Journal of Attention Disorders最新文献

Objective: Females represent a growing proportion of adults with ADHD yet remain understudied in the literature compared to males. An important aspect of the experience of females with ADHD is the impact of the menstrual cycle and ovarian hormones on both the symptoms of ADHD and effects of stimulant medications on treating these symptoms.

Method: In the present pilot study, female participants being treated with amphetamine salts for ADHD (n = 30) were recruited to complete 35 daily online surveys to track ADHD symptoms, mood, and medication use through the menstrual cycle.

Results: Results indicated that the degree of ADHD symptoms was significantly associated with menstrual cycle phase with ADHD symptoms being most severe in the menstruation phase and comparatively milder ADHD symptoms in the mid-follicular phase. This difference was positively correlated with subjective changes in negative mood.

Conclusion: These results indicate that ADHD symptoms vary across the menstrual cycle among females being treated with amphetamine salts for their ADHD, a finding that could inform clinical and prescribing practices for physicians caring for females with ADHD.

Background: Attention deficit hyperactivity disorder (ADHD) is well-established as a disorder that persists into adulthood and is commonly comorbid with other mental health conditions. Despite increasing numbers of women entering reproductive years with this diagnosis, there is limited research on it in the perinatal period.

Objective: To critically appraise the available literature and examine the association between maternal ADHD and depression in the perinatal period.

Methods: A systematic review was conducted by searching EMBASE, PsycINFO, MEDLINE and Google Scholar up to August 2024. The available literature was evaluated in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). The quality assessment was performed using the Joanna Briggs Institute framework, and a narrative synthesis was completed.

Results: Ten studies were identified as meeting the inclusion criteria. The majority were of medium quality, with issues identified in sample size, study design and validity of the self-report scale used. Our review found a prevalence of 16.76% to 57.6% of perinatal depression in women with ADHD. An increased risk of developing perinatal depression was also identified in women with ADHD (OR 1.8-2.63) compared to those without the disorder. Finally, our review also found a positive association between ADHD symptoms and depressive symptoms in perinatal women.

Conclusion: Our findings suggest a much greater vulnerability to perinatal depression among women with ADHD, and an association between ADHD symptoms and depressive symptoms in the perinatal period. There is, however, a clear need for more high-quality studies to replicate and further explore these findings.

Objective: The rates of women of reproductive age diagnosed with ADHD have increased significantly. However, little is known about how pregnancy, childbirth, and the postpartum period influence ADHD related problems, help-seeking behaviors or the timing of ADHD diagnosis. This study aimed to investigate incident ADHD diagnoses among women from 5 years before to 5 years after childbirth.

Method: The population-based cohort study utilized Danish nationwide registers to identify mothers of all childbirths between 2010 and 2018. ADHD diagnoses, defined as ICD-10 codes (F90 or F98.8) or redemption of ADHD medication prescriptions, were recorded during 1994 to 2023. Women who received an ADHD diagnosis prior to the five-year pre-birth period were excluded. We estimated calendar-year adjusted incidence of first-time maternal ADHD diagnoses using Poisson regression, and compared incidence across pre-pregnancy, pregnancy, postpartum up to 2 years, and 2 to 5 years postpartum, reporting adjusted incidence rate ratios (IRRs). Analyses included psychiatric comorbidities and non-ADHD psychotropic medication use prior to an ADHD diagnosis, for women diagnosed with ADHD postpartum.

Results: The study included 363,904 mothers with a total of 524,936 childbirths. ADHD incidence rates decreased significantly during pregnancy (IRR = 0.28, 95% CI [0.22, 0.37]), remained lower than the pre-pregnancy period 2 years postpartum (IRR 0.82, 95% CI [0.74, 0.92]), and increased significantly above pre-pregnancy levels 2 to 5 years postpartum (IRR = 1.24, 95% CI [1.13, 1.35]). Among mothers diagnosed with ADHD postpartum, 53.9% had an in- or outpatient contact to psychiatric services or redeemed non-ADHD psychotropic medication prescriptions, in the period from childbirth until ADHD diagnosis.

Conclusion: Incident ADHD diagnoses among women giving birth increased postpartum above pre-pregnancy levels, with peak rates observed between 2 and 5 years after childbirth. These findings highlight the postpartum period as a potential critical window of ADHD symptom worsening, underscoring the need for targeted mental health screenings and support for women during the years after childbirth.

Objective: Previous animal studies have suggested a link between progesterone exposure and the development of attention deficit hyperactivity disorder (ADHD). This study clinically evaluated the effect of progesterone use during pregnancy on the risk of ADHD in children.

Methods: In this prospective case-control study, 97 children diagnosed with ADHD and 194 age- and sex-matched controls were included. Maternal progesterone use-via suppositories or injections-during pregnancy was assessed. Data were analyzed using SPSS.

Results: The mean age was slightly higher in the ADHD group, but not significantly. Male predominance was observed among ADHD cases, although not statistically significant. While neonatal hospitalization rates were similar, the duration was longer in the ADHD group (p = .009). Cesarean delivery and lower maternal education levels were significantly more common in the ADHD group (p = .004 and p = .013, respectively). No significant difference in overall progesterone use was found between ADHD and control groups (17.5% vs. 19.1%; p = .749). Injectable progesterone was used in 5.2% of ADHD cases and 10.8% of controls (p = .130), and the timing of use across pregnancy trimesters did not differ significantly (p = .493). Vaginal suppository use was also comparable (15.5% vs. 12.4%; p = .465). However, continuous progesterone use throughout all trimesters was more frequently reported among ADHD cases (20.0% vs. 4.2%), suggesting a possible association that needs further investigation.

Conclusion: Unlike findings from animal models, progesterone use during pregnancy does not appear to be associated with ADHD development. Still, prolonged exposure may warrant further investigation.

Objective: Cognitive behavioral therapy (CBT) is an efficacious treatment for adult ADHD, yet access and availability concerns limit scalability. Mobile health apps are promising tools for delivering scalable CBT. The current study reports findings from a randomized controlled trial (RCT) of a CBT-informed health app for adults with ADHD.

Methods: A sample of assessed adults with ADHD (N = 154; ages 18-55 years) were recruited to participate and randomized to either 8 weeks of use of the CBT-informed app or a waitlist control condition. Participants in both groups completed measures of ADHD symptoms and functioning at baseline, at 4 weeks, and at 8 weeks.

Results: Linear mixed-effects models for repeated measurements revealed significant group x time interactions for inattentive symptoms (η² = .15), hyperactive-impulsive symptoms (η² = .05), and ADHD associated quality of life (η² = .04) in favor of the CBT-informed app relative to participants who knew they were not receiving help; however, these results did not extend to a measure of functional impairment. Changes in organizational, time management, and planning behaviors and ADHD-related cognitions partially mediated the association between group and inattentive symptom changes. ADHD inattentive symptom reductions were positively associated with the total number of app exercises completed.

Conclusions: The confidence in our results is limited by our use of a waitlist control design. However, participants who used the CBT-informed app perceived improvements in inattentive and hyperactive-impulsive symptoms and quality of life relative to participants who knew they were not receiving help.

Object: Temperament provides a valuable framework for understanding ADHD across the lifespan, as extreme temperamental traits are considered etiological risk factors. The dual-pathway model links specific temperamental traits to ADHD symptom domains: elevated reactive traits, surgency and negative affect, to hyperactivity/impulsivity, and a low regulatory trait, effortful control, to inattention.

Method: One hundred fifty-eight adults (79 with clinical diagnoses of ADHD and 79 controls) filled in the Adult Temperament Questionnaire. Consistent with a compensatory extension of the dual-pathway model, it was hypothesized that effortful control would moderate the effects of reactive traits (surgency/negative affect) on hyperactive/impulsive symptoms and influence both ADHD symptom domains. For exploratory purposes, orienting sensitivity, an adult temperament factor related to perceptual sensitivity, was included in the analyses.

Results: Binary logistic regression identified lower effortful control as the strongest predictor of an ADHD diagnosis. Negative affect had a significant but small effect, while surgency and orienting sensitivity were non-significant. Two hierarchical regressions were performed for self-rated symptoms of hyperactivity/impulsivity and inattention. Consistent with a compensatory model, effortful control was significantly related to symptom expression in both ADHD symptom domains. Contrary to expectations, surgency did not explain variance in hyperactivity/impulsivity, and the effect of negative affect was strongly reduced, after effortful control was added to the model. Effortful control did not moderate the effects of surgency and negative affect.

Conclusion: These findings challenge the dual-pathway model and highlight self-regulation deficits over reactive traits in sustaining ADHD in adulthood. They underscore the value of temperament-based approaches for refining diagnosis and developing targeted interventions for adult ADHD.

Background: Sleep problems are highly prevalent in adults with ADHD. Sleep problems and ADHD symptoms can cause, amplify, and maintain each other. We studied the effects of additive treatment for sleep problems on self-reported symptoms of ADHD as primary outcome, with subscales of inattention and hyperactivity-impulsivity, objective, performance-based ADHD symptoms, sleep quality, fatigue, and depressive symptoms as secondary outcomes.

Methods: Preliminary open-label randomized controlled trial of adult patients diagnosed with ADHD and a positive screening for at least one sleep disorder. Participants were recruited between March, 2020 and May, 2023, during the COVID-19 pandemic. Seventy patients (60% female, mean age 27.9 years [SD = 8.2]) were randomized to a 12-week period of: (1) ADHD treatment as usual (TAU, n = 25), (2) ADHD TAU + sleep treatment (n = 22), or (3) stand-alone sleep treatment (n = 33). Outcome measures were assessed at baseline, and after 6 and 12 weeks of treatment. A total of 20% of participants did not complete the post-treatment assessment. Primary analyses compared changes between groups 1 and 2. Exploratory within-group analyses were conducted to assess improvements in the stand-alone sleep treatment group. All performed analyses were pre-specified.

Results: Primary analysis showed no significant difference in the reduction of subjective ADHD symptoms between the ADHD TAU + sleep treatment group and the ADHD TAU group (β = -1.30, 95% CI [-5.57, 2.96], d = 0.21). The ADHD TAU + sleep treatment group did show significantly larger improvements in subjective sleep quality (β = -1.98, 95% CI [-3.65, -0.30], d = 0.42) and fatigue (β = -6.52, 95% CI [-12.33, -0.70], d = 1.59) compared to the ADHD TAU group. Pre-specified, exploratory within-group analysis showed a significant reduction in subjective ADHD symptoms in the stand-alone sleep treatment group (β = -4.80, 95% CI [-7.60, -2.01], d = 0.62).

Conclusion: Adding sleep treatment to standard ADHD treatment did not lead to significantly greater reductions in subjective or objective, performance based ADHD symptoms. However, combined treatment showed the largest improvements in sleep quality and fatigue, suggesting that such an approach may offer additional benefits. Subjective ADHD symptoms improved in the stand-alone sleep treatment group, but to a lesser extent than the other groups. Future studies with greater statistical power are needed, with long-term effects and quality of life as important outcomes.

ADHD is complex neurodevelopmental disorder that causes considerable individual and social difficulties, creating significant parental stress. This study aimed to examine the indirect associations between parental stress and child irritability through two sequential parenting mechanisms: experiential avoidance and negative parent-child relationship, within a sample of school-aged children with ADHD (ages 6-12). Using a two-wave longitudinal serial path analysis based on parent-reported data collected at two time points 1-month apart (Time 1 and Time 2), the study investigated whether early parental stress predicted subsequent child irritability via its influence on experiential avoidance and the quality of the parent-child relationship. Findings supported the hypothesized model. More precisely, higher parental stress was associated with greater experiential avoidance, which in turn predicted more negative parent-child relationship, ultimately resulting in elevated child irritability. Longitudinal serial mediation effects confirmed that all Time 1 variables significantly predicted corresponding Time 2 outcomes across the proposed sequential pathway. Notably, the model explained 41.1% of the variance in child irritability at Time 2, underscoring how stress-related disruptions in experiential avoidance and parent-child relationship can affect child irritability even over a short period of time. Taken together, these findings provide empirical support for a stress-driven sequence of parental mechanisms through which parental stress may contribute to child irritability in ADHD. In this context, interventions targeting parental experiential avoidance and improving the quality of parent-child relationship may help mitigate the early development of irritability in children with ADHD. Clinical implications are discussed.