Adult Adult Attention-deficit/hyperactivity Disorder Rating Scale Research Articles

Treatment of adult attention-deficit hyperactivity disorder (ADHD) with transcranial direct current stimulation (tDCS): study protocol for a parallel, randomized, double-blinded, sham-controlled, multicenter trial (Stim-ADHD)

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation treatment used as an alternative or complementary treatment for various neuropsychiatric disorders, and could be an alternative or add-on therapy to psychostimulants in attention-deficit hyperactivity disorder (ADHD). Previous studies provided some evidence for improvements in cognition and clinical symptoms in pediatric and adult ADHD patients. However, data from multi-center randomized controlled trials (RCTs) for this condition are lacking. Thus, our aim is to evaluate short- and mid-term effects of tDCS in this multi-center, randomized, double blind, and sham-controlled, parallel group clinical trial with a 1:1 randomization ratio. Primary endpoint is the total score of DSM-IV scale of the internationally established Conners’ Adult ADHD Rating Scales (German self-report screening version, CAARS-S-SR), at day 14 post-intervention (p.i.) to detect short-term lasting effects analyzed via analyses of covariance (ANCOVAs). In case of significant between-groups differences at day 14 p.i., hierarchically ordered hypotheses on mid-term lasting effects will be investigated by linear mixed models with visit (5 time points), treatment, treatment by visit interaction, and covariates as fixed categorical effects plus a patient-specific visit random effect, using an unstructured covariance structure to model the residual within-patient errors. Positive results of this clinical trial will expand the treatment options for adult ADHD patients with tDCS and provide an alternative or add-on therapy to psychostimulants with a low risk for side effects.Trial Registration The trial was registered on July 29, 2022 in the German Clinical Trials Register (DRKS00028148).

Long-term treatment of adult ADHD in a naturalistic setting: clinical predictors of attrition, medication choice, improvement, and response

Objectives: The aim of this study was to identify clinical predictors of treatment attrition, medication choice, improvement and response to pharmacotherapy in adult attention-deficit/hyperactivity disorder (ADHD). Methods: 150 ADHD patients were enrolled and naturalistically followed-up for at least 4 months. Conners’ Adult ADHD Rating Scales–Observer: Screening Version (CAARS-O:SV) were used to measure ADHD severity. Results: 58 subjects (38.7%) were lost at follow-up, while 75 (50%) completed follow-up assessment, on average after 26.05 ± 11.99 weeks; 35 were treated with atomoxetine (ATX) and 40 with methylphenidate (MPH). Treatments were moderately effective (d = 0.72) and 37 patients (49.3%) were responders (≥30% CAARS-O:SV decrease). Patients lost at follow-up had lower inattentive symptoms, less generalized anxiety and family history of bipolar disorder, more amphetamine use disorder than follow-up completers. Compared to ATX-treated subjects, MPH-treated patients had greater severity of hyperactivity/impulsivity and were more frequently diagnosed with alcohol use disorder. While MPH and ATX showed similar efficacy, more pronounced improvements were observed in patients with combined ADHD, anxiety and substance use disorders. ADHD severity and comorbid substance use positively predicted response. Conclusions: Consensus-based hierarchical treatment of ADHD comorbidity is not consistently supported. Comorbid anxiety, mood and substance use disorders should not discourage the treatment of adult ADHD.

Multimodal treatment efficacy differs in dependence of core symptom profiles in adult Attention-Deficit/Hyperactivity Disorder: An analysis of the randomized controlled COMPAS trial

There is broad consensus that to improve the treatment of adult Attention-Deficit/Hyperactivity Disorder (ADHD), the various therapy options need to be tailored more precisely to the individual patient's needs and specific symptoms. This post-hoc analysis evaluates the multimodal effects of first-line medication (methylphenidate [MPH] vs placebo [PLB]) and psychotherapeutic (group psychotherapy [GPT] vs clinical management [CM]) treatments on the ADHD core symptoms inattention, hyperactivity and impulsivity. For the two-by-two factorial, observer-blinded, multicenter, randomized controlled Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS; ISRCTN54096201), 419 outpatients with ADHD were considered for analysis. ADHD symptoms were assessed by blind observer-rated and patient-rated Conners Adult ADHD Rating Scales before treatment (T1), 13 weeks (T2) and 26 weeks (T3) after T1, at treatment completion after 52 weeks (T4), and at follow-up (130 weeks, T5). MPH was superior to PLB in improving symptoms of inattention at almost all endpoints (observer-rated T2, T3, T4, T5; patient-rated T2, T3, T4), while a significant decrease in hyperactivity and impulsivity was at first found after 6 months of treatment. CM compared to GPT decreased inattention and impulsivity in the early treatment phase only (observer-rated T2, patient-rated T2, T3). In conclusion, while MPH seems to have a direct and sustained effect on inattention, premature medication discontinuation should particularly be avoided in patients with hyperactive-impulsive symptoms. Also, especially in high inattention and/or impulsivity presentations, initial individual patient management might be beneficial. Consequently, considering individual core symptom profiles may enhance the efficacy of treatments in adult ADHD.

Development and psychometric properties of the ADHD-SCL-90-R screening scale for adult ADHD.

Adult attention-deficit/hyperactivity disorder (ADHD) is a prevalent disorder with serious impairments, but it often remains undetected. The aim of the study was to developan ADHD screening scale from the Symptom Check-List-90-R (SCL-90-R) and describe its psychometric properties. The item selection was based on the ADHD-specific Conners' Adult ADHD Rating Scale (CAARS-S:L). In total, 412 subjects of an ADHD Special Consultations Unit were investigated, who completed the SCL-90-R, CAARS-S:L, and ADHD Self-Rating Behavior Questionnaire. The ADHD-SCL-90-R Screening Scale consisted of 16 items with a four-factor structure, including Inattention/Memory Problems, Hyperactivity/Restlessness, Impulsivity/Emotional Lability, and Problems with Self-Concept. It showed excellent internal consistency (Cronbachs α = .90) and good convergent validity (r = .57-.59). Sensitivity was 78%, specificity was 56%, and the discriminatory power was acceptable (area under the curve = 0.74). The newly developed ADHD-SCL-90-R Screening Scale showed good psychometric properties,and it has a versatile application in clinical practice.

Use of machine learning to classify adult ADHD and other conditions based on the Conners\u2019 Adult ADHD Rating Scales

A reliable diagnosis of adult Attention Deficit/Hyperactivity Disorder (ADHD) is challenging as many of the symptoms of ADHD resemble symptoms of other disorders. ADHD is associated with gambling disorder and obesity, showing overlaps of about 20% with each diagnosis. It is important for clinical practice to differentiate between conditions displaying similar symptoms via established diagnostic instruments. Applying the LightGBM algorithm in machine learning, we were able to differentiate subjects with ADHD, obesity, problematic gambling, and a control group using all 26 items of the Conners’ Adult ADHD Rating Scales (CAARS-S: S) with a global accuracy of .80; precision (positive predictive value) ranged between .78 (gambling) and .92 (obesity), recall (sensitivity) between .58 for obesity and .87 for ADHD. Models with the best 5 and best 10 items resulted in less satisfactory fits. The CAARS-S seems to be a promising instrument to be applied in clinical practice also for multiclassifying disorders displaying symptoms resembling ADHD.

Development of the Korean Practice Parameter for Adult Attention-Deficit/Hyperactivity Disorder.

Objectives:Adult attention-deficit/hyperactivity disorder (ADHD) is an important mental health problem that needs resolution, especially considering the high rates of ADHD continuation from childhood to adolescence/adulthood and the high prevalence of ADHD in adults. Adults with ADHD have lifelong negative impacts and require close monitoring with long-term follow-up. Hence, the establishment of a Korean practice parameter for adult ADHD is necessary to minimize discontinuation of treatment and enable information sharing among Korean mental health professionals.Methods:The Korean practice parameter was developed using an evidence-based approach consisting of expert consensus survey coupled with literature review.Results:According to the expert consensus survey, the most commonly used diagnostic methods were clinical psychiatric interview (20.66%) and self-report scales (19.25%) followed by attention (14.71%) and psychological tests (14.24%). Key evaluation instruments currently available in Korea are the World Health Organization Adult ADHD Self-Report Rating Scale, Korean Adult ADHD Rating Scale, Diagnostic Interview for ADHD in Adults, Barkley Deficits in Executive Functioning Scale for adults, Comprehensive Attention Test, Conners’ Continuous Performance Test, and the subtests of Wechsler Adult Intelligence Scale, Digit Span and Letter-Number Sequencing. Although pharmacotherapy is recommended as the first-line of treatment for adult ADHD, we recommend that it be followed by a multimodal and multidisciplinary approach including psychoeducation, pharmacotherapy, cognitive behavior therapy and coaching.Conclusion:The Korean practice parameter introduces not only general information for the diagnosis and treatment of adult ADHD on a global scale, but also the process of diagnosis and treatment options tailored to the Korean population.

Long-term Effects of Multimodal Treatment on Adult Attention-Deficit/Hyperactivity Disorder Symptoms

Knowledge about the long-term effects of multimodal treatment in adult attention-deficit/hyperactivity disorder (ADHD) is much needed. To evaluate the long-term efficacy of multimodal treatment for adult ADHD. This observer-masked, 1.5-year follow-up of the Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS), a prospective, multicenter randomized clinical trial, compared cognitive behavioral group psychotherapy (GPT) with individual clinical management (CM) and methylphenidate (MPH) with placebo (2 × 2 factorial design). Recruitment started January 2007 and ended August 2010, and treatments were finalized in August 2011 with follow-up through March 2013. Overall, 433 adults with ADHD participated in the trial, and 256 (59.1%) participated in the follow-up assessment. Analysis began in November 2013 and was completed in February 2018. After 1-year treatment with GPT or CM and MPH or placebo, no further treatment restrictions were imposed. The primary outcome was change in the observer-masked ADHD Index of Conners Adult ADHD Rating Scale score from baseline to follow-up. Secondary outcomes included further ADHD rating scale scores, observer-masked ratings of the Clinical Global Impression scale, and self-ratings of depression on the Beck Depression Inventory. At follow-up, 256 of 433 randomized patients (baseline measured in 419 individuals) participated. Of the 256 patients participating in follow-up, the observer-masked ADHD Index of Conners Adult ADHD Rating Scale score was assessed for 251; the mean (SD) baseline age was 36.3 (10.1) years; 125 patients (49.8%) were men; and the sample was well-balanced with respect to prior randomization (GPT and MPH: 64 of 107; GPT and placebo: 67 of 109; CM and MPH: 70 of 110; and CM and placebo: 55 of 107). At baseline, the all-group mean ADHD Index of Conners Adult ADHD Rating Scale score was 20.6, which improved to adjusted means of 14.2 for the GPT arm and 14.7 for the CM arm at follow-up with no significant difference between groups (difference, -0.5; 95% CI, -1.9 to 0.9; P = .48). The adjusted mean decreased to 13.8 for the MPH arm and 15.2 for the placebo arm (difference, -1.4; 95% CI, -2.8 to -0.1; P = .04). As in the core study, MPH was associated with a larger reduction in symptoms than placebo at follow-up. These results remained unchanged when accounting for MPH intake at follow-up. Compared with participants in the CM arm, patients who participated in group psychotherapy were associated with less severe symptoms as measured by the self-reported ADHD Symptoms Total Score according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) of Conners Adult ADHD Rating Scale (AMD, -2.1; 95% CI, -4.2 to -0.1; P = .04) and in the subscale of reducing pure hyperactive symptoms, measured via the Diagnostic Checklist for the diagnosis of ADHD in adults (AMD, -1.3; 95% CI, -2.8 to 0.1; P = .08). Regarding the Clinical Global Impression scale assessment of effectiveness, the difference between GPT and CM remained significant at follow-up (odds ratio, 1.63; 95% CI, 1.03-2.59; P = .04). No differences were found for any comparison concerning depression as measured with the Beck Depression Inventory. Results from COMPAS demonstrate a maintained improvement in ADHD symptoms for adults 1.5 years after the end of a 52-week controlled multimodal treatment period. The results indicate that MPH treatment combined with GPT or CM provides a benefit lasting 1.5 years. Confirming the results of the core study, GPT was not associated with better results regarding the primary outcome compared with CM. isrctn.org Identifier: ISRCTN54096201.

Reliability, Validity, Factor Structure, and Measurement Invariance of the Japanese Conners’ Adult ADHD Rating Scales (CAARS)

To examine reliability, validity, factor structure, and measurement invariance (i.e., configural, metric, and scalar invariance) of the Japanese Conners’ Adult attention deficit hyperactivity disorder (ADHD) Rating Scales (CAARS), Japanese nonclinical adults ( N = 786) completed the CAARS Self-Report (CAARS-S). Each participant was also rated by one observer using the CAARS Observer Form (CAARS-O). For the test of measurement invariance, excerpts from the original (North American) CAARS norming data ( N = 500) were used. Dimensional structure was examined by exploratory and confirmatory factor analyses. Test–retest reliability, internal consistency, and concurrent validity were satisfactory. Based on the DSM-IV model and Japanese four-factor model, configural and metric invariance were established for the CAARS-S/O across Japanese and North American populations. Scalar invariance was established for the CAARS-O based on the Japanese model. The use of the Japanese CAARS for diagnostic purposes in Japan was supported; however, it should be used with caution for cross-cultural comparison research.

Effects of mindfulness and psychoeducation on working memory in adult ADHD: A randomised, controlled fMRI study

Adult attention-deficit/hyperactivity disorder (ADHD) is a serious mental disorder associated with impaired neurocognitive performance related to working memory function. Recent clinical trials have suggested that mindfulness is a promising intervention in adults with ADHD. We performed a randomised controlled clinical trial to investigate working memory (WM) with an n-back task in adults with ADHD during fMRI before and after an 8-week mindfulness intervention (MAP) compared with psychoeducation (PE). ADHD symptoms were assessed using the self- and observer-rated Conners Adult ADHD Rating Scales (CAARS).The complete pre–post data of 21 MAP and 19 PE participants were analysed. We found no group difference in ADHD symptoms or task performance at the pre-measurement, but there was a significant decrease in ADHD symptoms and significant improvement in task performance in both groups at the post-measurement. Furthermore, we found a significant increase in task-related activation in the right parietal lobe, with no difference between groups. Exploratory two-sample paired t-tests revealed significant increased brain activation after MAP in the bilateral inferior parietal lobule, right posterior insula and right precuneus. A decrease in self-rated ‘Inattention/Memory Problems’ after MAP compared to baseline was associated with stronger activation in parts of the left putamen, globus pallidus and thalamus.

Emotional dysregulation is a primary symptom in adult Attention-Deficit/Hyperactivity Disorder (ADHD)

BackgroundClinical observations suggest that adults have more diverse deficits than children with Attention Deficit/Hyperactivity Disorder (ADHD). These seem to entail difficulties with emotionality, self-concept and emotion regulation in particular, along with the cardinal symptoms of inattention, impulsivity, and hyperactivity for adult patients. Here, we probed a model that explicitly distinguished positive and negative affect, problems with self-concept and emotion regulation skills as distinct but correlating factors with the symptom domains of inattention, hyperactivity, and impulsivity. MethodsParticipants were 213 newly diagnosed adults with ADHD (62.9% male, mean age 33.5 years). Symptoms were assessed via self-report on the Conners’ Adult ADHD Rating Scales, a modified version of the Positive and Negative Affect Scale and the Emotion Regulation Skill Questionnaire. A confirmatory factor analysis with the R package lavaan, using a robust Maximum Likelihood estimator (MLR) for non-normal data, was conducted to test our new non-hierarchical 7-factor model. ResultsAll calculated model-fit statistics revealed good model-fit (χ2/df ratio = 2.03, robust RMSEA = .07). The SRMR in our model reached .089, indicating an acceptable model fit. Factor loadings on the postulated factors had salient loadings ≥ .31 except for one item on the hyperactivity factor. Latent factor associations were especially salient between emotional dysregulation and problems with self-concept, and also partially with impulsivity/emotional lability. LimitationsThe three models of ADHD and emotion regulation as suggested by Shaw et al. (2014) could not be disentangled in this study, though the overall results support the model with shared neurocognitive deficits. Further, we did not separately analyze ADHD with or without comorbid disorders. As our sample of clinical cases with ADHD is highly comorbid (47.9%), other disorders than ADHD might account for the emotion regulation deficits, though a sensitivity analysis revealed no such differences. ConclusionsOur model adequately characterizes the relations between and among clinically and therapeutically relevant symptoms in adult ADHD, thus potentially informing future therapeutic interventions by targeting the successful and flexible use of adaptive emotion regulation skills.

ADHD, circadian rhythms and seasonality

ObjectiveWe evaluated whether the association between Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Seasonal Affective Disorder (SAD) was mediated by the circadian rhythm. MethodData of 2239 persons from the Netherlands Study of Depression and Anxiety (NESDA) were used. Two groups were compared: with clinically significant ADHD symptoms (N = 175) and with No ADHD symptoms (N = 2064). Sleep parameters were sleep-onset and offset times, mid sleep and sleep duration from the Munich Chronotype Questionnaire. We identified the prevalence of probable SAD and subsyndromal SAD using the Seasonal Pattern Assessment Questionnaire (SPAQ). Clinically significant ADHD symptoms were identified by using a T score>65 on the Conners Adult ADHD Rating Scale. ResultsThe prevalence of probable SAD was estimated at 9.9% in the ADHD group (vs. 3.3% in the No ADHD group) and of probable s-SAD at 12.5% in the ADHD group (vs 4.6% in the No ADHD group). Regression analyses showed consistently significant associations between ADHD symptoms and probable SAD, even after adjustment for current depression and anxiety, age, sex, education, use of antidepressants and benzodiazepines (B = 1.81, p < 0.001). Late self-reported sleep onset was an important mediator in the significant relationship between ADHD symptoms and probable SAD, even after correction for confounders (total model effects: B = 0.14, p ≤ 0.001). ConclusionBoth seasonal and circadian rhythm disturbances are significantly associated with ADHD symptoms. Delayed sleep onset time in ADHD may explain the increase in SAD symptoms. Treating patients with SAD for possible ADHD and delayed sleep onset time may reduce symptom severity in these complex patients.

AZD3480, a Novel Nicotinic Receptor Agonist, for the Treatment of Attention-Deficit/Hyperactivity Disorder in Adults

Laboratory studies have found that acute stimulation of nicotinic acetylcholine receptors improves cognition in adult attention-deficit/hyperactivity disorder (ADHD). Clinical trials of nicotinic agonists have been mixed, underscoring the need to understand the mechanisms for individual differences in clinical response. Using cognitive models within a clinical trial framework may provide insight into these differences. This was a within-subjects, randomized, placebo-controlled double-blind trial of the nicotinic agonist AZD3480 (also termed TC-1734) at doses of 5 mg and 50 mg and placebo in adults with ADHD. The order of the 2-week treatment periods was randomized, and a 3-week wash out separated each drug treatment period. Response inhibition (Stop Signal Task [SST]) and clinical efficacy (Investigator Rated Conners Adult ADHD Rating Scale [CAARS-INV]) were the a priori primary outcome measures of cognitive and clinical effects. We hypothesized that AZD3480 treatment would improve SST performance and clinical symptoms (CAARS-INV Total ADHD Symptoms Score). Thirty subjects were randomized, with 24 included in the intent-to-treat analyses. SST performance and total ADHD symptoms were significantly improved with 50 mg of AZD3480. CAARS-INV ratings of inattention, memory problems, and emotional lability/impulsivity were significantly improved with 50 mg of AZD3480. These results support previous work suggesting that nicotinic agonists are viable as treatments for adult ADHD. Measuring cognitive endophenotypes related to both the disorder and mechanism of treatment may help further rational drug development for dimensional features that cross-cut psychiatric disorders.

Association between Adult Attention Deficit-Hyperactivity Disorder and motorcycle traffic injuries in Kerman, Iran: a case-control study

Purpose: To assess the association between adult Attention Deficit-Hyperactivity Disorder(ADHD) and motorcycle rider traffic injuries METHODS: A case-control study was conducted over a period of six months in 2012. Two hundred and five motorcycle riders involved in traffic accidents, and 200 age-matched non-traumatic controls were enrolled. The Conners' Adult ADHD Rating Scale (CAARS) self-report (screening version) was used for screening in both groups. Finally the score of ADHD was compared between the groups and associations were assessed using multivariate logistic regression analysis. RESULTS: Two hundred and five males were recruited with a mean age of 24.3±10.2 years in the case and 25.0 ±7.7 years in control groups. Univariate Analysis showed significant association with educational level, job, daily riding amount, driving at night, helmet usage, motorcycle engine size, household income, individual income and socio-economic status. In all ADHD subscales (A,B,C,D), significant associations were found and all subscale scores were higher in the case group. Multivariate analysis confirmed the association of ADHD screening score with motorcycle traffic injuries. CONCLUSIONS: The results indicated existance of an association between Adult ADHD and motorcycle traffic injuries.

The Adult ADHD Self-Report Scale for Screening for Adult Attention Deficit-Hyperactivity Disorder (ADHD)

Adult attention deficit-hyperactivity disorder (ADHD) is underdiagnosed in the primary care setting despite 3% to 6% of adults having ADHD-like symptoms. The Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1) is a validated, 6-question screen for adult ADHD. Our purpose was to analyze this tool for evaluating patients in a busy primary care setting. The ASRS-V1.1 was administered to patients in 8 busy primary care practices. All with a positive score and a random sample of those with a negative screening score were asked to complete the Conners' Adult ADHD Rating Scale Self Report-Short Version. Each was administered within the clinic setting during the same session. Sensitivity, specificity, and positive/negative predictive values were calculated. Data were evaluated for site-specific differences. It took an average of 54.3 seconds (range, 22-252 seconds) to complete the ASRS-V1.1. There was an inconsistency-adjusted sensitivity of 1.0, a specificity of 0.71, a positive predictive value of 0.52, and a negative predictive value of 1.0. No site-specific differences were found. Because of its ease of use, short time to administer, high sensitivity, and moderate specificity, the ASRS-V1.1 is an effective adult ADHD screening to guide further evaluations for ADHD.

P-1361 - Sleep disturbance and attention deficit/hyperactivity symptoms

Introduction Insomnia as a disorder is rather common in general population. By definition, it causes distress and impairment in several areas, such as attention. Insomnia can present itself as an isolated condition or as a co-morbid phenomenon of various somatic and neuropsychiatric disorders; an example is adult attention-deficit/hyperactivity disorder (ADHD), characterized by the triad of inattention, hyperactivity and impulsivity. Objectives To identify individuals likely to suffer from chronic insomnia and/or adult ADHD, as well as to measure the impairment caused by these conditions. Aims To assess whether young adults complaining of insomnia are undiagnosed patients suffering from ADHD. Methods Adults recruited from the general community and students from two Romanian universities were invited to fill in a battery of scales consisting in the Romanian translations of the Sleep Disorders Questionnaire, Sleep Condition Indicator, Adult ADHD Self-Report Scale and Barkley Adult ADHD Rating Scale. Results To date, three hundred twenty five participants enlisted: 208 young adults, aged 23 ± 3 (78% women) and 117 older adults aged 44 ± 11 (73% women). Chronic insomnia was suspected in 5% of the young adults and 15% of the older ones (9% overall). Adult ADHD was likely in 19% of the younger participants and in 9% of the older ones (16% overall). Half of the young likely to suffer from chronic insomnia were likely to suffer from ADHD, too, compared to only 12% of the older (p = 0.03). Conclusions Young adults suspected of chronic insomnia were significantly more likely to suffer from adult ADHD, too.

A Randomized, Waiting List-Controlled 12-Week Trial of Atomoxetine in Adults with ADHD

With the increasing recognition of adult attention-deficit/hyperactivity disorder (ADHD) there is an emerging need to investigate medication in this population. In this waiting list-controlled trial, 64 ADHD-patients (mean age 35.8 ± 8.7 years) were randomly assigned to a daily dosage of up to 80 mg atomoxetine (Atx) or waiting list for 12-weeks. Primary outcome was the change of the observer-rated DSM-IV total ADHD score on the Conners' Adult ADHD Rating Scales (CAARSO: L DSM-IV total ADHD score) from baseline to endpoint. Other efficacy measures included selfrated CAARS-S:L DSM-IV total ADHD score, CAARS-O/S:L problems with self-concept and emotional lability score, Wender-Reimherr Adult Attention Defi cit Disorder Scale Emotional Dysregulation Score, and General Activities Score on the Quality of Life Enjoyment and Satisfaction Questionnaire. Efficacy measures were analysed in the per-protocol population. Mean change in CAARS:O-L DSM-IV total ADHD score was -13.1 ± 7.7 in the Atx vs. -0.4 ± 4.8 in the control group (p < 0.005). Treatment response ( ≥ 30 % reduction) was 60.1 % in the Atx vs. 0 % in the waiting list group. The other efficacy measures also showed significant improvements. The overall incidence of adverse events (AEs) was 70.4 % in the Atx group, the most frequent included fatigue, irritability, nausea and decreased appetite. In Atx-treated patients 18.5 % discontinued early due to AEs. Our results suggest that Atx is an effective treatment in adult ADHD. It reduces ADHD core and associated emotional symptoms and increases self-esteem and quality of life. AEs were consistent with those reported in other studies in adult ADHD.

Obstetric Complications in Adults with ADHD: A Retrospective Cohort Study

Obstetric complications have been associated with a number of mental disorders. In this study, we investigate how obstetric complications relate with clinically significant determinants of adult attention deficit hyperactivity disorder (ADHD), such as gender, age of diagnosis, psychiatric co morbidity, severity of symptomatology and general functioning. Presence of obstetric complications as reported in the psychiatric history of 64 patients in transition from adolescence to adulthood referred to the Yorkshire service for adults with ADHD between June 2009 and October 2010 were recorded. The presence or not of these complications was examined as a factor determining a number of clinically significant variables, such as gender, age at first diagnosis, psychiatric comorbidity, severity of symptomatology (measured with Conners Adult ADHD Rating Scale (CAARS)) and general functioning (measured using the DSM-IV General Assessment of Functioning (GAF) index). Obstetric complications were not associated with any of the variables examined. Adults with ADHD in transition to adult services were highly symptomatic and disabled with a mean Conner’s score (n = 56) of 30.5 (SD = 12.8) and the most common frequency of the GAF score (n = 55) on the 60–51 range. Although it has been reported that environmental factors are associated with ADHD, the presence or absence of obstetric complications in an adult ADHD population was not associated with a number of proxy measures clinically associated with organic aetiology in mental health conditions. Future research on etiology and etiopathology should focus on prenatal and genetic factors instead.

Borderline personality traits and adult attention-deficit hyperactivity disorder symptoms: a genetic analysis of comorbidity.

Previous research has established the comorbidity of adult Attention-Deficit Hyperactivity Disorder (ADHD) with different personality disorders including Borderline Personality Disorder (BPD). The association between adult ADHD and BPD has primarily been investigated at the phenotypic level and not yet at the genetic level. The present study investigates the genetic and environmental contributions to the association between borderline personality traits (BPT) and ADHD symptoms in a sample of 7,233 twins and siblings (aged 18-90 years) registered with the Netherlands Twin Register and the East Flanders Prospective Twin Survey (EFPTS) . Participants completed the Conners' Adult ADHD Rating Scales (CAARS-S:SV) and the Personality Assessment Inventory-Borderline Features Scale (PAI-BOR). A bivariate genetic analysis was performed to determine the extent to which genetic and environmental factors influence variation in BPT and ADHD symptoms and the covariance between them. The heritability of BPT and ADHD symptoms was estimated at 45 and 36%, respectively. The remaining variance in BPT and ADHD symptoms was explained by unique environmental influences. The phenotypic correlation between BPT and ADHD symptoms was estimated at r = 0.59, and could be explained for 49% by genetic factors and 51% by environmental factors. The genetic and environmental correlations between BPT and ADHD symptoms were 0.72 and 0.51, respectively. The shared etiology between BPT and ADHD symptoms is thus a likely cause for the comorbidity of the two disorders.

성인기 주의력결핍 과잉행동장애의 평가척도

This review aimed to assist clinicians in the identification and assessment of adult attention-deficit hyperactivity disorder (ADHD) with an emphasis on diagnostic and rating instruments. Pubmed and RISS were utilized to identify relevant studies and critical reviews on the diagnosis and assessment of adult ADHD, published between 1988 and 2010. The Adult ADHD Self-Report Scale-v1.1, the ADHD Rating Scale-IV, the Conners Adult ADHD Rating Scale, and the Current Symptoms Scale have been utilized for self-reporting of current ADHD symptoms. The Brown ADD Rating Scale, the ADHD Rating Scale-IV, the Current Symptoms Scale, and the Conners Adult ADHD Rating Scale have also been evaluated by an observer. The Childhood Symptom Scale and the Wender-Utah Rating Scale have been used for retrospective assessment of childhood ADHD symptoms and the Adult ADHD Investigator Symptom Rating Scale, the Adult Interview, the Brown ADD Diagnostic Form, the Conners adult ADHD diagnostic interview for DSM-IV, and the Wender-Reimherr Interview have been available as comprehensive diagnostic interviews. There is a wide variety of instruments available with respect to adult ADHD. The choice of appropriate instruments is essential for achieving accurate diagnosis and assessment of this disorder.

ABT-089, A Neuronal Nicotinic Receptor Partial Agonist, for the Treatment of Attention-Deficit/Hyperactivity Disorder in Adults: Results of a Pilot Study

This pilot study was designed to evaluate ABT-089, a neuronal nicotinic receptor partial agonist, as treatment for adult attention-deficit/hyperactivity disorder (ADHD). Adults with ADHD received placebo, 2 mg, 4 mg, or 20 mg of ABT-089 for 2 weeks each in a randomized, double-blind, placebo-controlled, 4 x 4 Latin square design for a total of 8 weeks. In addition to the primary outcome, the Conner's Adult ADHD Rating Scale (CAARS), secondary rating scales, and neuropsychological and safety assessments were completed. A total of 11 adults with well-characterized ADHD completed this crossover study. ABT-089 b.i.d. was superior to placebo for the CAARS Total Symptom Score, which was the primary endpoint (placebo: 38.0 +/- 1.9; 2 mg b.i.d.: 32.2 +/- 1.9, one-tail p = .021; 4 mg b.i.d.: 33.2 +/- 1.9, p = .047; 20 mg b.i.d.: 33.5 +/- 1.9, p = .056). ABT-089 was also superior to placebo for the CAARS ADHD Index and Hyperactive/Impulsive scores and the Clinical Global Impression-ADHD Severity score. On the clinical efficacy endpoints, CAARS Total Symptom Score and CAARS Hyperactive/Impulsive score, a shallow inverted U-shaped dose-response curve was observed; however, the dose-response curve for attention and memory effects as measured by computerized cognitive testing seemed dose-linear. No clinically meaningful findings in safety assessments or side effect profile were observed. Data from this pilot study suggest that ABT-089 might be effective in treating adult ADHD and that it is well tolerated. On the basis of these promising results, larger, parallel-group ABT-089 studies of longer duration are warranted.