Adult Attention-deficit/hyperactivity Disorder Group Research Articles

Abnormal wiring of the structural connectome in adults with ADHD.

Current knowledge of white matter changes in large-scale brain networks in adult attention-deficit/hyperactivity disorder (ADHD) is scarce. We collected diffusion-weighted magnetic resonance imaging data in 40 adults with ADHD and 36 neurotypical controls and used constrained spherical deconvolution-based tractography to reconstruct whole-brain structural connectivity networks. We used network-based statistic (NBS) and graph theoretical analysis to investigate differences in these networks between the ADHD and control groups, as well as associations between structural connectivity and ADHD symptoms assessed with the Adult ADHD Self-Report Scale or performance in the Conners Continuous Performance Test 2 (CPT-2). NBS revealed decreased connectivity in the ADHD group compared to the neurotypical controls in widespread unilateral networks, which included subcortical and corticocortical structures and encompassed dorsal and ventral attention networks and visual and somatomotor systems. Furthermore, hypoconnectivity in a predominantly left-frontal network was associated with higher amount of commission errors in CPT-2. Graph theoretical analysis did not reveal topological differences between the groups or associations between topological properties and ADHD symptoms or task performance. Our results suggest that abnormal structural wiring of the brain in adult ADHD is manifested as widespread intrahemispheric hypoconnectivity in networks previously associated with ADHD in functional neuroimaging studies.

Depression and other correlates of adult Attention Deficit Hyperactivity Disorder (ADHD) symptoms among Hungarian university students

IntroductionAttention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and/or impulsivity. It is one of the most common disabilities in college populations and comorbidity with depression is frequently reported.ObjectivesThe aim of the study is to shed light on depression as comorbidity and other intrapersonal correlates of ADHD in young adults.MethodsParticipants were Hungarian university students (N=420; M=24.5, SD=5.0 years). Criteria of the ADHD group were based on the Adult ADHD Self Report Scale V1.1 (ASRS-V.1.1) screening tool. The participants filled in the Beck’s Depression Inventory, the Hyperfocus Scale, Flow State Scale, Academic Persistence Scale, Satisfaction With Life Scale, General Self-Efficacy Scale, and the Connor-Davidson Resilience Scale.ResultsWe found that in the group of students who had ADHD symptoms, depression score was significantly (p<.001) higher (M=18.38, SD=5.87) than the control group’s scores (M=14.56, SD=4.45). Frequency of severe depression was 13.4% (moderate: 33.5%) while in the control group: 1.6% and 17.6% respectively. Participants reporting ADHD symptoms (N=164, 39%) also reported lower levels of resilience (M=23.40, SD=6.96), relative to their non-ADHD peers (M=27.69, SD=6.48). Significant differences were found in the areas of self-efficacy, depression, flow and hyperfocus as well, and ADHD symptoms contributed to lower level of life satisfaction (β=-0.24, p<.001).ConclusionsOur findings suggest that university students reporting symptoms of ADHD may be assisted with strategies that are focused on increasing protective factors (i.e., resilience, self-efficacy, flow) to prevent depression and improve their life satisfaction and quality of life.DisclosureNo significant relationships.

Psychometric Properties of the Diagnostic Interview for Adult Attention-Deficit/Hyperactivity Disorder 2.0 Turkish Version

There is no structured diagnostic interview validated in Turkish for adult attention-deficit/hyperactivity disorder (ADHD). This study aimed to examine the reliability and validity of the Turkish version of the Diagnostic Interview for ADHD in adults 2.0 (DIVA-2.0). The sample included 158 patients with ADHD and 96 patients without ADHD referred to the ADHD outpatient clinic of the psychiatry department. Pearson's correlation coefficient was used to examine the convergent validity between DIVA-2.0 and the Wender Utah Rating Scale (WURS), the Adult ADHD Self-Report Scale (ASRS), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). The internal consistency of DIVA- 2.0 was high. There were statistically significant differences for class repetition, employment status, job change, income, discipline penalty, BDI, BAI, WURS, and ASRS points between the ADHD and non-ADHD groups. Correlation analysis between DIVA-2.0 and WURS, ASRS, BDI, and BAI was statistically significant. These results show that the Turkish version of DIVA-2.0 presented good psychometric properties to diagnose ADHD in the Turkish population. [ Psychiatr Ann . 2022;52(2):76–84.]

Acceptability and Feasibility of the Transfer of Face-to-Face Group Therapy to Online Group Chats in a Psychiatric Outpatient Setting During the COVID-19 Pandemic: Longitudinal Observational Study.

BackgroundAt the height of the COVID-19 pandemic, several mental health care providers were obliged to shut down outpatient services, including group therapy and psychoeducational sessions. The lockdown in many countries is a serious threat to people’s mental well-being, especially for individuals with severe mental illnesses. Discontinued outpatient treatments and disruption of daily routines are considered to be risk factors for destabilization of patients with mental illness.ObjectiveThe aim of this study was to evaluate the acceptability, usability, and feasibility of a group chat program to replace cancelled face-to-face group sessions in an outpatient psychiatric department.MethodsParticipants (N=33) were recruited in the outpatient department of a large university medical center in Leipzig, Germany. Former face-to-face group participants were invited to take part in a therapist-guided group-chat for 4 weeks (8 sessions) and were asked to evaluate the program via self-administered standardized questionnaires at baseline (T0, preintervention), after every chat session (T1), and posttreatment (T2, after 4-6 weeks). The chat groups were specific to the following mental disorder diagnoses and based on the same therapeutic principles and techniques as the former face-to-face groups: anxiety, depression, obsessive-compulsive disorder, and adult attention-deficit/hyperactivity disorder (ADHD). Sociodemographic measures, attitudes toward the COVID-19 pandemic, depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), treatment credibility/expectancy (Credibility Expectancy Questionnaire), and participants’ satisfaction (Client Satisfaction Questionnaire-8 [ZUF-8]) were measured.ResultsParticipants joined an average of 5 out of 8 offered chat sessions. Participation rates in the respective groups were highest in the ADHD group (8.6/11, 78%) and lowest in the anxiety group (3.7/9, 41%). The overall preintervention level of depressive symptoms was moderate and showed a slight, nonsignificant improvement at posttreatment (T0: mean 10.7, SD 5.5; T2: mean 10.2, SD 5.5). A similar result was observed regarding quality of life (T0: median 41.7-68.8; T2: median 50-70.3). Treatment credibility and expectancy scores were medium-high (T0: meancredibility 18.1, SD 3.8; meanexpectancy 11.2, SD 5.1; T2: meancredibility 17.1, SD 4.8; meanexpectancy 10.3, SD 5.8). Further, significant correlations were detected between posttreatment expectancy score and posttreatment PHQ-9 score (r=–0.41, P=.02), posttreatment physical quality of life (r=0.54, P=.001), and posttreatment psychological quality of life (r=0.53, P=.002). Overall, participants’ satisfaction with the program was very high, both after chat sessions and at posttreatment (ZUF-8: mean score 20.6, SD 1.0). Of all participants, a majority (27/31, 87%) rated the program as excellent/good and indicated they would recommend the group chat program to a friend in need of similar help (23/31, 74%).ConclusionsA therapist-guided group chat program to substitute outpatient group setting treatment during the COVID-19 lockdown was shown to be feasible, usable, and highly acceptable for participants. Web-based programs such as this one provide an easy-to-implement tool to successfully stabilize participants during a difficult time, such as the COVID-19 pandemic.Trial RegistrationGerman Clinical Trials Register DRKS00021527; https://tinyurl.com/3btyxc2r

Adult attention deficit hyperactivity disorder and early maladaptive schemas.

The purpose of the current study is to present the early maladaptive schemas in adult attention deficit hyperactivity disorder (ADHD). The study sample comprised 107 participants, including 55 adult ADHD and 52 healthy volunteers. The age of the participants ranged between 18 and 32 years. Structured Clinical Interview Form for DSM-IV Axis I (SCID-I) and Structured Clinical Interview Form for DSM-III-R Disorders (SCID-II) were applied to all participants and Diagnostic Interview for ADHD (DIVA) for ADHD group based on DSM-5 criteria. The participants filled the Young Schema Questionnaire (YSQ-S3), Adult ADHD Self-Report Scale (ASRS), Wender Utah RatingScale-25 (WURS), Beck Depression Inventory (BDI) and The Beck Anxiety Inventory (BAI). All maladaptive schemas were found to be statistically significantly higher in the ADHD group. As compatible with ADHD core symptoms, "Failure," "Emotional Inhibition," "Insufficient Self-Control" and "Social Isolation" were the most seen maladaptive schemas in the ADHD group. "Approval Seeking," "Entitlement/Grandiosity" and "Punitiveness" were found the weakest schemas in the ADHD group. This study besides supporting the theory of early maladaptive schemas suggests that identifying and modifying maladaptive schemas interventions based on specific schemas can be an important and useful method for psychotherapy in treatment of ADHD.

Altered cortical functional network in drug-naive adult male patients with attention-deficit hyperactivity disorder: A resting-state electroencephalographic study

Relatively little is known about the neurophysiology of adult Attention-deficit/hyperactivity disorder (ADHD). Brain network analysis can yield important insights into the neuropathology in adult ADHD. The objective of this study was to investigate source-level cortical functional network using resting-state electroencephalography (EEG) in drug-naive adult patients with ADHD. Resting-state EEG was performed for 30 adult male patients with ADHD and 27 male healthy controls. Source-level weighted functional networks based on graph theory were evaluated, including strength, clustering coefficient (CC) and path length (PL) in six frequency bands. At the global level, strength (η2 = 0.167) and CC (η2 = 0.156) were lower while PL (η2 = 0.159) was higher for the high beta band in the ADHD patient group compared to healthy controls. At the nodal level, CCs of the high beta band were lower in the left middle temporal gyrus (η2 = 0.244), right inferior occipital cortex (η2 = 0.214), right posterior transverse collateral sulcus (η2 = 0.237), and right anterior occipital sulcus (η2 = 0.251) for the adult ADHD group. Furthermore, the nodal-level high beta band CCs of the left middle temporal gyrus and right anterior occipital sulcus were significantly negatively correlated with ADHD symptoms. The altered cortical functional network showed inefficient connectivity in the left middle temporal gyrus, belonging to the default mode network, the right inferior occipital cortex, belonging to the extrastriate visual resting state network, the right posterior transverse collateral sulcus, belonging to the visual network, and the anterior occipital sulcus, reflecting visual attention, which might affect the pathophysiology of ADHD. Taken together, these attenuated network inefficiencies in adult patients with ADHD may lead to suboptimal information processing and affect symptoms of ADHD, such as inattention and hyperactivity. Our findings should be further replicated using longitudinal study designs.

Comparison of Working Memory and Executive Function in Patients with Internet Addiction Disorder, Attention Deficit Hyperactivity Disorder, and Normal Individuals

Background: Cognitive functions are higher-order cortical activities that include various parameters such as concentration, executive function, and working memory. Objectives: The purpose of this study was to compare cognitive functions in three groups of Adult Attention Deficit Hyperactivity Disorder (ADHD), Internet Addiction Disorder (IAD), and normal people. Patients and Methods: This descriptive-analytical study included patients with ADHD, IAD, and normal individuals (26 normal individuals and 27 patients in each of the IAD and ADHD groups) who were evaluated by Conners’ Adult Scale, General Health Questionnaire (GHQ), Young Internet Addiction Test, and Persian Paper and Pencil Cognitive Assessment Package (PCAP). Data were analyzed by SPSS 23 software. The ANOVA test with Bonferroni’s pairwise comparison and chi-square test were used for data analysis at a significance level of 0.05. Results: The results showed that the ADHD subjects scored higher (P < 0.01) on the GHQ test and its subscales, as well as the Conners’ test. Also, patients with ADHD had lower scores on attention, concentration, and working memory scales than IAD and normal counterparts (P < 0.01). Working memory was weaker in IAD patients than normal subjects and ADHD and cognitive function is more damaged than IAD. Conclusions: The results showed that patients with ADHD had higher levels of impairment in working memory than IAD patients. Meanwhile, cognitive deficits were more sensible in ADHD.

Cognitive deficits and psychosocial functioning in adult ADHD: Bridging the gap between objective test measures and subjective reports

ABSTRACT Introduction Self-reported cognitive deficits in adult Attention-Deficit/Hyperactivity-Disorder (ADHD) are often not corroborated by standardized tests. Tests and reports also differ in their correspondence to aspects of psychosocial functioning. Executive function tasks (EF-tasks) using material close to daily life, may provide a more ecologically-valid assessment of cognitive deficits. Method 36 adults with ADHD and 36 healthy controls performed standardized EF-tasks and corresponding EF-tasks using material close to daily life and gave self-reports on cognitive functioning. The study investigated performance differences and the predictive utility of cognitive measures for psychosocial functioning. Results While all the self-reports showed substantial cognitive impairments for the ADHD group, this was only shown in some of task measures. For two domains, the deficits in EF-tasks with material close to daily life were similar or smaller than assessed with traditional measures. However, three tasks, which used material of daily life, revealed more deficits than the corresponding more standardized tasks. Beyond cognitive self-reports the new tasks did not contribute substantial to psychosocial functioning, similar to the standardized tasks. Conclusions Tasks using material close to daily life have the potential to objectify reported everyday life deficits better than more standardized tests, at least in single EF-domains. When relevant methodical aspects of these tasks will be more targeted and considered systematically in future research, the tasks might contribute to assessments of psychosocial functioning. Then they could also be used as outcome measures in intervention studies.

Onset and Severity of Early Disruptive Behavioral Disorders in Treatment-Seeking Substance Use Disorder Patients with and without Attention-Deficit/Hyperactivity Disorder

Aims: This study addressed the age of onset of conduct disorder (CD) and oppositional defiant disorder (ODD) in treatment-seeking substance use disorder (SUD) patients with and without adult attention-deficit/hyperactivity disorder (ADHD) and its association with early onset of SUD. Methods: We examined data from the 2nd International ADHD in Substance Use Disorders Prevalence Study, including 400 adults in SUD treatment from Puerto Rico, Hungary, and Australia. ADHD, SUD, and CD/ODD were assessed with the Conners Adult ADHD Diagnostic Interview for DSM-IV, the MINI International Neuropsychiatric Interview, and the K-SADS, respectively. Cox regression analyses modeled time to emergence of CD/ODD separately for SUD patients with and without adult ADHD. Linear regression models examined associations between age of onset of SUD and presence of ADHD and adjusted for sex, age, and country. To assess the mediating role of CD/ODD on the association of ADHD with onset of SUD, adjusted regression models were estimated. Results: Treatment-seeking SUD patients with ADHD presented an earlier onset of CD/ODD compared with those without ADHD. CD/ODD symptom loads were higher among the SUD and ADHD group. Age of first substance use and SUD were significantly earlier in SUD patients with ADHD, and these findings remained significant after adjustment for demographics and coexisting CD/ODD. Conclusions: ADHD is associated with earlier onset of SUD as well as with an earlier onset of more frequent and more severe disruptive behavioral disorders. These findings may inform preventive interventions to mitigate adverse consequences of ADHD.

Review of the New Zealand adult attention-deficit hyperactivity disorder work by Moffitt et al. (2015)

Despite a prevailing assumption that attention-deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder, no prospective-longitudinal study has described the childhoods of the adult ADHD population. Unexpectedly, the adult ADHD group did not show tested neurophysiological deficits in childhood or adulthood nor did they show polygenetic risk for childhood ADHD. Findings raise the possibility that adults presenting with the ADHD symptom picture may not have a childhood-onset neurodevelopmental disorder; thus, the disorder’s place in the classification system must be reconsidered, and research must investigate the etiology of adult ADHD.

Accident patterns in trauma surgery patients with and without self-reported ADHD.

Attention deficit/hyperactivity disorder (ADHD) has been associated with a higher risk for accidents and injuries, leading to increased mortality. The objective of this study was to identify the types and mechanisms of accidents in a group of adult trauma victims with self-reported ADHD compared to a control group, based on Adult ADHD Self-Report Scale Version 1.1 (ASRSv1.1). A semi-open/qualitative accident questionnaire was conducted with 116 recruited patients from three trauma surgery units. The adult ADHD (aADHD) group differed significantly from the control group in self-reported psychiatric co-morbidities (p = 0.012), regular psychotropic medication use (p = 0.005), other accidents in the past year (p = 0.002), substance use before the accident (p = 0.007), and overconfidence in relation to the accident (p = 0.033). Most interestingly, we found significantly greater subjective ratings for stress (p = 0.002) and stressful/pressurising events before the accident (p = 0.026) in the adult ADHD group, as well as for self-reported stress at the time when conducting the interview (p = 0.016). The data demonstrate that special attention should be paid to interventions in stress reduction and sufficient treatment of ADHD in terms of preventing accidents and injuries in aADHD. Therefore, we suggest, in addition to pharmaceutical therapy, the integration of stress-management and coping strategies into aADHD management.

Psychometric properties of the Japanese version of the Adult Attention-deficit hyperactivity disorder (ADHD) Self-Report Scale (ASRS-J) and its short scale in accordance with DSM-5 diagnostic criteria

We developed the Japanese version of the Adult ADHD Self-Report Scale (ASRS-J) and report its psychometric properties. The ASRS-J and other questionnaires were administered to 48 adults with ADHD, 46 adults with non-ADHD psychiatric disorders, 96 non-clinical adults, and 894 university students. ADHD diagnoses were made using the Japanese semi-structured diagnostic interview for adult ADHD, which is compatible with the DSM-5. The ASRS-J, its subscales, and the short form, all had Cronbach's α values of around 0.80. Total scores on the ASRS-J and the ASRS-J-6 were highly correlated with readministration after a two-week interval. The total and 18 individual item scores in the ASRS-J were significantly higher in the ADHD group than the other three groups. ASRS-J scores were correlated with scores on the Japanese version of Conners’ Adult ADHD Rating Scales-Self Report subscales (0.59≤r≤0.77), with one exception. ASRS-J scores were also correlated (albeit more weakly; r=0.38) with Beck Depression Inventory-II total scores. Employing optimal cut-offs, sensitivity, specificity, and positive and negative predictive values of the ASRS-J and ASRS-J-6 are all above 0.69. The ASRS-J and ASRS-J-6 showed acceptable psychometric properties, although further study is necessary.

Psychopathological, temperamental, and characteristic factors in adults with remaining childhood attention-deficit hyperactivity symptoms

Objectives: To investigate differences in psychopathological, temperamental and characteristic factors between young adults with and without persistent Attention-Deficit Hyperactivity disorder (ADHD) symptoms.Methods: A total of 429 university students were divided into three groups: persistent adult ADHD (n = 53), only childhood ADHD (n = 56) and healthy controls (n = 320). The Korean Adult ADHD Scale, Korean Wender-Utah Rating Scale, Beck Depression Inventory-II, Beck Anxiety Inventory, Barratt Impulsiveness Scale, Korean Young Internet Addiction Scale, and Temperament Character Inventory-Revised (TCI-R; based on Cloninger’s seven factor model of temperament and character) were used to evaluate psychopathological factors.Results: Participants with persistent adult ADHD symptoms had significantly higher levels of childhood ADHD, depression, anxiety and the Internet addiction symptoms than did the only-childhood ADHD and control groups. The adult ADHD group also had significantly higher tendencies toward novelty seeking, harm avoidance, and self-transcendence, as well as low self-directedness and cooperativeness.Conclusions: Results suggest that persistent ADHD is associated with several unfavourable psychopathological, temperamental and characteristic factors. Therefore, thorough evaluation of these factors for childhood ADHD could help predict prognoses and provide treatment plans for preventing persistent ADHD into adulthood.

The impact of failing to identify suspect effort in patients undergoing adult attention-deficit/hyperactivity disorder (ADHD) assessment.

[Correction Notice: An Erratum for this article was reported in Vol 28(10) of Psychological Assessment (see record 2016-22725-001). In the article, the penultimate sentence of the abstract should read “These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (62%).” All versions of this article have been corrected.] This retrospective study examines how many adult patients would plausibly receive a diagnosis of attention-deficit/hyperactivity disorder (ADHD) if performance and symptom validity measures were not administered during neuropsychological evaluations. Five hundred fifty-four patients were extracted from an archival clinical dataset. A total of 102 were diagnosed with ADHD based on cognitive testing, behavior rating scales, effort testing, and clinical interview; 115 were identified as putting forth suspect effort in accordance with the Slick, Sherman, and Iverson (1999) criteria. From a clinical decision-making perspective, suspect effort and ADHD groups were nearly indistinguishable on ADHD behavior, executive function, and functional impairment rating scales, as well as on cognitive testing and key clinical interview questions. These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (62%) [corrected]. This research makes clear that it is essential to evaluate task engagement and possible symptom amplification during clinical evaluations.

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.

"The impact of failing to identify suspect effort in patients undergoing adult attention-deficit/hyperactivity disorder (ADHD) assessment": Correction to Marshall et al. (2016).

Reports an error in "The Impact of Failing to Identify Suspect Effort in Patients Undergoing Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Assessment" by Paul S. Marshall, James B. Hoelzle, Danielle Heyerdahl and Nathaniel W. Nelson (Psychological Assessment, Advanced Online Publication, Jan 11, 2016, np). In the article, the penultimate sentence of the abstract should read “These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (62%).” All versions of this article have been corrected. (The following abstract of the original article appeared in record 2016-00618-001.) This retrospective study examines how many adult patients would plausibly receive a diagnosis of attention-deficit/hyperactivity disorder (ADHD) if performance and symptom validity measures were not administered during neuropsychological evaluations. Five hundred fifty-four patients were extracted from an archival clinical dataset. A total of 102 were diagnosed with ADHD based on cognitive testing, behavior rating scales, effort testing, and clinical interview; 115 were identified as putting forth suspect effort in accordance with the Slick, Sherman, and Iverson (1999) criteria. From a clinical decision-making perspective, suspect effort and ADHD groups were nearly indistinguishable on ADHD behavior, executive function, and functional impairment rating scales, as well as on cognitive testing and key clinical interview questions. These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (57%). This research makes clear that it is essential to evaluate task engagement and possible symptom amplification during clinical evaluations.

Aberrant brain activation of error processing among adults with attention deficit and hyperactivity disorder

Individuals with adult attention deficit/hyperactivity disorder (ADHD) have a deficit in their cognitive control. The aim of this study was to reveal the brain correlates of the deficits in response inhibition or error processing in adult ADHD. A total of 29 adults with ADHD and 25 control individuals were recruited. They completed an event-related-design Go/No-go task under functional magnetic resonance imaging scanning. Both the ADHD group and the control group exhibited activation of the frontostriatal network when processing response inhibition. They also exhibited activation of the frontoinsula cortex and anterior cingulate in error processing. Adults with ADHD have a lower brain activation of error processing over the right inferior frontal lobe adjacent to the insula than control individuals. The altered frontoinsula cortex activation may represent the mechanism of error processing deficit among adults with ADHD.

Excessive daytime sleepiness in adult patients with ADHD as measured by the Maintenance of Wakefulness Test, an electrophysiologic measure.

To quantify the objective level of sleepiness in adult attention-deficit/hyperactivity disorder (ADHD) patients and to determine the relationship between excessive daytime sleepiness and simulated driving performance. Forty adult ADHD patients (DSM-IV criteria) and 19 matched healthy control subjects were included between June 30, 2010, and June 19, 2013. All participants completed the Epworth Sleepiness Scale and the Manchester Driving Behavior Questionnaire. After nocturnal polysomnography, they performed 2 neuropsychological tests, a 4 × 40-minute Maintenance of Wakefulness Test, and a 1-hour driving session. The primary outcome measure was the mean sleep latency on the Maintenance of Wakefulness Test. ADHD patients were divided into 3 groups defined by their Maintenance of Wakefulness Test scores. Participants (patients and control subjects) were allocated as follows: sleepy ADHD (0-19 min), intermediate ADHD (20-33 min), alert ADHD (34-40 min), and control group (34-40 min). The driving performance outcome was the mean standard deviation of lateral position of the vehicle during the simulated session. The group mean (SD) Epworth Sleepiness Scale score was higher in ADHD patients (12.1 [4.4]) than in controls (6.0 [2.7]) (P < .001). On the basis of the Maintenance of Wakefulness Test scores, 14 patients (35%) were in the sleepy group, 20 (50%) were in the intermediate group, and only 6 (15%) were in the alert group. Sleepy ADHD patients exhibited significantly deteriorated driving performance compared to the other 3 groups (P < .01). Our study shows that a significant proportion of adult ADHD patients exhibit an objective excessive daytime sleepiness, which, in addition, has an impact on simulated driving performance. Excessive daytime sleepiness, therefore, may be a key element needed to better evaluate these ADHD patients. ClinicalTrials.gov identifier: NCT01160874.

Neuropsychologic functions and soft neurologic signs in adult ADHD

Objective: Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric illness and etiopathogenetic studies focus on fronto-striatal circuit. Soft neurologic signs that are used in the investigation of brain function disorders in psychiatric diseases were studied more in childhood ADHD. In the present study, it is aimed to study the neuropsychologic test performances that are sensitive to frontal lobe functions and soft neurologic signs in adult ADHD. Methods: Sixty subjects with ADHD and 60 healthy control subjects aging between 18-60 years were included into the study. Presence of comorbid psychiatric disorder was not investigated in the ADHD group. Neurological examination for soft signs and neuropsychologic tests (Digit span, verbal memory, Stroop task and Wisconsin card sorting test (WCST)) were performed to both groups. Neurological examination for soft signs and neuropsychologic tests of 59 patients and 46 control subjects were regarded as effective and were analyzed statistically. Results: Mean age was 28.93±8.08 years in the ADHD group (59.3% female, 40.7% male) and 32.07±8.11 years in the control group (63.0% female, 37.0% male). Significantly low performance was determined in digit span, verbal memory and Stroop task tests in adult ADHD group according to the control group. No difference was determined in WCST between adult ADHD and control groups. In the neurological examination for soft signs, adult ADHD group had significantly low performance according to the control group in motor coordination and finger-thumb opposition tests. Adult ADHD group had significantly low performance according to the control group in sensory integration and audiovisual integration and extinction tests. Adult ADHD group had low performance according to the control group in memory, synkinesis and gaze impersistence tests in “Others tests”. Discussion: It is implied that ADHD is common in childhood and its symptoms decrease in adulthood. It is also thought that a functional defect continues in frontal lobe, cerebellum, parietal lobe and/or in fronto-striatal pathways that provide associations between each other and this may affect the prognosis and treatment of the disorder.

Brain activation deficit in increased-load working memory tasks among adults with ADHD using fMRI

Working memory (WM) is impaired among adults with attention-deficit hyperactivity disorder (ADHD). This study aimed to investigate the brain activation deficit for low-level or increased-load WM among adults with ADHD. A total of 20 adults with ADHD and controls were recruited according to diagnostic interviewing by a psychiatrist. Phonological and visual-spatial 2-back and 3-back tasks were performed under functional magnetic resonance scanning. The results demonstrated that both the adults with ADHD and the controls exhibited activation of the fronto-parietal network for WM, and the intensity was greater in the adult ADHD group. The ADHD group had higher brain activation over the bilateral anterior cingulate, left inferior frontal lobe, hippocampus, and supplementary motor area (SMA) for phonological WM than the control group. When the task loading increased from 2-back to 3-back tasks, the adults with ADHD perceived greater difficulty. The control group exhibited increased brain activation over the frontal-parietal network in response to increased phonological WM load. However, the ADHD group showed decreased brain activation over the left precuneus, insula, and SMA. Further analysis demonstrated that the ADHD group exhibited a greater decrease in brain activation over the left fronto-parietal network, including the precuneus, SMA, insula/inferior frontal lobe, and dorsolateral prefrontal cortex, than the control group. These results suggest that adults with ADHD pay more effort to low demanding phonological WM. On the other hand, brain activation of the left fronto-parietal network is impaired when the demands of WM exceed the capacity of adults with ADHD.