Age-related cognitive complaints and emotional difficulties associated with symptoms of ADHD: a study of gender differences

Smokers with attention deficit hyperactivity disorder (ADHD) have greater difficulty quitting than those without ADHD, but preliminary data (McClernon, Kollins, Lutz, Fitzgerald, Murray, Redman, et al., 2008) suggest equivalent severity of withdrawal symptoms following brief abstinence. The objective of this study was to characterize the differential effects of intermediate term smoking abstinence on self-reported withdrawal and ADHD symptoms in adult smokers with and without ADHD. Forty adult (50% female), nontreatment seeking moderate-to-heavy smokers with and without ADHD were enrolled in a 12-day quit study in which monetary incentives were provided for maintaining biologically verified abstinence. Self-reported withdrawal, mood, and ADHD symptoms were measured pre- and post-quitting. ADHD and controls did not vary on smoking or demographic variables. Significant Group × Session interactions were observed across a broad range of withdrawal symptoms and were generally characterized by greater withdrawal severity among ADHD smokers, particularly during the first 5 days of abstinence. In addition, Group × Sex × Session interactions were observed for craving, somatic symptoms, negative affect, and habit withdrawal; these interactions were driven by greater withdrawal severity among females with ADHD. Group × Session interactions were not observed for ADHD symptom scales. The results of this study suggest that smokers with ADHD, and ADHD females in particular, experience greater withdrawal severity during early abstinence-independent of effects on ADHD symptoms. Whereas additional research is needed to pinpoint mechanisms, our findings suggest that smoking cessation interventions targeted at smokers with ADHD should address their more severe withdrawal symptoms following quitting.

Introduction This study aims to assess whether electroencephalogram (EEG) spectral power change scores (e.g. task spectral power subtracted from resting state spectral power) across three different frequency bands, alpha (8–12 Hz), theta (4–7 Hz), and beta (13–30 Hz), predicts self-reported attention-deficit hyperactivity disorder (ADHD) symptoms using the Adult ADHD Self-Report Scale (ASRS) over and above self-reported executive function (EF) abilities using the Behavior Rating Inventory of Executive Function (BRIEF-A) Global Executive Composite (GEC) T-scores for adults. Methods Data were collected at a rural, mid-sized southeastern university (N = 52) and participants received course credit for participation. Participants self-reported ADHD symptoms and EF abilities before completing eyes open resting state and the attention network test (ANT), a common flanker task that measures ability to orient attention, stay alert, and resolve conflict (i.e. distractor arrows) while recording EEG spectral power at electrodes F3 and F4. Bivariate correlations determine associations between EEG measures and self-reported ADHD symptoms and EF abilities. Linear regressions were used to assess whether EEG change scores were predictive of ADHD symptoms over and above EF abilities. Results High correlation coefficients were found only when comparing the ASRS and BRIEF-A GEC T-scores (r = .822, p <.001). Regression analyses produced significant results indicating EEG spectral change scores were predictive of ADHD symptoms, over and above GEC T-Scores, for the alpha band but not the theta and beta bands. Additionally, we found an inverse relationship when comparing change scores in the alpha band across the right (F4) and left (F3) hemispheres supporting the theory of frontal asymmetry for individuals with increased ADHD symptoms. Conclusion This study is the first to assess the predictive ability of EEG spectral power change scores in predicting ADHD symptoms, which are not solely explained by deficits in executive control. Past research has indicated significant differences when comparing task and resting state spectral power indicating change scores might have some utility in measuring cognitive load, specifically in the alpha band, which has been associated with inhibition, working memory, and anticipation of stimuli. Further research should be conducted to assess the utility change scores might have in providing an objective measure related to a clinical population with ADHD.

Objective: Heroin dependence is associated with deficits in impulsivity, which is also a core feature of attention deficit hyperactivity disorder (ADHD). This study aimed to explore the association between childhood ADHD symptoms and cognitive and motor impulsivity among abstinent individuals with a history of heroin dependence. Methods: Thirty-two abstinent Bulgarian males with a history of heroin dependence participated in the study. Self-rated childhood ADHD symptoms were obtained using the Wender-Utah Rating Scale. Cognitive impulsivity was measured using the Iowa Gambling Task (IGT), an index of impulsive decision making, and the Delayed Reward Discounting Task (DRDT), a measure of intertemporal choice. Motor impulsivity was indexed with the Stop Signal Task (SST), a measure of response inhibition. Results: Participants, whose average age was 27.66 years (SD = 2.7), had an average ADHD symptom score of 36.6 (SD = 18.6), had roughly 7 years (SD = 2.9) of heroin use, and had been abstinent for just over a year (M = 402.5 days, SD = 223.8). Linear regression analyses revealed that self-reported ADHD symptoms predicted impulsive decision making (IGT), but not delayed discounting (DRDT) or response inhibition (SST). Conclusions: Self-reported childhood ADHD symptoms do not uniformly predict impulsivity among abstinent individuals with heroin dependence. Results suggest the IGT may be more sensitive to externalizing psychopathology among individuals with heroin dependence than other measures of impulsivity.

To determine the prevalence of self-reported attention deficit hyperactivity disorder (ADHD) symptoms among medical students in Eldoret, Kenya. A cross-sectional descriptive study of all medical students who gave consent to participate in the study. Undertaken at Moi University's School of Medicine in Eldoret, Kenya. Comprising two hundred and fifty three (253) undergraduate medical students, with a mean age of 23.7 years (19-42, s.d. 4.1), of whom 51% were female. Measuring ADHD symptomatology using the Adult ADHD Self-Report Scale (ASRS v1.1). The prevalence rate of self-reported ADHD symptoms using the ASRS screener was 23.7%. This was significantly associated with being in the age-group 17-20 years compared (p<0.05). The prevalence rate was higher among females (25.6%) than among males (21.8%), but this difference was not statistically significant. Preclinical students had a higher prevalence rate of ADHD symptoms (28.7%) compared to clinical students (19.6%), but this was also not statistically significant. Using a modification of the ASRS full symptom checklist to approximate a Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) ADHD diagnosis yielded a 'possible ADHD' prevalence rate of 8.7%. Of these, the inattentive type was the most common (40.9%). The prevalence rate of self-reported ADHD symptoms among medical students in Eldoret is very high and possibly interferes with the students' social and academic functioning. Further studies are suggested to generate information on the real ADHD prevalence in the general population and in special populations such as schools and colleges.

Pathological gambling (PG) is a prevalent public health problem associated with fronto-temporal dysfunction and maladaptive personality traits. To further test these associations, we assessed neuropsychological performance in pathological gamblers (PGs) and controls. We also examined selected personality characteristics and symptoms of attention deficit hyperactivity disorder (ADHD). Subjects were recruited from the community. All received a comprehensive neuropsychological battery, the ADHD Rating Scale, and personality measures including the Barratt Impulsiveness Scale and a version of the Temperament and Character Inventory. People with DSM-IV PG (n = 54) and controls (n = 65) were comparable in age, sex, and education level. PGs were more likely to have comorbid lifetime mood, anxiety, and substance use disorders; antisocial personality disorder; and other impulse control disorders. PGs performed significantly worse on the Wisconsin Card Sort Test-64 perseverative responses subscale and the Trails B test; they also had lower performance and full scale IQs. PGs had elevated levels of depression, ADHD symptoms, trait impulsivity, novelty seeking, and harm avoidance, but lower levels of reward dependence. High levels of self-reported impulsivity or ADHD symptoms in PGs did not predict worse neuropsychological performance. We conclude that PGs performed worse than controls on two measures of executive function and had lower IQs. They also had more psychiatric comorbidity, higher levels of trait impulsivity and ADHD symptoms, and both novelty seeking and harm-avoidance, but lower levels of reward-dependence. This study does not support the notion that there is a pattern of neuropsychological deficits associated with high levels of impulsivity or ADHD symptoms in PGs.

Background:Attention-deficit/hyperactivity disorder (ADHD) frequently persists into adulthood and is associated with impairments in attention, emotional regulation, executive functioning, and quality of life. Although mindfulness-based interventions (MBIs) have been proposed as promising non-pharmacological treatments, the evidence regarding their efficacy in adults with ADHD remains inconsistent.Methods:A systematic search was conducted using the MEDLine, CINAHL, and PsycINFO databases to identify controlled trials published up to 2023. Studies were included if they evaluated the effects of MBIs in adults with ADHD using a control group, regardless of randomization. Only studies in which mindfulness was the primary therapeutic modality were included, even if limited psychoeducational or behavioral components were present. Ten studies met the inclusion criteria. Outcomes were categorized into 6 domains: self-reported and observer-rated ADHD symptoms, negative and positive affect, mindfulness skills, and functional outcomes. Meta-analyses were performed using standardized mean differences (SMDs) or mean differences with 95% confidence intervals (CIs). Risk of bias and publication bias were assessed using Cochrane tools and funnel plots, respectively.Results:Statistically significant improvements were observed in self-reported ADHD symptoms (SMD = 0.48, 95% CI [0.19, 0.76]), observer-rated ADHD symptoms (SMD = 0.32, 95% CI [0.09, 0.56]), and functional outcomes (SMD = 0.56, 95% CI [0.22, 0.90]). However, there were no significant effects on mindfulness skills (SMD = −0.20, 95% CI [−0.47, 0.08]), negative affect (SMD = 0.31, 95% CI [−0.06, 0.67]), or positive affect (SMD = −0.21, 95% CI [−0.58, 0.16]).Conclusion:MBIs may be effective in improving core ADHD symptoms and overall functioning in adults with ADHD. However, their effects on emotional well-being and mindfulness skills remain inconclusive. These findings support the utility of MBIs as complementary interventions for ADHD while highlighting the need for further high-quality studies to clarify their long-term effects and mechanisms of action.

It has previously been hypothesized that individuals with elevated attention deficit hyperactivity disorder (ADHD) symptoms are at greater risk of bullying perpetration and victimization. Using autoregressive latent trajectory models with structured residuals (ALT-SR) and four waves (ages 11, 13, 15, and 17) of longitudinal data from the normative z-proso study (n = 1526, 52% male), we evaluated the developmental relations between ADHD and bullying using both self- and teacher-reported ADHD symptom data. Analyses suggested that ADHD symptoms primarily increase the risk of bullying perpetration, with a within-person effect of ADHD symptoms on bullying perpetration symptoms identified across ages 13-15 (β = .13) and ages 15-17 (β = .19) based on self-reported ADHD symptoms and a similar effect identified across ages 11-13 (β = .24) and 13-15 (β = .29) based on teacher-reported inattention symptoms. There were also some indications of reciprocal effects and effects involving victimization that merit further exploration in future research. Results imply that the content of bullying intervention and prevention programs should take account of ADHD symptoms to ensure that those with elevated symptoms can benefit as much as their typically developing peers. This will involve addressing bullying perpetration that may reflect impulsive/reactive aggression and impaired social skills rather than instrumental aggression. Further, programs should go beyond classical curriculum/classroom-based delivery to ensure that individuals with elevated ADHD symptoms can be successfully engaged.

BackgroundReduced total brain volume is a consistent finding in children with Attention Deficit/Hyperactivity Disorder (ADHD). In order to get a better understanding of the neurobiology of ADHD, we take the first step in studying the dimensionality of current self-reported adult ADHD symptoms, by looking at its relation with total brain volume.Methodology/Principal FindingsIn a sample of 652 highly educated adults, the association between total brain volume, assessed with magnetic resonance imaging, and current number of self-reported ADHD symptoms was studied. The results showed an association between these self-reported ADHD symptoms and total brain volume. Post-hoc analysis revealed that the symptom domain of inattention had the strongest association with total brain volume. In addition, the threshold for impairment coincides with the threshold for brain volume reduction.Conclusions/SignificanceThis finding improves our understanding of the biological substrates of self-reported ADHD symptoms, and suggests total brain volume as a target intermediate phenotype for future gene-finding in ADHD.

ABSTRACTObjectives: To investigate the prevalence of attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) symptoms in adult patients with primary restless legs syndrome (RLS) and to determine the iron biological correlates of these comorbidities. Participants and Methods: We obtained demographic and clinical data from consecutive 105 outpatients with idiopathic RLS who answered validated questionnaires designed to assess the presence of ADHD and OCD symptoms. In these patients, iron blood parameters were routinely checked. Results: Of the total sample, 42.86% of the patients with RLS showed symptoms reminiscent either of ADHD or OCD. Prevalence of ADHD and OCD symptoms was 27.62% and 7.62%, respectively. Compared to other groups, a significantly higher percentage of RLS patients with ADHD symptoms was on antidepressant (p = 0.012); and women with ADHD symptoms, either alone or combined with OCD symptoms, showed significant reduced ferritin concentrations compared to men with either isolated ADHD symptoms or with combined ADHD and OCD symptoms (p = 0.028 and p = 0.025, respectively). Conclusions: Our findings highlight the high prevalence of ADHD and OCD symptoms in adult patients with primary RLS and independently of serum iron stores decrease, except for women with ADHD symptoms either alone or in combination with OCD symptoms. This may suggest an overlapping neurobiological dopaminergic and serotoninergic dysfunction in ADHD, OCD, and RLS, and question the expression of different RLS phenotypes. The efficacy of dopamine agonists in these groups of patients should be questioned in future studies.

To explore the influence of recovery from eating disorders (ED) at 1-year follow-up on self-reported attention deficit hyperactivity disorder (ADHD) symptoms in an unselected group of patients in a specialized ED clinic. Four hundred and eight adult females with an ED were assessed with the World Health Organization adult ADHD Self-Report Scale-Screener, and for comorbid psychiatric symptoms at baseline and 1-year follow-up. Recovery was registered at follow-up. ADHD symptoms decreased between baseline and follow-up in recovered patients treated for bulimic ED. In not recovered patients, ADHD symptoms were stable. Decreased depressive symptoms were associated to decreased ADHD symptoms at 1-year follow-up. Bulimic ED and ADHD are linked together. This link, although not known in every detail, has clinical implications with possible value for bulimic ED patients. Clinical studies exploring implementation of ADHD treatment strategies for Bulimia Nervosa are recommended.

Treatment Controversies in Adult ADHD.

BackgroundAttention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in children that can extend into adulthood and that is often associated with a variety of comorbid psychiatric disorders.AimAssess the comorbidity of ADHD with anxiety disorders and depressive disorders in school-aged children, and the relationship of the severity of ADHD, anxiety, and depressive symptoms in children who have ADHD with the severity of the corresponding symptoms in their parents.MethodsA two-stage screening process identified children 7-10 years of age with and without ADHD treated at the Xin Hua Hospital in Shanghai. ADHD and other DSM-IV diagnoses were determined by a senior clinician using the Schedule for Affective Disorder and Schizophrenia for School-Aged Children (K-SADS-PL). One parent for each enrolled child completed three self-report scales: the ADHD Adult Self Report Scale (ASRS), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). In total 135 children with ADHD and 65 control group children without ADHD were enrolled; parents for 94 of the children with ADHD and 63 of the children without ADHD completed the parental assessment scales.ResultsAmong the 135 children with ADHD, 27% had a comorbid anxiety disorder, 18% had a comorbid depressive disorder, and another 15% had both comorbid anxiety and depressive disorders. Parents of children with ADHD self-reported more severe ADHD inattention symptoms than parents of children without ADHD and were more likely to meet criteria for adult ADHD. Mothers (but not fathers) of children with ADHD had significantly more severe trait anxiety and depressive symptoms than mothers of children without ADHD. Among children with ADHD, the severity of ADHD symptoms was not significantly correlated with the severity of ADHD symptoms in parents, but depressive symptoms and anxiety symptoms in the children were significantly correlated with the corresponding symptoms in the parents.ConclusionSchool-aged children with ADHD commonly suffer from comorbid anxiety and depressive disorders, and the severity of these symptoms parallels the level of anxiety and depressive symptoms in their parents. Self-reported symptoms of ADHD are significantly more common in parents of children with ADHD than in parents of children without ADHD. Longitudinal studies are needed to disentangle the genetic, biological, and social factors responsible for these complex inter-relationships.

To explore the influence of self-reported Attention Deficit Hyperactivity Disorder (ADHD) symptoms on recovery rate at 1-year follow-up in an unselected group of patients in a specialized eating disorder (ED) clinic. Four hundred forty-three adult females with an ED were assessed with the ADHD Self-Report Scale for Adults (ASRS-screener), and for demographic variables and ED symptoms. Recovery was registered at 1-year follow-up. A high degree of ADHD symptoms at baseline was predictive for nonrecovery of ED at 1-year follow-up in patients with loss of control over eating, bingeing, or purging. The presence of inattentive ADHD symptoms was stronger associated with nonrecovery than hyperactive/impulsive symptoms. A high degree of ADHD symptoms may have a negative impact on recovery in ED. Screening/diagnostic evaluation of ADHD in all loss of control over eating/bingeing/purging ED patients and studies of the effect of implementing ADHD-treatment strategies in this patient group are recommended.

Prospective Follow-up Studies of ADHD: Helping Establish a Valid Diagnosis in Adults

Research found that adults with attention deficit hyperactivity disorder (ADHD) have more problems with financial decision-making than healthy controls. The present study investigates the impact of symptoms of ADHD on impulsive buying and the use of financial decision styles. Furthermore, the influence of personality, symptoms of depression and demographics on the association between ADHD and these aspects of financial decision-making is evaluated. A community sample of 1292 participants (age range 18–93 years, 45.4% male) completed questionnaires related to ADHD, impulsive buying, financial decision styles, personal financial situation, depression and personality. Four groups were formed based on self-reported ADHD symptoms: an ‘ADHD’ group (n = 45), an ‘Adult-only ADHD’ group (n = 57), a ‘Subthreshold ADHD’ group (n = 162) and a ‘No ADHD’ group (n = 265). Groups were compared using ANOVA and chi-square tests. Furthermore, multiple regression analyses in the complete sample were employed to examine the association between ADHD and financial decision-making. The ADHD and Adult-only ADHD groups reported significantly more impulsive buying, used more often an avoidant or spontaneous decision style and less often saved money compared to the No ADHD group. Regression analyses revealed that impulsive buying and financial decision styles were not significantly associated with ADHD symptoms when controlling for personality, symptoms of depression and demographics. The present study confirms previous research on adults with ADHD by indicating more impulsive buying and a more frequent use of disadvantageous financial decision styles (i.e., avoidant and spontaneous styles) in individuals with an elevated number of current symptoms of ADHD compared to individuals without symptoms of ADHD. Personality and demographic variables were found to be related to both impulsive buying and the use of specific financial decision styles and might be of influence on the association between impulsive buying, the use of financial decision styles and ADHD.