Susan Young

Characteristic neurocognitive profile associated with adult attention-deficit/hyperactivity disorder.

BACKGROUND It is now accepted that attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood. However, relative to the considerable literature concerning the profile of neurocognitive deficits associated with this disorder in childhood, equivalent investigations in adult populations have been less common. The current study examined cognitive function in adults diagnosed with ADHD employing well-validated neuropsychological tasks. METHOD Nineteen adult patients who satisfied DSM-IV criteria for ADHD and 19 matched (gender, age and verbal IQ), non-clinical control subjects were recruited. Patients were either unmedicated or had abstained from a psychostimulant medication regime for at least 24 h prior to neurocognitive assessment. A functionally wide-ranging test battery was administered. RESULTS Relative to controls, ADHD adults performed significantly worse on spatial working memory, planning, and attentional-set shifting tests and were significantly slower to respond to target stimuli on the go/no-go task. In contrast, the two subject groups performed equivalently on decision-making and pattern/spatial recognition memory assessments. CONCLUSIONS The demonstration of neuropsychological dysfunction in the adult ADHD cohort provides some support for the validity of this diagnosis in adulthood. In particular, there is broad consistency between the cognitive profile revealed in the current investigation and that previously demonstrated in a study of medication-naïve ADHD children. There is evidence that frontostriatal function is especially disrupted.

Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: Update on recommendations from the British Association for Psychopharmacology

Attention deficit hyperactivity disorder (ADHD) is a common condition with a high societal burden. The present guidelines summarise current literature, generating expert consensus recommendations for the treatment of ADHD in children and adults. These guidelines also provide a review of recent research in the fields of neuroimaging, neuropsychology and genetics of ADHD. Novel discoveries in these areas have informed physiological models for the disease. Since the publication of the previous British Association for Psychopharmacology guidelines in 2008, new drugs have been licensed and further compounds are being investigated. The publication of randomised controlled trials of psychological interventions has contributed to the range of treatment options for ADHD. As the disorder has been diagnosed more frequently there has been greater focus on comorbid conditions and how they impact treatment. Services have continued to develop for the treatment of ADHD in adults and care agreements have been introduced to facilitate access to treatment.

The identification and management of ADHD offenders within the criminal justice system: a consensus statement from the UK Adult ADHD Network and criminal justice agencies

The UK Adult ADHD Network (UKAAN) was founded by a group of mental health specialists who have experience delivering clinical services for adults with Attention Deficit Hyperactivity Disorder (ADHD) within the National Health Service (NHS). UKAAN aims to support mental health professionals in the development of services for adults with ADHD by the promotion of assessment and treatment protocols. One method of achieving these aims has been to sponsor conferences and workshops on adult ADHD.This consensus statement is the result of a Forensic Meeting held in November 2009, attended by senior representatives of the Department of Health (DoH), Forensic Mental Health, Prison, Probation, Courts and Metropolitan Police services. The objectives of the meeting were to discuss ways of raising awareness about adult ADHD, and its recognition, assessment, treatment and management within these respective services. Whilst the document draws on the UK experience, with some adaptations it can be used as a template for similar local actions in other countries.It was concluded that bringing together experts in adult ADHD and the Criminal Justice System (CJS) will be vital to raising awareness of the needs of ADHD offenders at every stage of the offender pathway. Joint working and commissioning within the CJS is needed to improve awareness and understanding of ADHD offenders to ensure that individuals are directed to appropriate care and rehabilitation. General Practitioners (GPs), whilst ideally placed for early intervention, should not be relied upon to provide this service as vulnerable offenders often have difficulty accessing primary care services. Moreover once this hurdle has been overcome and ADHD in offenders has been identified, a second challenge will be to provide treatment and ensure continuity of care. Future research must focus on proof of principle studies to demonstrate that identification and treatment confers health gain, safeguards individuals rights, improves engagement in offender rehabilitation programmes, reduces institutional behavioural disturbance and, ultimately, leads to crime reduction. In time this will provide better justice for both offenders and society.

Comorbidity and psychosocial profile of adults with Attention Deficit Hyperactivity Disorder

Abstract The objective of the study was to investigate the comorbid problems and the psychosocial profile of Attention Deficit Hyperactivity Disorder (ADHD) adults. It was hypothesised that, compared with a community control group, the ADHD group would have a history of academic underachievement, poor occupational adjustment, antisocial behaviour, relationship difficulties, substance misuse, mood and affective problems and personality disorder. Compared with a clinic control group, it was hypothesised that the ADHD group would report an earlier onset of problems. Two clinical groups were drawn from referrals to an adult ADHD assessment clinic and a normal control group was recruited from the community. Groups were matched for age, sex and social class. The ADHD group ( N =30) was compared with the clinic control group ( N =30) and the normal control group ( N =30) on measures of anxiety, depression and personality. Psychosocial variables were measured by the ADHD-Adult Functioning Interview, a semi-structured interview of childhood and adulthood functioning. The hypotheses were largely supported with the ADHD group being significantly more impaired than the normal control group on all psychosocial domains and comorbidity. The ADHD group was more impaired than the clinical control group on childhood measures of academic underachievement, antisocial and criminal behaviour. It was concluded that ADHD is a risk for the development of multiple problems and comorbidity in adulthood. Results emphasise the need to take a developmental perspective when diagnosing ADHD in adulthood.

Impaired spatial working memory in adults with attention-deficit/hyperactivity disorder: comparisons with performance in adults with borderline personality disorder and in control subjects.

Objective:  This study investigated a previous claim that working memory may be ‘particularly impaired’ in adult attention‐deficit/hyperactivity disorder (ADHD), compared with other psychiatric disorders which affect frontal lobe‐mediated executive functions.

The relationship between satisfaction with life, ADHD symptoms, and associated problems among university students.

Objective: To ascertain whether ADHD symptoms, and associated problems, are negatively related to subjective well-being. Method: The Satisfaction With Life Scale (SWLS) was completed by 369 university students, along with the Reasoning & Rehabilitation (R&R) ADHD Training Evaluation (RATE), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Scale for current ADHD symptoms, and the Depression Anxiety Stress Scales (DASS). Results: The SWLS was negatively correlated with all the other measures, and the strongest correlations were with the Total RATE score. A multiple regression analysis showed that the variables in the study accounted for 22% and 25% of the variance of the SWLS among males and females, respectively. Among males poor social functioning was the best predictor of dissatisfaction with life, whereas among females it was poor emotional control. Conclusion: Both ADHD symptoms and associated problems are significantly related to poorer satisfaction with life. (J. of Att. Dis. 2009; 12(6) 507-515 )

Predictors of offending among prisoners: the role of attention-deficit hyperactivity disorder and substance use

The aim of the study was to investigate predictors of offending among prisoners from official records after controlling for age at first conviction and antisocial personality disorder. The participants were 198 Scottish prisoners, who had completed Diagnostic Statistical Manual IV screens for child and adult attention-deficit hyperactivity disorder (ADHD) symptoms and the Millon Clinical Multiaxial Inventory III for Axis I and Axis II disorders. The ADHD symptomatic group had significantly higher rates of total, acquisitive and violent offending than other prisoners, as well as greater regular heroin use. Hierarchical multiple regressions, using child and adult symptoms as dimensions, showed that frequent use of heroin in the year prior to imprisonment was the single most powerful predictor of the extent of total offending, with ADHD symptoms also adding independently to the variance in offending. In contrast, for violent offending, ADHD symptoms were the strongest predictor followed by alcohol dependence. The findings demonstrate the importance of heroin use and ADHD symptoms in the persistence of offending. There is an urgent need to treat drug addiction and ADHD symptoms in order to reduce offending among the most persistent offenders. Recently, treatment programmes have been developed for adults with ADHD, heroin and crack cocaine addiction which can be applied to this population.

Is ADHD a valid diagnosis in adults? Yes

Philip Asherson and colleagues argue that the concept of ADHD in adults is valid (doi:10.1136/bmj.c549) but Joanna Moncrieff and Sami Timimi believe that it is supported by little more than aggressive marketing

Executive functioning differences between adults with attention deficit hyperactivity disorder and autistic spectrum disorder in initiation, planning and strategy formation

Executive functioning deficits characterize the neuropsychological profiles of the childhood neurodevelopmental disorders of attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD). This study sought to determine whether similar impairments exist in adults with ADHD (N = 53) and ASD (N = 45) in comparison with a healthy control group (N = 31), whether the two disorders can be distinguished on the basis of their executive functioning features, and whether these impairments are related to symptom severity. Both clinical groups were found to exhibit executive functioning deficits. The ADHD group had difficulty withholding a response, with relative preservation of initiation and planning abilities. In contrast, the ASD group exhibited significant impairments in initiation, planning and strategy formation. The specific executive functioning deficits were related to severity of response inhibition impairments in ADHD and stereotyped, repetitive behaviours in ASD. These findings suggest the pattern of executive functioning deficits follows a consistent trajectory into adulthood.

The Experience of Receiving a Diagnosis and Treatment of ADHD in Adulthood A Qualitative Study of Clinically Referred Patients Using Interpretative Phenomenological Analysis

Objective: To evaluate the psychological impact of receiving a diagnosis of ADHD in adulthood and treatment with medication and to examine how diagnosis and treatment with medication changes an individuals self-perception and view of the future. Method: Participants were eight individuals diagnosed with ADHD at a tertiary service. Semistructured interviews were conducted and the data were analyzed according to the principles of Interpretative Phenomenological Analysis. Results: Three master themes emerge from the analysis: Participants engage in a (a) review of the past, particularly how they feel different from others, (b) the emotional impact of the diagnosis, and (c) consideration of the future. These themes suggest a six-stage model of psychological acceptance of a diagnosis of ADHD: (a) relief and elation, (b) confusion and emotional turmoil, (c) anger, (d) sadness and grief, (e) anxiety, and (f) accommodation and acceptance. Conclusion: The model indicates an important role for psychological treatment, which should begin at the point of diagnosis. Cognitive behavioral techniques will help clients diagnosed with ADHD in adulthood cope with the adjustment process. Adults should be taught skills to anticipate future hurdles and challenges and apply appropriate coping strategies. (J. of Att. Dis. 2008; 11(4) 493-503)