Journal of Attention Disorders最新文献

Objective: To examine the Strengths and Weaknesses of ADHD-Symptoms and Normal Behavior scale (SWAN) clinical utility as a diagnostic measure of ADHD in an ADHD clinic sample.

Method: In a sample of 357 children (6-11 years old) referred for evaluation at an academic medical center, we explored the SWAN's diagnostic and convergent validity with the Hyperactivity-Inattention subscale of the Strengths and Difficulties Questionnaire (SDQ/HI) and concurrent validity with the Impairment Rating Scale (IRS).

Results: The averaged (SWAN total) and the SWAN Hyperactivity/Impulsivity subscale (SWAN HI) showed significant and large correlations with the SDQ/HI (r = .69 and .65), respectively. The SWAN Attention Deficit subscale (SWAN AD) had a significant but smaller correlation (r = .49). The SWAN total had moderate correlation with the IRS average score ( = .33). In receiver operating characteristic (ROC) curve analyses (area under the curve (AUC) = 0.71) for the SWAN total, the SWAN distinguished ADHD cases from non-ADHD cases with sensitivity of 83% but specificity of 47%.

Conclusion: In a clinical sample, the SWAN total scores displayed a near-normal distribution. ADHD cases were distinguished from non-ADHD cases by the SWAN. The SWAN showed adequate convergent and concurrent validity with other symptoms and impairment measures.

Objectives: Although ADHD has its roots in childhood, significant symptoms persist into adulthood for more than half of individuals. Adults with ADHD are heterogeneous in terms of symptom presentations, impairment domains, and relative strengths. Consequently, it is essential to better understand the diverse self-perceptions and experiences of adults with ADHD; qualitative methods are a valuable complement to quantitative work in this area. Our aim is to provide a scoping review of qualitative studies on adults with ADHD to articulate the current status of the field and establish future research directions.

Method: We review 41 studies, separating findings into four subpopulations: (1) adults with childhood ADHD, (2) college students with ADHD, (3) adults diagnosed with ADHD in adulthood, and (4) other studies (unspecified age of diagnosis).

Results: Qualitative research on all four subgroups identifies recurring themes: substance use, decisions about medication for ADHD, perceived domains of impairment, factors that promote or hinder success, and concerns about identity and stigma. Notably, the relative emphasis of each theme varies as a function of sample type. Specifically, qualitative research among adults with a childhood ADHD diagnosis focuses principally on substance use and treatment desistance, whereas studies of individuals diagnosed with ADHD as adults often examine emotional responses to receiving the diagnosis. For college students with ADHD, themes frequently relate to struggles with the increased independence demanded by post-secondary educational environments and the adoption of accommodations or coping strategies. For future studies of adult ADHD, we highlight key domains for which mixed-methods strategies will be critical: (a) similarities and differences between multiple reporters of functioning, (b) willingness to receive treatment, (c) women, (d) participants from diverse racial and ethnic groups, and (e) middle age and older adults.

Conclusion: In all, we highlight the value of qualitative and mixed-methods approaches to ensure that research captures the beliefs, intentions, experiences, emotions, and self-perspectives of people with ADHD.

Background: First-time diagnoses of attention-deficit/hyperactivity disorder (ADHD) in adults can be challenging due to diverse methodologies available for assessment, and the choices clinicians need to make about how to interpret diagnostic criteria. Network analysis is a statistical approach that has received growing attention in clinical research of recent years. It has the potential to aid visualization and illustrate the intricate relationships between the wide range of clinical measures.

Aim: The goal of the present study is to examine the value of network analysis on a sample of N = 896 adults newly diagnosed with ADHD in an outpatient referral context.

Method and results: The network depicts the interrelationship of a comprehensive set of measures and test variables, including symptom self- and other-reports, cognitive tests, motor activity, as well as measures of symptom and performance validity.

Conclusion: Our network analysis supports ADHD symptom clusters with distinct networks of motor activity and attention/impulsivity and reflects the mode of assessment, i.e., neuropsychological versus self- and observer-ratings. The network further depicts the dissociable role of symptom and performance validity measures, and the different nature of embedded and freestanding validity tests. We discuss the future application of network analysis in clinical research on ADHD.

Background: Individuals with cognitive disengagement syndrome (CDS) report both lower physical activity levels and more insomnia than the general population. However, reliable data on adults with CDS are missing so far. The aims of the present study were three-fold: (1) to investigate the associations between CDS and physical activity patterns among young adults, and more specifically dimensions of physical activity (walking time/week, bicycling time/week, and aerobic physical activity/week), (2) to explore, if CDS scores, physical activity patterns, and insomnia were interrelated, and (3) to explore, if physical activity was directly or indirectly associated with CDS via decreased insomnia.

Method: A total of 246 young adult students (M_age = 22.62; 56.3% females) participated in the present cross-sectional study. They completed a booklet of questionnaires covering socio-demographic information, cognitive disengagement syndrome (Adult Concentration Inventory; ACI), physical activity patterns (International Physical Activity Questionnaire; IPAQ), and insomnia (Insomnia Severity Index; ISI).

Results: Higher scores for the ACI as a proxy of CDS were associated with lower physical activity patterns (durations of walking, bicycling, and aerobic exercising per week), and with higher scores for insomnia. Conditional effects modelings showed that while there was no direct and indirect association of physical activity on CDS scores, both a direct and indirect association of insomnia via lower physical activity on higher CDS scores was observed.

Conclusions: Among a smaller sample of young adults, higher CDS scores were associated with lower physical activity patterns and with more insomnia. Given that standardized behavioral intervention programs are available to improve both daily and weekly physical activity patterns and insomnia, such interventions might also favorably improve CDS.

Objectives: Work performance is a critical aspect of daily living, significantly impacted by the characteristics of ADHD. However, current research lacks sophisticated, theoretically, and empirically supported instruments for assessing work performance in this context. Therefore, this study aimed to develop a comprehensive and psychometrically sound self-report instrument for assessing the work performance of adults with ADHD and related disorders.

Methods: An initial set of 40 work performance items was developed based on a multifactorial model, various preexisting questionnaires, and input from an interdisciplinary working group. Extensive psychometric analyses were conducted on a community sample of 714 participants engaged in paid work for at least 9 hr a week, randomly split into two subsamples.

Results: Confirmatory factor analyses (CFA) validated the 7-factor structure of the work performance scale. The initial set of items was reduced by 10 based on internal consistency and item redundancy, resulting in a final set of 30 items which we called Work and Occupational Performance in ADHD (WOPA). The WOPA was further evaluated for floor and ceiling effects, internal consistency, and item-rest correlation. Additionally, associations of work performance were examined concerning work characteristics, ADHD symptom severity, indicators of functional impairments, executive function deficits, and internal emotional states.

Discussion: The 30-item WOPA was developed based on empirically informed models, clinical considerations, and robust psychometric foundations. Subsequent clinical application is necessary to demonstrate its utility in clinical practice.

Objective: This study examines the impact of long-acting stimulant (LAS) pharmacotherapy for ADHD on academic outcomes among students in grades K-12 using retrospective analysis of administrative data.

Methods: ADHD diagnosis was identified based on ADHD management plans in school records, physician notes in billing records, and/or prescription records. Prescription records identified LAS-treated students (n = 15,544), excluding those treated with immediate/intermediate-acting stimulants or atomoxetine. A control group without ADHD (n = 204,681), and another with untreated ADHD (n = 27,880) were also identified. The following outcomes were examined using multivariate regression: report card scores, standardized assessment exam performance, graduation from high school, school attendance, and transition to post-secondary education.

Results: ADHD was associated with lower average report card scores and provincial assessment exam scores and increased frequency of school absence among grades K-12, and decreased likelihood of high school graduation and transition to post-secondary education. LAS treatment was associated with improved report card (score estimate -4.93 Treated, -6.19 Untreated) and provincial assessment exam scores (percentile rank estimate -9.20 Treated, -11.50 Untreated) among grades 9 to 12, reduced absences among grades K-12 (absence rate estimate -3.33 Treated, 7.96 Untreated), and increased likelihood of graduation (OR of failure to graduate 1.39 Treated, 2.22 Untreated) and transition to post-secondary education (OR of no transition 0.77 Treated, 1.42 Untreated; reference = No ADHD group).

Conclusion: LAS pharmacotherapy is associated with improved academic performance, attendance, and likelihood of graduation and transition to post-secondary education.

Objective: ADHD is commonly comorbid with depression and this comorbidity is associated with increased symptom severity and worse outcomes than either condition alone. Depression is highly heterogeneous and may present differently in populations with ADHD. This study aimed to explore different symptom presentations of depression and associated clinical correlates in a clinical ADHD sample. Method: We analysed data from the Study of ADHD Genes and Environment (SAGE). Parents completed semi-structured interviews about their child's psychopathology at baseline (M_age = 10.9 years) and the Mood and Feelings Questionnaire to capture their child's depression symptoms approximately 5 years later (M_age = 14.6 years, N = 246). Depression symptom presentations were derived by latent profile analysis. Results: Analyses found three presentations of depression symptoms: a 'low symptoms' class (48.5% of the sample), a 'high symptoms' class (15.5%) with consistently high depression symptoms, particularly for suicidality and poor self-esteem items, and an 'irritable/poor sleep' class (36.1%) with high scores for irritability and poor sleep and intermediate levels of other depression symptoms. All three classes had elevated irritability and symptoms that overlap with ADHD. Behavioural problems (oppositional defiant disorder; conduct disorder) were associated with an increased likelihood of being in the high symptoms compared to low symptoms class, and higher autism symptoms were associated with being in the 'irritable/poor sleep' compared to low symptoms class. Conculsion: Our findings suggest that while young people with ADHD often have elevated depression symptoms, there is notable heterogeneity. Young people with ADHD and behavioural disorders may be particularly at risk of a more severe depression symptom presentations characterised by high suicidal cognitions, whilst those with ADHD and autistic traits may present with more irritability and poor sleep.

Background: This review aimed to systematically review and synthesize qualitative evidence of the experiences of adults with ADHD who engage in stimulant medication treatment. A secondary aim was to establish the factors that influence adherence behavior regarding stimulant medication treatment for ADHD and appraise the quality of existing research.

Methods: Psych Info, Academic Search Complete, Embase, and Medline were searched between the 20th and 28th June 2024 for qualitative studies that explored the experiences of adults who had been prescribed stimulant medication for ADHD. A modified Critical Appraisal Skills Programme checklist was used to assess the risk of bias in included studies and a meta-ethnographic approach was used to synthesize the results.

Results: Forty-seven second-order constructs were identified from the 13 included papers (263 participants). Four third-order themes were identified: 1. Fitting in with society: Performance. 2. The impact of ADHD versus the side effects of stimulants. 3. Fitting in with society: Social functioning. 4. Difficulty accessing medication and specialist care. Further synthesis of these themes highlighted that access to a specialist doctor who was willing to "tweak" medication and dosage was both a key stimulus that triggered adherence behavior and a factor that influenced other stimuli for adherence behavior.

Discussion: Adults consistently found ADHD medications to be effective at reducing symptoms of ADHD, but their experience of taking the medications varied greatly due to the range of social, psychological, and physical side effects that could occur. All participants spoke about their experiences of taking ADHD medications in the context of "fitting in" with society: Being able to perform academically and in the workplace, as well as being able to meet familial and friendship obligations. However, "fitting in" could be both a motivation for adherence and non-adherence to medication. Societal perceptions and stigma around ADHD and ADHD medications was also discussed as important context regarding "fitting in" and medication adherence. When the results were viewed through the lens of the Health Belief Model, it was highlighted that the four themes identified could be considered stimuli for adherence behavior. A potential methodical limitation of the review was the weighted synthesis approach, which prevented themes being generated from lower quality, less relevant studies. However this approach could also be considered a strength.

Objective: The association between perceived stress (PS) and ADHD symptoms in adulthood is well established, yet the underlying mechanisms remain unclear. This study employed a genetically informative design to investigate the roles of gene-environment (GE) correlation and gene-environment interaction (G × E) in explaining this association. Three G × E interaction models were considered: the diathesis-stress model, the bioecological model, and the differential sensitivity model.

Method: In total, 1,270 twins (mean age: 23.3 ± 2.4 years) participated in an online survey, which included ADHD symptoms and PS scales. The PS scale measured stress across five categories: Friendship Stress (FS), Family Conflicts (FC), Financial Difficulties (FD), Academic Stress (AS), and Future Career Concerns (FCC).

Results: Bivariate Cholesky model-fitting analyses revealed significant genetic correlations between ADHD symptoms and all five PS categories, indicating a pervasive influence of GE correlations on these associations. Further bivariate G × E model-fitting analyses showed that G × E interaction effects were not significant for FS or FC but were significant for FD, AS, and FCC. Specifically, the relationship between FD and ADHD symptoms aligned with the differential sensitivity model, where genetic variance was heightened at extreme levels of FD. The association between AS and ADHD symptoms followed the bioecological model, characterized by increased shared environmental variance at higher stress levels. Finally, the association between FCC and ADHD symptoms was consistent with the diathesis-stress model, where genetic influences amplified with increasing stress levels.

Conclusion: These findings underscore the complex interplay of genetic and environmental factors in the ADHD symptoms-PS relationship and suggest the importance of incorporating these mechanisms into intervention strategies for ADHD symptoms.

Objective: Few trials in ADHD incorporate participant-centered outcomes that evaluate the impact of interventions on meaningful life activities. Additionally, in psychiatry, the translation of changes in symptom rating scales into meaningful impacts on participants' lives has been questioned. The Transcranial Direct Current Stimulation (tDCS) for the Treatment of Inattention Symptoms in Adult Patients with ADHD (TUNED) trial demonstrated improved inattention symptoms, assessed using a clinician-administrated scale, after a 4-week treatment with daily home-based tDCS in adults with ADHD. Here, our primary objective was to evaluate the impact of tDCS in ADHD using a participant-centered and clinically relevant outcome.

Method: We analyzed data from the TUNED trial (ClinicalTrials.gov Identifier: NCT04003740), a randomized, double-blind, parallel, sham-controlled study testing tDCS in adults with ADHD. At the baseline assessment, all participants were instructed to select up to three goals they desired to achieve during the trial period. The goals had to be specific, measurable, achievable, relevant, and time-bound. Our main outcome was the number of goals achieved at the end of the intervention.

Results: Of the 64 participants randomized, 55 completed the trial and were included in the analyses (26 [47%] inattentive presentation and 29 [53%] combined presentation; mean (SD) age, 38.1 [9.8] years; 40% women). In the active tDCS group (n = 25), eight participants (32%) achieved one goal, 5 (20%) achieved two goals, 3 (12%) achieved all three goals, and 9 (36%) achieved no goals. In the sham tDCS group (n = 30), 3 (10%) participants achieved one goal, 3 (10%) achieved two goals, 3 (10%) achieved all three goals, and 21 (70%) achieved no goals. Ordinal logistic regression analyses showed that participants in the active tDCS group were more likely to achieve a higher number of goals compared to those in the tDCS sham group (OR = 3.05, 95% CI [1.06, 8.75], p = .03]).

Conclusion: This study demonstrated that tDCS can significantly enhance the ability to achieve personal goals in adults with ADHD. By using a participant-centered approach, our findings not only support tDCS as a promising treatment for ADHD but also align with the growing emphasis on personalized medicine and clinically relevant, participant-reported outcomes in clinical research.