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Many adults with a diagnosed psychiatric disorder also have attention-deficit/hyperactivity disorder (ADHD). In many cases, comorbid ADHD is unrecognized and/or undertreated. Differential diagnosis of adult ADHD can be challenging because ADHD symptoms may overlap with other psychiatric disorders and patients may lack insight into their ADHD-related symptoms. Current ADHD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision may prevent appropriate diagnosis of many patients with significant ADHD symptoms. Adults may not be able to provide a history of onset of symptoms during childhood, and it may be difficult to confirm that ADHD symptoms are not better accounted for by other comorbid psychiatric conditions. Comorbid ADHD is most prevalent among patients with mood, anxiety, substance use, and impulse-control disorders. ADHD can negatively affect outcomes of other comorbid psychiatric disorders, and ADHD symptoms may compromise compliance with treatment regimens. Furthermore, unrecognized ADHD symptoms may be mistaken for poor treatment response in these comorbid disorders. In these individuals, ADHD pharmacotherapy seems to be as effective in reducing core ADHD symptoms, as it is in patients who have no comorbidity. Limited evidence further suggests that ADHD therapy may help to improve symptoms of certain psychiatric comorbidities, such as depression. Therefore, management of ADHD may help to stabilize daily functioning and facilitate a fuller recovery.
The aim of the meta-analysis was to develop a mathematical model of the extent to which attention-deficit hyperactivity disorder (ADHD) prevalence decreases with age. In DSM-III, the category of residual attention-deficit disorder was defined to include adults who met full criteria for the disorder as children and have a partial syndrome as adults, but this category was removed from DSM-III-R. The strongest socio-demographic correlate of adult ADHD in the NCS-R was race-ethnicity, with non-Hispanic Blacks having significantly lower odds of the disorder than non-Hispanic Whites. Statistically significant comorbodities were found in the NCS-R between adult ADHD and a wide range of other DSM-IV/CIDI anxiety, mood, impulse-control, and substance use disorders. The NCS-R analysis also examined associations of adult ADHD with work performance. An analysis of work performance based on the WHO Health and Work Performance Questionnaire showed that ADHD was associated with an enormous amount of work role impairment.
Past studies find that attention deficit hyperactivity disorder (ADHD) creates a higher risk for adverse driving outcomes. This study comprehensively evaluated driving in adults with ADHD by comparing 105 young adults with the disorder (age 17–28) to 64 community control (CC) adults on five domains of driving ability and a battery of executive function tasks. The ADHD group self-reported significantly more traffic citations, particularly for speeding, vehicular crashes, and license suspensions than the CC group, with most of these differences corroborated in the official DMV records. Cognitively, the ADHD group was less attentive and made more errors during a visual reaction task under rule-reversed conditions than the CC group. The ADHD group also obtained lower scores on a test of driving rules and decision-making but not on a simple driving simulator. Both self- and other-ratings showed the CC group employed safer routine driving habits than the ADHD group. Relationships between the cognitive and driving measures and the adverse outcomes were limited or absent, calling into question their use in screening ADHD adults for driving risks. Several executive functions also were significantly yet modestly related to accident frequency and total traffic violations after controlling for severity of ADHD. These results are consistent with earlier studies showing significant driving problems are associated with ADHD. This study found that these driving difficulties were not a function of comorbid oppositional defiant disorder, depression, anxiety, or frequency of alcohol or illegal drug use. Findings to date argue for the development of interventions to reduce driving risks among adults with ADHD.
A significant discrepancy between intelligence and daily adaptive functioning, or adaptive
disability (AD), has been previously found to be a associated with significant psychological
morbidity in preschool children with disruptive behavior (DB). The utility of AD as a predictor of
later developmental risks was examined in a 3-year longitudinal study of normal ( N=
43) and DB preschool children. The DB children were grouped into those with AD (DB+AD; N = 28) and those without AD (DB-only; N = 98). All children were
followed with annual evaluations to the end of second grade. Both DB groups demonstrated
substantial and pervasive psychological and educational morbidity at 3-year follow-up. In
comparison to DB-only children, DB+AD children had more symptoms of attention-deficit
hyperactivity disorder (ADHD) and conduct disorder (CD), more severe and pervasive behavior
problems at home, more parent-rated externalizing and internalizing, and lower academic
competence and more behavioral problems at school. Parents of DB+AD children also reported
greater parenting stress than did parents in the other groups. A significant contribution of AD to
adverse outcomes in the DB group remained on some measures even after controlling for initial
severity of DB. AD also contributed significantly to CD symptoms at follow-up after controlling
for initial DB severity and initial CD symptoms. The results corroborate and extend earlier
findings of the utility of AD as a risk indicator above severity of DB alone. They also imply that
AD in the context of normal intellectual development may arise from both the deficient
self-regulation associated with ADHD and from disrupted parenting, with exposure to
kindergarten moderating these adverse effects.
Annual screenings of preschool children at kindergarten registration identified 158 children
having high levels of aggressive, hyperactive, impulsive, and inattentive behavior. These
“disruptive” children were randomly assigned to four treatment conditions lasting the
kindergarten school year: no treatment, parent training only, full-day treatment classroom
only, and the combination of parent training with the classroom treatment. Results showed
that parent training produced no significant treatment effects, probably owing largely to
poor attendance. The classroom treatment produced improvement in multiple domains:
parent ratings of adaptive behavior, teacher ratings of attention, aggression, self-control,
and social skills, as well as direct observations of externalizing behavior in the classroom.
Neither treatment improved academic achievement skills or parent ratings of home behavior
problems, nor were effects evident on any lab measures of attention, impulse control, or
mother–child interactions. It is concluded that when parent training is offered at school
registration to parents of disruptive children identified through a brief school registration
screening, it may not be a useful approach to treating the home and community behavioral
problems of such children. The kindergarten classroom intervention was far more effective
in reducing the perceived behavioral problems and impaired social skills of these children.
Even so, most treatment effects were specific to the school environment and did not affect
achievement skills. These findings must be viewed as tentative until follow-up evaluations
can be done to determine the long-term outcomes of these interventions.
A recent theory of ADHD predicts a deficiency in
sense of time in the disorder. Two studies were conducted
to test this prediction, and to evaluate the effects of
interval duration, distraction, and stimulant medication
on the reproductions of temporal durations in children
with ADHD. Study I: 12 ADHD children and 26 controls (ages
6–14 years) were tested using a time reproduction
task in which subjects had to reproduce intervals of 12,
24, 36, 48, and 60 s. Four trials at each duration were
presented with a distraction occurring on half of these
trials. Control subjects were significantly more accurate
than ADHD children at most durations and were unaffected
by the distraction. ADHD children, in contrast, were significantly
less accurate when distracted. Both groups became less
accurate with increasing durations to be reproduced. Study
II: Tested three doses of methylphenidate (MPH) and placebo
on the time reproductions of the 12 ADHD children. ADHD
children became less accurate with increasing durations
and distraction was found to reduce accuracy at 36 s or
less. No effects of MPH were evident. The results of these
preliminary studies seem to support the prediction that
sense of time is impaired in children with ADHD. The capacity
to accurately reproduce time intervals in ADHD children
does not seem to improve with administration of stimulant
medication. (JINS, 1997, 3, 359–369.)
The purpose of the present paper is to (1) provide an overview of the nature of attention-deficit hyperactivity disorder (ADHD) as it seems to be viewed by North American clinicians and clinical scientists; (2) describe its diagnostic criteria as they are applied in that region; (3) discuss the prevalence of ADHD in the region; and (4) briefly present a new theoretical model of the authors emerging from that North American perspective. Some of the critical issues related to these matters will be raised along the way. Given the thousands of scientific papers on this topic, however, an overview of these various topics is all that space here can afford. Readers wishing a more thorough treatment of these topics as well as those pertaining to history, developmental courses, associated risks, assessment, and treatments for ADHD are directed to other writings by the author (Barkley, 1990).