Adult ADHD Research Articles

Exploring the impact of probiotics on adult ADHD management through a double-blind RCT.

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric condition often persisting into adulthood, characterized by inattention, impulsivity, and hyperactivity. Emerging research suggests a connection between ADHD and gut microbiota, highlighting probiotics as potential therapeutic agents. This study involved a double-blind, randomized controlled trial where college students with ADHD received either a multi-strain probiotic supplement or a placebo daily for three months. ADHD symptoms were evaluated using a computerized performance test (MOXO) and the MATAL questionnaire. Academic records provided performance data. Additionally, eating and sleeping habits, gastrointestinal symptoms, and anthropometrics were assessed through questionnaires before and after the intervention. Fingernail cortisol concentrations (FCC) measured the long-term activity of the hypothalamic-pituitary-adrenal axis. The findings indicated that the probiotic significantly decreased hyperactivity, improved gastrointestinal symptoms, and enhanced academic performance. A multivariate analysis identified age as a significant predictor, with younger participants experiencing greater overall benefits from the intervention. There was also a negative correlation between FCC and symptoms of attention and impulsivity. Furthermore, higher academic grades were associated with lower levels of hyperactivity and impulsivity. These results suggest a beneficial impact of probiotics on ADHD symptoms and lay the groundwork for further studies to evaluate the effects of various probiotic strains on clinical outcomes in ADHD.

Identifying Factors that Increase False-Positive Rates on Embedded Performance Validity Testing in ADHD Evaluations.

This study investigated why certain embedded performance validity indicators (EVIs) are prone to higher false-positive rates (FPRs) in attention-deficit/hyperactivity disorder (ADHD) evaluations. The first aim was to establish the relationship between FPRs and 15 EVIs derived from six cognitive tests when used independently and together among adults with ADHD who have valid test performance. The second aim was to determine which specific EVIs increase the FPRs in this population. Participants were 517 adult ADHD referrals with valid neurocognitive test performance as determined by multiple performance validity tests and established empirical criteria. FPRs were defined by the proportion of participants who scored below an empirically established EVI cutoff with ≥0.90 specificity. EVIs derived from two of the six tests exhibited unacceptably high FPRs (>10%) when used independently, but the total FPR decreased to 8.1% when the EVIs were aggregated. Several EVIs within a sustained attention test were associated with FPRs around 11%. EVIs that did not include demographically adjusted cutoffs, specifically for race, were associated with higher FPRs around 14%. Conversely, FPRs did not significantly differ based on whether EVIs included timed versus untimed, verbal versus nonverbal, or graphomotor versus non-graphomotor components, nor whether they had raw versus standardized cut scores. Findings suggest that practitioners should consider both the type of test from which an EVI is derived and the aggregate number of EVIs employed to minimize the FPRs in ADHD evaluations. Findings also indicate that more nuanced approaches to validity test selection and development are needed.

Asymmetry of attentive networks contributes to adult Attention-deficit/hyperactivity disorder (ADHD) pathophysiology.

Diffusion imaging studies in Attention-deficit/hyperactivity disorder (ADHD) have revealed alterations in anatomical brain connections, such as the fronto-parietal connection known as superior longitudinal fasciculus (SLF). Studies in neurotypical adults have shown that the three SLF branches (SLF I, II, III) support distinct brain functions, such as attention and inhibition; and that their pattern of lateralization is associated with attention performance. However, most studies in ADHD have investigated the SLF as a single bundle and in children; thus, the potential contribution of the lateralization of the SLF branches to adult ADHD pathophysiology remains to be elucidated. We used diffusion-weighted spherical deconvolution tractography to dissect the SLF branches in 60 adults with ADHD (including 26 responders and 34 non-responders to methylphenidate, MPH) and 20 controls. Volume and hindrance modulated orientational anisotropy (HMOA), which respectively reflect white matter macro- and microstructure, were extracted to calculate the corresponding lateralization indices. We tested whether neurotypical controls differed from adults with ADHD, and from treatment response groups in sensitivity analyses; and investigated associations with clinico-neuropsychological profiles. All the three SLF branches were lateralized in adults with ADHD, but not in controls. The lateralization of theSLFI HMOA was associated with performance at the line bisection, not that of the SLF II volume as previously reported in controls. Further, an increased left-lateralization of the SLF I HMOA was associated with higher hyperactivity levels in the ADHD group. Thus, an altered asymmetry of the SLF, perhaps especially of the dorsal branch, may contribute to adult ADHD pathophysiology.

Working memory related functional connectivity in adult ADHD and its amenability to training: A randomized controlled trial

BackgroundWorking memory (WM) deficits are among the most prominent cognitive impairments in attention deficit hyperactivity disorder (ADHD). While functional connectivity is a prevailing approach in brain imaging of ADHD, alterations in WM-related functional brain networks and their malleability by cognitive training are not well known. We examined whole-brain functional connectivity differences between adults with and without ADHD during n-back WM tasks and rest at pretest, as well as the effects of WM training on functional and structural brain connectivity in the ADHD group. MethodsForty-two adults with ADHD and 36 neurotypical controls performed visuospatial and verbal n-back tasks during functional magnetic resonance imaging (fMRI). In addition, seven-minute resting state fMRI data and diffusion-weighted MR images were collected from all participants. The adults with ADHD continued into a 5-week randomized controlled WM training trial (experimental group training on a dual n-back task, n = 21; active control group training on Bejeweled II video game, n = 21), followed by a posttraining MRI. Brain connectivity was examined with Network-Based Statistic. ResultsAt the pretest, adults with ADHD had decreased functional connectivity compared with the neurotypical controls during both n-back tasks in networks encompassing fronto-parietal, temporal, occipital, cerebellar, and subcortical brain regions. Furthermore, WM-related connectivity in widespread networks was associated with performance accuracy in a continuous performance test. Regarding resting state connectivity, no group differences or associations with task performance were observed. WM training did not modulate functional or structural connectivity compared with the active controls. ConclusionOur results indicate large-scale abnormalities in functional brain networks underlying deficits in verbal and visuospatial WM commonly faced in ADHD. Training-induced plasticity in these networks may be limited

Assessing suicidality in adult ADHD patients: prevalence and related factors

BackgroundThe association between Attention-deficit hyperactivity disorder (ADHD) and suicidality has been subject of growing interest for research in the latest years. Suicidality was generally assessed categorically and without the use of validated instruments, leading to heterogeneous or even conflicting evidence. The prevalence of both suicidal ideation and attempts varies considerably, and the associated risk factors remain unclear. Our study investigated suicidality in ADHD using a dimensional approach and a validated and internationally recognized instrument. Our primary aim was to evaluate the prevalence of suicidal ideation (SI), severe suicidal ideation (SSI), suicidal behavior (SB) and non suicidal self-injury behavior (NSSIB) in a sample of adult patients with ADHD. The second objective was to identify sociodemographic and clinical features associated with increased risk of suicidality in these patients.MethodsThe sample included 74 adult patients with clinical diagnosis of ADHD. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic regressions were used to examine predictors of SI, SSI, SB and NSSIB.ResultsThe lifetime prevalence of SI and SSI were 59.5% and 16.2%, respectively. The 9.5% of patients showed lifetime SB, while NSSIB was found in 10.8% of the subjects. Lifetime SI was associated with severity of inattentive symptoms during adulthood, low self-esteem and impairment in social functioning. Lifetime SSI appeared related to severity of inattentive symptoms during childhood, attentional impulsiveness and number of hospitalizations, while physical activity appeared to be protective. The prevalence of lifetime SB and NSSIB did not appear significantly related to any socio-demographic or clinical feature.ConclusionsAdults with ADHD should be considered at risk of suicide and it is important to determine which patients are at higher risk, in order to guide preventive interventions. The association between ADHD and suicidal ideation did not appear to be influenced by psychiatric comorbidities, but rather by inattention itself, which represents the core symptom of ADHD.

Focus on Executive Functions. Part 2: Nonverbal and Verbal Working Memory

The second in a 3-part series on executive functions. This series for adults with ADHD discusses the 7 executive functions that foster self-control—the abilities we use to monitor our own behavior to attain our goals. —Excerpted from Taking Charge of Adult ADHD (2nd ed.), by Russell A. Barkley with Christine M. Benton. Part 1: Self-awareness (the mind's mirror) and inhibition (the mind's brakes). Part 2: Nonverbal and verbal working memory (the mind’s eye and the mind’s voice). Part 3: Emotion regulation (the mind’s heart), self-motivation (the mind’s fuel tank), and planning/problem-solving (the mind’s playground).

성인 ADHD 어머니의 자녀양육 경험에 대한 내러티브 탐구

Objectives This study conducted a narrative inquiry to explore the difficulties of parenting experience as an adult ADHD mother, the experiences and meanings of life of participants, and to help them understand life. Methods To this end, one adult ADHD mother was selected as a participant, and 6-8 in-depth interviews were conducted from May 2023 to February 2024. The research procedure applied the five steps suggested by Clandinin and Connelly (2000): being present in the field, moving to the field text, constructing the field text, constructing meaning for the experience, and constructing the research text. Results The results of the child-rearing experiences of mothers with adult ADHD tendencies derived with the study participants are as follows. There were five themes: ‘No one taught me emotions’, ‘Pushing me to the end’, ‘Walking with hands’, and ‘The path to becoming solid- Becoming a mom who takes notes’. Conclusions Based on these results, suggestions for counseling were discussed in the context of personal justifi-cation ‘looking back on myself’, actual justification ‘Knowing but not being able to control it’, and social justification ‘growing together- spring again’, and the significance of the study and suggestions for follow-up research were made.

Using Bifactor Twin Modeling to Assess the Genetic and Environmental Dimensionality of Adult ADHD Symptoms.

Attention Deficit Hyperactivity Disorder (ADHD) is a common and heritable neurodevelopmental condition that has been the subject of a wealth of genetics research. Because ADHD has an early age of onset, most of this work has focused on children, meaning that less is known about the genetics of ADHD in adults. Additionally, while much research has assessed the heritability of ADHD as a general dimension, less has assessed the heritability of individual subtypes (inattention, hyperactivity) or symptoms of ADHD. It therefore remains unclear whether the genetic factors underlying ADHD symptoms conform to a unidimensional or multidimensional structure. The aim of this study was to assess the genetic and environmental dimensionality of adult ADHD symptoms. We analyzed data from 10,454 twins of the Twins Early Development Study, who provided self-reports of ADHD symptoms using the Conners scale at age 21 years. The data conformed well to a psychometric bifactor model, providing support for a general dimension of ADHD in addition to secondary dimensions for inattention and hyperactivity. However, a bifactor independent pathway twin model provided support for a general dimension only at the level of non-shared environmental effects and not additive genetic or shared environmental effects. This suggests that symptoms of ADHD cluster together under a general dimension of non-shared environmental effects, although the two subtypes of ADHD (inattention and hyperactivity) are meaningfully genetically distinct. We found the overall heritability of ADHD to be 40%, comparable with previous estimates for adult ADHD symptoms. Our results provide useful insights into the genetic and environmental architecture of specific ADHD symptoms.

Gambling disorder and its associated factors in university students

Abstract Background Gambling disorder (GD) is defined as persistent and uncontrollable gambling behaviour that has negative effects on an individual’s life. This can lead to financial problems, poor academic performance, and health problems. GD has been associated with psychological disorders like depression, anxiety, and attention-deficit hyperactivity disorder (ADHD). We aimed to examine the gambling disorder and its associated factors in university students. Methods We conducted a cross-sectional study among students at a university in Eskisehir (Türkiye) in 2024. A stratified random sample design was used. Five faculties were randomly selected. A total of 1,201 students were included according to the stratum weight of the faculties. A questionnaire including sociodemographic characteristics, South Oaks Gambling Screen (SOGS), and Adult ADHD Self-Report Scale (ASRS) was applied. Data were analysed through descriptive statistical analyses and multivariate logistic regression models. Results The mean age was 21.5±2.8 years, and 46.8% were male. While 48.7% of the students stated that they had gambled at least once, 2.2% had a gambling disorder. The three most common types of gambling played by students were stock market (28.2%), bet on sports (22.0%), and scratch cards (18.2%). In multivariate analysis, being male (Odds ratio-OR:6.5, 95%CI:1.4-29.8), having lost years during education (OR:2.7, 1.1-6.8), having relatives with gambling problems (OR:8.0, 1.8-36.2), investing greater amounts of money in gambling (OR:3.7, 1.0-13.0), and having a high probability of ADHD (OR:4.3, 1.4-12.8) were found to be predictors for GD. Conclusions Although about half of the students had engaged in gambling activities, only a small proportion showed signs of GD. We can conclude that being male, having lost years in education, having relatives with gambling problems, investing larger amounts of money in gambling, and having a higher probability of ADHD are predictors of GD among students. Key messages • Implementing educational campaigns at universities to raise awareness of the potential risks and consequences associated with GD could be beneficial. • It may be helpful if mental health services at the university were equipped to consider mental health conditions such as ADHD, that contribute to GD.

Diagnosing and Treating ADHD in Adults

This Viewpoint advocates for proactively addressing concerns related to the diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD) in US adults to balance individual benefits with population-level risk.

An investigation of the Bernstein’s strengths Scale: factorial validity and network analysis of attention-deficit/hyperactivity symptoms, mental health, and the strengths of the healthy adult self

BackgroundBernstein’s heuristic model of personal strengths describes 16 positive attributes of the healthy adult self, grouped into four higher-order factors: self-directedness (identity, self-reflection, self-confidence, self-assertion, imagination/creativity), self-regulation (emotional balance, resilience, self-control, self-care, reality testing), connection (empathy, compassion, humour, responsibility), and transcendence (gratitude and wisdom). The study aimed to explore the factorial validity of Bernstein’s Strengths Scale developed for the assessment of these constructs. Furthermore, we explored the association of strengths with attention-deficit hyperactivity (ADHD) symptoms and mental health in a nonclinical sample using a network approach.MethodsFive hundred and twenty-eight adults filled out an online questionnaire, including Bernstein’s Strengths Scale (BSS), the Mental Health Continuum – Short Form (MHC-SF), and the Adult ADHD Self-Report Scale (ASRS).ResultsThough our data showed an acceptable fit to the 16-factor model, the Self-control subscale and item 28 of the Compassion subscale were excluded because of reliability issues. The final model with 15 factors and 44 items showed excellent fit, χ2(797) = 1130.149, p < .001, RMSEA = 0.028, 90% CI [0.024, 0.032], SRMS = 0.049, CFI = 0.993, TLI = 0.991. Principal component analysis revealed three instead of four second-order factors. In the network model, Self-confidence and Wisdom emerged as the most influential nodes. ADHD symptoms were negatively connected to Responsibility, Self-care, Identity, Emotional balance, Self-confidence, and mental health, while they had positive edges with Humor, Self-reflection, and Imagination/creativity. Mental health was positively related to several strengths, with the strongest association being between mental health and Gratitude.ConclusionThe BSS has acceptable factorial validity and is a reliable tool for assessing the personal strengths of the healthy adult self. ADHD symptoms in adults may be associated with deficits in personal strengths, but protective factors could also be identified. Addressing personal strengths in psychosocial interventions for ADHD in adults may improve patients’ emotional well-being and everyday functioning.

Executive functioning in adults with attention deficit hyperactivity disorder: A systematic review

Introduction: Executive function deficits are associated with attention deficit hyperactivity disorder (ADHD) in both children and adults. The inattentive subtype is primary related to “cold” executive functions, while the hyperactive subtype is related to “warm” executive functions. Objective: To systematically review studies on executive functioning in adults with attention deficit hyperactivity disorder published during the last decade. Methodology: A documentary research was conducted, encompassing 33 articles retrieved from PubMed, Web of Science and EBSCO platforms. The analysis considered years and countries of publication, attention deficit hyperactivity disorder diagnostic criteria, participants, comorbidities, subtypes, medication use, assessment tools, and processes of executive functions evaluated. Results: It was evidenced that there is a high percentage of adults with attention deficit hyperactivity disorder who present a deficit or lower performance in executive function tests. However, the results varied depending on specific characteristics of the study and/or participants, which confirms the heterogeneity of the disorder. In addition, the main instruments for measuring executive functions and diagnostic criteria for adult attention deficit hyperactivity disorder were identified. Discussion: These results support the established links between attention deficit hyperactivity disorder , impaired executive functions, and major life activities found in the adult attention deficit hyperactivity disorder literature. However, some of the limitations were the poorly controlled variables such as comorbidities, attention deficit hyperactivity disorder subtypes that were not assessed, and usage of instruments that measure executive functions that can lead to reduced credibility of the results presented here. Conclusions: According to the results presented, there is a high percentage of adults with attention deficit hyperactivity disorder who present a deficit or lower performance in executive function tests, compared to both neurotypical adults and those with other psychiatric disorders. Further research is recommended to continue studies on the topic and to include other variables.

Examining the utility of the BAARS-IV scales as embedded symptom validity indicators for adult attention-deficit/hyperactivity disorder evaluations

Objective: This study investigated whether extreme cut-scores on the Barkley Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale-Fourth Edition (BAARS-IV) self-report scales could serve as symptom overreporting indicators in adult ADHD evaluations. Method: The sample consisted of 162 adults who underwent a neuropsychological evaluation for ADHD. Patients were classified into valid (n = 115) and invalid (n = 47) groups based on multiple criterion symptom validity tests. Results: Overreporting cut-scores identified for each of the BAARS-IV scales demonstrated acceptable classification accuracy or better. The Current Total scale yielded the highest classification accuracy (area under the curve of .83). An optimal raw cut-score of ≥56 for this scale yielded 47% sensitivity when upholding ≥90% specificity. A cut-score of ≥31 for the Current Inattention scale (90% specificity; 47% sensitivity) and ≥29 for the Current Sluggish Cognitive Tempo scale (88% specificity; 46% sensitivity) were also relatively strong indicators of overreporting. The Current Total and Current Sluggish Cognitive Tempo scales captured nonredundant aspects of symptom validity, and using them together increased sensitivity to 57% while maintaining ≥90% specificity. Conclusions: Findings provide preliminary support for the criterion and construct validity of extreme cut-scores on the BAARS-IV Current Sluggish Cognitive Tempo, Current Inattention, and Current Total scales as indicators of ADHD symptom overreporting. However, employing the cut-scores from the Current Sluggish Cognitive Tempo (≥29) and Current Total (≥56) together may be the most promising way to detect overreporting. Scores above both of these cut-points should, at a minimum, prompt further investigation into the validity of a patient’s reported symptoms.

Traits of Developmental Disorders in Adults With Listening Difficulties Without Diagnosis of Autism Spectrum Disorder And/or Attention-Deficit/Hyperactivity Disorder.

Background: Some individuals have a normal audiogram but have listening difficulties (LiD). As many studies have investigated the relationship between listening and developmental disorders, the traits of developmental disorders might explain the symptoms of LiD. In this study, we examined the traits of developmental disorders of adults with LiD to help clarify the cause of LiD symptoms. Methods: In total, 60 adults with LiD and 57 adults without LiD were included. Participants completed a questionnaire for the autism spectrum quotient (AQ) test, the Adult Attention-Deficit Hyperactivity Disorder Self-Rating Scale (A-ADHD), the Adolescent/Adult Sensory Profile (SP), and the severity of subjective LiD in daily life. Results: Before analysis, we excluded participants with LiD who were already diagnosed or met the criteria for autism spectrum disorder (ASD) or ADHD, and the results of the remaining 30 participants (50.0%) with LiD were analyzed. Adults with LiD showed higher scores than those without LiD in the AQ. Attention switching in the AQ and attention ability in the A-ADHD scale were correlated with the severity of LiD symptoms in everyday life. The AQ scores were also significantly correlated with subscales of the SP. Conclusions: Adults with LiD showed greater autistic traits than those without LiD; therefore, LiD symptoms are possibly related to autistic symptoms. Furthermore, adults with LiD might have attention disorder traits of both ASD and ADHD and sensory processing problems. These findings suggest that the attention problems in adults with LiD noted in previous studies might be related to these traits of developmental disorders.

Heightened suicidal risk in ADHD and subthreshold ADHD: Understanding the role of psychiatric comorbidities

ObjectivesRecently, adult ADHD diagnoses have increased, complicating treatment when comorbid with other disorders. Subthreshold ADHD(sADHD) also poses challenges, especially with comorbidities and suicidality. This study explores psychiatric comorbidities' role in ADHD and sADHD suicidality. MethodsWe analyzed microdata from the National Mental Health Survey of Korea 2021 to examine the association of ADHD on comorbidities and suicide-related behaviors. ResultsOf the 5511 participants, 194(3.52 %) were diagnosed with ADHD, and 775(14.1 %) had sADHD. In 12-month prevalence, suicidal ideation and plans were more prevalent in both ADHD and sADHD patients than in controls, with higher odds ratios(ADHD vs. control OR 12.87; suicidal ideation, 54.06; suicidal plan, sADHD vs control OR 8.26; suicidal ideation, 17.63; suicidal plans). Lifetime suicidal ideation and plans were notably associated with alcohol use disorder(OR 6.15 in ideation, 3.83; plan) and nicotine use disorder in participants with ADHD(OR 5.36 in ideation, 5.31; plan), whereas sADHD associations were found with alcohol use disorder(OR 1.80 in ideation) and depressive disorder(OR 1.90 in ideation) compared to the controls. Additionally, differences in suicidal behavior between sADHD and ADHD were identified for alcohol use disorder(OR 3.42 in ideation, 4.15; plan) and nicotine use disorder(OR 4.02 in ideation, 4.98 in plan). ConclusionThese results indicated a heightened risk of psychiatric comorbidities and suicidal ideation or plans in the ADHD and sADHD groups. These results suggest the need for a more diverse focus on comprehensive mental health assessments and proactive support for patients with ADHD, regardless of symptom severity.

How evidence-based is the "hashtag ADHD test" (#adhdtest). A cross-sectional content analysis of TikTok videos on attention-deficit/hyperactivity disorder (ADHD) screening.

TikTok is being increasingly used as an easily accessible source of information on Attention-Deficit/Hyperactivity Disorder (ADHD). This study aimed to find the quality of information on ADHD screening or self-test in TikTok videos with the hashtag #adhdtest and the engagement of these videos with their viewers. The content of the top 50 TikTok videos with the "hashtag #ADHDtest" was analyzed cross-sectionally and categorized as "useful" or "misleading" after comparison of its content with the "Adult ADHD Self-Report Scale" (ASRS-v1.1). The videos were categorized as "useful" if its contents had at least 4 out of the 6 questions on the ASRS-v1.1 screener. Its level of engagement was quantified by measuring the number of times the video was liked, commented on, or added to favorites. Descriptive statistics were used for analysis. Out of the 50 included #adhdtest videos, 92% (n = 46) were misleading. Furthermore, useful videos had minimal engagement, with only 4% of the total likes, 1% of the total comments, and 7% of the total favorites. There is misleading information related to adult ADHD screening and testing on TikTok. There is a need to address this misinformation.

Frequency and Mental Health Condition of Students with Developmental Disabilities Among First-Year Japanese University Students: A Cross-Sectional Survey.

Students with developmental disabilities are anxious about a change in environment when graduating from high school to college. Existing research, which is scarce, focuses on the mental health status of students with developmental disabilities entering university. This study investigated the frequency of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) among first-year Japanese university students and their mental health risks post-admission. We conducted a cross-sectional survey for university students within a month of admission, using the Autism Spectrum Quotient (AQ) and Adult ADHD Test (A-ADHD) to demonstrate the frequency of ASD and ADHD. The Counseling Center Assessment of Psychological Symptoms (CCAPS)-Japanese (depression, eating concerns, hostility, social anxiety, family distress, alcohol use, generalized anxiety, and academic distress) evaluated their mental health condition.Of 711 students (20.3 ± 2.1years; 330 male, 381 female), the number of those showing either ASD or ADHD tendencies was 61 (8.58%). Twenty-three (3.23%) showed symptoms of only ASD, 34 (4.78%) of ADHD, and four (0.56%) of ASD and ADHD. No significant differences existed in the frequency of ASD and ADHD between each sex and major. The scores and frequency of high risk (over the cut-off points) students on all CCAPS-Japanese subscales (except alcohol use) were significantly higher among the ASD and ADHD groups than the control group, which showed no ASD or ADHD tendencies. The frequency of ASD and ADHD characteristics among first-year Japanese university students was 8.58%. They have a high risk of mental health problems when they enter university.

Measuring clinical outcomes in adult ADHD clinics: psychometrics of a new scale, the adult ADHD Clinical Outcome Scale.

Adult attention-deficit hyperactivity disorder (ADHD) clinics are in their infancy in Ireland and internationally. There is an urgent need for clinical evaluation of these services. Until now, clinical outcomes have relied mainly on functional scales and/or quality of life. However, adult ADHD is a longstanding disorder with many comorbidities. Although medication for ADHD symptoms can have immediate effects, co-occurring problems may take considerably longer to remediate. To present the psychometrics of a short outcome measure of key clinical areas including symptoms. The ADHD Clinical Outcome Scale (ACOS), developed by the authors, is a clinician-rated scale and was administered in consecutive adults attending an ADHD clinic. A modified version was completed by the participant. A second clinician independently administered the scale in a subsample. ACOS consists of 15 items rated on a Likert scale. Two self-report scales, the Adult ADHD Quality of Life Questionnaire (AAQoL) and Weiss Functional Impairment Rating Scale (WFIRS), were also administered. The mean age of 148 participants was 30.1 years (s.d. = 9.71), and 81 were female (54.7%). The correlation for interrater reliability was r = 0.868, and that between the participant and clinician versions was r = 0.663. The intraclass correlation coefficient for the internal consistency was 0.829, and the correlations for concurrent validity with total AAQoL and WFIRS scores were r = -0.573 and r = 0.477, respectively. Factor analysis revealed four factors: (a) attentional/organisational problems; (b) hyperactivity/impulsivity; (c) comorbidities; and (d) alcohol/drug use, self-harm and tension in relationships. The psychometrics of the ACOS are promising, and the inclusion of typically co-occurring clinical domains makes it suitable for use as a clinician-rated outcome measure in every contact with patients attending adult ADHD clinics.

Symptom validity testing in adults with clinically diagnosed ADHD: comparison of the Conner’s Adult ADHD Rating Scale (CAARS) and the Self-Report Symptom Inventory (SRSI)

ABSTRACT Objectives Compared to the number of performance validity measures, the range of available symptom validity measures is limited. The Self-Report Symptom Inventory (SRSI) is a recently developed freestanding symptom validity test with promising psychometric characteristics for use on non-criminal forensic and a range of clinical populations. The goal of this study was to evaluate the utility of the SRSI for symptom validity testing in the clinical evaluation of adults with attention-deficit/hyperactivity disorder (ADHD). Methods This analogue study compared 76 German patients diagnosed with ADHD (age range 19–63 years) with typically developing individuals from the Netherlands/Germany who were assigned to either a control group (N = 58; age range 18–73 years) or a simulation group (N = 46; age range 18–57 years). All participants completed the Conners’ Adult ADHD Rating Scale (CAARS) with its two embedded validity indicators Infrequency Index (CII) and ADHD Credibility Index (ACI), the SRSI, and the Digit Span (to derive the Reliable Digit Span). Results Specificity in controls was perfect for the CAARS, but reached only about 90% for the SRSI. In contrast, sensitivity in experimental simulators ranged from 24% to 65% for the CAARS, but reached high rates of 69% to 82% for the SRSI. In the sample of patients with ADHD, the failure rate ranged from 8% to 34% (CAARS), and 33% to 47% (SRSI). Further, we found limited classification agreement between the validity measures. Conclusion The divergent results on the different validity indicators reflects the ongoing discussion on poor construct unity and clarity, and calls for more research addressing the heterogeneous construct. The utility of the SRSI to reliably distinguish between valid and invalid symptom report in the clinical evaluation of adult ADHD has to be investigated by more refined studies including both symptom and performance validity indicators.

Combined Methylphenidate and Selective Serotonin Reuptake Inhibitors in Adults With Attention-Deficit/Hyperactivity Disorder.

Depression is a common comorbidity of adult attention-deficit/hyperactivity disorder (ADHD), and the combination of methylphenidate and selective serotonin reuptake inhibitors (SSRIs) is a frequently prescribed treatment. However, there is limited clinical evidence on the safety of this medication combination in adults with ADHD. To evaluate the safety of administering a combination of SSRI and methylphenidate in adults with ADHD and comorbid depression. This cohort study obtained data from a nationwide claims database in South Korea from January 2016 to February 2021. Participants were adults aged 18 years or older with a diagnosis of ADHD and depressive disorder who were prescribed methylphenidate. Comparisons of 4 groups who received prescriptions were conducted: (1) SSRI plus methylphenidate (hereafter, SSRI) group vs methylphenidate-only group and (2) methylphenidate plus fluoxetine (hereafter, fluoxetine) group vs methylphenidate plus escitalopram (hereafter, escitalopram) group (compared to find a preferable treatment option). Data analysis was conducted between July and December 2023. New users of the methylphenidate and SSRI combination among adults with both ADHD and depressive disorder. A total of 17 primary and secondary outcomes, including neuropsychiatric and other events, were assessed, with respiratory tract infection used as a control outcome. Groups were matched at a 1:1 ratio using a propensity score to balance confounders. A Cox proportional hazards regression model was used to calculate hazard ratio (HRs) and 95% CIs. Subgroup analysis by sex and sensitivity analyses in varying epidemiologic settings were conducted. The study included 17 234 adults with ADHD (mean [SD] age at study entry, 29.4 [10.8] years; 9079 females [52.7%]). There was no difference in the risk of outcomes between the methylphenidate-only and SSRI groups, except for a lower risk of headache in the SSRI group (HR, 0.50; 95% CI, 0.24-0.99). In sensitivity analyses of fluoxetine vs escitalopram, the risk of hypertension (HR: 1:n matching, 0.26; 95% CI, 0.08-0.67) and hyperlipidemia (HR: 1:n matching, 0.23; 95% CI, 0.04-0.81) was lower in the fluoxetine group than in the escitalopram group. Results of this study revealed no significant increase in adverse event risk associated with use of SSRI plus methylphenidate vs methylphenidate alone in adults with ADHD and comorbid depression. Instead, the combination was associated with a lower risk of headache.