Prevalence and risk factors of attention deficit hyperactivity disorder among college students in Changsha

Treatment Controversies in Adult ADHD.

FIGURE 1. Changes in cortical thickness provide one measure of brain maturation. A large longitudinal study found that for most areas of cortex, children with attention deficit hyperactivity disorder (ADHD) reach peak cortical thickness several years later than typically developing children, supporting presence of developmental delay. The rate of cortical thinning also differed between the group who continued to meet diagnostic criteria into adulthood (persistent ADHD) and those who did not (remitted ADHD). Areas of cortex in which the rate of thinning correlated with adult symptom level (green, more symptoms associated with more thinning) are approximated on medial and lateral simplified representations of cortex. An earlier study also identified multiple areas in which cortex was thinner in adults with persistent ADHD compared with controls (orange). In addition, this study noted some areas of thicker cortex in remitted ADHD when compared with persistent ADHD (blue).

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

As in many other countries, child psychiatry in China has gradually developed from general psychiatry. In the early days of the profession, child psychiatry was considered as psychiatry for "little adults". Child psychiatry in China has gradually developed and expanded since the implementation of Professor Guotai Tao's child psychiatric services in Nanjing in the 1930s. In particular, the profession has developed rapidly since its affiliation with the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) in 1998. Child psychiatry has been one of the fastest developing advanced international disciplines over the past 10 years. Pediatric psychiatry mainly focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. In 1899, the term ''child psychiatry'' (in French) was used as a subtitle in Manheimer 's monograph Les Troubles Mentaux de l'Enfance. The Swiss psychiatrist Moritz Tramer (1882–1963) was probably the first to define child psychiatry, in 1933, in terms of diagnosis, treatment, and prognosis within the medical discipline. In 1934, he founded the Journal of Child Psychiatry (1934–1952), which later became Acta Paedopsychiatrica (1953–1994). The first academic pediatric psychiatry department was established in 1930 at the Johns Hopkins Hospital in Baltimore by Leo Kanner (1894–1981). Since then, the clinical practice, research, and teaching of child psychiatry have gradually developed around the world.1 There have been three stages to the development of children's psychiatry in China. The first is the exploration and development period, which occurred mainly during the 1930s to the 1950s. This period was characterized by the introduction of Western models by experts and the exploratory development of child psychiatric services. Professor Yulin Cheng, Guotai Tao, and Yonghe Ling other professors are the pioneers. The second stage is the initial development period, which occurred from the 1950s to the late 1970s. Child psychiatric clinics and/or wards were established in Nanjing, Shanghai, Beijing, Guangzhou, Sichuan, Hunan and other places and child psychiatric teams were formed. Although there was a pause in the early 1970s, child psychiatric service models continued to be developed. The third period, from the late 1970s to the present, was characterized by rapid progress. The development of child psychiatry has been promoted mainly since the economic reform and opening-up in China, with the transformation of the medical model from a pure biomedical model to a biopsychosocial medical model. Psychiatrists, pediatricians, and psychologists have begun to focus on child mental health and have conducted some interdisciplinary research and practice. Following the establishment of the Nanjing Child Mental Health Research Center, many provinces and cities have established child mental health centers. Psychiatric hospitals or mental health institutes affiliated to major medical universities in Nanjing, Beijing, Hunan, Sichuan, Shanghai and other places have successively established Master's and doctoral training sites for child psychiatry and applied psychology. Relevant disciplines and research institutions such as child health care, behavioral pediatrics, special education schools, and autism training centers have successively joined the ranks of child mental health services. In particular, Professor Guotai Tao founded the Nanjing Child Mental Health Research Center in 1984. In August 1987, the center was appointed by the World Health Organization (WHO) as a scientific research and training cooperation center, and was appointed by the Chinese Ministry of Health (now the National Health Commission) as a child mental health guidance center. Many child psychiatrists and mental health workers have been trained, and academic exchanges have been promoted in China and abroad.2 With the rapid development of disciplines, Chinese child psychiatry has reached an internationally renowned and advanced level. Multidisciplinary participation in child psychiatry is good. For example, the psychology of child development, developmental behavior pediatrics, child neurology, child health care, education, and sociology have begun to attach importance to clinical practice and research on mental health. A growing number of universities and colleges offer degrees for social workers in clinical psychology and childcare. In addition, with more primary care centers in the community, primary care physicians can implement screening and follow-up for children with mental health disorders. However, the primary care providers still need more education and training. To address this problem, the National Health Commission has been advocating multilevel collaboration. Pediatricians and primary care physicians across the country are now being trained in early diagnosis and basic treatment for common mental disorders in children. They are taught to screen patients for signs of developmental disorders by checking, for example, whether a 3-month-old baby's eyes can follow moving objects or whether an 18-month-old child can make eye contact. The problem of the shortage of child psychiatrists has been partially solved.3 Children and adolescent mental health problems are related to a country's development and to global changes. About 20% of children and adolescents worldwide experience mental health disorders. The major challenges for children and adolescents with mental disorders are stigma, isolation, discrimination, and the lack of access to health care and education facilities. Obviously, children and adolescents are vulnerable groups; they have no political power and their mental health problems are complicated. The mental health of children and adolescents requires multisectoral cooperation and the attention of the whole society. In particular, the protection afforded by government actions and policies is crucial. Policies must be designed to ensure that children and adolescents can access even the most basic mental healthcare. However, there are few countries worldwide that provide specific policies for the mental health needs of children and adolescents.4 China has a large population of children. Rapid economic development and social reforms in recent years have had a substantial impact on the mental health of children and adolescents. Increasing social pressures and workers migration, and changes in family planning, have changed traditional family structures and social support systems.3 As part of development and progress within China, the Chinese government has initiated a series of policies and regulations to promote mental health. Some of these policies are aimed at promoting mental health in children and adolescents; for example, "The Law of the People's Republic of China on the Protection of Minors", "The Law of the People's Republic of China on the Protection of the Rights and Interests of Women and Children", "The Law of the People's Republic of China on the Protection of Disabled Persons", "Mental Health Law of the People's Republic of China", and programmatic documents such as the "Healthy China 2030 Planning Outline", "National Program of Outline for Action for Child Development in China (2011–2020)", "Guidelines for the Prevention and Treatment of Attention-Deficit/Hyperactivity Disorder'', ''Guidelines for the Diagnosis, Treatment and Rehabilitation of Children with Autism'', and ''Technical Specifications for Children's Mental Health Care''.5-10 These reflect how the support of national policies has driven the development of child psychiatry. Major national basic and clinical research projects have invested in child psychiatry research, such as the National Natural Science Foundation of China, which has supported national research and development plans in key health areas. Research by a team led by Professor Zhang Dai has demonstrated that FMR1, DISC1, EN2, and SHANK3 genes are related to autism. Studies by a team led by Professor Kun Xia and Jingping Zhao have shown that XRXN1, GRIN2B, RELN, and DAB1 genes may be antecedents of autism. Such research has been published in several high quality academic journals in recent years.11, 12 Some research of the National "12th and 13th Five-Year Plan" scientific and technological support projects led by Professor Yi Zheng, on "The Epidemiological Study of Child Mental Disorders in China" and "Comprehensive Intervention Strategies for Chronic Non-communicable Diseases with Attention Deficit-Hyperactivity Disorder". These show that Chinese child psychiatry has become a discipline supported by the national key research project. Traditional research group in child psychiatry include the team led by Professor Guotai Tao, Jie Lin and Xiaoyan Ke about autism, mental retardation and childhood schizophrenia; team led by Professor Yufeng Wang on attention deficit hyperactivity disorder; team led by Professor Xiaoling Yang and Jing Liu about autism spectrum disorders; team led by Professor Xuerong Li, Linyan Su and Xuerong Luo on epidemiological surveys and tool scales for child mental disorders; team led by Professor Rene Xin, Yasong Du and Wenhong Chen on epidemiological investigation of children's behavior problems and related research on child psychology and family therapy; team led by Professor Shiji Zhang, Yi Zheng, Yonghua Cui and Fan He on tics and related disorders; and team led by Professor Youhe Shan, Lanting Guo and Yi Huang on behavioral scales and tic disorders. The above studies have published valuable articles in academic journals and won many awards. Child psychiatrists need to be dedicated. The treatment of patients with mental illness is difficult and often daunting, and children's mental health disorders are particularly difficult to treat. Treatment of children with autism or mania requires tackling difficult problems and good practice in basic clinical skills. In China, child psychiatrists experience low returns and low income. The number of child psychiatric inpatients and outpatients is constantly increasing, and their treatment often relies on the dedication of child psychiatrists. To treat such patients, there are now more than 10 centers, nearly 1000 beds, and dozens of special education centers, such as autism rehabilitation centers. To care for left-behind children, children infected with AIDS, children affected by natural disasters such as earthquakes, and children with substance abuse and internet addiction, many child mental health workers and full-time child psychiatrists have formed competent national and local emergency response teams. Child psychiatrists are now available to help children to cope with a variety of social disasters, such as the Wenchuan earthquake or the "3.01" terrorist incident in Kunming. The development of modern child psychiatry in China is interlinked with foreign exchange. Since Professor Guotai Tao's studies in the United States in 1940, Chinese child psychiatry has been continuously introducing and incorporating foreign advanced diagnosis and treatment and research concepts. At present, Professor Tao has discussed diagnostic issues with international authoritative experts in foreign journals and participated in the preparation of the 11th revision of the International Classification of Diseases (ICD-11). Professor Tao was the first international participant in efforts to promote the integration of child and adult psychiatry and the popularization of the notion of the lifelong effects of mental illness, such as the Cross-Strait Summit Forum, and domestic and foreign academic institutions and academic exchanges, such as the Asian Society for Child and Adolescent Psychiatry and Allied Professions (ASCAPAP) and the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP). Chinese child psychiatrists have attended and contributed to both of the latter societies. Since the 1930s, older generations of individuals, such as Yulin Cheng, Guotai Tao, and Xueshi Chen, have made substantial contributions to the development of the discipline of child psychiatry. In 1989, Professor Jie Lin set up and led the Child Psychiatric Group of the Chinese Medical Association Psychiatry Branch. Professor Guotai Tao served as a consultant of the Group. Almost at the same time, the Chinese Mental Health Association established the Child and Adolescent Professional Committee, with Xuerong Li as director. Xueshi Chen serves as a consultant. Since then, two academic organizations have held annual meetings or training courses. In 1998, Professor Shiji Zhang, Yi Zheng, and Linyan Su participated in the IACAPAP congress and joined this organization, which is the most highly regarded academic organization in international child psychiatry. Chinese child psychiatry is fully in line with international developments in child psychiatry. In 2003, Professor Yi Zheng and Linyan Su attended the WHO Expert Headquarters "Concern for Children and Adolescents with Mental Disorders" meeting as Chinese representatives. In the same year, Professor Yi Zheng participated in the ASCAPAP congress and was elected as an executive member. In 2004, Professor Yi Zheng was appointed onto the IACAPAP executive committee. Professor Yi Zheng created the Cross-Strait Children's Psychiatry Summit Forum, which is held once every 2 years alternately in the mainland of China and Taiwan province, China. The Forum is now in its ninth session and has promoted the rapid development of the discipline. In 2010, the 19th IACAPAP International congress was successfully held in Beijing. This was the first time that this congress had been held in a developing country. Professor Yi Zheng served as Executive Chairman, and Professor Jing Liu served as Chairman of the organizing committee. Xiulian Gu, Zhu Chen, Wenkang Zhang and the country's main health care officials attended the opening ceremony and delivered speeches. More than 1300 foreign scholars and 500 domestic scholars attended the congress. Yi Zheng was elected onto the ASCAPAP executive committee and was elected Chairman, and Jing Liu was elected Vice-Chairman of ASCAPAP. At the 21st IACAPAP Conference held in South Africa in 2014, Professor Yi Zheng was elected Vice-President of IACAPAP and won the International Child Psychiatry Outstanding Contribution Award, indicating that Chinese child psychiatry has played a major role on the international stage.2 China has a population of more than 1.3 billion individuals, of which 238 million are children younger than 15 years of age.13 Though a nationwide prevalence study is lacking, some regional epidemiological studies show that the prevalence of mental health disorders in children is close to the worldwide prevalence of 20%,14-18 indicating that about 50 million children in China require treatment for mental health disorders. However, there is a scarcity of child and adolescent psychiatrists (CAPs) in China, and there are less than 500 full-time CAPs nationwide. Currently, only a national psychiatrist certification system exists, and there is no child psychiatrist certification system. Instead, students must obtain a postgraduate training certificate or a nationally approved Ph.D. or Master 's degree training certificate to become a child psychiatrist. A recent survey showed that training units for CAPs are mainly concentrated in large and medium-sized cities. Moreover, only a small number of medical personnel in China can diagnose and treat children and adolescents with mental health disorders, and these have insufficient training. Currently available training for child psychiatrists contains insufficient scientific, practical, and problem-solving content. Furthermore, current educational training poorly equips child psychiatrists for subsequent teaching and professional scientific research abilities. Therefore, a greater training focus is needed on more comprehensive qualities and abilities, such as dedication. Although CAPs undertake a long process of training, this mainly comprises postgraduate or doctoral Master's degree training; the national specialized certification system for CAPs has only been piloted in major cities. The CAP training system requires further improvements, and more CAPs are needed.19 China still has a shortage of child psychiatrists. To address this, a new type of multilevel collaboration is currently being implemented. Pediatricians and primary care physicians are also receiving training in child psychiatry. In addition, psychotherapists from other countries have been recruited to help train psychiatrists. China is currently exploring all possible ways to strengthen multilevel collaboration to promote the children's physical and mental health.3 The artificial boundary between children and adults with mental health disorders will be removed: more attention and value will be placed upon the treatment of adult attention deficit–hyperactivity disorder (ADHD), adult autism spectrum disorder (ASD), adult tic disorder, and other issues. Gene diagnosis and classification of child neurological and mental development disorders will become a reality: the detection of genes for susceptibility to ASD, ADHD, tic disorders, child schizophrenia, and child bipolar disorder will become possible. The concept of the supremacy of child mental health will gradually be accepted. More and more studies have confirmed that among the main factors for healthy and successful child developmental, child mental health is of paramount importance. As physical health and nutritional issues have been generally resolved in most parts of China, the impact of mental health on the future success of children will be a core health issue. Therefore, mental health should start with children. The multidisciplinary and multisector nature of child mental health will be further improved: medicine, economics, sociology, and other disciplines will pay close attention to child mental health. In particular, the only-child problem, the problems experienced by elderly parents in raising a second child, the problem of left-behind children, AIDS-infected children, Internet addiction problems, youth suicide, and crime prevention problems will become the focus of social attention. There will be new breakthroughs in early diagnosis and interventions for child mental health disorders: the ICD-11 (containing input from Chinese experts) will soon be released. Early warning indicators for child psychological problems and quantitative assessment techniques for child mental health care will be promoted from the national level to the whole country. Like child vaccination, assessments and interventions for child psychological conditions will benefit every child, which will set a global precedent. Treatment methods for child mental health disorders will be qualitatively improved. In addition to the further optimization of the structure and dosage of antipsychotics, research on functional food will make significant progress, and the use of alternative medicine and traditional Chinese medicine for child mental health disorders will be further clarified. In conclusion, the development of child psychiatry in China is still far behind developed countries, but a golden age of rapid development is approaching. Research on prevention and control of major chronic non-communicable diseases in the Ministry of Science and Technology (No: 2016YFC1306100) None.

Introduction: Repeated use of social network is said to cause addiction. Attention deficit hyperactivity disorder (ADHD) is disorder found in childhood. Studies have shown that such children continue to have the symptoms of ADHD as adults. The aim of this study was to find the prevalence of social networking addiction and Internet addiction and their relationship with ADHD. Also, to assess the relationship between perceived stress and sociodemographic factors with social networking and internet addiction. Material and Methods: A cross-sectional study was conducted among 150 undergraduate and postgraduate students of BMCRI after ethical clearance. Medical students who gave consent were included through stratified random sampling. Those who were taking treatment for psychiatric illness were excluded. Scales like the Young Internet addiction test (IAT); Bergen's Facebook Reporting Scale, ADHD Self-Reporting Scale, and Wender Utah Brief Rating Scale for ADHD, and Cohen Perceived Stress Scale (PSS) for perceived stress have been used. Results: The mean age was found to be 21.56 ± 3 years. 62.6% were males and 37.33% of were females. The prevalence of Internet addiction was found to be 23.3% (n = 35), with 2% (n = 3) were having severe addiction, 6.6% (n = 10) were having moderate Internet and 14.6% (n = 22) having mild internet addiction according to modified Young's criteria (2011). The prevalence of social networking addiction as per the Bergen Facebook Addiction Scale (BFAS) score was 4.66% and adult ADHD was 15%. There was a strong positive correlation (0.76) between Internet Addiction and Facebook addiction scores and between BFAS score and IAT score. A moderate positive correlation (0.46 and 0.47) between Internet addiction and Facebook addiction with perceived stress and ADHD and IAT score with PSS score and ASRS score, weak positive correlation with PSS score and ASRS score was observed. Conclusion: A significant proportion of medical students develop Internet addiction and minority develops social network addiction. Furthermore, perceived stress and ADHD scores are positively correlated with internet and social networking addiction.

Review question/objective The objective of the systematic review is to identify and synthesize the best available evidence on how parents experience living with a child with attention deficit hyperactivity disorder (ADHD) including their experiences of ADHD health care services. The review questions are: How does living with a child with ADHD affect family life?What are the parental challenges of having a child with ADHD?How do parents experience collaboration with health care settings and professionals? Background Attention deficit hyperactivity disorder is the most prevalent mental disorder among children and adolescents worldwide, and the incidence of ADHD has increased in recent years.1 Attention deficit hyperactivity disorder in children is characterized by inattention, hyperactivity and impulsivity, and these characteristics are often present before the age of seven. The prevalence estimates for ADHD vary considerably worldwide due to demographic, cultural and socioeconomic characteristics of the population as well as the various criteria used for diagnosis. However, it is estimated that the prevalence in school children aged between five and 12 is 4-7%.2,3 Attention deficit hyperactivity disorder occurs in all socioeconomic groups, although it is more frequent in lower socioeconomic groups in society.2-4 Children with ADHD have care needs that reinforce a multimodal approach. They are often treated with medication which is supplemented with a variety of psychosocial and psycho educational interventions to improve their functioning.5 Furthermore, ADHD can be complicated by co-morbid conditions such as depression, anxiety and conduct disorders. Compared with the general population, ADHD is also associated with an increased prevalence of physical conditions including asthma, food allergy, epilepsy and severe headaches.2,8 Attention deficit hyperactive disorder often presents with challenging behavior and is associated with impairment in social, familial, emotional, academic and behavioral functioning.6,7 Attention deficit hyperactivity disorder may impact the lives of children and their families, for example, it affects practical and psychological aspects of daily life, school life and social life.6,7 The lives of families with children with ADHD can be influenced by many factors.9 Studies on parenting experiences show that parents find it challenging to raise and support the child.1,6 Findings indicate that the parents are struggling to maintain a bearable family life and to learn how to successfully handle their child.1,6 In addition, parents raising children with ADHD experience more emotional distress, stress and exhaustion than parents raising children without ADHD.1 Raising a child with ADHD also affects the families' social life as parents are worried how the child with ADHD will behave if they go on visits, holidays etc.9 Mental illness is associated with stigma, and living with a child with ADHD seems to have a significant impact on the families' experiences of stigma.10 Parenting a child with ADHD may cause experiences of social isolation, negative public views and sometimes the characteristics of the child with ADHD provoke negative reactions and intolerance from other parents or family members.9,10 Thus, the parents are concerned how society will judge a child diagnosed with ADHD, and they fear that the diagnosis may have a negative impact on their child's future opportunities.10 Although the majority of studies imply that raising a child with ADHD affects family lives negatively, studies report that the parents benefit from early identification and help and support from professionals.11 Some families develop strategies to cope with the problems related to their child's disorder.6,12 Parenting experiences of living with a child with ADHD include experiences of ADHD care and treatment.20 Children with ADHD are cared for and treated in various settings both in and outside of medical settings. Parents may be challenged by coordinating care and treatment as the diverse settings and professionals do not always tend to collaborate.14,15,20 A study estimates that as the rate of mental illness in the child population continues to increase, an extended use of collaboration with health professionals such as school psychology services, public health nursing, hospital psychiatry etc. is an important factor in providing high quality services.13 Treatment and care for children with mental health problems can involve between six to ten professionals across sectors.13 Studies reveal different perceptions regarding parents' collaboration with professionals. On one hand, parents of children with ADHD are grateful for the help and support from professionals to provide the best possible care for their children.1,4 On the other hand, parents experience barriers to treatment and care, as it is provided in diverse settings with numerous professionals involved.14,15 In addition, professionals and parents may conceptualize ADHD differently and have different perceptions of what collaboration entails.11 Studies show that parents lack directions and help from professionals to make decisions concerning medication.16-18 ADHD treatment and care may also be compromised by lack of continuity of care and if health professionals do not meet the families' individual emotional and educational needs.4,20 Family factors such as conflicts within the family and the psychopathology of the parents may also contribute to barriers in treatment and care.4,19 The literature indicates that parenting children with ADHD is influenced and challenged in different ways.1,20 However, diverse perspectives exist as how parenting a child with ADHD influences the families' daily life, how the parents manage raising the child, which factors parents find important and helpful factors and how parents experience ADHD care in diverse settings and the involvement with professionals across sectors. Studies find that the parents need more intensive support to help their child in the best possible way, and it is also recommended that professionals must be aware of the families' situations and their needs.1,11 An initial search in the databases of PubMed, CINAHL, JBIConnect+, Cochrane Library and PsycINFO showed that no systematic review on this topic exists or in progress currently. It is necessary to aggregate knowledge to further understand parenting experiences of living with a child with ADHD including their experiences of ADHD health care services to identify important and helpful factors in care and treatment. This may contribute to knowledge on how professionals can support the families in managing their situations. It may also contribute to the pertinent discussion on continuity of patient care and on how health care services ought to be organized to ensure the best possible care and treatment for children with ADHD and their parents.

Back to table of contents Previous article Next article LetterFull AccessADHD in Adult Psychiatric OutpatientsBen Lomas, M.D., and Peter Gartside, M.S., Ph.D.Ben LomasSearch for more papers by this author, M.D., and Peter GartsideSearch for more papers by this author, M.S., Ph.D.Published Online:1 May 1999https://doi.org/10.1176/ps.50.5.705AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Anxiety and depression are two of the most common complaints of psychiatric outpatients, and anxiety and mood disorders are among the most common psychiatric disorders in the United States (1). These disorders are also frequently associated with attention-deficit hyperactivity disorder (ADHD) in both children and adults (2).ADHD is a chronic psychiatric disorder characterized by early childhood onset of motor overactivity (hyperactivity), distractibility (inattentiveness), and impulsivity that often persists into adulthood (3). ADHD affects 3 to 5 percent of all classroom children, and clinically significant signs and symptoms of ADHD may persist into adulthood in 60 to 70 percent of the cases. Therefore, one would expect to find a disproportionately large number of psychiatric patients with ADHD.This report describes a study that attempted to measure the frequency of ADHD in a cross-sectional sample of 212 randomly assigned adult psychiatric outpatients, none of whom were referred for or were being treated for ADHD. The sample consisted of 130 veterans being treated in a Veterans Affairs mental hygiene clinic, 42 outpatients at a community mental health center, and 40 consecutive private psychiatric outpatients first seen by the first author in 1993 and followed for 24 to 36 months.Of the 212 outpatients, only 114, or 54 percent, received a complete ADHD assessment. Ninety-eight patients (46 percent) were excluded because of psychosis or evidence of structural brain damage. The average age of the 114 patients was 43 years, 68 percent were male, and 97 percent were Caucasian. Sixty-one percent were married, and 21 percent were divorced. Fifty-one percent were employed; the remainder were partly or total disabled or retired.Formal ADHD evaluation consisted of a review of family and childhood history and a review of grade-school report cards and school records whenever possible. Patients were also evaluated by DSM-III-R criteria for ADHD. They were scored on the Wender Utah Rating Scale (WURS) and Wender's suggested 25 items (WURS-25), which measure recollected early grade school problems (4), and on Hallowell and Ratey's 20-item Suggested Adult ADHD Criteria (5). The first author interviewed significant others and first-degree relatives using Wender's ten-item Parental Rating Scale (WPRS), which measures observations of motor overactivity, distractibility, and impulsivity, or relied on professional staff's observations.To receive a diagnosis of ADHD, a subject had to meet eight or more of the DSM-III-R criteria and have a score of 46 or more on the WURS-25, 12 or more on the Hallowell-Ratey criteria, or 10 or more on the WPRS. The subject also had to be found positive for ADHD by clinical observation, by observation of a significant other, or according to childhood school records.Fifty-seven of the 114 patients, or 50 percent, received a diagnosis of ADHD. Patients who were diagnosed with ADHD met a mean±SD of 10.3±2.5 DSM-III-R criteria. WPRS scores were obtained for 40 patients; the mean score was 15.9±3.8. The mean score on the Hallowell-Ratey scale was 17.2±1.6; on the WURS-25 it was 58.9±14.1; and on the WURS it was 113.8±28.3. Childhood school records indicated ADHD in 27 of 30 cases in which records were available.Seventeen cases of panic disorder were found in the ADHD group, but only four cases in the group without ADHD. A total of 29 cases of anxiety disorder were found in the ADHD group, compared with 11 in the other group.Fifteen of the 18 outpatients, or 83 percent, who were assessed from the community mental health center received a diagnosis of ADHD. This disproportionately high figure might be related to a higher incidence of poverty among these patients, but further study is needed.This preliminary study of ADHD in adults relied primarily on clinical observations over comparatively long time periods, ranging from 24 to 36 months. Future studies will require separating the processes of diagnosis, ADHD assessment, and treatment into controlled segments for the sake of believability and accuracy. However, the fact that the patients in the study were observed over a substantial period increases the likelihood that they did in fact have ADHD.Dr. Lomas is a staff psychiatrist at the Veterans Affairs Medical Center in Cincinnati and associate professor of psychiatry at the University of Cincinnati Medical Center. Dr. Gartside is associate professor of biostatistics and epidemiology in the department of enviromental health at the University of Cincinnati College of Medicine.

IntroductionThis study aimed to estimate prevalence and incidence of attention deficit/hyperactivity disorder (ADHD) and comorbid relationships between ADHD and other psychiatric disorders in Japan.MethodsUsing the real-world JMDC Claims Database, we conducted a cross-sectional study (analysis years 2017–2021) and retrospective cohort study (observation 2 years before/after the initial ADHD diagnosis; data collection 2005–2021; enrollment 2017–2019). Patients were male or female, aged 0–57 years. Cross-sectional study patients had an ADHD or other psychiatric disorder diagnosis (with or without medication) and were continuously registered in each analysis year; retrospective study patients had an ADHD diagnosis and ≥2 years’ observation before and after diagnosis. Endpoints were annual prevalence and incidence of ADHD in Japan, prevalence and risk ratio of each psychiatric comorbidity in patients with ADHD, prevalence and risk ratios of ADHD in patients with each psychiatric comorbidity, and prevalence of psychiatric disorders before/after the initial ADHD diagnosis.ResultsADHD prevalence in children/adolescents and adults increased each year from 2017 to 2021. Prevalence in boys was 3.5–4.1 times higher than in girls. Prevalence in adults was lower than in children/adolescents, with a small sex difference. ADHD was highly comorbid with various psychiatric disorders. In 2019, the most common comorbidity in children/adolescents with ADHD was autism spectrum disorder (ASD; 54.4%); in adults, it was mood disorders (60.9%). ADHD prevalence in patients with various psychiatric disorders was higher than in the control population. ADHD prevalence was highest in patients with oppositional defiance disorder among both children/adolescents and adults (77.2% and 69.2%, respectively). In the retrospective cohort study (N = 14,940), the most common psychiatric disorders diagnosed prior to ADHD diagnosis were ASD in children/adolescents (33.9% of patients), and mood disorders and sleep disorders in adults (36.9% and 23.8% of patients, respectively).DiscussionADHD was comorbid with various psychiatric disorders in Japan. In children and adolescents with ADHD, ASD was often diagnosed prior to ADHD. Psychiatric disorders, especially mood disorders and sleep disorders, were frequently diagnosed prior to the initial ADHD diagnosis in adults. The likelihood of comorbid ADHD should be considered when diagnosing adult patients with psychiatric disorders.

BackgroundThe prevalence of attention deficit hyperactivity disorder (ADHD) in adult obsessive-compulsive disorder (OCD) patients has been reported to range from 5.5% to 52%. Conversely, adult ADHD patients are often associated with a variety of comorbidities including OCD. The reported prevalence of comorbidity of OCD in adult ADHD patients had varied widely in previous studies, ranging from 3%–44%. These findings regarding comorbidity indicate a bilateral linkage between OCD and ADHD, suggesting the possible existence of common biological bases for the development of the disorders.On the other hand, ADHD is considered as a complex disorder with clinical and genetic heterogeneity and elevated heritability, and childhood ADHD symptoms fulfilling diagnostic criteria often improve with age. Thus, it is clinically meaningful and useful to regard the continuous nature of ADHD psychopathology as widely variable, ranging from a diagnostic entity to a trait with subthreshold ADHD conditions in general and clinical populations. Indeed, it can be assumed that there may be a population of OCD patients with ADHD traits, even if they do not meet the diagnostic threshold for ADHD.AimsIn this study, we sought to clarify the subthreshold characteristics of ADHD examining validity or clinical utility of the ADHD-trait group defined by the ADHD index score on CAARS in the OCD population.MethodsWe assessed lifetime comorbidity of ADHD using a structured diagnostic interview on the basis of DSM-5 diagnostic criteria in 87 adult Japanese patients with OCD. Additionally, we used the Japanese version of Conners’ Adult ADHD Rating Scales to assess the characteristics and severity of ADHD in each participant. According to the results, we divided these subjects into 3 groups; OCD subjects in the ADHD+ group were determined as having comorbid ADHD during their lifetime, along with the ADHD index score >65 at the initial assessments. the ADHD-trait group was assigned by the finding that they did not have lifetime ADHD but who exceeded the threshold of the ADHD index, and others that exhibited the ADHD index below the threshold score were included in the non-ADHD group (ADHD− group). We compared these groups in terms of background profiles and clinical features, such as OCD symptomatology and psychometric test results. Additionally, the 6-month treatment outcome was compared prospectively between the groups.ResultsIn the ADHD trait group (N=23), in addition to each subscale score on the CAARS distributed between the ADHD+ (N=14) and ADHD- (N=50) groups. the clinical features such as a higher impulsivity, a lower level of functioning, and increased prevalence of substance and/or behavioral addictions. were comparable to those in the ADHD+ group or in between those in the ADHD+ group and the ADHD- group, Moreover, the subjects in the ADHD+ group were significantly less responsive to the 6-month standard OCD treatments than those in the OCD- group, and the ADHD trait group showed intermediate responsivity.DiscussionThese results suggested the existence of possible continuous nature of ADHD pathology among the OCD patients, and also supported clinical utility and some validity of this group classification.

We still need to know more about adolescents with attention deficit hyperactivity disorder who undergo surgery for severe obesity

Attention‐deficit hyperactivity disorder in a life perspective

Practical considerations for the evaluation and management of Attention Deficit Hyperactivity Disorder (ADHD) in adults

The purpose of this study was to determine the prevalence rates of attention deficit hyperactivity disorder (ADHD) and comorbid disorders in an adult inpatient psychiatric setting. Patient charts were reviewed from a state hospital in the western United States. Of the 292 persons served in 2002, only 6 received a diagnosis of ADHD. Of these patients, 2 received additional diagnoses for Major Depression, 1 for General Anxiety and 1 for Bipolar Disorder. Five of the 6 ADHD participants had a history of substance abuse and 4 were diagnosed with Personality Disorders. None of the 6 diagnosed with ADHD received a diagnosis of Learning Disability. A variety of nonstimulant medications were utilized to treat these patients. Characteristics of adult psychiatric populations are reviewed. Prevalence, comorbidity and implications for future research regarding adult ADHD are discussed.

Living with symptoms of Attention Deficit-Hyperactivity Disorder (ADHD) in adulthood: a systematic review protocol of qualitative evidence

ADHD: The Mammoth Task of Disentangling Genetic, Environmental, and Developmental Risk Factors.