Diagnosed Attention Deficit Hyperactivity Disorder Research Articles

Association of prenatal and postnatal exposure to air pollution with clinically diagnosed attention deficit hyperactivity disorder: a systematic review

Attention deficit hyperactivity disorder (ADHD), a prevalent neurodevelopmental disorder in children, originates from a multifaceted interplay of genetic, neurological, and environmental factors. Recent studies have increasingly concentrated on environmental determinants, notably air pollution, and their impact on the risk of developing ADHD. Additionally, previous research has often conflated clinically diagnosed ADHD cases with instances of mere ADHD-like symptoms, a methodology that can introduce bias and obscure the true relationship between environmental factors and ADHD. To address this oversight, our systematic review meticulously investigates the relationship between both prenatal and postnatal exposures to particular air pollutants and strictly clinically diagnosed ADHD. Our comprehensive review encompassed 801 studies from PubMed, Cochrane Library, Web of Science, and Embase databases, out of which eight met our rigorous inclusion criteria. The Newcastle-Ottawa Scale (NOS) was utilized to gauge quality and bias. Our review found substantiated the connection between prenatal exposure to PM2.5 and NOx and a heightened risk of ADHD, while exposure to PM10 during the prenatal stage was not associated with ADHD. These findings hint at varied health impacts from different particulate matters and the prospect of gender-specific susceptibilities to such exposures. We also identified an association between postnatal exposure to PM2.5, PM10, and NO2 and an increased ADHD risk, underlining the potential neurodevelopmental harms from early exposure to these pollutants. These relationships, seemingly intricate and potentially dose-dependent, underscore the need for more detailed scrutiny. The unique value of our review is in its detailed exploration of the association between specific air pollution exposures and clinically diagnosed ADHD. Our findings offer much-needed clarity in this complex domain and emphasize the importance of future research to standardize exposure and outcome metrics, probe potential mechanisms, and reduce bias and heterogeneity.

Neuropsychological Assessment of the Relationship of Working Memory with K-BIT Matrices and Vocabulary in Normal Development and ADHD Children and Adolescents.

The present report tries to understand the possible relationship between working memory (WM) and intelligence measurements, using the direct scores of the Working Memory Test Battery for Children (WMTBC) and Kaufman's Brief Intelligence Test (K-BIT), in normal development (ND) and diagnosed attention deficit hyperactivity disorder (ADHD) children and adolescents. Partial correlations, discounting the effect of age, showed a significant correlation in ND subjects between the central executive (CE) component of WM and the WM visuospatial sketchpad (VSS) component and the WM phonological loop (PL); also, significant correlations were obtained for the WM VSS with the K-BIT Matrices scores, the WM PL with the K-BIT Vocabulary, and the K-BIT Matrices scores with the K-BIT Vocabulary. For ADHD subjects, there were significant correlations between WM VSS and WM CE, and WM VSS and K-BIT Matrices. We tested the robustness of these correlations by selecting a small number of subjects through permutations; a robust correlation between WM CE and WM PL in ND, and between WM VSS and WM CE and WM VSS and K-BIT Matrices scores was obtained. These results were also supported by mediation analysis. There is a relationship during development between WM as measured with WMTBC and general intelligence as measured with K-BIT in ND and ADHD subjects. The dysexecutive character of ADHD has been shown, given that by controlling for intelligence, the differences in WM performance between ND and ADHD disappear, except for WM CE. The results suggest that in ADHD subjects, the WM VSS component presents a more pivotal role during cognitive processing compared to ND subjects.

Altered Arginine/Nitric Oxide Pathway in Children Diagnosed Attention Deficit Hyperactivity Disorder, and the Effect of 10 Weeks Methylphenidate Treatment.

ObjectiveIn this study, we investigated the levels of arginine, nitric oxide (NO), asymmetric dimethylarginine (ADMA), and adrenomedullin that are presumed to play a role in attention deficit hyperactivity disorder (ADHD) etiology, and to compare the findings with healthy controls.MethodsThirty ADHD patients and thirty healthy control subjects aged 6−12 years were included in the study. Sociodemographic data form, Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version; Conners’ Parent/Teacher Rating Scale-Revised Long Form; Children’s Depression Inventory; and The State-Trait Anxiety Inventory for Children were applied to all cases. All participants included in the study were evaluated in terms of their serum arginine, NO, ADMA, and adrenomedullin levels. Subsequently, methylphenidate treatment was started in ADHD patients and blood parameters were tested again in the tenth week of treatment.ResultsAt the start of the study, arginine and ADMA levels were significantly higher and NO and adrenomedullin levels were significantly lower in the ADHD group compared to the control group. Post-treatment arginine and ADMA levels were found to be significantly lower than in the pre-treatment period. There were no significant differences in NO and adrenomedullin levels before and after treatment. There was no correlation between scale scores and blood parameters.ConclusionThese variations in the blood parameters of the ADHD group seem to be worth further investigation. Studies to be conducted with larger sample groups after longer-term treatment may provide new information about the alterations in neurobiological processes related to ADHD etiology and treatment.

The partial \xb5-opioid agonist buprenorphine in autism spectrum disorder: a case report

BackgroundThere are currently no approved medications for impaired social cognition and function, core symptoms of autism spectrum disorder. We describe marked improvement of these symptoms with long-term low-dose administration of the partial µ-opioid agonist buprenorphine. We discuss these observations in the context of a role for endogenous opioid systems in social attachment, and theories integrating those findings mechanistically with autism spectrum disorder.Case presentationM, a 43-year-old Caucasian male, is medically healthy. Despite social difficulties since childhood, he completed high school with better-than-average grades, but failed university education. A psychiatric evaluation in his twenties diagnosed attention deficit hyperactivity disorder but also noted symptoms of coexisting autism spectrum disorder. M accidentally came across buprenorphine in his late twenties and experienced progressively improved social functioning on a low daily dosage (0.5–1.0 mg/day), an effect maintained for 15 years. He lived independently and maintained a part-time occupation. After abrupt discontinuation of treatment, his autistic symptoms returned, and function deteriorated. Following evaluation by our team, buprenorphine was resumed, with gradual return to prior level of functioning. An attempt to formally evaluate M both on and off medication was agreed with him and approved by the Swedish Ethics Authority, but medication had to be resumed when the patient worsened following discontinuation.ConclusionsAccording to the µ-opioid receptor balance model, both excessive and deficient μ-receptor activity may negatively influence social behavior, and accordingly both opioid agonist and opioid antagonist treatment may be able to improve social functioning, depending on an individual’s opioid tone before treatment. Our case report is consistent with these hypotheses, and given the extensive unmet medical needs in individuals with autism spectrum disorders, randomized controlled trial appears warranted.

Morbidities and mortality of diagnosed attention deficit hyperactivity disorder (ADHD) over the youth lifespan: A population-based retrospective cohort study.

ObjectivesTo estimate the prevalence of ADHD, and related comorbidities, mortality, and type of health service use among children and young adults, using different case definitions.MethodsWe conducted a population‐based retrospective cohort study between 2000 and 2018, using the Quebec Integrated Chronic Disease Surveillance System (QICDSS) database. All residents aged less than 25 years eligible for health insurance coverage were included. We compared outcomes of three indicators (morbidity, services use and mortality) according two different algorithms of ADHD definitions, to the general population.ResultsThe cumulative prevalence of ADHD has risen steadily over the past decade, reaching 12.6% in 2017–2018. People with ADHD have a higher prevalence of psychiatric comorbidities, make greater use of medical, mental health services, and are hospitalized more often. The comparison of prevalence between the two algorithms and the general population for the three indicators showed that the cohort having one claim was very close to that with two or more, and statistically significant higher to that of people without ADHD.ConclusionThis finding support that a single claim algorithm for ADHD can be used for case definition. More research is needed on the impact of potentially effective treatments in improving consequences of ADHD.

Screening for intimate partner violence in the early postpartum period: Maternal and child health and social outcomes from birth to 5-years post-delivery

BackgroundIntimate partner violence (IPV) during pregnancy is a substantial public health concern, yet little is known about the developmental trajectory of these women and their children after birth. ObjectiveThe objective was to examine maternal and child health as well as social outcomes from birth to 5-years post-delivery associated with a positive (vs. negative) maternal IPV screen around the time of delivery. Participants and SettingManitoban women giving birth to a live singleton infant from January 1, 2003 to December 31, 2006 were followed from birth to 5-years post-delivery (analytic sample: N = 40,051). MethodsAdministrative databases from the Manitoba Centre for Health Policy provided data for the study. Descriptive statistics and logistic regression were used to examine relationships between IPV screen response around the time of birth (i.e., current, or history of, violence between parenting partners) with maternal and child health as well as social outcomes. ResultsWomen screening positive for IPV had increased odds of diagnosed mood/anxiety disorders, personality disorders, substance use disorders, diabetes, respiratory morbidity, and intentional/non-intentional injury hospitalizations (adjusted odds ratio [AOR] range 1.81–5.59, p < .01). Children of women screening positive for IPV had increased odds of diagnosed attention deficit-hyperactivity disorder, lower respiratory infections, and injury hospitalizations (AOR range 1.53–2.00, p < .01), child welfare organization contact (AOR = 8.84, p < .01), and of being more developmentally vulnerable at kindergarten across domains of functioning (AOR range 1.69–1.93, p < .01) than children of mothers screening negative for IPV. ConclusionA positive IPV screen was associated with poorer maternal and child health, increased child and family services contact, and children being more developmentally vulnerable in the 5-years after delivery.

Loneliness Accounts for the Association Between Diagnosed Attention Deficit-Hyperactivity Disorder and Symptoms of Depression Among Adolescents

The heightened levels of peer relationship difficulties associated with Attention Deficit/Hyperactivity Disorder (ADHD) potentially predispose adolescents to feelings of loneliness and depressive symptoms. The current study explores whether feelings of loneliness mediate the effects of ADHD on depressive symptoms. Eighty-four adolescents (Mage = 13.01 years, 75% Male) in Western Australian schools completed mental health and wellbeing surveys. Multivariate analysis of variance assessed whether adolescents with ADHD had greater loneliness and depressive symptoms, and mediation analysis explored whether loneliness mediated the relationship between ADHD and depressive symptoms. Adolescents with ADHD reported significantly greater depressive symptomatology and feelings of isolation and lower quality of friendships. Together, friendship and isolation related loneliness fully mediated the relationship between ADHD and depressive symptoms. Loneliness is associated with depression in adolescents with ADHD and may be an important consideration when addressing symptoms of depression among young people diagnosed with ADHD.

Generation of four iPSC lines from peripheral blood mononuclear cells (PBMCs) of an attention deficit hyperactivity disorder (ADHD) individual and a healthy sibling in an Australia-Caucasian family

Peripheral blood mononuclear cells were donated by a male teenager with clinically diagnosed attention deficit hyperactivity disorder (ADHD) under the Diagnostic and Statistical Manual of Mental Disorders IV criteria and his unaffected male sibling. Induced pluripotent stem cells were developed using integration-free Sendai Reprogramming factors containing OCT4, SOX2, KLF4, and c-MYC. All four iPSC lines displayed pluripotent cell morphology, pluripotency-associated factors at the DNA and protein level, alkaline phosphatase enzymatic activity and a male karyotype of 46, XY. All lines had capacity for in vitro differentiation into all the three germ layers. All were negative for Mycoplasma.

Proportion of Raised Blood Pressure and Raised Blood Sugar Level in Newly Diagnosed Attention Deficit Hyperactivity Disorder in Children

Proportion of Raised Blood Pressure and Raised Blood Sugar Level in Newly Diagnosed Attention Deficit Hyperactivity Disorder in Children

Generation of urine iPS cell lines from patients with Attention Deficit Hyperactivity Disorder (ADHD) using a non-integrative method

Urine samples were collected from three patients (2 males, 1 female) with clinically diagnosed Attention Deficit Hyperactivity Disorder (ADHD) according to DSM-5 criteria using semi-structured interviews (K-SADS adapted for adults) by a trained psychiatrist. Urine epithelial cell lines were established and expanded for subsequent reprogramming procedure. Induced pluripotent stem cells (iPSCs) were derived using integration-free CytoTune®-iPS 2.0 Sendai Reprogramming Kit, which includes Sendai virus particles of the four Yamanaka factors Oct3/4, Sox2, Klf4 and c-Myc.

Attentional control and subjective executive function in treatment-naive adults with Attention Deficit Hyperactivity Disorder.

We investigated performance-derived measures of executive control, and their relationship with self- and informant reported executive functions in everyday life, in treatment-naive adults with newly diagnosed Attention Deficit Hyperactivity Disorder (ADHD; n = 36) and in healthy controls (n = 35). Sustained attentional control and response inhibition were examined with the Test of Variables of Attention (T.O.V.A.). Delayed responses, increased reaction time variability, and higher omission error rate to Go signals in ADHD patients relative to controls indicated fluctuating levels of attention in the patients. Furthermore, an increment in NoGo commission errors when Go stimuli increased relative to NoGo stimuli suggests reduced inhibition of task-irrelevant stimuli in conditions demanding frequent responding. The ADHD group reported significantly more cognitive and behavioral executive problems than the control group on the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). There were overall not strong associations between task performance and ratings of everyday executive function. However, for the ADHD group, T.O.V.A. omission errors predicted self-reported difficulties on the Organization of Materials scale, and commission errors predicted informant reported difficulties on the same scale. Although ADHD patients endorsed more symptoms of depression and anxiety on the Achenbach System of Empirically Based Assessment (ASEBA) than controls, ASEBA scores were not significantly associated with T.O.V.A. performance scores. Altogether, the results indicate multifaceted alteration of attentional control in adult ADHD, and accompanying subjective difficulties with several aspects of executive function in everyday living. The relationships between the two sets of data were modest, indicating that the measures represent non-redundant features of adult ADHD.

G159(P) Differential effects of dexamphetamine and methylphenidate on symptoms of inattention-overactivity, oppositional-defiant and weight

AimsThere is evidence that the dose of stimulant medication that optimises behaviour is higher than the optimal dose for improvement in cognitive functioning (Sprague and Sleator 1977). This implies two...

The heritability of clinically diagnosed attention deficit hyperactivity disorder across the lifespan

No prior twin study has explored the heritability of clinically diagnosed attention deficit hyperactivity disorder (ADHD). Such studies are needed to resolve conflicting results regarding the importance of genetic effects for ADHD in adults. We aimed to estimate the relative contribution of genetic and environmental influences for clinically diagnosed ADHD across the lifespan with a specific focus on ADHD in adults. Information on zygosity and sex was obtained from 59514 twins born between 1959 and 2001 included in the nationwide population-based Swedish Twin Registry. Clinical data for ADHD diagnoses (i.e. stimulant or non-stimulant medication for ADHD) were obtained from the Swedish Prescribed Drug Register (PDR) and from the National Patient Register (i.e. ICD-10 diagnosis of ADHD). Twin methods were applied to clinical data of ADHD diagnoses using structural equation modeling with monozygotic (MZ) and dizygotic (DZ) twins. The best-fitting model revealed a high heritability of ADHD [0.88, 95% confidence interval (CI) 0.83-0.92] for the entire sample. However, shared environmental effects were non-significant and of minimal importance. The heritability of ADHD in adults was also substantial (0.72, 95% CI 0.56-0.84). This study shows that the heritability of clinically diagnosed ADHD is high across the lifespan. Our finding of high heritability for clinically diagnosed ADHD in adults indicates that the previous reports of low heritability are best explained by rater effects, and that gene-identification studies of ADHD in adults need to consider pervasiveness (e.g. multiple raters) and developmentally (e.g. childhood-onset criteria) informative data.

Lead, mercury, and cadmium exposure and attention deficit hyperactivity disorder in children

BackgroundThere is limited research examining the relationship between lead (Pb) exposure and medically diagnosed attention deficit hyperactivity disorder (ADHD) in children. The role of mercury (Hg) and cadmium (Cd) exposures in ADHD development is even less clear. ObjectivesTo examine the relationship between Pb, Hg, and Cd and ADHD in children living inside and outside a Lead Investigation Area (LIA) of a former lead refinery in Omaha, NE. MethodsWe carried out a case-control study with 71 currently medically diagnosed ADHD cases and 58 controls from a psychiatric clinic and a pediatric clinic inside and outside of the LIA. The participants were matched on age group (5–8, 9–12 years), sex, race (African American or Caucasians and others), and location (inside or outside LIA). We measured whole blood Pb, total Hg, and Cd using inductively coupled plasma mass spectrometry. ResultsInside the LIA, the 27 cases had blood Pb geometric mean (GM) 1.89µg/dL and the 41 controls had 1.51µg/dL. Outside the LIA, the 44 cases had blood Pb GM 1.02µg/dL while the 17 controls had 0.97µg/dL. After adjustment for matching variables and maternal smoking, socioeconomic status, and environmental tobacco exposure, each natural log unit blood Pb had an odds ratio of 2.52 with 95% confidence interval of 1.07–5.92. Stratification by the LIA indicated similar point estimate but wider CIs. No associations were observed for Hg or Cd. ConclusionsPostnatal Pb exposure may be associated with higher risk of clinical ADHD, but not the postnatal exposure to Hg or Cd.

A Research Strategy to Discover the Environmental Causes of Autism and Neurodevelopmental Disabilities

A Research Strategy to Discover the Environmental Causes of Autism and Neurodevelopmental Disabilities

Seeing red: poetry and metaphor as responses to representational challenges in critical narrative research

Research with young people who ‘do not fit the mould’ requires innovative and unconventional methods, but what are the implications of such methods for scholarly representation? This paper reports on the development of such a method with students diagnosed Attention Deficit Hyperactivity Disorder and offers one view of the borderland spaces and tensions between critical theory and narrative inquiry. In particular, the paper defines the methodology that underpins the ‘critical cover narratives’ method, describes the application of this approach within a doctoral study, and identifies resultant issues of representation when combining narrative and critical approaches. The paper then details the use of a tapestry metaphor to reconcile these issues. The central premise of the paper is that differing methods produce different knowledge, which demands different forms of representation. In making this case, the paper discusses the importance of a balance between the epistemological and aesthetic within scholarly representations of narrative inquiry.

Treatment of refractory obesity in severely obese adults following management of newly diagnosed attention deficit hyperactivity disorder

To determine whether attention deficit hyperactivity disorder (ADHD) pharmacological treatment of severely obese subjects with newly diagnosed ADHD would result in sustained weight loss. Longitudinal clinical intervention study of the effects of ADHD medication on weight change over 466 days. 78 subjects (6 male, 72 female, mean age 41.3 years, BMI 42.7 kg m(-2)) out of 242 consecutively referred severely obese, weight loss refractory individuals were diagnosed as having ADHD. Sixty-five subjects received treatment and 13 remained as controls. Standard screening tests identified subjects likely to have ADHD. A diagnosis was made in 78 subjects by semi-structured clinical interview. ADHD subjects were screened for comorbid conditions (binge eating disorder, mood disorder, sleep apnea, chronic pain, gastroesophageal reflux disease). Satisfactory resolution of symptoms of comorbid conditions was achieved prior to the introduction of pharmacotherapy for ADHD. Subjects not accepting, tolerating or remaining on ADHD medication served as controls. Weight was measured at sequential clinic visits after initiation of pharmacotherapy. Comorbid conditions were found to be highly prevalent (sleep apnea 56.4%, binge eating disorder 65.4%, mood disorder 88.4%). After an average of 466 days (s.d.=260) of continuous ADHD pharmacotherapy, weight change in treated subjects was -12.36% of initial weight and in controls +2.78%, P<0.001. Weight loss in treated subjects was 15.05 kg (10.35%) and weight gain 3.26 kg (7.03%) in controls, P<0.001. ADHD is a highly prevalent condition in the severely obese population. Treatment of ADHD is associated with significant long-term weight loss in individuals with a lengthy history of weight loss failure. This result is likely because of the positive effects of treatment on self-directedness, persistence and novelty-seeking behaviors. ADHD should be considered as a primary cause of weight loss failure in the obese. Individuals seeking medical or surgical weight loss should be evaluated for ADHD and treated appropriately before intervention. This may improve the outcome for medically managed patients and avoid complications in surgical subjects because of poor compliance with diet and supplement requirements.

Assessment and Treatment of Correctional Inmates With ADHD

Mr. A is a 32-year-old inmate in a medium-security prison who is being treated by the facility psychiatrist for recently diagnosed attention deficit hyperactivity disorder (ADHD). His school records are not available, but Mr. A's parents report that they always struggled to get him to do his homework and that he had academic difficulties from the third or fourth grade. They recall his teachers reporting that he easily became bored in class, often fidgeted, could not sit still, had problems focusing on schoolwork, and generally did not perform up to his potential. He did not complete high school. While in prison, he enrolled in GED courses, and the instructors confirm that despite his apparent motivation, he still has difficulty concentrating, organizing his work, and finishing projects. He also has a job in the prison kitchen, and his supervisor reports that Mr. A often forgets to complete assigned tasks and makes mistakes with tasks that involve multiple steps. He has received a warning that he could lose his job if his performance does not improve. Officers on his cellblock report that he seems restless during times of high activity or noise on the unit. Mr. A never had a clinical assessment for his problems prior to his incarceration. Not long after his arrival, the prison psychologist administered an ADHD symptom questionnaire and tested for problems with attention. Interview and test results were consistent with a diagnosis of ADHD. The prison psychiatrist prescribed a 2-month course of 400 mg/day of bupropion, which brought no noticeable improvement. Mr. A has also enrolled in an ADHD educational group at the prison that includes a focus on organizational skills and impulse control. Mr. B is a 29-year-old inmate in a maximum-security prison who presents with the complaint I need something to help me concentrate and keep me out of trouble. He reports that he was always a lousy student and is a high school dropout. He also states that he was diagnosed with ADHD as a child and took methylphenidate prior to incarceration. He complains that it now takes him a long time to read a book or to complete a letter, and he has received several disciplinary reports for fighting, for disobeying correctional officers, and for positive urine drug screens for benzodiazepines and opiates. He endorses multiple ADHD symptoms on a self-report checklist. Since his incarceration, he has not tried to enroll in educational, work, or other prison programming because he believes that he would not be able to focus on any of these tasks. Mr. B will not consent to contact with his family or sign a release for past treatment records and states that none of that matters to what he needs now. He refuses additional psychological testing, and he believes that group treatment is just a lot of talk and a waste of time. He knows that other inmates receive stimulant medications for their ADHD, and he has no interest in trying any medication other than a stimulant.

Trouble déficitaire de l'attention avec hyperactivité : premiers résultats psychodynamiques d'une étude croisée

The authors present the first results of pluridisciplinary research concerning the study of the way children's mind diagnosed Attention Deficit Hyperactivity Disorder (ADHD) work. The psychodynamic and neuropsychological approaches, often viewed as opposed, have received the same methodology so as to determine the profile of this section of the population, and the most appropriate types of treatment with their short and medium term effects. Twenty-five hyperactive children have benefited from 6 months of the first stage of both psychodynamic and neuropsychological evaluations. The psychodynamic evaluation treated in this article, is based on a methodology comprising clinical interview and projective tests (Rorschach and TAT or CAT). Their protocols have been analysed according to the views of French school, which takes its inspiration from the psychoanalytical conception of the mind. The first results of the neuropsychological tests, corroborated by the psychodynamic evaluation, show that the symptoms of the dual relationship have been attenuated for some of the children. Moreover, the projective tests reveal that most of the children's feeling of identity and their internal representations are fragile, but no deficiencies as regard their adaptation to reality. Those elements confirm these children's difficulty with autonomy and how necessary it is to help them build up, concretely continuity in their relational investments. Although it is fundamental to attenuate their symptoms — and medication is instrumental in this — it is nevertheless necessary to offer interpersonal treatment on which the child can rely.

A DSM-IV Axis I comorbidity study of males (n = 120) with paraphilias and paraphilia-related disorders.

One hundred and twenty consecutively evaluated outpatient males with paraphilias (PAs; n = 88, including 60 sex offenders) and paraphilia-related disorders (PRDs; n = 32) were systematically assessed for certain developmental variables and DSM-IV-defined Axis I comorbidity. In comparison with the PRDs, the PA group was statistically significantly more likely to self-report a higher incidence of physical (but not sexual) abuse, fewer years of completed education, a higher prevalence of school-associated learning and behavioral problems, more psychiatric/substance abuse hospitalizations, and increased employment-related disability as well as more lifetime contact with the criminal justice system. In both groups, the most prevalent Axis I disorders were mood disorders (71.6%), especially early onset dysthymic disorder (55%) and major depression (39%). Anxiety disorders (38.3%), especially social phobia (21.6%), and psychoactive substance abuse (40.8%), especially alcohol abuse (30%), were reported as well. Cocaine abuse was statistically significantly associated with PA males (p = .03). There was a statistically significant correlation between the lifetime prevalence of Axis I nonsexual diagnoses and hypersexual diagnoses (PAs and PRDs). The prevalence of retrospectively diagnosed attention deficit hyperactivity disorder (ADHD) was 35.8%, the third most prevalent Axis I disorder. ADHD (p = .01), especially ADHD-combined subtype (p = .009), was statistically significantly associated with PA status. ADHD was statistically significantly associated with conduct disorder, and both of these Axis I disorders were associated with the propensity for multiple PAs and a higher likelihood of incarceration. When the diagnosis of ADHD was controlled, the differences reported above between PAs and PRDs either became statistically nonsignificant or remained as only statistical trends. Thus, ADHD and its associated developmental sequellae and Axis I comorbidities was the single most common nonsexual Axis I diagnosis that statistically significantly distinguished males with socially deviant sexual arousal (PAs) from a nonparaphilic hypersexual comparison group (PRDs). Sex offender paraphiliacs were more likely to be diagnosed with conduct disorder, alcohol abuse, cocaine abuse, and generalized anxiety disorder. The prevalence of any ADHD in the sex offender paraphiliacs was 43.3%, and nearly 25% of offenders were diagnosed with ADHD-combined subtype.