compiledby Teresa Binstock for
Generation Rescue
June 2008
Adults with ADHD
1. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder
Fayyad J et al.
Br J Psychiatry. 2007 May;190:402-9.
http://bjp.rcpsych.org/cgi/reprint/190/5/402
BACKGROUND: Little is known about the epidemiology of adult
attention-deficit hyperactivity disorder (ADHD). AIMS: To estimate the
prevalence and correlates of DSM-IV adult ADHD in the World Health
Organization World Mental Health Survey Initiative. METHOD: An ADHD
screen was administered to respondents aged 18-44 years in ten
countries in the Americas, Europe and the Middle East (n=11422). Masked
clinical reappraisal interviews were administered to 154 US respondents
to calibrate the screen. Multiple imputation was used to estimate
prevalence and correlates based on the assumption of cross-national
calibration comparability. RESULTS: Estimates of ADHD prevalence
averaged 3.4% (range 1.2-7.3%), with lower prevalence in lower-income
countries (1.9%) compared with higher-income countries (4.2%). Adult
ADHD often co-occurs with other DSM-IV disorders and is associated with
considerable role disability. Few cases are treated for ADHD, but in
many cases treatment is given for comorbid disorders. CONCLUSIONS:
Adult ADHD should be considered more seriously in future
epidemiological and clinical studies than is currently the case.
PMID: 17470954
2. Impact of psychometrically defined deficits of executive functioning in adults with attention deficit hyperactivity disorder
Biederman J, Petty C, Fried R, Fontanella J, Doyle AE, Seidman LJ, Faraone SV.
Am J Psychiatry. 2006 Oct;163(10):1730-8.
http://ajp.psychiatryonline.org/cgi/content/full/163/10/1730
OBJECTIVE: The association between deficits in executive functioning
and functional outcomes was examined among adults with attention
deficit hyperactivity disorder (ADHD). METHOD: Subjects were adults who
did (N=213) and did not (N=145) meet DSM-IV criteria for ADHD. The
authors defined having deficits in executive functioning as having at
least two measures of executive functioning with scores 1.5 standard
deviations below those of matched comparison subjects. RESULTS:
Significantly more adults with ADHD had deficits of executive
functioning than comparison subjects. Deficits of executive functioning
were associated with lower academic achievement, irrespective of ADHD
status. Subjects with ADHD with deficits of executive functioning had a
significantly lower socioeconomic status and a significant functional
morbidity beyond the diagnosis of ADHD alone. CONCLUSIONS:
Psychometrically defined deficits of executive functioning may help
identify a subgroup of adults with ADHD at high risk for occupational
and academic underachievement. More efforts are needed to identify
cost-effective approaches to screen individuals with ADHD for deficits
of executive functioning.
PMID: 17012683
3. Diagnosing adult attention deficit hyperactivity disorder: are late onset and subthreshold diagnoses valid?
Faraone SV, Biederman J, Spencer T, Mick E, Murray K, Petty C, Adamson JJ, Monuteaux MC.
Am J Psychiatry. 2006 Oct;163(10):1720-9.
http://ajp.psychiatryonline.org/cgi/content/full/163/10/1720
OBJECTIVE: Diagnosing attention deficit hyperactivity disorder (ADHD)
in adults is difficult when diagnosticians cannot establish an onset
before the DSM-IV criterion of age 7 or if the number of symptoms
recalled does not achieve DSM's diagnosis threshold. METHOD: The
authors addressed the validity of DSM-IV's age-at-onset and symptom
threshold criteria by comparing four groups of adults: 127 subjects
with full ADHD who met all DSM-IV criteria for childhood-onset ADHD, 79
subjects with late-onset ADHD who met all criteria except the
age-at-onset criterion, 41 subjects with subthreshold ADHD who did not
meet full symptom criteria for ADHD, and 123 subjects without ADHD who
did not meet any criteria. The authors hypothesized that subjects with
late-onset and subthreshold ADHD would show patterns of psychiatric
comorbidity, functional impairment, and familial transmission similar
to those seen in subjects with full ADHD. RESULTS: Subjects with
late-onset and full ADHD had similar patterns of psychiatric
comorbidity, functional impairment, and familial transmission. Most
children with late onset of ADHD (83%) were younger than 12.
Subthreshold ADHD was milder and showed a different pattern of familial
transmission than the other forms of ADHD. CONCLUSIONS: The data about
the clinical features of probands and the pattern of transmission of
ADHD among relatives found little evidence for the validity of
subthreshold ADHD among such subjects, who reported a lifetime history
of some symptoms that never met DSM-IV's threshold for diagnosis. In
contrast, the results suggested that late-onset adult ADHD is valid and
that DSM-IV's age-at-onset criterion is too stringent.
PMID: 17012682
4. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication
Kessler RC et al.
Am J Psychiatry. 2006 Apr;163(4):716-23.
http://ajp.psychiatryonline.org/cgi/content/full/163/4/716
OBJECTIVE: Despite growing interest in adult attention deficit
hyperactivity disorder (ADHD), little is known about its prevalence or
correlates. METHOD: A screen for adult ADHD was included in a
probability subsample (N=3,199) of 18-44-year-old respondents in the
National Comorbidity Survey Replication, a nationally representative
household survey that used a lay-administered diagnostic interview to
assess a wide range of DSM-IV disorders. Blinded clinical follow-up
interviews of adult ADHD were carried out with 154 respondents,
oversampling those with positive screen results. Multiple imputation
was used to estimate prevalence and correlates of clinician-assessed
adult ADHD. RESULTS: The estimated prevalence of current adult ADHD was
4.4%. Significant correlates included being male, previously married,
unemployed, and non-Hispanic white. Adult ADHD was highly comorbid with
many other DSM-IV disorders assessed in the survey and was associated
with substantial role impairment. The majority of cases were untreated,
although many individuals had obtained treatment for other comorbid
mental and substance-related disorders. CONCLUSIONS: Efforts are needed
to increase the detection and treatment of adult ADHD. Research is
needed to determine whether effective treatment would reduce the onset,
persistence, and severity of disorders that co-occur with adult ADHD.
PMID: 16585449
5. What happens when children with attention deficit/hyperactivity disorder grow up?
Newton-Howes G.
J R Soc Med. 2004 Nov;97(11):531-5.
http://jrsm.rsmjournals.com/cgi/content/full/97/11/531
PMID: 15520147
6. Attention-deficit/hyperactivity disorder in adults: a survey of current practice in psychiatry and primary care
Faraone SV, Spencer TJ, Montano CB, Biederman J.
Arch Intern Med. 2004 Jun 14;164(11):1221-6.
http://archinte.ama-assn.org/cgi/content/full/164/11/1221
BACKGROUND: Recognition and treatment of
attention-deficit/hyperactivity disorder (ADHD) in adults in psychiatry
and primary care have faced many obstacles. METHODS: Review by 50
psychiatrists and 50 primary care practitioners (PCPs) of 537 and 317
medical records, respectively, of adults diagnosed as having ADHD.
Information on other psychiatric disorders, time of onset of ADHD,
source of referral, use of referrals for diagnosis, ADHD treatment, and
use of drug holidays was recorded. RESULTS: Forty-five percent of the
patient records reviewed by psychiatrists and 65% reviewed by PCPs
indicated previous diagnoses of ADHD. Only 25% of the adults with ADHD
had been first diagnosed as having the disorder in childhood or
adolescence. A diagnosis of ADHD was the initial cause for referral in
80% of psychiatric patients and 60% of PCP patients. Most patients with
previously diagnosed and undiagnosed ADHD were self-referred. Among
patients who had not received a prior diagnosis, 56% complained about
ADHD symptoms to other health professionals without being diagnosed;
PCPs were the least aggressive in diagnosing ADHD. In psychiatric and
PCP settings, there was a statistical difference in the use of
pharmacotherapy (91% vs 78%, respectively) and the proportion of
patients taking drug holidays (24% vs 17%, respectively); most drug
holidays were initiated by the patient (57%). Stimulants were the
treatment of choice for adult ADHD (84% treated with stimulants).
CONCLUSION: Data contained within this medical record review suggest
that adult ADHD is a substantial source of morbidity in both
psychiatric and PCP settings.
PMID: 15197048
7. Attention deficit hyperactivity disorder in adulthood
Toone B.
J Neurol Neurosurg Psychiatry. 2004 Apr;75(4):523-5.
http://jnnp.bmj.com/cgi/content/full/75/4/523
PMID: 15026486
|
