Paul H. Wender

Adults with ADHD. An overview.

Abstract: Attention‐Deficit Hyperactivity Disorder (ADHD) is a common, genetically transmitted neurological disorder, with onset in childhood, probably mediated by decreased brain dopaminergic functioning. The first author was one of the earliest to describe the persistence of symptoms into adulthood. Prevalence and natural history data suggest that of the 3 to 10% of children diagnosed with ADHD, one‐ to two‐thirds (somewhere between 1 and 6% of the general population) continue to manifest appreciable ADHD symptoms into adult life. This paper describes how ADHD in adults can be readily diagnosed and treated, despite resembling or coexisting with other psychiatric disorders. The Wender Utah diagnostic criteria address adult characteristics of the disorder. Informant and patient interviews and rating scales are used to determine the psychiatric status of the patient as a child, make a retroactive diagnosis of childhood ADHD, and establish the current diagnosis of the adult. Stringent diagnosis is key to determining effective treatment. Dopamine agonist stimulant medications appear to be the most effective in treating ADHD. About 60% of patients receiving stimulant medication showed moderate‐to‐marked improvement, as compared with 10% of those receiving placebo. The core symptoms of hyperactivity, inattention, mood lability, temper, disorganization, stress sensitivity, and impulsivity have been shown to respond to treatment with stimulant medications. Non‐dopaminergic medications, such as the tricyclic antidepressants and SSRIs have generally not been useful in adults with ADHD in the absence of depression or dysthymia. Pemoline is no longer appoved for use in these patients, despite early favorable reports. Appropriate management of adult patients with ADHD is multimodal. Psychoeducation, counseling, supportive problem‐directed therapy, behavioral intervention, coaching, cognitive remediation, and couples and family therapy are useful adjuncts to medication management. Concurrent supportive psychosocial treatment or polypharmacy may be useful in treating the adult with comorbid ADHD.

Prevalence of attention deficit–/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates*

AbstractObjectiveThis study was performed to evaluate the prevalence of ADHD as well as comorbid conditions among young male prison inmates.MethodWe investigated 129 prison inmates (mean age ± SE: 19.2±2.0 years) and 54 healthy male control subjects (mean age ± SE: 22.2±3.12 years) for the presence of adult ADHD using the Wender Utah Rating Scale (WURS), the Eysenck Impulsivity Questionnaire (EIQ), the diagnostic criteria for ADHD according to DSM–IV and ICD–10–research criteria and the Utah criteria for adult ADHD. In order to determine comorbid personality disorders we applied the International Personality Disorder Examination (IPDE). Externalization (ED) and Internalization Disorders (ID) were evaluated by means of the Achenbach Scales. Alcoholism (ALC) was examined via the Alcohol Use Disorder Test (AUDIT) and substance use disorder (SUD) has been investigated with the Structured Clinical Interview for DSM–IV (SCID).ResultsThe overall prevalence of ADHD according to DSM–IV was 45%. The prevalence of disturbance of activity and attention (DAA) and hyperkinetic conduct disorder (HCD) via the ICD–10 research criteria was 21.7%. Sole DAA without any comorbid condition could be detected in one case. The most common diagnostic combinations were DAA/HCD and SUD/ALC (89% of all DAA/HCD cases).ConclusionThe prevalence of DAA/HCD or ADHD in young adult prison inmates is significantly elevated when compared to nondelinquent controls. Generally the population of young adult male prison inmates exhibits a considerable psychiatric morbidity. Of the total sample, 64% suffered from at least 2 disorders. Only 8.5 % had no psychiatric diagnoses. This indicates the urgent need for more psychiatric expertise in young offender facilities.

Wender Utah Rating Scale (WURS-k) Die deutsche Kurzform zur retrospektiven Erfassung des hyperkinetischen Syndroms bei Erwachsenen

ZusammenfassungDie diagnostische Abklärung einer Aufmerksamkeitsdefizit/Hyperaktivitätsstörung beim Erwachsenen macht die retrospektive Erfassung von Krankheitssymptomen, die bereits im Kindesalter bestanden, notwendig. Die Wender Utah Rating Scale (WURS) ist ein hierfür entwickelter Fragebogen. In der vorliegenden Arbeit wurde die deutsche Übersetzung der WURS einer statistischen Analyse unterzogen. Grundlage für diese Analyse bildete die Untersuchung von insgesamt 703 Probanden. Anhand der korrigierten Trennschärfeindizes wurde unter Berücksichtigung der mittleren Antwortausprägung sowie inhaltlicher Aspekte der Items eine Itemselektion durchgeführt. Nach der Itemselektion verblieben 21 Items mit einer korrigierten Trennschärfe ri(t–i) zwischen 0,19 und 0,61 in der Fragebogenendform. Die Retestreliabilität der gekürzten Version betrug r=0,9.SummaryThis work presents a statistical analysis of the German version of the Wender Utah rating scale (WURS) for the retrospective diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults. Data were obtained from 703 subjects. Item selection according to item-total correlation scores, frequency, and plausibility led to a short version of the scale that includes 21 items with item-total correlations from 0.19 to 0.61. Retest reliability of the WURS-k was r=0.9.

Codistribution of a sensory gating deficit and schizophrenia in multi-affected families

Because the clinical diagnosis of schizophrenia has not generally been an adequate phenotypic marker to detect the genes that convey risk for schizophrenia, efforts have been directed toward the identification of more elementary neuronal dysfunctions in schizophrenic patients and their families. Psychophysiological studies of sensory gating and selective attention suggest that defects in these brain functions are present in schizophrenic patients and some of their relatives. This study examines one of these defects in sensory gating, failure to suppress the P50 evoked response to repeated auditory stimuli. Six pedigrees, chosen because of the presence of large sibships containing several cases of schizophrenia, were studied. A mathematical model was developed to assess the familial association of the P50 defect with schizophrenia. The model preserves the quantitative nature of the data and is suitable for use in a sample with small numbers of pedigrees comprising many individuals. It is thus suitable for the evaluation of putative phenotypes in families to be studied by linkage analysis with polymorphic genetic markers. The results suggest that the P50 defect is familially associated with schizophrenia.

Schizophrenics' offspring reared in adoptive homes

THIS is the first of a projected series of reports on what Dr. Kety, Dr. Wender and I call the Adoptees Study.l The one that Dr. Kety presented we call the Extended Family Study and the one that Dr. Wender presented we call the Adoptive Parents Study. The names may help to distinguish the studies in future discussions of them. This is a preliminary as well as a first report, since we are still very much in the midst of our extensive research activities. We will be finding and examining subjects for at least another year. In June 1967 we began the third year of this project. The reader will observe a strong resemblance, as well as important differences in conception and method, between the Adoptees Study and the study reported by Heston. We want to point out that our study was conceived and planned years before we learned of Heston’s remarkable feat, and it was well under way for some time before Heston’s report appeared. Although all our studies attempt to assess the relative contributions of heredity and environment to schizophrenia, the major focus of the Adoptees Study is somewhat different. Here we are trying to obtain evidence that a diathesis-stress theory of schizophrenia is correct. What we would like to do is to detect and describe some behavioral and psychological aspects of that inherited diathesis. Paul Meehl would call it the “schizotype”, which is a perfectly good name for it.

[Wender Utah rating scale. The short-version for the assessment of the attention-deficit hyperactivity disorder in adults].

ZusammenfassungDie diagnostische Abklärung einer Aufmerksamkeitsdefizit/Hyperaktivitätsstörung beim Erwachsenen macht die retrospektive Erfassung von Krankheitssymptomen, die bereits im Kindesalter bestanden, notwendig. Die Wender Utah Rating Scale (WURS) ist ein hierfür entwickelter Fragebogen. In der vorliegenden Arbeit wurde die deutsche Übersetzung der WURS einer statistischen Analyse unterzogen. Grundlage für diese Analyse bildete die Untersuchung von insgesamt 703 Probanden. Anhand der korrigierten Trennschärfeindizes wurde unter Berücksichtigung der mittleren Antwortausprägung sowie inhaltlicher Aspekte der Items eine Itemselektion durchgeführt. Nach der Itemselektion verblieben 21 Items mit einer korrigierten Trennschärfe ri(t–i) zwischen 0,19 und 0,61 in der Fragebogenendform. Die Retestreliabilität der gekürzten Version betrug r=0,9.SummaryThis work presents a statistical analysis of the German version of the Wender Utah rating scale (WURS) for the retrospective diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults. Data were obtained from 703 subjects. Item selection according to item-total correlation scores, frequency, and plausibility led to a short version of the scale that includes 21 items with item-total correlations from 0.19 to 0.61. Retest reliability of the WURS-k was r=0.9.

Psychometric and psychopathological characterization of young male prison inmates with and without attention deficit/hyperactivity disorder

Abstract.There is considerable evidence that attention deficit/hyperactivity disorder (ADHD) is associated with conduct problems, social maladaptation and delinquent behavior. The “Ottweiler Study” was performed to elaborate the prevalence of ADHD and comorbid disorders in 129 young adult detainees of the juvenile prison of Ottweiler (Germany) according to DSM-IV and ICD-10 criteria. Here we report psychopathological characteristics of 28 inmates, who fulfilled the diagnostic criteria for persisting ADHD, and 37 individuals with neither a history nor current ADHD symptoms. Childhood ADHD symptoms but no current ADHD were present in 64 individuals. The Wender–Reimherr Interview (WRI) based on the Utah criteria for adult ADHD, the NEO–five factor personality inventory (NEO–FFI) and the youth self report/young adult self report (YSR/YASR) according to Achenbach were used for the assessment of psychopathology and the description of behavioral problems. Regarding WRI and YSR/YASR we found a significant increase of emotional and internalizing problems in the ADHD group compared to delinquents without ADHD or ADHD history. ADHD delinquents scored higher on the personality dimension neuroticism, and showed lower scores on the dimensions agreeableness and consciousness. Using discriminant analysis, high scores on the WRI subscales disorganization and attention difficulties and NEO–FFI neuroticism were the best predictors of ADHD diagnosis. The results support prior findings of high ADHD prevalence in prison inmates and suggest that emotional and internalizing abnormalities are prominent problems in this population. Further studies are needed to elucidate the role of ADHD as an independent factor for life–persistent criminality, since specific treatment may help to ameliorate the legal prognosis.

Mental illness in the biological and adoptive families of adopted individuals who have become schizophrenic

In a sample of 5483 adults who had been legally adopted early in life by persons not biologically related to them, 33 were identified, from mental hospital records, for whom a diagnosis of definite schizophrenia (chronic, latent, or acute) could be agreed upon by four raters. An equal number of matched controls were selected from the sample of adopted individuals who had never been admitted to a mental hospital. Ninety percent of the living parents, siblings, and half-siblings, biological and adoptive, cooperated in an extensive psychiatric interview permitting a consensus diagnosis by three blind raters. Schizophrenia and uncertain schizophrenia were found to be significantly concentrated in the population genetically related to the schiziphrenic adoptees. Their adoptive relatives did not differ from the control populations in the prevalence of schizophrenic illness.

SOME SPECULATIONS CONCERNING A POSSIBLE BIOCHEMICAL BASIS OF MINIMAL BRAIN DYSFUNCTION

Publisher Summary This chapter describes a possible biochemical basis of minimal brain dysfunction (MBD). MBD is one of a number of designations for a common behavioral syndrome of childhood. Other terms which have been employed include: the hyperactive child syndrome, hyperactivity, hyperkinesis, minimal brain damage, and minimal cerebral dysfunction. The boundaries of the syndrome are unclearly defined, however, there is general consensus regarding the signs of typical MBD children. These are behavioral and perceptual and cognitive. The characteristic features include hyperactivity, involuntary, and constant over-activity that completely surpasses the normal and may already be present during early infancy and a short attention span and poor powers of concentration, with the children generally being unable to persist for long in an activity whether at play or at school and impulsivity and inability to delay gratification. An overlapping strategy for unraveling the MBD problem would be to manipulate monoaminergic activity levels, determine the effects on the behavior and attempt to extrapolate to children. It is found that MBD is a genetically produced disorder of monoamine metabolism obviously suggests assessment of such metabolism in children.

Analysis of chromosome 18 DNA markers in multiplex pedigrees with manic depression

Six pedigrees segregating manic-depressive illness (MDI) were analyzed for linkage to 21 highly polymorphic microsatellite DNA markers on chromosome 18. These markers span almost the entire length of the chromosome, and gaps between markers are less than 20 cM. In particular, we analyzed several markers localizing to the pericentromeric region of chromosome 18 which generated lod scores suggestive of linkage in an independent study. Lod score analysis was performed and results were examined by family. One region produced positive lod scores, though at 18q23 and not in the pericentromeric region. We additionally used two nonparametric methods because the true mode of transmission of MDI is unknown; results were again somewhat suggestive for markers in the region of 18q23 but not in the pericentromeric region.