategy developed to overcome the constraints of stem cell research has the potential to significantly impact advanced stem cell therapies. Drawing on the advantages and progress achieved through SCT-based approaches, this study aims to provide an overview of the advancements and concepts associated with the utilization of SCT in stem cell research and its related fields.

[Are the concepts of "chronic mania" in German-speaking psychiatry around 1900 early contributions to the disorder of the adult form of attention deficit hyperactivity disorder (ADHD)?]

The adult form of attention deficit hyperactivity disorder (ADHD) has increasingly become a focus of adult psychiatry. Despite long-established diagnostic criteria and specific therapeutic approaches for the disorder, the common misconception that ADHD is a "fad" has persisted. Examining the history of psychiatry can make an educational contribution by showing that the adult form of ADHD is a continuously existing illness phenomenon. The present study examines the discussion of sometimes prominent authors about "chronic mania" in German-speaking psychiatry around 1900. The individual concepts were analyzed for their content and compared with each other and with modern diagnostic manuals for adult ADHD. The aim of this work is to question and discuss whether these "chronic-manic concepts" are part of the conceptual history of adult ADHD and whether a gap in the history of this disorder can be filled with their help. It is concluded that in the early twentieth century neurologists reported and discussed about patients who nowadays would almost certainly receive the diagnosis of ADHD. The psychiatrists had difficulty in classifying this disorder into their nosological schemes but their "chronic-manic concepts" show clear parallels to the current diagnostic criteria for adult ADHD and its symptoms.

Motor proficiency of persons with attention deficit hyperactivity disorder or autism spectrum disorder diagnosed in adulthood

PURPOSE

To compare (1) motor proficiency of persons diagnosed in adulthood with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) with normative values of motor proficiency, and (2) motor proficiency between persons with ADHD and those with ASD diagnosed in adulthood.

METHODS

A total of 153 adults (median age 32 years, 36% women) participated in this cross-sectional study. Fifty-three persons with predominately inattentive presentation (ADHD-I), 67 persons with combined presentation (ADHD-C), and 33 persons with ASD performed the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). One-sample binominal tests were used to compare motor proficiency against standardized norms of BOT-2 for young adults. One-way ANOVAs and Kruskal-Wallis tests were used to compare test outcomes between the groups.

RESULTS

The total sample showed significantly impaired motor proficiency in comparison to norms in all test domains (p < 0.001-0.006), except for fine motor skills. The ASD group showed significantly poorer body coordination compared with the ADHD-I and ADHD-C groups, with a moderate effect size (p = 0.003-0.02, η2 = 0.061).

CONCLUSIONS

Motor proficiency is impaired in most persons with ADHD or ASD diagnosed in adulthood, suggesting that motor assessment should be included in clinical examinations of adults with suspected neurodevelopment disorders.

Effects of mind-body exercise on individuals with ADHD: a systematic review and meta-analysis

Objective

To explore the effects of mind-body exercise (MBE) on ADHD through a systematic review and meta-analysis.

Methods

After identifying relevant search keywords based on the study's technical terminology, research articles were retrieved from five databases. Two researchers independently screened the results to select studies that met the inclusion criteria. A random-effects model was used to conduct a meta-analysis on the included studies.

Results

The findings indicate that MBE interventions significantly improved attention in individuals with ADHD [SMD=-0.97, 95% CI (-1.56, -0.39), P < 0.05]. However, the meta-analysis found no evidence that MBE improved executive function, emotional issues, or hyperactivity/impulsivity in ADHD patients.

Conclusions

MBE is beneficial for attention improvement in ADHD patients. However, further evidence is needed to support its efficacy as an adjunctive treatment for other symptoms.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier CRD42023447510.

Depressive Symptoms and Quality of Life Among Women Living With a Partner Diagnosed With ADHD

Objective: This study explores the depressive symptoms and quality of life (QoL) of women in relationships with partners diagnosed with ADHD, as well as the role of engagement in health-promoting activities (HPA) on these outcomes, spotlighting the often-neglected perspective of these women. Methods: Employing a cross-sectional approach, the study used Structural Equation Modeling (SEM) to explore associations between partners' ADHD functional impairment, women's involvement in HPA, and their depressive symptoms and QoL. Results: Functional impairment in partners with ADHD was positively associated with women's depressive symptoms and negatively associated with their QoL, whereas women's engagement in HPA was positively associated with their QoL and negatively associated with their depressive symptoms. Conclusions: The findings suggest that women partnered with individuals diagnosed with ADHD may face an elevated risk of depressive symptoms and lowered QoL. The results highlight the potential need for a more comprehensive clinical approach to adult ADHD treatment that considers functional impairments and the experiences of partners. Incorporating HPA into therapeutic strategies appears beneficial. However, longitudinal research is needed to examine the direction of these associations and to develop potential interventions to support these women.

An investigation of the acute effects of aerobic exercise on executive function and cortical excitability in adolescents with attention deficit hyperactivity disorder (ADHD)

Previous studies have shown that aerobic exercise has beneficial effects on executive function in adolescents with attention-deficit hyperactivity disorder (ADHD). The underlying mechanisms could be partially due to aerobic exercise-induced cortical excitability modulation. The aim of this study was to explore the effects of acute aerobic exercise on executive functions and cortical excitability and the association between these phenomena in adolescents with ADHD. The study was conducted using a complete crossover design. Executive functions (inhibitory control, working memory, and planning) and cortical excitability were assessed in twenty-four drug-naïve adolescents with ADHD before and after acute aerobic exercise or a control intervention. Inhibitory control, working memory, and planning improved after acute aerobic exercise in adolescents with ADHD. Moreover, cortical excitability monitored by transcranial magnetic stimulation (TMS) decreased after intervention in this population. Additionally, improvements in inhibitory control and working memory performance were associated with enhanced cortical inhibition. The findings provide indirect preliminary evidence for the assumption that changes in cortical excitability induced by aerobic exercise partially contribute to improvements in executive function in adolescents with ADHD.

Exploring ADHD understanding and stigma: Insights from an online survey in Lebanon

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder. Public knowledge of ADHD plays a crucial role in shaping attitudes, reducing stigma, and fostering a supportive environment for individuals with this disease. This study aimed to assess the level of knowledge and stigma of the general Lebanese population regarding ADHD and identify potential factors associated with these variables.

METHODS

An online cross-sectional study was conducted between July and August 2023 among adults from all Lebanese regions. The questionnaire was self-administered, available in Arabic and English, and included a sociodemographic section and the validated tools Knowledge of Attention Deficit Disorders Scale (KADDS) and the ADHD Stigma Questionnaire (ASQ).

RESULTS

A total of 647 participants were included. Most participants (n = 483 (74.7%)) lacked prior experience with individuals who have ADHD, and only 12.8% reported having good information about the condition. The participants had a mean knowledge score of 20.49 ±3.23 and a mean ADHD stigma score of 75.71 ±20.58. A significantly higher knowledge score was associated with a university level of education (B = 0.14, p < 0.001), older age (B = 0.14, p = 0.001), using the internet (B = 0.13, p = 0.001) and lecture (B = 0.09, p = 0.015) as a source of ADHD information, having a high monthly income (B = 0.13, p = 0.001), being female (B = 0.08, p = 0.030) and having a health coverage (B = 0.08, p = 0.025). Conversely, a lower knowledge was significantly associated with obtaining ADHD information from television (B = -0.13, p = 0.001) and family (B = -0.08, p = 0.043). A significantly lower score was associated with ever being diagnosed with ADHD (B = -0.18, p < 0.001), having an intermediate monthly income (B = -0.10, p = 0.005), and consuming alcohol (B = -0.11, p = 0.004), while a higher score was significantly associated with a higher KADDS total score (B = 0.12, p = 0.002) and being employed (B = 0.07, p = 0.044).

CONCLUSION

The present study addressed a gap in the existing literature by examining ADHD knowledge and stigma in the Lebanese population. Surprisingly, a positive correlation between higher ADHD knowledge and increased stigma challenges common assumptions, suggesting a complex relationship between knowledge, misconceptions, and societal attitudes. The findings emphasize the need for targeted education and advocacy to improve knowledge and alleviate misconceptions and stigma within the general population.

The contribution of attention-deficit/hyperactivity disorder polygenic load to metabolic and cardiovascular health outcomes: a large-scale population and sibling study

Emerging evidence suggests that ADHD is associated with increased risk for metabolic and cardiovascular (cardiometabolic) diseases. However, an understanding of the mechanisms underlying these associations is still limited. In this study we estimated the associations of polygenic scores (PGS) for ADHD with several cardiometabolic diseases and biomarkers. Furthermore, we investigated to what extent the PGS effect was influenced by direct and indirect genetic effects (i.e., shared familial effects). We derived ADHD-PGS in 50,768 individuals aged 18-90 years from the Dutch Lifelines Cohort study. Using generalised estimating equations, we estimated the association of PGS with cardiometabolic diseases, derived from self-report and several biomarkers measured during a physical examination. We additionally ran within-sibling PGS analyses, using fixed effects models, to disentangle direct effects of individuals' own ADHD genetic risk from confounding due to indirect genetic effects of relatives, as well as population stratification. We found that higher ADHD-PGS were statistically significantly associated with several cardiometabolic diseases (R-squared [R2] range = 0.03-0.50%) and biomarkers (related to inflammation, blood pressure, lipid metabolism, amongst others) (R2 range = 0.01-0.16%) (P < 0.05). Adjustment for shared familial factors attenuated the associations between ADHD-PGS and cardiometabolic outcomes (on average 56% effect size reduction), and significant associations only remained for metabolic disease. Overall our findings suggest that increased genetic liability for ADHD confers a small but significant risk increase for cardiometabolic health outcomes in adulthood. These associations were observable in the general population, even in individuals without ADHD diagnosis, and were partly explained by familial factors shared among siblings.

Support for primary care prescribing for adult ADHD in England: national survey

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, for which there are effective pharmacological treatments that improve symptoms and reduce complications. Guidelines published by the National Institute for Health and Care Excellence recommend that primary care practitioners prescribe medication for adult ADHD under shared-care agreements with Adult Mental Health Services (AMHS). However, provision remains uneven, with some practitioners reporting a lack of support.

AIM

This study aimed to describe elements of support, and their availability/use, in primary care prescribing for adult ADHD medication in England to improve access for this underserved population and inform service improvement.

DESIGN AND SETTING

Cross-sectional surveys were used to elicit data from commissioners, health professionals (HPs), and people with lived experience of ADHD (LE) across England about elements supporting pharmacological treatment of ADHD in primary care.

METHOD

Three interlinked cross-sectional surveys were used to ask every integrated care board in England (commissioners), along with convenience samples of HPs and LEs, about prescribing rates, AMHS availability, wait times, and shared-care agreement protocols/policies for the pharmacological treatment of ADHD in primary care. Descriptive analyses, percentages, and confidence intervals were used to summarise responses by stakeholder group. Variations in reported provision and practice were explored and displayed visually using mapping software.

RESULTS

Data from 782 responders (42 commissioners, 331 HPs, 409 LEs) revealed differences in reported provision by stakeholder group, including for prescribing (95% of HPs versus 64% of LEs). In all, >40% of responders reported extended AMHS wait times of ≥2 years. There was some variability by NHS region - for example, London had the lowest reported extended wait time (25%), while East of England had the highest (55%).

CONCLUSION

Elements supporting appropriate shared-care prescribing of ADHD medication via primary care are not universally available in England. Coordinated approaches are needed to address these gaps.

Exploring the Relationship of Smartphone Addiction on Attention Deficit, Hyperactivity Symptoms, and Sleep Quality Among University Students: A Cross-Sectional Study

BACKGROUND

The prevalence of smartphone usage is steadily rising, leading to the potential development of addiction due to problematic use. This study examined the relationship between smartphone addiction, self-perceived attention deficit and hyperactivity symptoms, and sleep quality among 443 university students at Bingöl University.

METHODS

Participants completed several questionnaires, including the Smartphone Addiction Scale-Short Version, the Pittsburgh Sleep Quality Index, and the Adult ADHD Self-Report Scale.

RESULTS

This study examined 443 participants, with a mean age of 20.97 ± 3.29, of whom 72.7% (n = 322) were female. Results showed that the majority of participants primarily used smartphones (94.8%, n = 420) for social media browsing (49.9%, n = 221). Factors such as smoking, preference for smartphone screens, and prolonged screen exposure significantly affected sleep quality. Smartphone addiction rates were notable, with 50.4% (n = 61) of males and 47.2% (n = 152) of females being affected; this addiction was associated with poorer sleep quality. Correlations were found between age, sleep duration, and scores on smartphone addiction, sleep quality, and attention deficit scales. Linear regression analysis revealed that age, attention deficit scores, and sleep quality scores significantly influenced levels of smartphone addiction.

CONCLUSIONS

These findings contribute valuable insights into the impact of smartphone addiction on attention and sleep in university students.

Practitioner Review: Continuity of mental health care from childhood to adulthood for youths with ADHD - who, how and when?

Many youths with attention-deficit/hyperactivity disorder (ADHD) experience significant long-term impairment and may develop concurrent mental and somatic health difficulties as adults. This is associated with burden and costs for the individual and society which could be prevented through continued support in youth. Yet, only few young people transition to adult mental health services for ongoing care in different countries worldwide. We provide an overview on current transition practices, highlighting the gaps in knowledge and the barriers to effective service transitioning, while considering the large geographical variation in available guidelines and service provision. For ease of use, this review is organized in a question-and-answer format covering different aspects of the transition process and considering both service users' and clinicians' perspectives. Consensus is needed to identify those that require continued care, the optimal timing to arrange transition, and the most suitable services. Finally, we discuss cost-effectiveness of transition practices, consider examples of best practice, and propose recommendations on how to improve transitional care, including the importance of service users' input into transition planning.

Having Reliable Support: A Prerequisite to Promote Sexual and Reproductive Health in Young Women with ADHD

Living with attention deficit hyperactivity disorder (ADHD) may influence sexual behaviors and intimate relationships in young women, resulting in a higher risk of unwanted pregnancy, sexual victimization, and sexual dysfunction. To develop adequate support, the study aimed to describe conceptions of how to promote sexual and reproductive health (SRH) in young women with ADHD. A secondary analysis using phenomenography was performed on qualitative interview data exploring variations of support. The study involved 15 young women with ADHD, aged 15-29 years, and 16 health care professionals, with various professions, working in the fields of gynecology, youth health, and psychiatry. Having reliable support was conceptualized as fundamental for promoting SRH. Access to information concerning SRH and living with ADHD as well as early support from health care contributed to a reliable support enabling self-knowledge and management of sexual relationships. Trustful relationships in health care were perceived as important because of previous experiences of feeling misunderstood and criticized in life, making them feel comfortable discussing SRH. Clinical encounters with a clear structure were further perceived to make information more accessible and clinics that provided appropriate organizational conditions and collaborated with other clinics were described to enhance the availability of support. This study reveals the need for clinics to provide conditions that ensure SRH support is available, accessible, and free of stigmatization. Early intervention programs for young women with ADHD may be considered, offering guidance on SRH issues in both psychiatric and sexual health clinics.

Examining the utility of the BAARS-IV scales as embedded symptom validity indicators for adult attention-deficit/hyperactivity disorder evaluations

Objective: This study investigated whether extreme cut-scores on the Barkley Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale-Fourth Edition (BAARS-IV) self-report scales could serve as symptom overreporting indicators in adult ADHD evaluations. Method: The sample consisted of 162 adults who underwent a neuropsychological evaluation for ADHD. Patients were classified into valid (n = 115) and invalid (n = 47) groups based on multiple criterion symptom validity tests. Results: Overreporting cut-scores identified for each of the BAARS-IV scales demonstrated acceptable classification accuracy or better. The Current Total scale yielded the highest classification accuracy (area under the curve of .83). An optimal raw cut-score of ≥56 for this scale yielded 47% sensitivity when upholding ≥90% specificity. A cut-score of ≥31 for the Current Inattention scale (90% specificity; 47% sensitivity) and ≥29 for the Current Sluggish Cognitive Tempo scale (88% specificity; 46% sensitivity) were also relatively strong indicators of overreporting. The Current Total and Current Sluggish Cognitive Tempo scales captured nonredundant aspects of symptom validity, and using them together increased sensitivity to 57% while maintaining ≥90% specificity. Conclusions: Findings provide preliminary support for the criterion and construct validity of extreme cut-scores on the BAARS-IV Current Sluggish Cognitive Tempo, Current Inattention, and Current Total scales as indicators of ADHD symptom overreporting. However, employing the cut-scores from the Current Sluggish Cognitive Tempo (≥29) and Current Total (≥56) together may be the most promising way to detect overreporting. Scores above both of these cut-points should, at a minimum, prompt further investigation into the validity of a patient's reported symptoms.

Cognitive profiles and developmental variations in ADHD: A comparative analysis of childhood and adolescent diagnoses

This retrospective study investigates the cognitive profiles of individuals with ADHD, categorized by the age at which they were diagnosed-either during childhood or adolescence. The sample comprised 424 participants aged 6 to 20 years, with a predominance of males. Participants were assessed using a variety of neuropsychological standardized tests. The study found significant differences in cognitive performance between those diagnosed in childhood and those diagnosed in adolescence. Specifically, childhood diagnoses were associated with poorer performance in vigilance, selective attention, and motor control, while adolescent diagnoses were linked to lower scores in the environment's perception of their flexibility, working memory, and planning. Binary logistic regression analyses indicated that the neuropsychological profile for the combined ADHD subtype did not vary by age group, in contrast with the inattentive subtype, in which different cognitive constructs were identified serving as significant predictors. Findings suggest that the cognitive challenges associated with ADHD evolve with development, highlighting the need for age-appropriate diagnostic criteria and interventions.

Psychiatric comorbidities of attention deficit/hyperactivity disorder in Japan: a nationwide population-based study

Introduction

This study aimed to estimate prevalence and incidence of attention deficit/hyperactivity disorder (ADHD) and comorbid relationships between ADHD and other psychiatric disorders in Japan.

Methods

Using the real-world JMDC Claims Database, we conducted a cross-sectional study (analysis years 2017-2021) and retrospective cohort study (observation 2 years before/after the initial ADHD diagnosis; data collection 2005-2021; enrollment 2017-2019). Patients were male or female, aged 0-57 years. Cross-sectional study patients had an ADHD or other psychiatric disorder diagnosis (with or without medication) and were continuously registered in each analysis year; retrospective study patients had an ADHD diagnosis and ≥2 years' observation before and after diagnosis. Endpoints were annual prevalence and incidence of ADHD in Japan, prevalence and risk ratio of each psychiatric comorbidity in patients with ADHD, prevalence and risk ratios of ADHD in patients with each psychiatric comorbidity, and prevalence of psychiatric disorders before/after the initial ADHD diagnosis.

Results

ADHD prevalence in children/adolescents and adults increased each year from 2017 to 2021. Prevalence in boys was 3.5-4.1 times higher than in girls. Prevalence in adults was lower than in children/adolescents, with a small sex difference. ADHD was highly comorbid with various psychiatric disorders. In 2019, the most common comorbidity in children/adolescents with ADHD was autism spectrum disorder (ASD; 54.4%); in adults, it was mood disorders (60.9%). ADHD prevalence in patients with various psychiatric disorders was higher than in the control population. ADHD prevalence was highest in patients with oppositional defiance disorder among both children/adolescents and adults (77.2% and 69.2%, respectively). In the retrospective cohort study (N = 14,940), the most common psychiatric disorders diagnosed prior to ADHD diagnosis were ASD in children/adolescents (33.9% of patients), and mood disorders and sleep disorders in adults (36.9% and 23.8% of patients, respectively).

Discussion

ADHD was comorbid with various psychiatric disorders in Japan. In children and adolescents with ADHD, ASD was often diagnosed prior to ADHD. Psychiatric disorders, especially mood disorders and sleep disorders, were frequently diagnosed prior to the initial ADHD diagnosis in adults. The likelihood of comorbid ADHD should be considered when diagnosing adult patients with psychiatric disorders.

An investigation of the Bernstein's strengths Scale: factorial validity and network analysis of attention-deficit/hyperactivity symptoms, mental health, and the strengths of the healthy adult self

BACKGROUND

Bernstein's heuristic model of personal strengths describes 16 positive attributes of the healthy adult self, grouped into four higher-order factors: self-directedness (identity, self-reflection, self-confidence, self-assertion, imagination/creativity), self-regulation (emotional balance, resilience, self-control, self-care, reality testing), connection (empathy, compassion, humour, responsibility), and transcendence (gratitude and wisdom). The study aimed to explore the factorial validity of Bernstein's Strengths Scale developed for the assessment of these constructs. Furthermore, we explored the association of strengths with attention-deficit hyperactivity (ADHD) symptoms and mental health in a nonclinical sample using a network approach.

METHODS

Five hundred and twenty-eight adults filled out an online questionnaire, including Bernstein's Strengths Scale (BSS), the Mental Health Continuum - Short Form (MHC-SF), and the Adult ADHD Self-Report Scale (ASRS).

RESULTS

Though our data showed an acceptable fit to the 16-factor model, the Self-control subscale and item 28 of the Compassion subscale were excluded because of reliability issues. The final model with 15 factors and 44 items showed excellent fit, χ2(797) = 1130.149, p < .001, RMSEA = 0.028, 90% CI [0.024, 0.032], SRMS = 0.049, CFI = 0.993, TLI = 0.991. Principal component analysis revealed three instead of four second-order factors. In the network model, Self-confidence and Wisdom emerged as the most influential nodes. ADHD symptoms were negatively connected to Responsibility, Self-care, Identity, Emotional balance, Self-confidence, and mental health, while they had positive edges with Humor, Self-reflection, and Imagination/creativity. Mental health was positively related to several strengths, with the strongest association being between mental health and Gratitude.

CONCLUSION

The BSS has acceptable factorial validity and is a reliable tool for assessing the personal strengths of the healthy adult self. ADHD symptoms in adults may be associated with deficits in personal strengths, but protective factors could also be identified. Addressing personal strengths in psychosocial interventions for ADHD in adults may improve patients' emotional well-being and everyday functioning.

Medication adherence among Japanese patients with developmental disabilities: a survey study

Aim

Developmental disabilities (DD) often persist into adulthood, necessitating early and continuous treatment. Although pharmacotherapy is a viable treatment option, managing medication can be challenging. Prior research has not explored medication use among patients with DD in Japan. Thus, this study aimed to identify the medication challenges faced by these patients.

Methods

A questionnaire survey was administered to 200 outpatients to collect data on the number of prescribed medications, the timing of administration, the frequency of missed doses, and the use of medication notebooks. This was a prospective observational study without intervention and a random sampling.

Results

The survey revealed that 57.0% of the participants were non-adherent to their medication regimen. Specifically, medication non-adherence rates were 44.7% among individuals with autism spectrum disorder (ASD), 86.9% for those with attention deficit hyperactivity disorder (ADHD), and 30.4% for patients with comorbid ASD and ADHD. Despite 48.3% of the participants taking measures to prevent forgetting their medication, 65.3% of them still failed to take their medication as prescribed. The possession rate of medication record books was 96.0%.

Conclusion

The study indicates that the frequency of medication non-adherence among patients with DD in Japan mirrors that in other countries. Patients who reported taking preventative measures still experienced high rates of non-adherence, suggesting limited effectiveness of these strategies. It is essential to develop more effective measures to improve adherence, enhance disease awareness, and increase understanding of medication instructions. The high possession rate of medication record books suggests they could play a significant role in managing DD, and their use is expected to increase in the future.

Prevalence of attention-deficit hyperactivity disorder (ADHD): systematic review and meta-analysis

BACKGROUND

The estimates of attention-deficit hyperactivity disorder (ADHD) prevalence across various studies are significantly variable, contributing to uncertainty in ADHD prevalence estimation. Previous systematic reviews and meta-analyses have attributed this variability primarily to the methodological characteristics of the studies, including the diagnostic criteria, source of information, and impairment requirement for the diagnosis.

METHODS

Review identified studies reporting ADHD prevalence in representative samples of children and adults in Europe and worldwide. Studies that were conducted in the general population were included. We focused on studies that report ADHD prevalence based on clinical diagnosis (clinical diagnostic criteria based on the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases criteria, other diagnostic tools, such as various scales or interviews based on clinical diagnostic criteria). PubMed/Medline was searched to identify relevant articles published until 2024/2/01. The study was registered in PROSPERO (CRD42020200220) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines for systematic review and meta-analysis.

RESULTS

In total, 117 studies were subjected to full evaluation. In the meta-analysis, 103 studies representing 159 independent datapoints were included. The overall prevalence of ADHD in register studies was 1.6%, 95% CI [0.9; 3.0], in survey studies 5.0%, 95% CI [2.9; 8.6], in one-stage clinical studies 4.2%, 95% CI [2.9; 6.0], and in two-stage clinical studies 4.8%, 95% CI [4.0; 5.8].

CONCLUSIONS

Exact comparisons among studies with different diagnostic criteria and types of sampling can impact prevalence estimates. When comparing data from methodologically different studies, these factors need to be considered.

Training of Awareness in ADHD: Leveraging Metacognition

Attention deficit hyperactivity disorder (ADHD) is a disorder that is prevalent in children and adults, with significant impact on life outcomes. Common treatment strategies include a combination of pharmacological and psychosocial interventions which have recognized limits to their effectiveness. Consequently, there exists interest in additional non-pharmacological interventions. In the current minireview we aim to complement existing surveys by focusing on a complementary approach, namely rooted in metacognition or the training of awareness. We review programs that incorporate metacognitive training of awareness in skill-training, psychosocial interventions, and mindfulness, and discuss existing assessments of metacognitive ability in ADHD. Existing data suggest that metacognitive approaches have potential in supporting symptom management in ADHD, with gains in objective assessments in near and far transfer tasks in educational research and high satisfaction from parents. Further research is warranted in assessment of the relative contribution of metacognitive elements relative to other treatment components, objective assessments of outcomes in psychosocial interventions, and efficacy in adult interventions.