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Baweja R, Faraone SV, Childress AC, Weiss MD, Loo SK, Wilens TE, Waxmonsky JG. From Consensus Statement to Pills to Pixels: New Innovations in Attention-Deficit/Hyperactivity Disorder Care. J Child Adolesc Psychopharmacol 2024; 34:167-182. [PMID: 38686563 DOI: 10.1089/cap.2024.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Objectives: This review aims to present recent innovations and advancements in attention-deficit/hyperactivity disorder (ADHD) care, encompassing international consensus statement, new medication formulations, digital therapeutics, and neurostimulation devices. Methods: A comprehensive literature search of relevant articles published in the past five years was conducted, emphasizing the evidence base, efficacy, safety, and practical implications of these advancements. Results: The World Federation of ADHD Consensus Statement offers an updated diagnostic and treatment framework rooted in global scientific evidence. There are several newer ADHD medication formulations, including a nonstimulant (Viloxazine extended release) and the first transdermal amphetamine patch approved to treat ADHD. These options offer some unique benefits to personalize treatment based on symptom profile, lifestyle, preferences, and response. Digital tools offer additional means to restructure environments for individuals with ADHD, reducing impairment and reliance on others. In addition, digital therapeutics enhance access, affordability, personalization, and feasibility of ADHD care, complementing or augmenting existing interventions. Trigeminal nerve stimulation emerges as a well-tolerated nonpharmacological, device-based treatment for pediatric ADHD, with initial trials indicating effect sizes comparable to nonstimulant medications. Conclusions: These innovations in ADHD care represent clinically significant new treatment options and opportunities for personalized care. Health care professionals should integrate these developments into clinical practice, mindful of individual patient and family needs and preferences. Future research should assess long-term outcomes, cost-effectiveness, and acceptability of these innovations.
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Affiliation(s)
- Raman Baweja
- Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
| | - Stephen V Faraone
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Ann C Childress
- Center for Psychiatry and Behavioral Medicine, Las Vegas, Nevada, USA
| | - Margaret D Weiss
- Los Angeles Semel Institute, University of California, Los Angeles, California, USA
| | - Sandra K Loo
- Cambridge Health Alliance, Cambridge, Massachusetts, USA
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Lynch JD, Xu Y, Yolton K, Khoury JC, Chen A, Lanphear BP, Cecil KM, Braun JM, Epstein JN. [Formula: see text] Environmental predictors of children's executive functioning development. Child Neuropsychol 2024; 30:615-635. [PMID: 37621102 PMCID: PMC10891297 DOI: 10.1080/09297049.2023.2247603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023]
Abstract
Executive functioning (EF) abilities develop through childhood, but this development can be impacted by various psychosocial environmental influences. Using longitudinal data from the Health Outcome and Measures of the Environment (HOME) Study, a prospective pregnancy and birth cohort study, we examined if psychosocial environmental factors were significant predictors of EF development. Study participants comprised 271 children and their primary caregivers (98.5% mothers) followed from birth to age 12. We identified four distinct EF developmental trajectory groups comprising a consistently impaired group (13.3%), a descending impairment group (27.7%), an ascending impairment group (9.95%), and a consistently not impaired group (49.1%). Higher levels of maternal ADHD and relational frustration appear to be risk factors for increased EF difficulty over time, while higher family income may serve as a protective factor delaying predisposed EF impairment. Important intervention targets might include teaching positive and effective parenting strategies to mothers whose children are at risk for EF dysfunction.
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Affiliation(s)
- James D. Lynch
- Department of Psychology, University of Cincinnati, 45 W. Corry Blvd, Cincinnati, OH, United States
- Center for ADHD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 10006, Cincinnati, OH, United States
| | - Yingying Xu
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 7035, Cincinnati, OH, United States
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH, United States
| | - Jane C. Khoury
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH, United States
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Philadelphia, PA, United States
| | - Bruce P. Lanphear
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
| | - Kim M. Cecil
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH, United States
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 234 Goodman St, Cincinnati, OH, United States
| | - Joseph M. Braun
- Department of Epidemiology, Brown University, 121 South Main St, Providence, RI, United States
| | - Jeffery N. Epstein
- Center for ADHD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 10006, Cincinnati, OH, United States
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH, United States
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Ramji AV, Runswick OR, Dommett EJ. Exercise Dependency and Overuse Injuries in Attention Deficit Hyperactivity Disorder. J Nerv Ment Dis 2024; 212:190-195. [PMID: 38412245 DOI: 10.1097/nmd.0000000000001762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
ABSTRACT Attention deficit hyperactivity disorder (ADHD) is a common condition, but current medications have limitations, pushing a drive for alternative approaches. Different exercise-focused approaches have shown promise, but concern has also been raised about individuals with ADHD showing greater risk of addiction, including exercise dependency. Using an online survey, we examined current exercise practices, including exercise dependency and the presence of overuse injury, which could result from overexercising, in 114 adults with ADHD. We found that most were regularly exercising. None were classified as exercise dependent, but 38.9% were deemed symptomatic nondependent. Hyperactive-impulsive symptoms were a predictor of the level of exercise withdrawal experienced, and the co-occurrence of autism spectrum disorder was associated with greater risk of overuse injuries. The data indicate that ADHD may confer some greater risk of exercise dependency, aligning with previous studies investigating other addictions and suggesting further research is critical.
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Affiliation(s)
- Anusha V Ramji
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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Sanguineti C, Nisticò V, Folatti I, Santangelo G, Faggioli R, Bertani A, Gambini O, Demartini B. Toward an Increased Attention on ADHD Symptoms and Traits in Young Adults: Prevalence Data From Screening Tools in a Psychiatric Outpatient Clinic. J Atten Disord 2024; 28:151-160. [PMID: 37919945 DOI: 10.1177/10870547231201954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE to analyze the prevalence of ADHD symptoms and traits in a heterogeneous clinical psychiatric sample of young adults (aged 18-24 years old), who referred to a specialized outpatient clinic for various psychiatric and psychological disturbances. METHOD 259 participants completed three validated self-report screening questionnaires for ADHD: the Wender Utah Rating Scale (WURS), the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 (ASRS-5), and the Conners' adult ADHD rating scale (CAARS). RESULTS 12.4% of our sample scored above the cut-off at both the WURS and the ASRS-5 and was considered at risk of ADHD. CONCLUSION the prevalence rate in our sample is higher than the one found in the adult general population (6.76%), and in the lower range of the one found in the adult clinical population (6.9%-38.8%). The potential role of sociodemographic (age, sex, gender identity, and employment) and comorbidity factors is discussed.
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Affiliation(s)
- Claudio Sanguineti
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
- Dipartimento di Psicologia, Università degli Studi di Milano-Bicocca, Italy
- Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy
| | - Irene Folatti
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Giulia Santangelo
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Raffaella Faggioli
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Angelo Bertani
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Orsola Gambini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
- Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Benedetta Demartini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
- Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
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Wijnen BFM, Ten Have M, de Graaf R, van der Hoek HJ, Lokkerbol J, Smit F. The economic burden of mental disorders: results from the Netherlands mental health survey and incidence study-2. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023:10.1007/s10198-023-01634-2. [PMID: 37872458 DOI: 10.1007/s10198-023-01634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 09/11/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE Currently, there is a paucity of up-to-date estimates of the economic burden caused by mental disorders. Such information could provide vital insight into one of the most serious and costly-yet to some extent preventable-health challenges facing the world today. METHOD Data from a national psychiatric-epidemiological cohort study (NEMESIS-2, N = 6506) were used to provide reliable, relevant, and up-to-date cost estimates (in 2019 Euro) regarding healthcare costs, productivity losses, and patient and family costs associated with DSM-IV mental disorders both at individual level, but also in the general population and in the workforce of the Netherlands (per 1 million population). RESULTS In the general population, the costs of mood disorders, specifically depression, are substantial and rank above those from the anxiety disorders, whilst costs of anxiety disorders are more substantial than those stemming from substance use disorders, even when the per-person costs of drug abuse appear highest of all. In the workforce, specific and social phobias are leading causes of excess costs. The workforce has lower healthcare costs but higher productivity costs than general population. DISCUSSION The findings suggest that (preventive) healthcare interventions targeting the workforce are likely to become cost-effective and underscore the importance for employers to create healthy work environments. Overall, the results highlight the need to strengthen the role of mental health promotion and prevention of mental disorders in the social domain before people require treatment to reduce the staggering and costly burden caused by mental disorders to individuals and society.
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Affiliation(s)
- B F M Wijnen
- Department of Epidemiology, Centre for Economic Evaluations, Trimbos-Instituut (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.
| | - M Ten Have
- Department of Epidemiology, Trimbos-Instituut (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - R de Graaf
- Department of Epidemiology, Trimbos-Instituut (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - H J van der Hoek
- Department of Epidemiology, Centre for Economic Evaluations, Trimbos-Instituut (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - J Lokkerbol
- Department of Epidemiology, Centre for Economic Evaluations, Trimbos-Instituut (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Filip Smit
- Department of Epidemiology, Centre for Economic Evaluations, Trimbos-Instituut (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Academic Medical Center Amsterdam, Location VUmc, Amsterdam, The Netherlands
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Forsström D, Oscarsson M, Buhrman M, Rozental A. A study protocol of a randomized controlled study of internet-based cognitive behavioral therapy for adult attention deficit hyperactivity disorder. Internet Interv 2023; 33:100652. [PMID: 37529408 PMCID: PMC10388197 DOI: 10.1016/j.invent.2023.100652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a disorder characterized by hyperactivity, impulsivity and lack of attention. It can have a major impact on everyday life and result in negative consequences for one's personal, academic, and work situation. For individuals with symptoms of ADHD, increased levels of anxiety and depression are common, and an overall reduction of quality of life is often present. This study protocol describes a clinical trial of internet-based cognitive behavioral therapy (iCBT), using a randomized controlled study design, with the primary aim to increase quality of life, as well as to reduce symptoms of ADHD, anxiety, depression, and stress. A second aim is to investigate, by qualitative means, what aspects of treatment were perceived as helpful and hindering when it comes to completing iCBT. Two hundred participants with symptoms of ADHD will be included and randomized to two conditions (treatment and wait-list control). The treatment period is comprised of a maximum of ten weeks, with two mandatory modules and ten modules from which the participants can choose freely. Self-report measures will be completed by the participants at baseline and end of treatment, as well as at a six-month follow-up. The treatment is guided by therapists and consists of weekly correspondence with the participants. The study will utilize an intention to treat design, with ANOVAs and Reliable Change Index to evaluate treatment effects. The qualitative part of the project will be interview-based and employ thematic analysis. Lastly, a psychometric evaluation of a common instrument for determining ADHD-symptoms will also be made. The results will hopefully contribute to the evidence base for iCBT for individuals with symptoms of ADHD and help disseminate potentially effective interventions.
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Affiliation(s)
- David Forsström
- Department of Psychology, Uppsala University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Department of Psychology, Stockholm University, Sweden
| | | | | | - Alexander Rozental
- Department of Psychology, Uppsala University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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7
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Mansoor M, Katz B. Differential Effects of ADHD Polygenic Risk on Cognitive Performance in Later Life. J Atten Disord 2023; 27:1272-1283. [PMID: 37190750 DOI: 10.1177/10870547231172768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Understanding the association between polygenic risk for ADHD and cognition throughout aging has not been widely studied. This study aimed to determine whether ADHD risk influences cognitive performance among individuals at both young-old and middle-old age. METHOD Participants from the Health and Retirement Study, a biennial survey of 20,000 Americans, were compared on executive function and delayed recall measures using regression analyses. RESULTS There was no significant effect of ADHD risk on memory at both age waves for African-ancestry (AA; n = 403) and European-ancestry (EA; n = 2,286). There was, however, a significant association between ADHD risk and performance on executive function for EA at middle-old age (p = .028), but not young-old age; no such association was observed for AA adults. CONCLUSION This finding suggests that ADHD risk may differentially influence cognition among older adults throughout the aging process, with important implications for future research.
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8
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Kosheleff AR, Mason O, Jain R, Koch J, Rubin J. Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment. J Atten Disord 2023; 27:669-697. [PMID: 36876491 PMCID: PMC10173356 DOI: 10.1177/10870547231158572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Among untreated adults, functional impairments associated with ADHD are widespread and cumulative, and can include social, educational, and professional impairments, increased risk of accidents and mortality, and reduced quality of life. Here, we review the most prominent functional impairments in adults with ADHD and summarize evidence describing the potential role of medication in improving outcomes. METHOD Articles related to the search terms "ADHD," "adult," and functional impairments were identified through Google Scholar and PubMed and selected for inclusion based on four criteria: strength of evidence, relevance to current challenges in adult ADHD, impact on the field, and recency of the results. RESULTS We identified 179 papers to support the conclusions on the relationship between ADHD and functional impairments, and the impact of pharmacological therapy on functional impairments. CONCLUSION This narrative review provides evidence that pharmacological treatment can be effective in minimizing not only the symptoms of ADHD, but its functional consequences as well.
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Affiliation(s)
| | - Oren Mason
- Attention MD, Grand Rapids, MI, USA and Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Rakesh Jain
- Texas Tech University School of Medicine, Midland, TX, USA
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9
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Girela-Serrano B, Miguélez C, Porras-Segovia AA, Díaz C, Moreno M, Peñuelas-Calvo I, Roselló R, Baca-García E, Carballo JJ. Predictors of mental health service utilization as adolescents with attention deficit hyperactivity disorder transition into adulthood. Early Interv Psychiatry 2023; 17:252-262. [PMID: 35706409 DOI: 10.1111/eip.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/01/2022] [Accepted: 05/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) symptoms may persist into adulthood and are likely to cause great problems in young adults. To date, few studies have explored the characteristics of patients diagnosed with ADHD that might influence the utilization of adult mental health services (AMHS). We aimed to examine and identify predictive symptoms of AMHS. METHODS We analysed data from 114 participants diagnosed with ADHD from a cohort of adolescents recruited at the age of 12-17 years, who, at the time of data analysis, were over 18 years old. RESULTS Among AMHS users, hyperactivity/impulsivity measures were significantly more severe (t = 2.668, df = 112, p < .001), ADHD combined subtype diagnosis (χ2 = 4.66, df = 1, p = .031) was more frequent and dysregulation profile in the SDQ-P was also significantly higher (t = -2.497, df = 109, p = .014). However, the dysregulation profile did not remain statistically significant after controlling for type of AMHS contact. CONCLUSIONS Our findings suggest that adolescents with ADHD are more likely continue their care under AMHS if they present more severe symptoms of hyperactivity/impulsivity and emotional dysregulation. The better characterization of the patient profile will help clinicians to early identify groups at-risk and to tailor interventions and prevention strategies.
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Affiliation(s)
- Braulio Girela-Serrano
- Westminster Child & Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, UK
- Division of Psychiatry, Imperial College, London, UK
| | - Carolina Miguélez
- Department of Child and Adolescent Psychiatry, Hospital Niño Jesús, Madrid, Spain
| | - Alejandro Albán Porras-Segovia
- Division of Psychiatry, Imperial College, London, UK
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | | | - Manon Moreno
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | | | - Rocio Roselló
- Division of Psychiatry, Imperial College, London, UK
- Department of Psychiatry, University Hospital Doctor Peset of Valencia & University of Valencia, Valencia, Spain
| | - Enrique Baca-García
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Infanta Elena, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Central de Villalba, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Universidad Católica del Maule, Talca, Chile
- Université de Nîmes, Nîmes, France
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10
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de Oliveira C, Saka M, Bone L, Jacobs R. The Role of Mental Health on Workplace Productivity: A Critical Review of the Literature. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:167-193. [PMID: 36376610 PMCID: PMC9663290 DOI: 10.1007/s40258-022-00761-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mental health disorders in the workplace have increasingly been recognised as a problem in most countries given their high economic burden. However, few reviews have examined the relationship between mental health and worker productivity. OBJECTIVE To review the relationship between mental health and lost productivity and undertake a critical review of the published literature. METHODS A critical review was undertaken to identify relevant studies published in MEDLINE and EconLit from 1 January 2008 to 31 May 2020, and to examine the type of data and methods employed, study findings and limitations, and existing gaps in the literature. Studies were critically appraised, namely whether they recognised and/or addressed endogeneity and unobserved heterogeneity, and a narrative synthesis of the existing evidence was undertaken. RESULTS Thirty-eight (38) relevant studies were found. There was clear evidence that poor mental health (mostly measured as depression and/or anxiety) was associated with lost productivity (i.e., absenteeism and presenteeism). However, only the most common mental disorders were typically examined. Studies employed questionnaires/surveys and administrative data and regression analysis. Few studies used longitudinal data, controlled for unobserved heterogeneity or addressed endogeneity; therefore, few studies were considered high quality. CONCLUSION Despite consistent findings, more high-quality, longitudinal and causal inference studies are needed to provide clear policy recommendations. Moreover, future research should seek to understand how working conditions and work arrangements as well as workplace policies impact presenteeism.
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Affiliation(s)
- Claire de Oliveira
- Centre for Health Economics, University of York, York, UK.
- Hull York Medical School, Hull and York, UK.
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | | | | | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
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11
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Helgesson M, Björkenstam E, Rahman S, Gustafsson K, Taipale H, Tanskanen A, Ekselius L, Mittendorfer-Rutz E. Labour market marginalisation in young adults diagnosed with attention-deficit hyperactivity disorder (ADHD): a population-based longitudinal cohort study in Sweden. Psychol Med 2023; 53:1224-1232. [PMID: 35275515 PMCID: PMC10009402 DOI: 10.1017/s0033291721002701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 04/26/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The objective of this population-based register study was (1) to investigate the association between young adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) and subsequent labour market marginalisation (LMM) in two comparison groups, i.e. matched young adults from the general population without ADHD and unaffected siblings to persons with ADHD and (2) to assess the role of comorbid disorders. METHODS This study included all young adults in Sweden, aged 19-29 years, with an incident diagnosis of ADHD 2006-2011 (n = 9718). Crude and multivariate sex-stratified hazard ratios (HRs) with 95% confidence intervals (CIs) were measured 5 years after the diagnosis of ADHD for the risk of disability pension, long-term sickness absence (SA) (>90 days), long-term unemployment (>180 days) and a combined measure of all three in young adults with ADHD compared to their siblings without ADHD and a matched comparison group. RESULTS In the adjusted analyses young adults with ADHD had a 10-fold higher risk of disability pension (HR = 10.2; CI 9.3-11.2), a nearly three-fold higher risk of long-term SA (HR = 2.7; CI 2.5-2.8) and a 70% higher risk of long-term unemployment (HR = 1.7; CI 1.6-1.8) compared to the matched comparison group. The risk estimates were lower compared to siblings for disability pension (HR = 9.0; CI 6.6-12.3) and long-term SA (HR = 2.5; CI 2.1-3.1) but higher in the long-term unemployed (HR = 1.9; CI 1.6-2.1). Comorbid disorders explained about one-third of the association between ADHD and disability pension, but less regarding SA and long-term unemployment. CONCLUSIONS Young adults with ADHD have a high risk for different measures of LMM and comorbidities explain only a small proportion of this relationship.
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Affiliation(s)
- Magnus Helgesson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Emma Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-17177 Stockholm, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Syed Rahman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Klas Gustafsson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Heidi Taipale
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-17177 Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-17177 Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
| | - Lisa Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-17177 Stockholm, Sweden
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12
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Gémes K, Taipale H, Björkenstam E, Rahman S, Gustafsson K, Tanskanen A, Ekselius L, Mittendorfer-Rutz E, Helgesson M. The role of sociodemographic and clinical factors in the initiation and discontinuation of attention deficit hyperactivity disorder medication among young adults in Sweden. Front Psychiatry 2023; 14:1152286. [PMID: 37168083 PMCID: PMC10165120 DOI: 10.3389/fpsyt.2023.1152286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/03/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Long-term medication use is a recommended treatment for attention-deficit/hyperactivity disorder (ADHD), however, discontinuation is common. Non-medical factors which might influence initiation and discontinuation are understudied. Therefore, we investigated how different sociodemographic factors and comorbidities were associated with the initiation and discontinuation of ADHD medication use among young adults. Methods and results We conducted a population-based prospective cohort study using individually linked administrative register data, in which we included all individuals residing in Sweden, between the age of 19 and 29 who were first diagnosed with ADHD between January 2006 and December 2016 (n = 59224). ADHD medication initiation was defined as the first prescription of ADHD medication in the period from 3 months before to 6 months after the cohort entry date. Those who initiated ADHD medication were followed up for medication use until discontinuation, death/emigration, or until 2019. Logistic and Cox regression models were used to investigate the associations between sociodemographics, health-related predictors and initiation, as well as discontinuation. Overall, 48.7% of the 41399 individuals initiated ADHD medication, most often methylphenidate (87%). Among the initiators, 15462 (77%) discontinued medication use during the follow-up (median time: 150 days). After mutually adjusting all other predictors, initiation was positively associated with older age, male sex, higher level of education, and negatively associated with living at home with parents, immigrant status, being unemployed during the year before inclusion, being on disability pension, having autism, substance use, schizophrenia-spectrum disorders, other mental disability/developmental disorders, cardiovascular diseases or previous accidents. Discontinuation was positively associated with being born abroad, living in big cities, being unemployed during the year before inclusion, having cancer, and negatively associated with a higher educational level, having depression, anxiety or stress-related disorder, autism spectrum disorder or diabetes. Conclusion Besides medical factors, sociodemographics, such as educational attainment and immigrant status might also play a role in the initiation and discontinuation of ADHD medication use among young adults newly diagnosed with ADHD.
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Affiliation(s)
- Katalin Gémes
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- *Correspondence: Katalin Gémes,
| | - Heidi Taipale
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Emma Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Syed Rahman
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Klas Gustafsson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
| | - Lisa Ekselius
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Magnus Helgesson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Health Equity and Working Life, Uppsala University, Uppsala, Sweden
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Suzuki T, Wada K, Nakazato M, Ohtani T, Yamazaki M, Ikeda S. Associations Between Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Traits and Sociodemographic Characteristics in Japanese Workers. Neuropsychiatr Dis Treat 2023; 19:759-773. [PMID: 37041858 PMCID: PMC10083016 DOI: 10.2147/ndt.s398478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/23/2023] [Indexed: 04/13/2023] Open
Abstract
Purpose Most previous studies that described associations between adult attention-deficit/hyperactivity disorder (ADHD) and sociodemographic characteristics were focused on individuals diagnosed with ADHD, and few studies investigated ADHD traits in the general population. Additionally, some workers, who experienced no problems while at university and successfully graduated from university, developed ADHD traits after finding employment. This study described associations between ADHD traits and sociodemographic characteristics among Japanese workers who were university graduates. Patients and Methods Participants were randomly selected workers (n=1240) from across Japan who completed a self-administered online survey. ADHD traits were measured using an adult ADHD Self-report Scale, with scoring rules applied to reflect the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Information was collected on sociodemographic characteristics including sex, age, socioeconomic status, working time, and health-related behaviors. We performed partial correlation analysis to estimate trend associations and used analysis of covariance to compare adjusted averages. This model was adjusted for all variables. Results Males had higher levels of ADHD traits than females (p = 0.001), and younger age was associated with higher levels of ADHD traits (p < 0.001). Workers with low incomes had higher levels of ADHD traits than workers with high incomes (p = 0.009). More frequent consumption of midnight meals was associated with higher levels of ADHD traits (p < 0.001), although there were no differences for breakfast, lunch, and dinner. Those who did not get enough rest from sleep had higher levels of ADHD traits (p = 0.007). Conclusion Results for high levels of ADHD traits among workers were consistent with previous studies for adults diagnosed with ADHD, even though all participants had successfully graduated from university. Assessment of these ADHD traits may support prevention of health deterioration related to these ADHD traits.
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Affiliation(s)
- Tomoko Suzuki
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
- Correspondence: Tomoko Suzuki, Department of Public Health, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan, Tel +81-476-20-7701, Fax +81-476- 28-1188, Email ;
| | - Koji Wada
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Michiko Nakazato
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Narita, Japan
| | | | - Michiko Yamazaki
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Shunya Ikeda
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan
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14
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Alarmingly high prevalence and lack of gender differences in ADHD among high school students: Screening for ADHD with ASRS among adolescents and working adults. CURRENT PROBLEMS OF PSYCHIATRY 2022. [DOI: 10.2478/cpp-2022-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Introduction: The aim was to examine the psychometric properties of the Polish version of the Adult ADHD Self-Report Scale (ASRS) among adolescents and adult working populations of different genders, the prevalence of ADHD, and its relationship to stress.
Materials and methods: A sample of 723 professionally active people and 1744 high school students participated in the study. Part A of the Adult ADHD Self-Report Scale (ASRS) was used to measure ADHD and the 4-item Perceived Stress Scale (PSS-4) was used to measure stress.
Results: Confirmatory factor analyses showed that the original 6-item two-factor solution of ASRS Part A had a satisfactory fit and showed basic measurement invariance between age groups and genders. Inattention and hyperactivity were related mostly similarly to stress in all groups. The prevalence of ADHD among adolescents was much higher than in previous reports, and no gender differences were found. About every fifth high school student and every tenth adult showed a risk of ADHD. The potential cause of the difference in the prevalence in the studied groups can be generation change.
Conclusions: ASRS is a well-functioning screening measure with good psychometric properties. It is a convenient option for large-scale epidemiological surveys necessary to understand potential generational changes in the prevalence of ADHD and the lack of gender differences among adolescents.
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Oscarsson M, Nelson M, Rozental A, Ginsberg Y, Carlbring P, Jönsson F. Stress and work-related mental illness among working adults with ADHD: a qualitative study. BMC Psychiatry 2022; 22:751. [PMID: 36451126 PMCID: PMC9714234 DOI: 10.1186/s12888-022-04409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Though many adults with ADHD underperform professionally, are more stressed, and have more days of sickness absence compared to adults without ADHD, few studies have explored the experience of working as an adult with ADHD. This study explores the general experience of working with ADHD, including stress and work-related mental illness. METHODS Semi-structured telephone interviews were conducted with 20 working adults with ADHD. Interview topics included how the ADHD diagnosis and/or symptoms of ADHD may have affected participants on the job, how work may have affected participants' well-being, and the need for support and accommodation. Qualitative content analysis was used to explore verbatim transcripts from the interviews. RESULTS The analysis yielded three themes that describe some of the challenges of working with ADHD: Working and living with ADHD, Needs, and Special abilities, with a total of eight subcategories. Subcategories were Specific challenges; Relationships and cooperation; Negative consequences; Planning, prioritization, organization, and structure; Support, interventions, accommodations, and aids; Openness, understanding, and acceptance; Strategies; Strengths and qualities. CONCLUSION Further knowledge about the challenges of working with ADHD is needed in workplaces; where organizational support is lacking, much in terms of accommodations and aids is up to the employee, and the disclosure of diagnoses may be associated with great dilemma.
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Affiliation(s)
- Martin Oscarsson
- Department of Psychology, Stockholm University, 106 91, Stockholm, Sweden.
| | - Martina Nelson
- grid.8993.b0000 0004 1936 9457Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Alexander Rozental
- grid.8993.b0000 0004 1936 9457Department of Psychology, Uppsala University, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - Ylva Ginsberg
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - Per Carlbring
- grid.10548.380000 0004 1936 9377Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
| | - Fredrik Jönsson
- grid.10548.380000 0004 1936 9377Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
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Kamradt JM, Eadeh HM, Nikolas MA. Sluggish Cognitive Tempo as a Transdiagnostic Link Between Adult ADHD and Internalizing Symptoms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022; 44:699-712. [PMID: 38221987 PMCID: PMC10786088 DOI: 10.1007/s10862-021-09926-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/25/2022]
Abstract
Objective Although absent from traditional diagnostic nosologies, Sluggish Cognitive Tempo (SCT) may have transdiagnostic utility given its robust associations with ADHD and internalizing symptoms as well as with cognitive impairments common to these conditions. Within-person variation in SCT symptoms may also serve to link ADHD, cognitive deficits, and internalizing psychopathology, however, few studies have utilized intensive longitudinal designs to probe within-person variation in SCT and its links to cognitive deficits and psychopathology. Method Ecological Momentary Assessment was used to measure between and within-person variance in SCT 4 times per day across 7 days (28 time-points) in 158 college students (approximately 51% with elevated ADHD and/or internalizing symptoms). Participants also completed ratings of current and childhood ADHD symptoms, cognitive function and internalizing psychopathology. Parameters derived from longitudinal multilevel models indexing between and within person variation in SCT were examined as mediators of the associations between (1) ADHD and internalizing symptoms and (2) self-reported cognitive functioning and internalizing symptoms. Results Results indicated that between-person differences in SCT, but not within-person variability, linked current and childhood ADHD and internalizing symptoms. Similarly, problems in time-management and organization influenced internalizing psychopathology via between-person differences in SCT. Conclusion Results found that SCT may be a transdiagnostic link bridging mental health comorbidities, cognitive dysfunction, and internalizing psychopathology.
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Affiliation(s)
- Jaclyn M Kamradt
- Department of Psychological and Brain Sciences, University of Iowa
| | - Hana-May Eadeh
- Department of Psychological and Brain Sciences, University of Iowa
| | - Molly A Nikolas
- Department of Psychological and Brain Sciences, University of Iowa
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Lauder K, McDowall A, Tenenbaum HR. A systematic review of interventions to support adults with ADHD at work—Implications from the paucity of context-specific research for theory and practice. Front Psychol 2022; 13:893469. [PMID: 36072032 PMCID: PMC9443814 DOI: 10.3389/fpsyg.2022.893469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is estimated to affect 3.5% of the global workforce. Despite the high prevalence rate, little is known about how best to support adults with ADHD (ADHDers) at work. Relevant research is dispersed across different disciplines such as medicine, health studies and psychology. Therefore, it is important to synthesize interventions aimed at ADHDers to examine what learning can be gleaned for effective workplace support. We conducted a systematic review of relevant interventions framed by realist evaluation and the Context-Intervention-Mechanism-Outcome classification to identify key mechanisms of effectiveness for workplace interventions. We searched 10 databases including a range of journals from medical science to business management applying predetermined inclusion criteria and quality appraisal through a risk of bias assessment for quantitative and qualitative methods. We synthesized 143 studies with realist evaluation. Most studies evaluated the effectiveness of pharmacological interventions highlighting the dominance of the medical approach to supporting ADHDers. Key mechanisms of effectiveness were identified from psychosocial interventions including group therapy, involvement of people in the ADHDers network, and the importance of the client-patient relationship. Overall, there is limited research that examines the effectiveness of workplace interventions for ADHDers. Furthermore, much of the existing research evaluates pharmacological interventions which is difficult to transfer to the workplace context. It is recommended that future research and practice consider the key mechanisms identified in this review when designing interventions as well as barriers to accessing support such as disclosure and self-awareness.
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Affiliation(s)
- Kirsty Lauder
- Centre for Neurodiversity Research at Work, Birkbeck College, London, United Kingdom
- *Correspondence: Kirsty Lauder
| | - Almuth McDowall
- Centre for Neurodiversity Research at Work, Birkbeck College, London, United Kingdom
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Gémes K, Björkenstam E, Rahman S, Gustafsson K, Taipale H, Tanskanen A, Ekselius L, Mittendorfer-Rutz E, Helgesson M. Occupational Branch and Labor Market Marginalization among Young Employees with Adult Onset of Attention Deficit Hyperactivity Disorder-A Population-Based Matched Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127254. [PMID: 35742503 PMCID: PMC9223828 DOI: 10.3390/ijerph19127254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
We compared labor market marginalization (LMM), conceptualized as days of unemployment, sickness absence and disability pension, across occupational branches (manufacturing, construction, trade, finance, health and social care, and education), among young employees with or without attention deficit hyperactivity disorder (ADHD) and examined whether sociodemographic and health-related factors explain these associations. All Swedish residents aged 19–29 years and employed between 1 January 2005 and 31 December 2011 were eligible. Individuals with a first ADHD diagnosis (n = 6030) were matched with ten controls and followed for five years. Zero-inflated negative binomial regression was used to model days of LMM with adjustments for sociodemographic and health-related factors. In total, 20% of those with ADHD and 59% of those without had no days of LMM during the follow-up. The median of those with LMM days with and without ADHD was 312 and 98 days. Having an ADHD diagnosis was associated with a higher incidence of LMM days (incident rate ratios (IRRs) 2.7–3.1) with no differences across occupational branches. Adjustments for sociodemographic and health-related factors explained most of the differences (IRRs: 1.4–1.7). In conclusion, young, employed adults with ADHD had a higher incidence of LMM days than those without, but there were no substantial differences between branches, even after adjusting for sociodemographic and health-related factors.
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Affiliation(s)
- Katalin Gémes
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
- Correspondence:
| | - Emma Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
- Department of Medical Sciences, Uppsala University, 75185 Uppsala, Sweden
| | - Syed Rahman
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
| | - Klas Gustafsson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
| | - Heidi Taipale
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
- Niuvanniemi Hospital, FI-70240 Kuopio, Finland;
- School of Pharmacy, University of Eastern Finland, FI-70211 Kuopio, Finland
| | | | - Lisa Ekselius
- Department Women’s and Children’s Health, Uppsala University, 75237 Uppsala, Sweden;
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
| | - Magnus Helgesson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; (E.B.); (S.R.); (K.G.); (H.T.); (E.M.-R.); (M.H.)
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Grinblat N, Rosenblum S. Work participation, sensory processing and sleep quality in adults with attention deficit hyperactive disorder. Work 2022; 73:1235-1244. [DOI: 10.3233/wor-211129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Although studies have indicated significant effects of attention-deficit hyperactive disorder (ADHD) on work participation, the mechanism underlying work participation of adults with ADHD is still unclear. OBJECTIVE: Following the World Health Organization’s international classification of functioning, disability, and health concepts, this study compares sensory processing and sleep quality (body functions) with work participation among adults with and without ADHD and examines predictive relationships among adults with ADHD. METHODS: Sixty-nine adults with ADHD and 52 matched controls completed a sociodemographic questionnaire, the Adult/Adolescent Sensory Profile, the Mini Sleep Questionnaire, and the Occupational Questionnaire. RESULTS: The ADHD group had significantly poorer body functions, sensory processing (i.e., low-registration, sensory-sensitivity, and sensation-avoiding patterns), sleep quality, and work performance compared to the control group (p < .001). For adults with ADHD, sensory sensitivity accounted for 10.9%, and sleep quality accounted for 22.0%, of the variance in their work performance. CONCLUSIONS: The deficient body functions of adults with ADHD may affect their work performance and therefore should be considered in further research, as well as in clinical applications.
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Affiliation(s)
- Nufar Grinblat
- Laboratory for Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Sara Rosenblum
- Laboratory for Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Schein J, Childress A, Cloutier M, Desai U, Chin A, Simes M, Guerin A, Adams J. Reasons for treatment changes in adults with attention-deficit/hyperactivity disorder: a chart review study. BMC Psychiatry 2022; 22:377. [PMID: 35659281 PMCID: PMC9164343 DOI: 10.1186/s12888-022-04016-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/19/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adults with attention-deficit hyperactivity disorder (ADHD) often cycle through multiple treatments for reasons that are not well documented. This study analyzed the reasons underlying treatment changes among adults treated for ADHD in a real-world setting. METHODS Data were collected via an online reporting form completed by eligible physicians between October and November 2020. Data for adult patients in the United States who were diagnosed with ADHD and initiated a treatment regimen within 1 to 5 years of chart abstraction were obtained. Reason for a treatment change was described for a randomly selected regimen episode, which spanned from treatment initiation until the earliest among treatment add-on/switch or discontinuation, death, or date of chart abstraction. The overall rate of ADHD/treatment-related complications were also described. Physician satisfaction with current treatment options for adult ADHD and opinions on areas for improvement were assessed. RESULTS Data on 320 patients were reported by 152 physicians specializing in psychiatry (40.1%), pediatrics (25.0%), family medicine (21.7%), and internal medicine (13.2%). Patients had a mean age of 29.3 years; most were diagnosed with ADHD as adults (57.5%) and within the previous 5 years (56.5%). Selected treatment regimens included stimulants (79.1%), nonstimulants (14.7%), and combination therapy (5.6%) for an average duration of 1.9 years. Among patients with treatment discontinuation (N = 59), the most common reasons for discontinuation were suboptimal symptom management (55.9%), occurrence of ADHD/treatment-related complications (25.4%), and patient attitude/dislike of medication (25.4%). The main reasons for other key treatment changes were inadequate/suboptimal management of symptoms and cost considerations. Over 40% of patients had ≥ 1 documented ADHD/treatment-related complication, irrespective of whether they led to a treatment change. One in 5 physicians (19.8%) were very dissatisfied, moderately dissatisfied, or neither satisfied nor dissatisfied with current treatment options for ADHD in adults; the top 3 suggested improvements were lower risk of abuse (71.7%), longer effect duration (65.1%), and fewer ADHD/treatment-related complications (61.2%). CONCLUSIONS The top reasons for treatment changes among adults with ADHD are lack of efficacy and ADHD/treatment-related complications, highlighting the importance of developing more effective and safer treatments to alleviate the burden of ADHD.
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Affiliation(s)
- Jeff Schein
- Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center, Princeton, NJ, 08540, USA
| | - Ann Childress
- Center for Psychiatry and Behavioral Medicine, 7351 Prairie Falcon Rd STE 160, Las Vegas, NV, 89128, USA
| | - Martin Cloutier
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Urvi Desai
- Analysis Group, Inc., 111 Huntington Avenue, 14th floor, MA, 02199, Boston, USA.
| | - Andi Chin
- Analysis Group, Inc., 151 W 42nd St 23rd floor, New York, NY, 10036, USA
| | - Mark Simes
- Analysis Group, Inc., 111 Huntington Avenue, 14th floor, MA, 02199, Boston, USA
| | - Annie Guerin
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Julie Adams
- Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center, Princeton, NJ, 08540, USA
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Peleikis DE, Fredriksen M, Faraone SV. Childhood trauma in adults with ADHD is associated with comorbid anxiety disorders and functional impairment. Nord J Psychiatry 2022; 76:272-279. [PMID: 34392781 DOI: 10.1080/08039488.2021.1962973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Child and adolescent psychological trauma exposure is associated with psychopathology in the adult population in general, but literature on childhood trauma (CT) in adults with ADHD is scarce. AIMS To determine the prevalence of CT among adult patients with ADHD, and whether a history of CT implies different adult outcomes of psychiatric comorbidities, and functional impairment than without. METHOD Previously unmedicated adult outpatients with ADHD (n = 250, median age 32 years) entered the study. Participants were diagnosed with ADHD using the Diagnostic Interview for ADHD in Adults, second edition (DIVA 2.0), and were assessed by historical data, validated questionnaires, and structured clinical interviews for CT and mental disorders including post-traumatic stress disorder (PTSD) and functional impairment. Analyses compared ADHD patients with and without CT. RESULTS Prevalence of CT was 44%. Of those with PTSD (n = 21), many had CT (85%, p < 0.001). In binary logistic regression analyses, CT was linked to an increased likelihood of concomitant panic disorder (unadjusted odds ratio, OR = 3.0, p < 0.001, and adjusted OR = 2.7, p < 0.01) and any anxiety disorders and two or more comorbid psychiatric disorders (adjusted OR = 1.9, p < 0.05 and OR = 1.7, p < 0.05, respectively), and was associated with significant functional impairment. CONCLUSIONS These findings suggest that awareness of child and adolescent trauma is clinically relevant among young to middle-aged adult ADHD patients, and implications for earlier detection of CT and treatment warrant further studies.
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Affiliation(s)
- Dawn E Peleikis
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Asker DPS, Drammen, Norway
| | - Mats Fredriksen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Stephen V Faraone
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA.,Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
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Chen L, Mittendorfer-Rutz E, Björkenstam E, Rahman S, Gustafsson K, Taipale H, Tanskanen A, Ekselius L, Helgesson M. Risk Factors for Disability Pension among Young Adults Diagnosed with Attention-deficit Hyperactivity Disorder (ADHD) in Adulthood. J Atten Disord 2022; 26:723-734. [PMID: 34154443 PMCID: PMC8785279 DOI: 10.1177/10870547211025605] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate risk factors of disability pension (DP) in young adults diagnosed with ADHD in Sweden. METHOD In total, 9718 individuals diagnosed with incident ADHD in young adult age (19-29 years) 2006 to 2011, were identified through national registers. They were followed for 5 years and Cox regression models were applied to analyze the DP risk (overall and by sex), associated with socio-demographics, work-related factors, and comorbid disorders. RESULTS Twenty-one percent of all received DP. Being younger at diagnosis (hazard ratio [HR] = 1.54; 95%confidence interval [CI] 1.39-1.71); low educational level (HR = 1.97; 95%CI 1.60-2.43 for <10 years); work-related factors at baseline (no income from work [HR = 2.64; 95%CI 2.35-2.98] and sickness absence >90 days [HR = 2.48; 95%CI2.17-2.83]); and schizophrenia/psychoses (HR = 2.16; 95%CI 1.66-2.80), autism (HR = 1.87; 95%CI 1.42-2.46), anxiety (HR = 1.34; 95%CI 1.22-1.49) were significantly associated with an increased risk of DP. Similar risk patterns were found in men and women. CONCLUSION Work-related factors and comorbid mental disorders need to be highlighted in early vocational rehabilitation for individuals with ADHD.
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Affiliation(s)
- Lingjing Chen
- Karolinska Institutet, Stockholm, Sweden,Lingjing Chen, Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Berzelius väg 3, Stockholm SE-171 77, Sweden.
| | | | - Emma Björkenstam
- Karolinska Institutet, Stockholm, Sweden,Uppsala University, Sweden
| | | | | | - Heidi Taipale
- Karolinska Institutet, Stockholm, Sweden,Niuvanniemi Hospital, Kuopio, Finland,University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Karolinska Institutet, Stockholm, Sweden,Niuvanniemi Hospital, Kuopio, Finland
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23
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Male sex bias in early and late onset neurodevelopmental disorders: shared aspects and differences in autism spectrum disorder, attention deficit/hyperactivity disorder, and schizophrenia. Neurosci Biobehav Rev 2022; 135:104577. [DOI: 10.1016/j.neubiorev.2022.104577] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/23/2022] [Accepted: 02/11/2022] [Indexed: 12/22/2022]
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24
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Maremmani I, Spera V, Maiello M, Maremmani AGI, Perugi G. Adult Attention-Deficit Hyperactivity Disorder/Substance Use Disorder Dual Disorder Patients: A Dual Disorder Unit Point of View. Curr Top Behav Neurosci 2022; 57:179-198. [PMID: 35507285 DOI: 10.1007/7854_2022_335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Substance Use Disorders (SUDs) are often associated with Attention-Deficit Hyperactivity Disorder (ADHD) in adult populations due to multiple neurobiological, genetic, and psychosocial risk factors. This chapter provides a picture of the clinical aspects of adults with both ADHD and SUDs at treatment entry into a Dual Disorder Unit introducing the concept of different types of craving that may lead to substance use and abuse. At treatment entry, the presence of different comorbid SUD clusters, characterized by either stimulants/alcohol or by the use of cannabinoids, has not been shown to influence ADHD-specific symptomatology or severity, despite being crucial for the identification of a specific type of craving. We identified four clinical presentations of adult ADHD: Emotional Dysregulation, Substance Use, Core-ADHD Symptoms, and Positive Emotionality variants, that offer a practical guide in diagnosing and managing adult ADHD patients. Although the evidence of an effective medical treatment for Cocaine Use Disorder is insufficient, in our experience, toxicomanic behavior during stimulant treatment is sharply reduced in ADHD patients with cocaine addiction. Moreover, caffeinated compounds in military soldiers with ADHD may help reduce ADHD symptoms, making caffeine a potential pharmacological tool worth further investigation. Finally, substance use comorbidity does not influence treatment retention rate.
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Affiliation(s)
- Icro Maremmani
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy.
- V.P. Dole Research Group, G. De Lisio Institute of Behavioral Sciences, Pisa, Italy.
- Saint Camillus International University of Health and Medical Sciences - UniCamillus, Rome, Italy.
| | - Vincenza Spera
- Psychiatric Clinic, Sociopsychiatric Organization, Mendrisio, Switzerland
| | - Marco Maiello
- Drug Addiction Unit, Northern-West Tuscany Region Local Health Unit, Apuan Zone, Massa, Italy
| | - Angelo G I Maremmani
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy
- V.P. Dole Research Group, G. De Lisio Institute of Behavioral Sciences, Pisa, Italy
- Department of Psychiatry, North-Western Tuscany Local Health Unit, Tuscany NHS, Versilia Zone, Viareggio, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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25
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Boesen K, Jørgensen KJ, Gøtzsche PC. Clinical trials were missing from regulatory documents of extended-release methylphenidate for ADHD in adults: a case study of public documents. Cochrane Database Syst Rev 2021. [PMID: 34752938 DOI: 10.1002/14651858.cd012857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess whether drug regulatory agencies decided on applications for extended-release methylphenidate for use in adult ADHD based on select samples of trials. STUDY DESIGN AND SETTING Case series of publicly available regulatory documents. We matched an index of extended-release methylphenidate trials for adult ADHD with trials appearing in regulatory documents of extended-release methylphenidate applications. Trials and regulatory documents were identified as part of this systematic review (https://doi.org/10.1002/14651858.CD012857). We sought to identify missing trials in the regulatory documents and to clarify regulatory submission requirements. RESULTS We indexed 18 trials and matched those with 13 drug applications (11 approved, 2 rejected) published by 7 agencies. There were trials missing in 7 (54%) of 13 applications, median 4 trials (range 1-6). The median proportion of missing trial participants was 45% (range 23% - 72%). Regulators seemingly require that all trials must be included in new drug applications, but wording is ambiguous. CONCLUSION In this sample of extended-release methylphenidate drug applications for adult ADHD, 7 of 13 regulatory decisions were missing entire trials according to public documents, even though regulatory requirements seem to stipulate that all available trials should be included in drug applications.
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Affiliation(s)
- Kim Boesen
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health at Charité, QUEST Center for Responsible Research, Germany; Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark.
| | - Karsten Juhl Jørgensen
- Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark; Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
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26
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Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, Newcorn JH, Gignac M, Al Saud NM, Manor I, Rohde LA, Yang L, Cortese S, Almagor D, Stein MA, Albatti TH, Aljoudi HF, Alqahtani MMJ, Asherson P, Atwoli L, Bölte S, Buitelaar JK, Crunelle CL, Daley D, Dalsgaard S, Döpfner M, Espinet S, Fitzgerald M, Franke B, Gerlach M, Haavik J, Hartman CA, Hartung CM, Hinshaw SP, Hoekstra PJ, Hollis C, Kollins SH, Sandra Kooij JJ, Kuntsi J, Larsson H, Li T, Liu J, Merzon E, Mattingly G, Mattos P, McCarthy S, Mikami AY, Molina BSG, Nigg JT, Purper-Ouakil D, Omigbodun OO, Polanczyk GV, Pollak Y, Poulton AS, Rajkumar RP, Reding A, Reif A, Rubia K, Rucklidge J, Romanos M, Ramos-Quiroga JA, Schellekens A, Scheres A, Schoeman R, Schweitzer JB, Shah H, Solanto MV, Sonuga-Barke E, Soutullo C, Steinhausen HC, Swanson JM, Thapar A, Tripp G, van de Glind G, van den Brink W, Van der Oord S, Venter A, Vitiello B, Walitza S, Wang Y. The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neurosci Biobehav Rev 2021; 128:789-818. [PMID: 33549739 PMCID: PMC8328933 DOI: 10.1016/j.neubiorev.2021.01.022] [Citation(s) in RCA: 411] [Impact Index Per Article: 137.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. METHODS We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. RESULTS We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. CONCLUSIONS Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and Neuroscience and Physiology, Psychiatry Research Division, SUNY Upstate Medical University, Syracuse, NY, USA; World Federation of ADHD, Switzerland; American Professional Society of ADHD and Related Disorders (APSARD), USA.
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Child and Adolescent Psychiatrist's Representative, Zentrales-ADHS-Netz, Germany; The German Association of Child and Adolescent Psychiatry and Psychotherapy, Germany
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Yi Zheng
- Beijing Anding Hospital, Capital Medical University, Beijing, China; The National Clinical Research Center for Mental Disorders, Beijing, China; Beijing Key Laboratory of Mental Disorders, Beijing, China; Beijing Institute for Brain Disorders, Beijing, China; Asian Federation of ADHD, China; Chinese Society of Child and Adolescent Psychiatry, China
| | - Joseph Biederman
- Clinical & Research Programs in Pediatric Psychopharmacology & Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mark A Bellgrove
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Australian ADHD Professionals Association (AADPA), Australia
| | - Jeffrey H Newcorn
- American Professional Society of ADHD and Related Disorders (APSARD), USA; Departments of Psychiatry and Pediatrics, Division of ADHD and Learning Disorders, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martin Gignac
- Department of Child and Adolescent Psychiatry, Montreal Children's Hospital, MUHC, Montreal, Canada; Child and Adolescent Psychiatry Division, McGill University, Montreal, Canada; Canadian ADHD Research Alliance (CADDRA), Canada
| | | | - Iris Manor
- Chair, Israeli Society of ADHD (ISA), Israel; Co-chair of the neurodevelopmental section in EPA (the European Psychiatric Association), France
| | - Luis Augusto Rohde
- Department of Psychiatry, Federal University of Rio Grande do Sul, Brazil
| | - Li Yang
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton,UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; University of Nottingham, Nottingham, UK
| | - Doron Almagor
- University of Toronto, SickKids Centre for Community Mental Health, Toronto, Canada; Canadian ADHD Research Alliance (CADDRA), Canada
| | - Mark A Stein
- University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | - Turki H Albatti
- Saudi ADHD Society Medical and Psychological Committee, Saudi Arabia
| | - Haya F Aljoudi
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Saudi ADHD Society Medical and Psychological Committee, Saudi Arabia
| | - Mohammed M J Alqahtani
- Clinical Psychology, King Khalid University, Abha, Saudi Arabia; Saudi ADHD Society, Saudi Arabia
| | - Philip Asherson
- Social Genetic & Developmental Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Lukoye Atwoli
- Department of Mental Health and Behavioural Science, Moi University School of Medicine, Eldoret, Kenya; Brain and Mind Institute, and Department of Internal Medicine, Medical College East Africa, the Aga Khan University, Kenya; African College of Psychopharmacology, Kenya; African Association of Psychiatrists, Kenya
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden; Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Sweden; Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Cleo L Crunelle
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Dept. of Psychiatry, Brussel, Belgium; International Collaboration on ADHD and Substance Abuse (ICASA), Nijmegen, the Netherlands
| | - David Daley
- Division of Psychiatry and Applied Psychology, School of Medicine University of Nottingham, Nottingham, UK; NIHR MindTech Mental Health MedTech Cooperative & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Søren Dalsgaard
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany; Zentrales-ADHS-Netz, Germany
| | | | | | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Professional Board, ADHD Europe, Belgium
| | - Manfred Gerlach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Catharina A Hartman
- University of Groningen, Groningen, the Netherlands; University Medical Center Groningen, Groningen, the Netherlands; Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands; ADHD Across the Lifespan Network from European College of Neuropsychopharmacology(ECNP), the Netherlands
| | | | - Stephen P Hinshaw
- University of California, Berkeley, CA, USA; University of California, San Francisco, CA, USA
| | - Pieter J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands
| | - Chris Hollis
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK; NIHR MindTech MedTech Co-operative, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Scott H Kollins
- Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - J J Sandra Kooij
- Amsterdam University Medical Center (VUMc), Amsterdam, the Netherlands; PsyQ, The Hague, the Netherlands; European Network Adult ADHD, the Netherlands; DIVA Foundation, the Netherlands; Neurodevelopmental Disorders Across Lifespan Section of European Psychiatric Association, France
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Tingyu Li
- Growth, Development and Mental Health Center for Children and Adolescents, Children's Hospital of Chongqing Medical University, Chongqing, China; National Research Center for Clinical Medicine of Child Health and Disease, Chongqing, China; The Subspecialty Group of Developmental and Behavioral Pediatrics, the Society of Pediatrics, Chinese Medical Association, China
| | - Jing Liu
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; The Chinese Society of Child and Adolescent Psychiatry, China; The Asian Society for Child and Adolescent Psychiatry and Allied Professions, China
| | - Eugene Merzon
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Leumit Health Services, Tel Aviv, Israel; Israeli Society of ADHD, Israel; Israeli National Diabetes Council, Israel
| | - Gregory Mattingly
- Washington University, St. Louis, MO, USA; Midwest Research Group, St Charles, MO, USA
| | - Paulo Mattos
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Brazilian Attention Deficit Association (ABDA), Brazil
| | | | | | - Brooke S G Molina
- Departments of Psychiatry, Psychology, Pediatrics, Clinical & Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joel T Nigg
- Center for ADHD Research, Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Diane Purper-Ouakil
- University of Montpellier, CHU Montpellier Saint Eloi, MPEA, Medical and Psychological Unit for Children and Adolescents (MPEA), Montpellier, France; INSERM U 1018 CESP-Developmental Psychiatry, France
| | - Olayinka O Omigbodun
- Centre for Child & Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Child & Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria
| | | | - Yehuda Pollak
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Israel; The Israeli Society of ADHD (ISA), Israel
| | - Alison S Poulton
- Brain Mind Centre Nepean, University of Sydney, Sydney, Australia; Australian ADHD Professionals Association (AADPA), Australia
| | - Ravi Philip Rajkumar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | | | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany; German Psychiatric Association, Germany
| | - Katya Rubia
- World Federation of ADHD, Switzerland; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK; European Network for Hyperkinetic Disorders (EUNETHYDIS), Germany
| | - Julia Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany; The German Association of Child and Adolescent Psychiatry and Psychotherapy, Germany; Zentrales-ADHS-Netz, Germany
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Neurodevelopmental Disorders Across Lifespan Section of European Psychiatric Association, France; International Collaboration on ADHD and Substance Abuse (ICASA), the Netherlands; DIVA Foundation, the Netherlands
| | - Arnt Schellekens
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behavior, Department of Psychiatry, Nijmegen, the Netherlands; International Collaboration on ADHD and Substance Abuse (ICASA), Nijmegen, the Netherlands
| | - Anouk Scheres
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Renata Schoeman
- University of Stellenbosch Business School, Cape Town, South Africa; South African Special Interest Group for Adult ADHD, South Africa; The South African Society of Psychiatrists/Psychiatry Management Group Management Guidelines for ADHD, South Africa; World Federation of Biological Psychiatry, Germany; American Psychiatric Association, USA; Association for NeuroPsychoEconomics, USA
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences and the MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Henal Shah
- Topiwala National Medical College & BYL Nair Ch. Hospital, Mumbai, India
| | - Mary V Solanto
- The Zucker School of Medicine at Hofstra-Northwell, Northwell Health, Hemstead, NY, USA; Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), USA; American Professional Society of ADHD and Related Disorders (APSARD), USA; National Center for Children with Learning Disabilities (NCLD), USA
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark
| | - César Soutullo
- American Professional Society of ADHD and Related Disorders (APSARD), USA; European Network for Hyperkinetic Disorders (EUNETHYDIS), Germany; Louis A. Faillace MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hans-Christoph Steinhausen
- University of Zurich, CH, Switzerland; University of Basel, CH, Switzerland; University of Southern Denmark, Odense, Denmark; Centre of Child and Adolescent Mental Health, Copenhagen, Denmark
| | - James M Swanson
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Wales, UK
| | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Geurt van de Glind
- Hogeschool van Utrecht/University of Applied Sciences, Utrecht, the Netherlands
| | - Wim van den Brink
- Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Saskia Van der Oord
- Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; European ADHD Guidelines Group, Germany
| | - Andre Venter
- University of the Free State, Bloemfontein, South Africa
| | - Benedetto Vitiello
- University of Torino, Torino, Italy; Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Yufeng Wang
- Asian Federation of ADHD, China; Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China
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May T, Aizenstros A, Aizenstros J. Characteristics of adults with attention deficit hyperactivity disorder consecutively referred to an Australian private psychiatric clinic. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1969211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tamara May
- Department of Paediatrics, Monash University, Clayton, Australia
| | - Abby Aizenstros
- School of Psychological Sciences, Monash University, Clayton, Australia
| | - Joel Aizenstros
- Department of Psychiatry, Monash University, Clayton, Australia
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Massuti R, Moreira-Maia CR, Campani F, Sônego M, Amaro J, Akutagava-Martins GC, Tessari L, Polanczyk GV, Cortese S, Rohde LA. Assessing undertreatment and overtreatment/misuse of ADHD medications in children and adolescents across continents: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 128:64-73. [PMID: 34089763 DOI: 10.1016/j.neubiorev.2021.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 03/11/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022]
Abstract
A controversy exists on whether there is an over or underuse of medications for Attention-Deficit/Hyperactivity Disorder (ADHD). We conducted the first meta-analysis to estimate the rate of ADHD pharmacological treatment in both diagnosed and undiagnosed individuals. Based on a pre-registered protocol (CRD42018085233), we searched a broad set of electronic databases and grey literature. After screening 25,676 abstracts, we retained 36 studies including 104,305 subjects, from which 18 studies met our main analysis criteria. The pooled pharmacological treatment rates were 19.1 % and 0.9 % in school-age children/adolescents with and without ADHD, respectively. We estimated that for each individual using medication without a formal ADHD diagnosis, there are three patients with a formal diagnosis who might benefit from medication but do not receive it in the US. Our results indicate both overtreatment/misuse of medication in individuals without ADHD and pharmacological undertreatment in youths with the disorder. Our findings reinforce the need for public health policies improving education on ADHD and discussions on the benefits and limitations of ADHD medications.
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Affiliation(s)
- Rafael Massuti
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Brazil
| | - Carlos Renato Moreira-Maia
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Brazil
| | - Fausto Campani
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Brazil
| | - Márcio Sônego
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Brazil
| | - Julia Amaro
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Brazil
| | | | - Luca Tessari
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK
| | | | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK; Solent NHS Trust, Southampton, UK; Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, New York, NY, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Luis Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Brazil; National Institute of Developmental Psychiatry, Brazil.
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Kim S, Lee HK, Lee K. Can the MMPI Predict Adult ADHD? An Approach Using Machine Learning Methods. Diagnostics (Basel) 2021; 11:diagnostics11060976. [PMID: 34071385 PMCID: PMC8229212 DOI: 10.3390/diagnostics11060976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/25/2021] [Accepted: 05/27/2021] [Indexed: 12/24/2022] Open
Abstract
(1) Background: Adult attention-deficit/hyperactivity disorder (ADHD) symptoms cause various social difficulties due to attention deficit and impulsivity. In addition, in contrast to ADHD in childhood, ADHD in adulthood is difficult to diagnose due to mixed psychopathologies. This study aimed to determine whether it is possible to predict ADHD symptoms in adults using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) with machine learning (ML) techniques; (2) Methods: Data collected from 5726 college students were analyzed. The MMPI-2-Restructured Form (MMPI-2-RF) was used, and ADHD symptoms in adults were evaluated using the Attention-Deficit/Hyperactivity Disorder Self-Report Scale (ASRS). For statistical analysis, three ML algorithms were used, i.e., K-nearest neighbors (KNN), linear discriminant analysis (LDA), and random forest, with the ASRS evaluation result as the dependent variable and the 50 MMPI-2-RF scales as predictors; (3) Results: When the KNN, LDA, and random forest techniques were applied, the accuracy was 93.1%, 91.2%, and 93.6%, respectively, and the area under the curve (AUC) was 0.722, 0.806, and 0.790, respectively. The AUC of the LDA method was the largest, with an excellent level of diagnostic accuracy; (4) Conclusions: ML using the MMPI-2 in a large group could provide reliable accuracy in screening for adult ADHD.
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Affiliation(s)
- Sunhae Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul 04763, Korea;
| | - Hye-Kyung Lee
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju 32588, Korea;
| | - Kounseok Lee
- Department of Psychiatry, Hanyang University Medical Center, Seoul 04763, Korea;
- Correspondence: ; Tel.: +82-2-2290-8481; Fax: +82-2-2298-2055
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30
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Watkins DJ, Meeker JD, Tamayo-Ortiz M, Sánchez BN, Schnaas L, Peterson KE, Téllez-Rojo MM. Gestational and peripubertal phthalate exposure in relation to attention performance in childhood and adolescence. ENVIRONMENTAL RESEARCH 2021; 196:110911. [PMID: 33640497 PMCID: PMC8119354 DOI: 10.1016/j.envres.2021.110911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
The prevalence of Attention Deficit/Hyperactivity Disorder (ADHD) has been increasing. Research suggests that exposure to endocrine disrupting chemicals such as phthalates may play a role, but studies of in utero phthalate exposure and ADHD-related symptoms beyond early childhood are limited. We investigated associations between measures of in utero phthalate exposure and ADHD symptoms, such as inattention and impulsivity, in childhood (age 6-11 years, n = 221) and in adolescence (age 9-18 years, n = 200), as well as cross-sectional relationships between phthalate exposure and ADHD symptoms in adolescence (n = 491) among participants in the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) cohort. Women provided urine samples up to three times during pregnancy and adolescents provided a urine sample at 9-18 years of age for phthalate metabolite measurement. We administered the Conners' Continuous Performance Test (CPT) when children were age 6-11 years and again at 9-18 years of age. We used multivariable linear regression to examine associations between the geometric mean of phthalate metabolite levels across pregnancy and CPT scores in childhood or adolescence separately, adjusting for age, years schooling (at 9-18 only), maternal education, and specific gravity. Although average in utero phthalate concentrations were not associated with CPT scores in childhood, interquartile range (IQR) increases of in utero MBzP, MCPP, and MBP were associated with 4.2%, 4.7%, and 4.5% (p < 0.05) higher Omissions scores in adolescence, respectively, indicating higher inattention. In utero MiBP levels were also associated with higher Inter-Stimulus Interval (ISI) and Variability scores (5.4% and 5.5% per IQR, p < 0.05) in adolescence. In addition, urinary DEHP metabolite levels during adolescence were cross-sectionally associated with poorer scores on several CPT indices indicating greater inattention. These findings suggest that in utero phthalate exposure may have adverse effects on attention, but these effects may not appear until adolescence, a period of extensive neurodevelopment. Future research investigating the long-term effects of in utero phthalate exposure on attention and ADHD in adolescence, as well as identification of potential mechanisms involved, is needed.
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Affiliation(s)
- Deborah J Watkins
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - John D Meeker
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Marcela Tamayo-Ortiz
- National Council of Science and Technology, National Institute of Public Health, Mexico City, Mexico
| | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Lourdes Schnaas
- National Institute of Perinatology, ABC Hospital, Mexico City, Mexico
| | - Karen E Peterson
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Martha María Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
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31
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Van Wijk CH, Meintjes WAJ. Associations Between Adverse Underwater Events and ADHD Diagnosis Among Military Divers. J Atten Disord 2021; 25:848-850. [PMID: 31319735 DOI: 10.1177/1087054719864654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Adult ADHD (A-ADHD) has been associated with an increased risk of accidents and workplace injuries. ADHD within professional diving may have major potential occupational health and safety implications, as accidents underwater may have severe consequences. The study investigated any association of increased risk for adverse underwater incidents with an ADHD diagnosis. Method: This analysis used retrospective records from 156 navy divers and computed an odds ratio using cases of ADHD and cases of underwater accidents. Results: Although the odds ratio was increased, it failed to reach significance. Conclusion: We do not yet have statistical evidence suggesting that the risk for adverse underwater events is significantly increased among the ADHD group in this sample of navy divers. Sufficiently powered studies are required to further address the potential risk of A-ADHD in working divers.
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Affiliation(s)
- Charles H Van Wijk
- Institute for Maritime Medicine, Simon's Town, South Africa.,Stellenbosch University, Cape Town, South Africa
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32
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Jangmo A, Kuja-Halkola R, Pérez-Vigil A, Almqvist C, Bulik CM, D’Onofrio B, Lichtenstein P, Ahnemark E, Werner-Kiechle T, Larsson H. Attention-deficit/hyperactivity disorder and occupational outcomes: The role of educational attainment, comorbid developmental disorders, and intellectual disability. PLoS One 2021; 16:e0247724. [PMID: 33730071 PMCID: PMC7968636 DOI: 10.1371/journal.pone.0247724] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/11/2021] [Indexed: 11/19/2022] Open
Abstract
Background Individuals with ADHD are at increased risk for poor occupational outcomes. Educational attainment and psychiatric comorbidity may be important contributing factors for these outcomes, but the role of these factors is not well characterized. This study aimed to investigate the associations between ADHD and occupational outcomes, and to examine the influence of educational attainment, comorbid developmental disorders and intellectual disability on these associations. Methods We linked the Swedish population graduating from compulsory school 1998–2008 (N = 1.2 millions) to population-wide register-based data on clinical psychiatric diagnoses and medications, objective annual measures of educational, and occupational outcomes. Individuals were followed for between 6 to 16 years after graduation. Results Individuals with ADHD had annually on average 17 percent lower income, ratio = 0.83 (95% CI 0.83–0.84), 12.19 (11.89–12.49) more days of unemployment, and a higher likelihood of receiving disability pension, odds-ratio = 19.0 (18.4–19.6), compared to controls. Comorbid diagnoses of intellectual disability and developmental disorder explained most of the association between ADHD and disability pension, while lifetime educational attainment partially explained associations between ADHD and all occupational outcomes. Analyses of occupational trajectories found that income was lower and unemployment elevated relative to controls with the same educational attainment. Higher educational attainment correlated with higher income similarly among individuals with ADHD and controls after accounting for individual background factors. Conclusions The occupational burden associated with ADHD is substantial. Comorbid developmental disorders, intellectual disability and educational difficulties (e.g., failing grades) from childhood to adulthood are important factors to consider when designing interventions to improve occupational outcomes in individuals with ADHD.
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Affiliation(s)
- Andreas Jangmo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ana Pérez-Vigil
- Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Brian D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, United States of America
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ewa Ahnemark
- Medical Affairs, Shire Sweden AB, a Takeda Company, Stockholm, Sweden
| | - Tamara Werner-Kiechle
- Global Medical Affairs, Shire International GmbH, a Takeda Company, Zug, Switzerland
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
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33
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Adamou M, Asherson P, Arif M, Buckenham L, Cubbin S, Dancza K, Gorman K, Gudjonsson G, Gutman S, Kustow J, Mabbott K, May-Benson T, Muller-Sedgwick U, Pell E, Pitts M, Rastrick S, Sedgwick J, Smith K, Taylor C, Thompson L, van Rensburg K, Young S. Recommendations for occupational therapy interventions for adults with ADHD: a consensus statement from the UK adult ADHD network. BMC Psychiatry 2021; 21:72. [PMID: 33541313 PMCID: PMC7863422 DOI: 10.1186/s12888-021-03070-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 01/25/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND ADHD is neurodevelopmental disorder which persists into adulthood. Presently, therapeutic approaches are mainly pharmacological and psychological whilst the role, scope and approaches of occupational therapists have not been adequately described. RESULTS In this consensus statement we propose that by assessing specific aspects of a person's occupation, occupational therapists can deploy their unique skills in providing specialist interventions for adults with ADHD. We also propose a framework with areas where occupational therapists can focus their assessments and give practice examples of specific interventions. CONCLUSIONS Occupational therapists have much to offer in providing interventions for adults with ADHD. A unified and flexible approach when working with adults with ADHD is most appropriate and further research on occupational therapy interventions is needed.
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Affiliation(s)
- Marios Adamou
- School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK.
| | - Philip Asherson
- grid.14105.310000000122478951MRC Social Genetic and Developmental Psychiatry Research Centre, London, UK
| | - Muhammad Arif
- grid.420868.00000 0001 2287 5201Leicestershire Partnership NHS Trust, Leicestershire, UK
| | - Louise Buckenham
- grid.500653.50000000404894769Northamptonshire Healthcare NHS Foundation Trust, Northamptonshire, UK ,The Royal College of Occupational Therapy and Heath Care Professionals Council, London, UK
| | | | - Karina Dancza
- grid.486188.b0000 0004 1790 4399Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Kirstie Gorman
- grid.439737.d0000 0004 0382 8292Lancashire Care NHS Foundation Trust, Lancashire, UK
| | - Gísli Gudjonsson
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Sharon Gutman
- grid.21729.3f0000000419368729Columbia University, New York, USA
| | - James Kustow
- grid.451052.70000 0004 0581 2008Barnet,Enfield and Haringey NHS Trust, London, UK
| | - Kerry Mabbott
- grid.500653.50000000404894769Northamptonshire Healthcare NHS Foundation Trust, Northamptonshire, UK ,The Royal College of Occupational Therapy and Heath Care Professionals Council, London, UK
| | | | | | - Emma Pell
- grid.499523.00000 0000 8880 3342South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Mark Pitts
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Jane Sedgwick
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | | | - Clare Taylor
- grid.439450.f0000 0001 0507 6811South West London and St George’s Mental Health NHS Trust, London, UK
| | - Lucy Thompson
- grid.499523.00000 0000 8880 3342South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Kobus van Rensburg
- grid.500653.50000000404894769Northamptonshire Healthcare NHS Foundation Trust, Northamptonshire, UK
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34
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Zhang KA, Markon KE. Age and Gender Measurement Noninvariance of the Adult ADHD Self-Report Scale Screener. J Atten Disord 2021; 25:403-413. [PMID: 30449230 DOI: 10.1177/1087054718808059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The nature and form of demographics-related differences in ADHD self-reported symptoms across adulthood is currently poorly understood. This study explored the psychometrics of the Adult ADHD Self-Report Scale Screener (ASRS-6), including its age- and gender-related measurement invariance. Method: Structural equation models were used to analyze adult data-aged 16 to 95 years-from the 2007 British Adult Psychiatric Morbidity Survey. Results: The three-factor model (disorganization, inattention, hyperactivity) outperformed one- and two-factor models. Self-reported attentional deficits may be more pathognomonic of overall self-reported ADHD in adults than other symptoms. All items exhibited age measurement noninvariance while only a subset exhibited gender measurement noninvariance. Individuals who are male and younger tend to have lower thresholds for endorsement for ASRS-6 items than individuals who are female and older. Conclusion: The ASRS-6 does not appear to be unidimensional, and self-reported ASRS-6 symptomatology changes in meaning with age.
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Affiliation(s)
- K Anne Zhang
- The University of Iowa, Iowa City, USA.,Indiana University, Bloomington, USA
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35
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Hastuti R, Timming AR. An inter-disciplinary review of the literature on mental illness disclosure in the workplace: implications for human resource management. INTERNATIONAL JOURNAL OF HUMAN RESOURCE MANAGEMENT 2021. [DOI: 10.1080/09585192.2021.1875494] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Rina Hastuti
- School of Management, RMIT University, Melbourne, VIC, Australia
- Faculty of Islamic Business and Economics, IAIN, Surakarta, Central Java, Indonesia
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36
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Symptomatological Variants and Related Clinical Features in Adult Attention Deficit Hyperactive Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030922. [PMID: 33494421 PMCID: PMC7908530 DOI: 10.3390/ijerph18030922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 12/20/2022]
Abstract
A large amount of the current literature has focused on the characteristic symptoms of attention deficit hyperactivity disorder (ADHD) in children and adolescents. In contrast, less attention has been devoted to ADHD clinical subtypes in adult patients. We evaluated 164 consecutive adult ADHD (A-ADHD) outpatients using DSM-5 criteria and many specific rating scales and questionnaires. A principal component factor analysis was performed on clinical and symptomatological variables to describe potential clinical variants. We sought to determine different A-ADHD variants focusing on demographic and clinical features. A four-factor solution was identified, and patients were clustered, according to their z-score, in 4 subgroups. The first was marked out by Emotional Dysregulation (ED), the second by Substance Use (SU), the third by Core-ADHD Symptoms (Co-ADHD) and the fourth by Positive Emotionality (PE). Predominantly ED patients showed worse overall function, early treatment with antidepressants and a greater presence of borderline personality disorder than predominantly Co-ADHD patients. Predominantly SU patients reported high rates of bipolar disorder and severe general psychopathology. The PE factor was related to hyperthymic temperament and hypomania and showed a higher level of functioning. Females with A-ADHD showed a lower risk of being included in SU, and A-ADHD patients with co-occurring delayed sleep phase had less risk of being included in the SU factor than the prevailing Co-ADHD group. Our empirically based description of four clinical A-ADHD variants shows several aspects beyond the definition given by the DSM-5 diagnostic criteria.
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Prakash J, Chatterjee K, Guha S, Srivastava K, Chauhan VS. Adult attention-deficit Hyperactivity disorder: From clinical reality toward conceptual clarity. Ind Psychiatry J 2021; 30:23-28. [PMID: 34483520 PMCID: PMC8395556 DOI: 10.4103/ipj.ipj_7_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/07/2022] Open
Abstract
There is ambiguity about the clinical picture and concept of attention-deficit hyperactivity disorder (ADHD) in adults. Relevant literature was extracted from various search engines, analyzed, and interpreted. Available literature suggests a significant prevalence of ADHD in the adult population affecting the quality of socio-occupational functioning. Inattentiveness was more commonly present than hyperactivity-impulsivity. Frequent comorbidities with other psychiatric disorders like anxiety disorders and substance use disorders were noted. Pharmacological management and psychotherapy have been found effective in its management. ADHD is a disorder across the lifespan and fairly prevalent among adults. Greater awareness and more research are required for a better understanding of Adult ADHD and its effective management.
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Affiliation(s)
- Jyoti Prakash
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - K. Chatterjee
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - S. Guha
- Private Consultant Psychiatrist, Sr Lecturer UQ School of Medicine and Griffith University School of Medicine, Australia
| | - K. Srivastava
- Department of Clinical Psychologist, Armed Forces Medical College, Pune, Maharashtra, India
| | - V. S. Chauhan
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
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38
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Single-dose pharmacokinetics of amphetamine extended-release tablets compared with amphetamine extended-release oral suspension. CNS Spectr 2020; 25:774-781. [PMID: 31964449 DOI: 10.1017/s1092852919001676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Evaluate the relative bioavailability of single-dose amphetamine extended-release tablet (AMPH ER TAB) 20 mg, swallowed whole or chewed, and amphetamine extended-release oral suspension (AMPH EROS) 2.5 mg/mL; evaluate food effect on AMPH ER TAB. METHODS Healthy volunteers (18-55 years) were randomized to 1 dose of AMPH ER TAB 20 mg swallowed (fasted), chewed (fed/fasted), or 20 mg AMPH EROS (fasted). A crossover study design was used. Plasma samples were collected each period predose and at time points to 60 hours postdose. d- and l-amphetamine were measured and pharmacokinetic (PK) was calculated (90% confidence intervals of the ratios of the plasma levels) for AUC0-t, AUC0-∞, and Cmax. Comparative relative bioavailability between formulations was determined when ratios were within 80% and 125%. Safety was also assessed. RESULTS Thirty-two subjects completed the study. AMPH ER TAB swallowed versus AMPH EROS (fasted): for d- and l-amphetamine, the total and peak exposure was similar: d: AUC0-t: 100.68% to 108.08%, AUC0-∞: 101.47% to 109.52%, Cmax: 98.10% to 103.17%; l: AUC0-t: 100.31% to 108.57%, AUC0-∞: 101.27% to 111.09%, Cmax: 98.2% to 103.37%. For d- and l-amphetamine when the tablet is swallowed whole, Tmax was 5.00 hours (with a range of 2.00-9.00 hours). AMPH ER TAB chewed versus AMPH EROS (fasted): for d- and l-amphetamine, the total and peak exposure was similar: d: AUC0-t: 99.23% to 106.62%, AUC0-∞: 99.58% to 107.59%, Cmax: 99.91% to 105.14%; l: AUC0-t: 98.16% to 106.35%, AUC0-∞: 98.44% to 108.11%, Cmax: 99.53% to 104.75%. For d- and l-amphetamine when the tablet has been chewed, Tmax was 5.00 hours (with a range of 3.00-7.00 hours). PK results were similar for patients in the fasted and fed groups, indicative of no presence of food effect. No serious adverse events (AEs) were reported, overall AE profiles between the tablet and oral suspension were comparable without any unanticipated safety concerns. CONCLUSIONS Single doses of AMPH ER TAB for both d- and l-amphetamine demonstrated comparable bioavailability to a 20 mg dose of AMPH EROS, 2.5 mg/mL under fasted conditions when chewed and swallowed whole, and demonstrated equivalent peak and overall exposure without apparent food effect. AMPH ER TAB was well-tolerated and consistent with adverse events noted in other amphetamine formulations.
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39
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Medication utilization among adult patients with attention-deficit/hyperactivity disorder after reimbursement criteria change. Int Clin Psychopharmacol 2020; 35:329-337. [PMID: 32897929 DOI: 10.1097/yic.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study analyzed the pattern of attention-deficit/hyperactivity disorder (ADHD) medication initiation in adult patients with ADHD after the reimbursement criteria change and identified the influencing factors associated with it using the claim data. We identified 243 adult patients with ADHD who had not been prescribed ADHD drugs before 1 September 2016. We conducted Kaplan-Meier survival analysis to calculate the time to initial prescription of ADHD medications, and Cox proportional hazard regression analysis to estimate the influencing factors. Approximately one-third of the patients (n = 76, 31.3%) were first prescribed ADHD medications after reimbursement approval, and 40 of them (16.5%) started treatment with osmotic release oral system methylphenidate. The patient's age group (30-39 years) and the status of diagnosis before the index date were associated with early initiation of pharmacotherapy. The odds of starting ADHD medications increased approximately 2.7-fold in the 30-39 age group and 0.2-fold in the case of patients who were diagnosed before the approval. Our findings show that both diagnosis and treatment of adult ADHD remains inadequate despite the change in reimbursement criteria. Improving awareness of adult ADHD among both the public and the professionals is essential to increase its chances of diagnosis and treatment.
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40
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McCracken HS, Murphy BA, Burkitt JJ, Glazebrook CM, Yielder PC. Audiovisual Multisensory Processing in Young Adults With Attention-Deficit/Hyperactivity Disorder. Multisens Res 2020; 33:599-623. [PMID: 31899870 DOI: 10.1163/22134808-20191472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/22/2019] [Indexed: 11/19/2022]
Abstract
Multisensory integration is a fundamental form of sensory processing that is involved in many everyday tasks. Those with Attention-Deficit/Hyperactivity Disorder (ADHD) have characteristic alterations to various brain regions that may influence multisensory processing. The overall aim of this work was to assess how adults with ADHD process audiovisual multisensory stimuli during a complex response time task. The paradigm used was a two-alternative forced-choice discrimination task paired with continuous 64-electrode electroencephalography, allowing for the measurement of response time and accuracy to auditory, visual, and audiovisual multisensory conditions. Analysis revealed that those with ADHD ( n = 10) respond faster than neurotypical controls ( n = 12) when presented with auditory, visual, and audiovisual multisensory conditions, while also having race model violation in early response latency quantiles. Adults with ADHD also had more prominent multisensory processing over parietal-occipital brain regions at early post-stimulus latencies, indicating that altered brain structure may have important outcomes for audiovisual multisensory processing. The present study is the first to assess how those with ADHD respond to multisensory conditions during a complex response time task, and demonstrates that adults with ADHD have unique multisensory processing when assessing both behavioral response time measures and neurological measures.
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Affiliation(s)
- Heather S McCracken
- 1University of Ontario Institute of Technology, Faculty of Health Sciences, Canada
| | - Bernadette A Murphy
- 1University of Ontario Institute of Technology, Faculty of Health Sciences, Canada
| | - James J Burkitt
- 1University of Ontario Institute of Technology, Faculty of Health Sciences, Canada
| | - Cheryl M Glazebrook
- 2University of Manitoba, Faculty of Kinesiology and Recreation Management, Canada.,3University of Manitoba, Health, Leisure and Human Performance Institute, Canada
| | - Paul C Yielder
- 1University of Ontario Institute of Technology, Faculty of Health Sciences, Canada.,4Deakin University, School of Medicine, Australia
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41
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Sar-El R, Sharon H, Lubianiker N, Hendler T, Raz G. Inducing a Functional-Pharmacological Coupling in the Human Brain to Achieve Improved Drug Effect. Front Neurosci 2020; 14:557874. [PMID: 33154714 PMCID: PMC7586318 DOI: 10.3389/fnins.2020.557874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/07/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roy Sar-El
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Roy Sar-El,
| | - Haggai Sharon
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nitzan Lubianiker
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Talma Hendler
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Gal Raz
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Steve Tisch School of Film and Television, Tel Aviv University, Tel Aviv, Israel
- Gal Raz,
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van Wijk C, Firfirey N. A brief screen for attention-deficit/hyperactivity disorder in the South African workplace. S Afr J Psychiatr 2020; 26:1500. [PMID: 33101727 PMCID: PMC7564909 DOI: 10.4102/sajpsychiatry.v26i0.1500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 08/03/2020] [Indexed: 11/11/2022] Open
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Adler LA, Robertson B, Chen J, Sarkis E. Post hoc Responder and Remission Analyses from Two Studies of SHP465 Mixed Amphetamine Salts Extended-Release Among Adults with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2020; 30:427-438. [PMID: 32423239 PMCID: PMC7475095 DOI: 10.1089/cap.2020.0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives: In two studies of adult attention-deficit/hyperactivity disorder (ADHD), SHP465 mixed amphetamine salts (MAS) extended-release significantly reduced ADHD-Rating Scale, 4th Edition total score (ADHD-RS-IV-TS) versus placebo (PBO). This report describes post hoc analyses of SHP465 MAS treatment response and remission rates from those studies. Methods: Adults with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision-defined ADHD were randomized to SHP465 MAS (12.5-75 mg) or PBO in a 7-week dose-optimization study and to SHP465 MAS (25, 50, or 75 mg) or PBO in a 6-week fixed-dose study. Response was examined using three definitions (definition 1: ≥30% ADHD-RS-IV-TS reduction + Clinical Global Impressions-Improvement [CGI-I] rating of 1 or 2; definition 2: ≥50% ADHD-RS-IV-TS reduction + CGI-I rating of 1 or 2; definition 3: ADHD-RS-IV-TS ≤18). Remission was defined as ADHD-RS-IV-TS ≤12. The Kaplan-Meier analyses assessed time to response or remission. Results: The intent-to-treat populations included 136 SHP465 MAS and 132 PBO participants in the dose-optimization study and 302 SHP465 MAS and 103 PBO participants in the fixed-dose study. Percentages of participants meeting response criteria (SHP465 MAS vs. PBO) at the final treatment week in the dose-optimization and fixed-dose studies, respectively, were 66.0% versus 31.6% and 72.7% versus 28.3% (definition 1); 47.9% versus 27.6% and 60.6% versus 16.7% (definition 2); and 54.3% versus 30.3% and 52.6% versus 18.3% (definition 3). The remission criterion (SHP465 MAS vs. PBO) at the final treatment week was met by 37.2% versus 19.7% of participants in the dose-optimization study and 39.7% versus 10.0% of participants in the fixed-dose study. Times to response and remission favored SHP465 MAS over PBO in both studies (all nominal log-rank p < 0.0001). Conclusion: These post hoc analyses indicate that SHP465 MAS was associated with greater response and remission rates than PBO in adults with ADHD, with times to response and remission also nominally favoring SHP465 MAS.
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Affiliation(s)
- Lenard A. Adler
- Department of Psychiatry and NYU Langone Medical Center, New York, New York, USA.,Department of Child and Adolescent Psychiatry, NYU Langone Medical Center, New York, New York, USA.,Address correspondence to: Lenard A. Adler, MD, Department of Psychiatry, NYU Langone Medical Center, 1 Park Avenue, 8th Floor, New York, NY 10016, USA
| | - Brigitte Robertson
- Global Clinical Development, Shire, a member of the Takeda group of companies, Lexington, Massachusetts, USA
| | - Jie Chen
- Biostatistics, Shire, a member of the Takeda group of companies, Lexington, Massachusetts, USA
| | - Elias Sarkis
- Sarkis Family Psychiatry, Gainesville, Florida, USA
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Virtanen M, Lallukka T, Kivimäki M, Alexanderson K, Ervasti J, Mittendorfer-Rutz E. Neurodevelopmental disorders among young adults and the risk of sickness absence and disability pension: a nationwide register linkage study. Scand J Work Environ Health 2020; 46:410-416. [PMID: 32076730 PMCID: PMC8506319 DOI: 10.5271/sjweh.3888] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Indexed: 11/11/2022] Open
Abstract
Objectives Attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and learning disabilities (LD) have an early onset and often persist into adulthood, although their relative contribution to incapacity for work is unclear. We examined this issue among young adults with ADHD, ASD or LD taking into account socioeconomic factors and comorbid mental disorders. Methods Recorded diagnoses between the ages of 10-35 years between 2001 and 2010 were derived from nationwide inpatient and specialized outpatient hospital registers in Sweden. We identified 15 632 individuals with a main diagnosis of ADHD, 8238 with ASD, and 1038 with LD, and the matched control group without recorded mental disorders (N=124 536). The outcome was the number of register-based sickness absence and work disability pension (SA-DP) days during a maximum of three years follow-up. Results Among men, the rate ratio (RR) of SA-DP was 11.17 [95% confidence interval (CI) 9.89-12.60] for ADHD, 35.59 (95% CI 30.30-41.81) for ASD, and 9.20 (95% CI 5.76-14.70) for LD, in comparison to those in the reference group. The corresponding risks among women were RR 12.05 (95% CI 10.30-14.09) for ADHD, RR 28.36 (95% CI 22.96-35.02) for ASD, and RR 9.60 (95% CI 5.83-15.81) for LD. The findings were, to a large extent, similar when individuals on DP at baseline were excluded. Comorbid mental disorders further increased the risk of SA-DP. Educational differences were smaller among the patients than in the reference group. Conclusions Early-onset neurodevelopmental disorders, particularly with comorbidity, have a far-reaching impact on adult life in terms of SA and DP.
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Affiliation(s)
- Marianna Virtanen
- Karolinska Institutet, Division of Insurance Medicine, SE-171 77 Stockholm, Sweden.
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Van Wijk CH, Meintjes WAJ. Adult attention-deficit/hyperactivity disorder prevalence among commercial divers in South Africa. Diving Hyperb Med 2020; 50:164-167. [PMID: 32557419 DOI: 10.28920/dhm50.2.164-167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/24/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Adult attention-deficit/hyperactivity disorder (ADHD) is associated with increased chance of workplace accidents, psychiatric comorbidities, other risky behaviours and sophisticated psychopharmacological treatment. These factors all contribute to a potentially complex risk profile within the commercial diving context. In order to make informed decisions regarding ADHD and commercial diving, further description of this condition among commercial divers is required. This paper reports on a study that aimed to determine the prevalence of adult ADHD among commercial divers. METHODS The study used a self-reporting survey-type questionnaire to determine likely diagnosis, based on Diagnostic and Statistical Manual of Mental Disorders, 5th ed. criteria, in a group of 245 commercial divers in South Africa. RESULTS Fourteen cases (5.7% of the sample) met criteria for ADHD. The majority of the cases presented with combined type, and reflected mild forms of ADHD. Adult ADHD did not appear to occur in significantly different proportions across the biographical variables of age, education or diving qualification. CONLCUSION Based on this small survey, adult ADHD may be over-represented in commercial diving in South Africa, compared to general workplace populations. However, ADHD may not necessarily be a contra-indication to commercial diving.
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Affiliation(s)
- Charles H Van Wijk
- Institute for Maritime Medicine, Simon's Town, South Africa.,Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Corresponding author: Dr Charles H Van Wijk, PO Box 494, Simon's Town 7995, South Africa,
| | - W A Jack Meintjes
- Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Camacho-Conde JA, Climent G. Attentional profile of adolescents with ADHD in virtual-reality dual execution tasks: A pilot study . APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:81-90. [PMID: 32400210 DOI: 10.1080/21622965.2020.1760103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is highly prevalent in children and adolescents, with estimated prevalence ranges from 5.9 to 7.1% globally and 1 to 6.8% in Spain. This has commonly been associated with deficits in attention threads and executive functions. This paper aims to study the cognitive-executive performance of adolescents between the ages of 17 and 23 with an ADHD diagnosis, relative to a control group. The total sample consisted of 120 male participants who were given the Nesplora Aquarium test. Dual execution tasks assessed attention, response speed, and inhibition capability. When comparing the experimental and control groups, statistically significant differences were detected in processing speed, selective attention, and cognitive inhibition [general execution (T_correct_n) (p = 0.008), attention arousal (T_omission_n) (p = 0.008), and processing speed (T_correctreactime_mean) (p = 0.008)]. We demonstrate that a new virtual reality tool, designed to measure attention in people over the age of 16 years, is effective at measuring attention and working memory. In addition, item difficulty and discrimination values were also acceptable.
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Affiliation(s)
| | - Gema Climent
- Department of I + I+I, Nesplora Technology & Behavior, San Sebastian, Spain
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Frick G, Yan B, Adler LA. Triple-Bead Mixed Amphetamine Salts (SHP465) in Adults With ADHD: Results of a Phase 3, Double-Blind, Randomized, Forced-Dose Trial. J Atten Disord 2020; 24:402-413. [PMID: 28413925 DOI: 10.1177/1087054717696771] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Evaluate the efficacy and tolerability of triple-bead mixed amphetamine salts (MAS) in ADHD. Method: Adults with ADHD Rating Scale IV (ADHD-RS-IV) total scores ≥32 were randomized to 6 weeks of triple-bead MAS (25, 50, or 75 mg) or placebo. The primary endpoint was ADHD-RS-IV total score change from baseline at end of study (EOS). Results: Least squares mean (95% confidence interval [CI]) treatment differences for ADHD-RS-IV total score changes from baseline to EOS significantly favored triple-bead MAS (all doses combined: -10.6 [-13.2, -8.0]; p < .0001); there were no significant differences between triple-bead MAS dosages. The most frequently reported TEAEs with triple-bead MAS (all doses combined) included insomnia, decreased appetite, and dry mouth. Mean ± SD pulse and systolic blood pressure increases at EOS were 3.5 ± 10.33 bpm and 0.3 ± 10.48 mmHg with triple-bead MAS (all doses combined). Conclusion: Triple-bead MAS significantly reduced adult ADHD symptoms; the safety profile was consistent with previous triple-bead MAS studies.
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Affiliation(s)
- Glen Frick
- Shire, Lexington, MA, USA.,Endo Pharmaceuticals, Malvern, PA, USA
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48
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Silverstein MJ, Faraone SV, Leon TL, Biederman J, Spencer TJ, Adler LA. The Relationship Between Executive Function Deficits and DSM-5-Defined ADHD Symptoms. J Atten Disord 2020; 24:41-51. [PMID: 30296883 DOI: 10.1177/1087054718804347] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To identify the relationship between the core Diagnostic and Statistical Manual of Mental Disorders (5th ed.) ADHD symptoms and executive function deficits (EFDs), to evaluate ADHD characteristics of those with executive dysfunction (ED), and to examine the predictive utility of the Adult ADHD Investigator Symptom Rating Scale (AISRS) in identifying those with adult ADHD and ED. Method: Two samples (referred and primary care practice) were pooled together for present analysis. Results: Final analysis included 297 respondents, 171 with adult ADHD. Spearman correlation coefficients and binary logistic regressions demonstrated that ADHD inattentive (IA) and hyperactive-impulsive (H-I) symptoms were moderately to strongly correlated with and highly predictive of EFDs. Receiver operating characteristic curve analysis showed that an AISRS DSM 18-item score of ⩾ 28 was most predictive of clinical ED. Conclusion: ADHD symptoms were strongly correlated with and predictive of EFDs, clinicians should screen adults with ADHD for EFDs and ADHD treatment providers should track EFD improvement in addition to DSM-5 ADHD symptoms.
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Affiliation(s)
- Michael J Silverstein
- Drexel University, Philadelphia, PA, USA.,New York University School of Medicine, New York City, USA
| | | | - Terry L Leon
- New York University School of Medicine, New York City, USA
| | | | | | - Lenard A Adler
- New York University School of Medicine, New York City, USA
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Bahn GH, Lee YS, Yoo HK, Kim EJ, Park S, Han DH, Hong M, Kim B, Lee SI, Bhang SY, Lee SY, Hong JP, Joung YS. Development of the Korean Practice Parameter for Adult Attention-Deficit/Hyperactivity Disorder. Soa Chongsonyon Chongsin Uihak 2020; 31:5-25. [PMID: 32612409 PMCID: PMC7324844 DOI: 10.5765/jkacap.190030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Adult attention-deficit/hyperactivity disorder (ADHD) is an important mental health problem that needs resolution, especially considering the high rates of ADHD continuation from childhood to adolescence/adulthood and the high prevalence of ADHD in adults. Adults with ADHD have lifelong negative impacts and require close monitoring with long-term follow-up. Hence, the establishment of a Korean practice parameter for adult ADHD is necessary to minimize discontinuation of treatment and enable information sharing among Korean mental health professionals. METHODS The Korean practice parameter was developed using an evidence-based approach consisting of expert consensus survey coupled with literature review. RESULTS According to the expert consensus survey, the most commonly used diagnostic methods were clinical psychiatric interview (20.66%) and self-report scales (19.25%) followed by attention (14.71%) and psychological tests (14.24%). Key evaluation instruments currently available in Korea are the World Health Organization Adult ADHD Self-Report Rating Scale, Korean Adult ADHD Rating Scale, Diagnostic Interview for ADHD in Adults, Barkley Deficits in Executive Functioning Scale for adults, Comprehensive Attention Test, Conners' Continuous Performance Test, and the subtests of Wechsler Adult Intelligence Scale, Digit Span and Letter-Number Sequencing. Although pharmacotherapy is recommended as the first-line of treatment for adult ADHD, we recommend that it be followed by a multimodal and multidisciplinary approach including psychoeducation, pharmacotherapy, cognitive behavior therapy and coaching. CONCLUSION The Korean practice parameter introduces not only general information for the diagnosis and treatment of adult ADHD on a global scale, but also the process of diagnosis and treatment options tailored to the Korean population.
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Affiliation(s)
- Geon Ho Bahn
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
| | - Young Sik Lee
- Department of Psychiatry, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | | | - Eui-Jung Kim
- Department of Psychiatry, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Subin Park
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Minha Hong
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Bongseog Kim
- Department of Psychiatry, Inje University College of Medicine, Seoul, Korea
| | - Soyoung Irene Lee
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Buchun, Korea
| | - Soo Young Bhang
- Department of Psychiatry, Eulji University School of Medicine, Seoul, Korea
| | - Seung Yup Lee
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo-Sook Joung
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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50
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Buadze A, Friedl N, Schleifer R, Young S, Schneeberger A, Liebrenz M. Perceptions and Attitudes of Correctional Staff Toward ADHD-A Challenging Disorder in Everyday Prison Life. Front Psychiatry 2020; 11:600005. [PMID: 33633596 PMCID: PMC7901975 DOI: 10.3389/fpsyt.2020.600005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/30/2020] [Indexed: 01/13/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is associated with risk-taking behaviors, poor self-control, and interpersonal difficulties. Affected individuals have an increased probability of involvement with the criminal justice system, contributing to a higher rate of arrest, and imprisonment compared with the general population; they are also inadequately treated once sentenced. Because prison staff play a central role in the identification of inmates with mental disorders, they could well be key to improving provision of care. There is however little knowledge of the conceptions, perceptions, and attitudes of prison staff toward ADHD. Such information could help to identify starting points for awareness training and further implementation of specific ADHD treatment. To bridge this gap, we undertook a study based on a qualitatively-driven mixed methods design, combining qualitative data collection in the form of narrative interviews with 19 prison staff from a Swiss correctional facility with quantitative data collection in the form of a survey that included the Attitudes toward Prisoners scale. The interviews were analyzed with QSR NVIVO 11 and a qualitative content analysis approach was used to evaluate findings. Prison staff were generally aware of ADHD and its symptomology, believing it to a be "real," but "fashionable" disorder and favoring hereditary-genetic or biological explanatory models for its development. They viewed inmates with ADHD rather negatively, as complicating correctional efforts, and perceived them as sticking out, as tying up more resources and as frequently being involved in confrontations. Our findings suggest that difficulties in pragmatic aspects of communication and language comprehension may be perceived "as not listening or following instructions," creating additional tensions. Consequently, inmates with ADHD are more often exposed to disciplinary sanctions, such as solitary confinement-an intervention deemed "necessary" by staff. Therefore, staff training on ADHD might need to cover evidence on adverse effects. Non-pharmacological interventions for treatment were preferred and considered to be highly efficacious. Skepticism toward pharmacological treatment prevailed, even when benefits from stimulant medication were described. Interestingly, this skepticism was not the result of negative experiences with the misuse and diversion of stimulants. Acceptance of multimodal treatment among prison staff may require customized strategies.
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Affiliation(s)
- Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Nadine Friedl
- Hospital of Psychiatry Münsingen, Münsingen, Switzerland
| | - Roman Schleifer
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Susan Young
- Psychology Services Limited, London, United Kingdom.,Department of Psychology, Reykjavik University, Reykjavík, Iceland
| | - Andres Schneeberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Psychiatrische Dienste Graubuenden, Chur, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
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