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Xiao G, Shi H, Lan Q, Hu J, Guan J, Liang Z, Zhou C, Huang Z, Chen Y, Zhou B. Association among attention-deficit hyperactivity disorder, restless legs syndrome, and peripheral iron status: a two-sample Mendelian randomization study. Front Psychiatry 2024; 15:1310259. [PMID: 38779543 PMCID: PMC11109751 DOI: 10.3389/fpsyt.2024.1310259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Background Epidemiological evidence indicates a high correlation and comorbidity between Attention Deficit Hyperactivity Disorder (ADHD) and Restless Legs Syndrome (RLS). Objective We aimed to investigate the causal relationship and shared genetic architecture between ADHD and RLS, as well as explore potential causal associations between both disorders and peripheral iron status. Methods We performed two-sample Mendelian randomization (MR) analyses using summary statistics from genome-wide meta-analyses of ADHD, RLS, and peripheral iron status (serum iron, ferritin, transferrin saturation, and total iron binding capacity). Additionally, we employed linkage disequilibrium score regression (LDSC) to assess genetic correlations between ADHD and RLS using genetic data. Results Our MR results supports a causal effect from ADHD (as exposure) to RLS (as outcome) (inverse variance weighted OR = 1.20, 95% CI: 1.08-1.34, p = 0.001). Conversely, we found no a causal association from RLS to ADHD (inverse variance weighted OR = 1.04, 95% CI: 0.99-1.09, p = 0.11). LDSC analysis did not detect a significant genetic correlation between RLS and ADHD (Rg = 0.3, SE = 0.16, p = 0.068). Furthermore, no evidence supported a causal relationship between peripheral iron deficiency and the RLS or ADHD onset. However, RLS may have been associated with a genetic predisposition to reduced serum ferritin levels (OR = 1.20, 95% CI: 1.00-1.04, p = 0.047). Conclusion This study suggests that ADHD is an independent risk factor for RLS, while RLS may confer a genetic predisposition to reduced serum ferritin levels. Limitations The GWAS summary data utilized originated from populations of European ancestry, limiting the generalizability of conclusions to other populations. Clinical implications The potential co-occurrence of RLS in individuals with ADHD should be considered during diagnosis and treatment. Moreover, iron supplementation may be beneficial for alleviating RLS symptoms.
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Affiliation(s)
- Guoqiang Xiao
- Department of Psychiatry and Psychology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongting Shi
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiaoyu Lan
- Department of Psychiatry and Psychology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiajia Hu
- Department of Psychiatry and Psychology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jincheng Guan
- Department of Neurology, Longhua District People’s Hospital, Shenzhen, China
| | - Zhuoji Liang
- Department of Neurology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chumeng Zhou
- Medical Administration College, Guangzhou Medical University, Guangzhou, China
| | - Zitong Huang
- Department of Psychiatry and Psychology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongyuan Chen
- Department of Neurology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Borong Zhou
- Department of Psychiatry and Psychology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Kwan D, Davin N, Harrison AG, Gillie S. Determining cutoff scores on the Conners' adult ADHD rating scales that can definitively rule out the presence of ADHD in a clinical sample. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-11. [PMID: 38569190 DOI: 10.1080/23279095.2024.2336204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
In recent years, the prevalence of Attention Deficit/Hyperactivity Disorder (ADHD) and the number of individuals seeking ADHD assessments has risen significantly, leading to an increased demand for accurate diagnostic tools. This study aimed to identify cutoff scores on the Conners' Adult ADHD Rating Scales (CAARS-S:L) that can definitively rule out the presence of ADHD. Among 102 clinically diagnosed adult ADHD participants and 448 non-ADHD participants who completed the CAARS-S:L, a receiver operating characteristic curve analysis established a perfectly discriminant cutoff T-score of <44 on the ADHD Symptoms Total subscale when looking at any ADHD diagnosis and <54 on the Inattentive Symptoms subscale when looking at individuals diagnosed with the inattentive subtype of ADHD. Alternative cutoffs of <54 (ADHD Symptoms Total subscale) and <63 (Inattentive Symptoms subscale) were also identified, both with a sensitivity of 0.95 or higher. Furthermore, the analysis found the ADHD Index to be a poor predictor of a negative ADHD diagnosis, suggesting against the use of this scale for cutoff determination. Despite this limitation, these findings indicate that with specific cutoffs, the CAARS-S:L may have the potential to conclusively rule out ADHD, effectively streamlining the diagnostic process and reducing unnecessary comprehensive assessments in clear negative cases.
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Affiliation(s)
- Dylan Kwan
- Regional Assessment & Resource Centre, Queens University, Kingston, ON, Canada
| | - Nathaniel Davin
- Regional Assessment & Resource Centre, Queens University, Kingston, ON, Canada
| | - Allyson G Harrison
- Regional Assessment & Resource Centre, Queens University, Kingston, ON, Canada
| | - Sienna Gillie
- Regional Assessment & Resource Centre, Queens University, Kingston, ON, Canada
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Simon KE, Buttram ME, Samuel KD, Doyle NA, Davis RE. Stigma Related to the Non-Medical Use and Diversion of Prescription Stimulant Drugs: Should We Care. Subst Use Misuse 2024; 59:1200-1209. [PMID: 38565901 DOI: 10.1080/10826084.2024.2330903] [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: 04/04/2024]
Abstract
BACKGROUND Non-medical use (NMU) and diversion of prescription stimulants are prevalent on college campuses. Diversion represents a primary source of acquisition for NMU among young adults. This study examined relationships between stigmatizing beliefs related to NMU and diversion of stimulant medications and engagement in these behaviors, as well as how such perceptions are associated with indicators of psychological distress among those who engage in these behaviors. METHODS Young adults (N = 384) were recruited from a large US university to participate in this cross-sectional electronic survey-based study. Relationships between stigma variables and NMU and diversion were assessed. Among those who engage in NMU and diversion, we tested relationships between stigma variables and indicators of psychological distress, using validated instruments. RESULTS Perceived social and personal stigmatic beliefs did not significantly predict NMU. However, perceived social and personal stigma of diversion significantly reduced diversion likelihood. For NMU, associations were found between stigma variables and indicators of psychological distress. Markedly, we found that as stigmatic perceptions of NMU increased, so did depressive, anxiolytic, and suicidal symptomatology among those who engage in NMU. CONCLUSIONS Stigmatization does not deter NMU; however, stigmatization is positively associated with psychological harm among those who engage in NMU. Interventions should be developed to reduce stigmatization in order to improve psychological health among those who engage in NMU. Stigmatic perceptions of diversion were not predictive of psychological harm, though they are negatively associated with diversion behavior.
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Affiliation(s)
- Kayla E Simon
- Department of Health, Human Performance, and Recreation, Substance Use and Mental Health Laboratory, University of Arkansas, Fayetteville, Arkansas, USA
| | - Mance E Buttram
- Department of Health, Human Performance, and Recreation, Center for Public Health and Technology, University of Arkansas, Fayetteville, Arkansas, USA
| | - Krishen D Samuel
- Department of Health, Human Performance, and Recreation, Substance Use and Mental Health Laboratory, University of Arkansas, Fayetteville, Arkansas, USA
| | - Nicole A Doyle
- College of Global Population Health, University of Health Sciences and Pharmacy, St. Louis, Missouri, USA
| | - Robert E Davis
- Department of Health, Human Performance, and Recreation, Substance Use and Mental Health Laboratory, University of Arkansas, Fayetteville, Arkansas, USA
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Brooks JM, Guilfoyle J, Alfonso D, Oh A, Nili AN, Frick LA, Resch ZJ, Soble JR, Ulrich DM. Differentiating Performance on the Connors Continuous Performance Test (CPT-3) as a Function of Comorbid Internalizing Psychopathology. J Atten Disord 2024; 28:1024-1031. [PMID: 38214177 DOI: 10.1177/10870547231219000] [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: 01/13/2024]
Abstract
OBJECTIVE Internalizing psychopathology commonly co-occurs with attention-deficit/hyperactivity disorder (ADHD). Attention concerns are present in both ADHD and internalizing disorders, yet the neuropsychological functioning of those with comorbid ADHD and internalizing psychopathology is underexamined. METHOD This study compared Conners' Continuous Performance Test-Third Edition (CPT-3) profiles across ADHD (n = 141), internalizing psychopathology (n = 78), and comorbid (ADHD/internalizing psychopathology; n = 240) groups. RESULTS Compared to the internalizing psychopathology group, the comorbid group had higher mean T-scores on CPT-3 indices indicative of inattentiveness and impulsivity and more clinically elevated T-scores (T>60) on indices measuring inattentiveness and impaired sustained attention. Patients in the comorbid group were also more likely to have abnormal overall CPT-3 profiles (>2 elevated T-scores) than the ADHD and psychopathology only groups. CONCLUSION Patients with comorbid ADHD/internalizing psychopathology may evidence a more impaired attentional performance on the CPT-3, which could aid in more tailored treatment planning.
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Affiliation(s)
- Julia M Brooks
- University of Illinois College of Medicine, Chicago, USA
- University of Illinois at Chicago, IL, USA
| | - Janna Guilfoyle
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Alison Oh
- Illinois Institute of Technology, Chicago, USA
| | - Amanda N Nili
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Jason R Soble
- University of Illinois College of Medicine, Chicago, USA
| | - Devin M Ulrich
- University of Illinois College of Medicine, Chicago, USA
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Parpottas P, Christofi Y, Ioannou I. Adaptation, Academic Performance and Support: Students with and without Disabilities and Future Considerations for Counselling Psychology. Behav Sci (Basel) 2023; 13:862. [PMID: 37887512 PMCID: PMC10604788 DOI: 10.3390/bs13100862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
The transition to university is a process that presents young adults with several challenges in adaptation, especially students with disabilities. The current study investigated the differences in adaptation and academic performance between students with and without disabilities and further examined these differences among students with disabilities. Additionally, we explored the role of academic support for students with disabilities' adaptation and academic performance, as well as their perceptions of a proposed specialised package of counselling psychology interventions. The sample consisted of 127 students with disabilities and 127 without disabilities, aged 18-24 years. Results revealed that students with disabilities reported a lower GPA and adaptation than students without disabilities. Additionally, differences among students with disabilities were observed only in terms of GPA, according to their disability type, existence of comorbidity and type of exam accommodations. Interestingly, no differences were found in GPA or adaptation between students with disabilities who utilised psychological therapy and those who did not. Finally, adaptation scores, but not GPA, were higher for students with disabilities who were positive in receiving a specialised package of counselling psychology interventions. The findings are discussed in relation to the existing literature and future considerations of counselling psychology's role in support of students with disabilities.
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Affiliation(s)
- Panagiotis Parpottas
- Department of Social and Behavioral Sciences, School of Humanities, Social and Education Sciences, European University Cyprus, 2404 Engomi, Cyprus
| | - Yianna Christofi
- Committee for Students with Special Educational Needs, European University Cyprus, 2404 Engomi, Cyprus; (Y.C.); (I.I.)
| | - Ioanna Ioannou
- Committee for Students with Special Educational Needs, European University Cyprus, 2404 Engomi, Cyprus; (Y.C.); (I.I.)
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Shebl EM, Abu Bakr Elsaid NM, Hassan HA, Kamal D, Araby E. Attention-deficit hyperactivity disorder in Egyptian medical students and how it relates to their academic performance. J Family Community Med 2023; 30:287-294. [PMID: 38044975 PMCID: PMC10688586 DOI: 10.4103/jfcm.jfcm_59_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/08/2023] [Accepted: 07/31/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The neurobehavioral disorder, known as attention-deficit hyperactivity disorder (ADHD), is characterized by impulsivity, hyperactivity, and a lack of focus. In addition, it is connected to poor academic performance. The purpose of this study was to determine the prevalence of ADHD and its effect on their academic performance among medical students. MATERIALS AND METHODS This web-based cross-sectional study was conducted among medical students of four medical colleges during December 2021 and April 2022. Data was collected using a self-administered questionnaire comprising Wender Utah Rating Scale and adult ADHD Self-Report Scale [ASRS]. The link to Google Form survey was distributed to students through academic emails and WhatsApp. Data analyzed using SPSS; Chisquare test or Fisher's exact test as appropriate, were used to determine statistical significance. RESULTS A total of 990 students filled online questionnaire; 54.7% were females.. The estimated prevalence of ADHD in Egyptian medical students was 11%. Students who had childhood ADHD were significantly linked with the present ADHD (r = 0.54, P < 0.001). There was a negative correlation between the ASRS score for ADHD and students' GPA (r = 0.2, P < 0.001). No statistically significant association was observed between ADHD and sex, type of university, and academic level. of the students. CONCLUSION ADHD is prevalent among medical students. Since most of our students with adult ADHD also had preexisting childhood ADHD, it is crucial that the primary care services, especially school health services, have appropriate standards for the early identification and management of ADHD. Health authorities should conduct a comprehensive health education campaign to raise public awareness of ADHD and its risk factors, the clinical picture, and the burden.
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Affiliation(s)
- Eman M. Shebl
- Department of Public Health and Community Medicine, Benha University, Benha, Egypt
| | - Noha M. Abu Bakr Elsaid
- Department of Public Health, Community, Environmental and Occupational Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Department of Basic Medical Sciences, Faculty of Medicine, King Salman International University, South Sinai, Egypt
| | - Hend A. Hassan
- Department of Public Health and Community Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Doaa Kamal
- Department of Medical Education, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Department of Basic Medical Sciences, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Eman Araby
- Department of Public Health and Community Medicine, Benha University, Egypt
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Maffly-Kipp J, Morey LC. Detecting Attention Deficit Hyperactivity Disorder and its feigning using the Personality Assessment Inventory. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-10. [PMID: 37155738 DOI: 10.1080/23279095.2023.2207215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Attention Deficit Hyperactivity Disorder is a relatively common and often disabling disorder in adults. However, feigning ADHD symptomatology is both easy and potentially common. We explored the most effective strategies for A) identifying individuals who had been diagnosed with ADHD based on existing PAI symptom indicators, and B), discriminating between feigned and genuine ADHD symptoms using PAI negative distortion indicators. Our sample consisted of 463 college aged participants who had been diagnosed with ADHD (n = 60), were asked to feign ADHD (n = 71), and a control group (n = 333). Self-reported diagnosis and successful feigning were corroborated by the CAARS-S: E scale. We first compared two PAI-derived ADHD indicators to determine which best differentiated between our ADHD and Control groups. Next, we compared seven negative distortion indicators to determine which could best distinguish between real and feigned ADHD symptoms. Our results revealed that the PAI-ADHD scale was the most effective symptom indicator. Further, the Negative Distortion Scale (NDS) and the Item-FAA scale were the most effective for identifying feigners. When assessing ADHD based on the PAI, the PAI-ADHD scale appears promising as an indicator of symptomatology, while the NDS and Item-FAA appear useful to rule-out feigning.
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Affiliation(s)
- Joseph Maffly-Kipp
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Leslie C Morey
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
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Hartman CA, Chen Q, Solberg BS, Du Rietz E, Klungsøyr K, Cortese S, Dalsgaard S, Haavik J, Ribasés M, Mostert JC, Libutzki B, Kittel-Schneider S, Cormand B, Vos M, Larsson H, Reif A, Faraone SV, Bellato A. Anxiety, mood, and substance use disorders in adult men and women with and without Attention-Deficit/Hyperactivity Disorder: a substantive and methodological overview. Neurosci Biobehav Rev 2023; 151:105209. [PMID: 37149075 DOI: 10.1016/j.neubiorev.2023.105209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 04/16/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
Knowledge on psychiatric comorbidity in adult ADHD is essential for prevention, detection, and treatment of these conditions. This review (1) focuses on large studies (n> 10,000; surveys, claims data, population registries) to identify (a) overall, (b) sex- and (c) age-specific patterns of comorbidity of anxiety disorders (ADs), major depressive disorder (MDD), bipolar disorder (BD) and substance use disorders (SUDs) in adults with ADHD relative to adults without ADHD; and (2) describes methodological challenges relating to establishing comorbidity in ADHD in adults as well as priorities for future research. Meta-analyses (ADHD: n=550,748; no ADHD n=14,546,814) yielded pooled odds ratios of 5.0(CI:3.29-7.46) for AD, 4.5(CI:2.44-8.34) for MDD, 8.7(CI:5.47-13.89) for BD and 4.6(CI:2.72-7.80) for SUDs, indicating strong differences in adults with compared to adults without ADHD. Moderation by sex was not found: high comorbidity held for both men and women with sex-specific patterns as in the general population: higher prevalences of ADs, MDD and BD in women and a higher prevalence of SUDs in men. Insufficient data on different phases of the adult lifespan prevented conclusions on developmental changes in comorbidity. We discuss methodological challenges, knowledge gaps, and future research priorities.
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Affiliation(s)
- Catharina A Hartman
- University Medical Center Groningen, Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, the Netherlands.
| | - Qi Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Berit Skretting Solberg
- Child- and adolescent psychiatric outpatient unit, Hospital Betanien, Bergen, Norway; Department of Biomedicine, University of Bergen, Norway
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Samuele Cortese
- Centre 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
| | - Søren Dalsgaard
- NCRR - National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark; CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Norway; Bergen Center of Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Marta Ribasés
- Department of Psychiatry, Mental Health and Addictions, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Department of Genetics, Microbiology & Statistics, University of Barcelona, Barcelona, Spain
| | - Jeanette C Mostert
- Department of Psychiatry, Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Center Nijmegen, the Netherlands; Department of Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Berit Libutzki
- University Medical Center Groningen, Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, the Netherlands
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatic, University Hospital Würzburg, Würzburg, Germany
| | - Bru Cormand
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Catalonia, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Catalonia, Spain
| | - Melissa Vos
- University Medical Center Groningen, Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, the Netherlands
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alessio Bellato
- School of Psychology, University of Nottingham, Semenyih, Malaysia
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Schein J, Childress A, Gagnon-Sanschagrin P, Maitland J, Bedard J, Cloutier M, Guérin A. Treatment Patterns Among Patients with Attention-Deficit/Hyperactivity Disorder and Comorbid Anxiety and/or Depression in the United States: A Retrospective Claims Analysis. Adv Ther 2023; 40:2265-2281. [PMID: 36913128 PMCID: PMC10129978 DOI: 10.1007/s12325-023-02458-5] [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: 10/21/2022] [Accepted: 02/10/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Patients with attention-deficit/hyperactivity disorder (ADHD) often have psychiatric comorbidities that may confound diagnosis and affect treatment outcomes and costs. The current study described treatment patterns and healthcare costs among patients with ADHD and comorbid anxiety and/or depression in the United States (USA). METHODS Patients with ADHD initiating pharmacological treatments were identified from IBM MarketScan Data (2014-2018). The index date was the first observed ADHD treatment. Comorbidity profiles (anxiety and/or depression) were assessed during the 6-month baseline period. Treatment changes (discontinuation, switch, add-on, drop) were examined during the 12-month study period. Adjusted odds ratios (ORs) of experiencing a treatment change were estimated. Adjusted annual healthcare costs were compared between patients with and without treatment changes. RESULTS Among 172,010 patients with ADHD (children [aged 6-12] N = 49,756; adolescents [aged 13-17] N = 29,093; adults [aged 18 +] N = 93,161), the proportion of patients with anxiety and depression increased from childhood to adulthood (anxiety 11.0%, 17.7%, 23.0%; depression 3.4%, 15.7%, 19.0%; anxiety and/or depression 12.9%, 25.4%, 32.2%). Compared with patients without the comorbidity profile, those with the comorbidity profile experienced a significantly higher odds of a treatment change (ORs [children, adolescents, adults] 1.37, 1.19, 1.19 for those with anxiety; 1.37, 1.30, 1.29 for those with depression; and 1.39, 1.25, 1.21 for those with anxiety and/or depression). Excess costs associated with a treatment change were generally higher with more treatment changes. Among patients with three or more treatment changes, annual excess costs per child, adolescent, and adult were $2234, $6557, and $3891 for those with anxiety; $4595, $3966, and $4997 for those with depression; and $2733, $5082, and $3483 for those with anxiety and/or depression. CONCLUSIONS Over 12 months, patients with ADHD and comorbid anxiety and/or depression were significantly more likely to experience a treatment change than those without these psychiatric comorbidities and incurred higher excess costs with additional treatment changes.
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Affiliation(s)
- Jeff Schein
- Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center Dr, Princeton, NJ 08540 USA
| | - Ann Childress
- Center for Psychiatry and Behavioral Medicine, Inc., 7351 Prairie Falcon Rd STE 160, Las Vegas, NV 89128 USA
| | - Patrick Gagnon-Sanschagrin
- Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
| | - Jessica Maitland
- Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
| | - Jerome Bedard
- Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
| | - Martin Cloutier
- Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
| | - Annie Guérin
- Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
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Müller V, Mellor D, Piko BF. How to Procrastinate Productively With ADHD: A Study of Smartphone Use, Depression, and Other Academic Variables Among University Students With ADHD Symptoms. J Atten Disord 2023:10870547231171724. [PMID: 37119209 DOI: 10.1177/10870547231171724] [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: 05/01/2023]
Abstract
OBJECTIVE The association between chemical dependency and Attention-Deficit Hyperactivity Disorder is widely recognized, but there is less data regarding modern behavioral addictions among young adults. METHOD In this cross-sectional study, a sample of 408 Hungarian college students (67.2% female, mean age 23.37 years [SD = 3.87]) responded to an online survey including the Adult ADHD Self-Report Scale, the Center for Epidemiologic Studies-Depression Scale (CES-D), the Procrastination Scale, the Short College Boredom Scale, and the Smartphone Addiction Scale (SAS-SV). RESULTS Regression analyses showed that passive procrastination (ß = .31, p < .001), depression (ß = .20, p < .001), academic boredom (ß = .18, p < .001), active procrastination (ß = -.12, p < .001), and smartphone addiction (ß = .13, p < .001) were significantly related to ADHD symptoms, accounting for 41% of the variance. CONCLUSION Findings provide important additions to knowledge of mental health challenges among young adults with ADHD.
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Sonuga-Barke EJS, Becker SP, Bölte S, Castellanos FX, Franke B, Newcorn JH, Nigg JT, Rohde LA, Simonoff E. Annual Research Review: Perspectives on progress in ADHD science - from characterization to cause. J Child Psychol Psychiatry 2023; 64:506-532. [PMID: 36220605 PMCID: PMC10023337 DOI: 10.1111/jcpp.13696] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 12/20/2022]
Abstract
The science of attention-deficit/hyperactivity disorder (ADHD) is motivated by a translational goal - the discovery and exploitation of knowledge about the nature of ADHD to the benefit of those individuals whose lives it affects. Over the past fifty years, scientific research has made enormous strides in characterizing the ADHD condition and in understanding its correlates and causes. However, the translation of these scientific insights into clinical benefits has been limited. In this review, we provide a selective and focused survey of the scientific field of ADHD, providing our personal perspectives on what constitutes the scientific consensus, important new leads to be highlighted, and the key outstanding questions to be addressed going forward. We cover two broad domains - clinical characterization and, risk factors, causal processes and neuro-biological pathways. Part one focuses on the developmental course of ADHD, co-occurring characteristics and conditions, and the functional impact of living with ADHD - including impairment, quality of life, and stigma. In part two, we explore genetic and environmental influences and putative mediating brain processes. In the final section, we reflect on the future of the ADHD construct in the light of cross-cutting scientific themes and recent conceptual reformulations that cast ADHD traits as part of a broader spectrum of neurodivergence.
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Affiliation(s)
- Edmund J S Sonuga-Barke
- School of Academic Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, King’s College London. UK
- Department of Child & Adolescent Psychiatry, Aarhus University, Denmark
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Sven Bölte
- Department of Women’s and Children’s Health, Karolinska Institutet, Sweden
- Division of Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Sweden
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Joel T. Nigg
- Department of Psychiatry, Oregon Health and Science University, USA
| | - 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
| | - Emily Simonoff
- School of Academic Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, King’s College London. UK
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Brown N, McLafferty M, O’Neill SM, McHugh R, Ward C, McBride L, Brady J, Bjourson AJ, Walsh CP, Murray EK. The Mediating Roles of Mental Health and Substance Use on Suicidal Behavior Among Undergraduate Students With ADHD. J Atten Disord 2022; 26:1437-1451. [PMID: 35118906 PMCID: PMC9277323 DOI: 10.1177/10870547221075844] [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: 11/16/2022]
Abstract
OBJECTIVE To evaluate the prevalence of suicidal ideation (SI), plans and attempts, and non-suicidal self-injury (NSSI) among students with attention deficit hyperactivity disorder (ADHD). Furthermore, we explored the mediating effects of depression, anxiety, alcohol and substance use on the association between ADHD and suicidal behaviors and NSSI. METHOD Participants were first-year undergraduate students (n = 1,829) recruited as part of the World Mental Health International College Student Initiative. Participants completed validated clinical measures online. RESULTS The prevalence of suicide behaviors and NSSI were significantly higher among students with ADHD than those without. Mediation analyses indicated that ADHD directly and indirectly increased suicidal behaviors and NSSI. While ADHD increased suicidal behaviors and NSSI through depression, ADHD and the co-variates age and gender also had indirect effects on suicidal behaviors via substance use. CONCLUSIONS Specific predictors of risk were identified for students with ADHD which may inform the development of more targeted mental health and suicide prevention strategies across campuses.
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Affiliation(s)
- Natasha Brown
- Letterkenny Institute of
Technology, Co. Donegal, Ireland
| | - Margaret McLafferty
- Northern Ireland Centre for
Stratified Medicine, School of Biomedical Sciences, C-TRIC, Altnagelvin
Hospital, Ulster University, Derry/Londonderry, UK
| | - Siobhan M. O’Neill
- School of Psychology, Coleraine
Campus, Ulster University, Coleraine, Co. Derry, UK
| | - Rachel McHugh
- School of Psychology, Coleraine
Campus, Ulster University, Coleraine, Co. Derry, UK
| | - Caoimhe Ward
- Northern Ireland Centre for
Stratified Medicine, School of Biomedical Sciences, C-TRIC, Altnagelvin
Hospital, Ulster University, Derry/Londonderry, UK
| | - Louise McBride
- Letterkenny Institute of
Technology, Co. Donegal, Ireland
| | - John Brady
- Western Health and Social Care
Trust, Tyrone and Fermanagh Hospital, Omagh, Co. Tyrone, UK
| | - Anthony J. Bjourson
- Northern Ireland Centre for
Stratified Medicine, School of Biomedical Sciences, C-TRIC, Altnagelvin
Hospital, Ulster University, Derry/Londonderry, UK
| | - Colum P. Walsh
- Genomics Medicine Research Group,
School of Biomedical Sciences, Coleraine Campus, Ulster University,
Coleraine, Co. Derry, UK
| | - Elaine K. Murray
- Northern Ireland Centre for
Stratified Medicine, School of Biomedical Sciences, C-TRIC, Altnagelvin
Hospital, Ulster University, Derry/Londonderry, UK,Elaine K. Murray, Northern Ireland
Centre for Stratified Medicine, School of Biomedical Sciences, Ulster
University, C-TRIC, Altnagelvin Hospital, Glenshane Road,
Derry/Londonderry BT47 6SB, UK.
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Riboldi I, Crocamo C, Callovini T, Capogrosso CA, Piacenti S, Calabrese A, Lucini Paioni S, Moretti F, Bartoli F, Carrà G. Testing the Impact of Depressive and Anxiety Features on the Association between Attention-Deficit/Hyperactivity Disorder Symptoms and Academic Performance among University Students: A Mediation Analysis. Brain Sci 2022; 12:brainsci12091155. [PMID: 36138891 PMCID: PMC9496751 DOI: 10.3390/brainsci12091155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 12/03/2022] Open
Abstract
Attention deficit/hyperactivity disorder (ADHD) is associated with poor academic performance also among university students. This relationship may be made more complex by comorbid conditions. The aim of this study was to evaluate the mediating role of anxiety and depressive symptoms in the relationship between ADHD and academic performance. Data were drawn from the CAMPUS study (registration number: 0058642/21), an ongoing survey on university students’ mental health. Using a logit model, mediation analyses were carried out to test whether the relationship between ADHD symptoms (assessed by ASRS-5) and academic performance might be mediated by depressive (assessed by PHQ-9) and anxiety (assessed by GAD-7) symptoms. Our results showed that worse academic performance is associated with ADHD symptoms (p < 0.001). However, about 24% of the overall association between ADHD symptoms and academic performance was mediated by depressive symptoms (indirect effect: 0.065, 95%CI 0.022; 0.100), whereas the contribution of anxiety symptoms to the model was not significant. Along with the association between ADHD symptoms and poor academic performance, our findings highlight the key mediating role of depressive symptoms, which may be targeted with tailored support, ultimately improving both the academic performance and the well-being of university students with ADHD.
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Affiliation(s)
- Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-02-5799-8647
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | | | - Susanna Piacenti
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Susanna Lucini Paioni
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
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