Exploring the Relationship between Adherence to Therapy, Treatment Acceptability, and Clinical Outcomes in Adults with Attention-Deficit/Hyperactivity Disorder: Results from the COMPAS Multicenter Randomized Controlled Trial.

INTRODUCTION: Cognitive behavioral therapy and dialectical behavior therapy (DBT) can be effective in treating adults with ADHD, and patients generally consider these interventions useful. While adherence, as measured by attendance at sessions, is mostly sufficient, adherence to therapy skills has not been assessed. Furthermore, the relationship between patient evaluation of therapy effectiveness, treatment adherence, and clinical outcomes is understudied. OBJECTIVE: This study aimed to examine treatment acceptability and adherence in relation to treatment outcomes in a large randomized controlled trial comparing a DBT-based intervention with a nonspecific active comparison, combined with methylphenidate or placebo. METHOD: A total of 433 adult patients with ADHD were randomized. Participants reported how effective they found the therapy, and adherence was measured by attendance at therapy sessions and by self-reports. Descriptive, between-groups, and linear mixed model analyses were conducted. RESULTS: Participants rated psychotherapy as moderately effective, attended 78.40-94.37% of sessions, and used skills regularly. The best-accepted skills were sports and mindfulness. Groups receiving placebo and/or nonspecific clinical management rated their health condition and the medication effectiveness significantly worse than the psychotherapy and methylphenidate groups. Improvements in clinical outcomes were significantly associated with treatment acceptability. Subjective (self-reported) adherence to psychotherapy was significantly associated with improvements in ADHD symptoms, clinical global efficacy and response to treatment. DISCUSSION: These results further support the acceptability of DBT for adult ADHD and suggest the need to address adherence to treatment to maximize clinical improvements. Results may be limited by the retrospective assessment of treatment acceptability and adherence using an ad hoc instrument.

Exploring the efficacy of dialectical behaviour therapy and methylphenidate on emotional comorbid symptoms in adults with attention Deficit/Hyperactivity disorder: Results of the COMPAS multicentre randomised controlled trial.

This study evaluated the efficacy of dialectical behaviour group therapy (GPT) vs. individual clinical management (CM) and methylphenidate (MPH) vs. placebo (PLB) on emotional symptoms in adults with ADHD. This longitudinal multicentre RCT compared four groups (GPT+MPH, GPT+PLB, CM+MPH, and CM+PLB) over five assessment periods, from baseline to week 130. Emotional symptomatology was assessed using SCL-90-R subscales. Of the 433 randomised participants, 371 remained for final analysis. At week 13, the GPT+MPH group showed smaller reductions in anxiety symptoms than the CM groups, but the differences disappeared at subsequent assessments. Improvements in emotional symptom were significantly predicted by reductions in core ADHD symptoms in all groups except the GPT+MPH group. The unexpected lack of between-group differences may be explained by a "floor effect", different intervention settings (group vs. individual), and psychotherapy type. Multiple regression analyses suggest a more specific effect of combined interventions (GPT+MPH). Implications for clinical practice are discussed. Clinical trial registration: ISRCTN54096201 (Current Controlled Trials).

The Suitability of the Childhood Trauma Questionnaire in Criminal Offender Samples.

Adverse childhood experiences (ACEs) are common in community samples and are associated with various dysfunctional physical, psychological, and behavioral consequences. In this regard, criminal offenders are at specific risk, considering their elevated ACE rates compared with community samples and the associations of ACEs with criminal behaviors. However, assessing ACEs in offender samples by self-reports has been criticized with regard to their validity and reliability. We examined the suitability of ACE-self-reports using the Childhood Trauma Questionnaire (CTQ) in a sample of 231 male offenders involved in the German criminal justice system by comparing self-reported to externally rated ACEs to externally rated ACEs based on the information from the offenders' criminal and health-related files and on interviews conducted by forensically trained psychological/psychiatric experts. The accordance between self-ratings and expert ratings was examined considering mean differences, correlations, inter-rater agreement measures, and regression analyses. Offenders themselves reported a higher ACE burden than the one that was rated externally, but there was a strong relationship between CTQ self-assessments and external assessments. However, associations were stronger in offenders seen for risk assessment than in those evaluated for criminal responsibility. Overall, the CTQ seems suitable for use in forensic samples. However, reporting bias in self-reports of ACEs should be expected. Therefore, the combination of self-assessments and external assessments seems appropriate.

["Released but still locked-in": Impact of the SARS-CoV-2 Pandemic on Forensic Outpatients]. / Entlassen und doch eingesperrt" ­ Auswirkungen der SARS-CoV-2-Pandemie auf Klienten forensischer Nachsorgeambulanzen.

The coronavirus pandemic (SARS-CoV-2) affects some people's psychological well-being and has become a challenge for our society. People in forensic settings are at specific risk, especially those who have been released from prison or forensic clinics just before or during the pandemic. Although there are theoretical assumptions about these peoples' experience of the pandemic and recommendations for treatment and risk management, supporting empirical findings are yet missing. The present study investigated forensic outpatients' experience of restrictions in various fields of their everyday life due to SARS-CoV-2-related measures and changes in their attitudes toward treatment and offending, psychological well-being, and resource awareness over the course of the current pandemic. Most patients were satisfied with treatment despite SARS-CoV-2-related limitations. There was a certain stability in psychological well-being, although increased SARS-CoV-2-related stress was associated with increased general psychological burden. Over the course of the pandemic, resource awareness declined, which is of specific importance regarding offense-oriented risk assessment and treatment. Implications are discussed for treatment that offers optimum support based on personal and situational factors and contributes to a lower risk of future delinquency and, thus, the protection of our society.

The Maltreatment-Aggression Link among Prosecuted Males: What about Psychopathy?

Criminal offenders constitute a high-risk sample regarding experiences of childhood maltreatment and engagement in severe aggression. Moreover, psychopathic traits are more common in samples of offenders than non-offenders. Although research has underlined the relationship between childhood maltreatment and adult aggression, the influence of psychopathy on this link is still unclear. We examined the dynamics of maltreatment, aggression, and psychopathy in a mixed sample of 239 male violent, sexual, and other offenders using latent factor structural equation modeling. We found a consistent positive association of maltreatment with aggression. Psychopathy did not mediate this relation. Maltreatment was not associated with psychopathy, although psychopathy had a positive effect on aggressive behavior. These dynamics appeared similar for violent, sexual, and other offenders. However, latent variables were constructed somewhat differently depending on the offender status. For instance, sexual abuse appeared to be of specific importance in sexual offenders. Violent offenders showed high rates of psychopathy compared to sexual and other offenders. The current findings may inspire future research to focus more closely on the different subtypes of psychopathy when examining its role in the prediction of aggression based on childhood maltreatment. Moreover, childhood maltreatment must not be neglected in treatment and prevention approaches aimed at reducing the risk of aggressive behavior.

Mental Health in Young Detainees Predicts Perpetration of and Desistance From Serious, Violent and Chronic Offending.

Mental health problems are common among young offenders but their role in predicting criminal recidivism is still not clear. Early identification and treatment of young offenders at risk of serious, violent, and chronic (SVC) offending is of major importance to increase their chances to develop into a healthy and non-criminal future and protect society from further crime. In the present study, we assessed mental health among 106 young offenders while incarcerated and analyzed their criminal careers up to 15 years after release. We found high rates of mental health issues, especially externalizing problems, but also concerning illegal substance and alcohol use patterns as well as personality disorders. Rule-breaking behavior and internalizing problems were negatively related to incarceration time until study assessment, but withdrawal and internalizing problems were positively associated with remaining time to release. Whereas, SVC status before assessment and after release were not statistically dependent, mental health issues predicted perpetration of and desistance from SVC offending after release. Alarming alcohol use appeared to be of specific importance in this regard. Findings indicate that young offenders at risk of future SVC offending may benefit from mental health treatment with specific focus on problematic alcohol consumption to prevent ongoing crime perpetration.

Sexuality in Adults With ADHD: Results of an Online Survey.

Establishing a secure sexual identity is a major developmental goal of an individual's transition from childhood to adolescence and the years that follow. Attention deficit/hyperactivity disorder (ADHD) as a neurodevelopmental disorder defined by the core symptoms of inattention, hyperactivity, and impulsivity, but also with emotional dysregulation, oppositional behaviors, or disorganization appearing early in life, can affect several areas of an individual's personal and social development, including sexual health. Yet, the scientific knowledge about the relationship between ADHD and sexual functioning is still scarce. Using an anonymous online survey, we compared different sexual behaviors including risky sexual behaviors, hypersexual behaviors, and sexual dysfunctions between 206 individuals with (n = 139) and without (n = 76) ADHD. Individuals with ADHD reported significantly more hypersexual behaviors than non-ADHD individuals, whereas no differences were found concerning risky sexual behaviors or sexual dysfunctions. In women with ADHD, hypersexual behaviors, sexual risk-taking as well as sexual dysfunctions were closely related to symptoms of emotional dysregulation, impulsivity, and oppositional symptoms. In men with ADHD, the associations between ADHD symptomatology and the sexuality-related measures were less clear, however, signs of emotional dysregulation seemed to be relevant as well. Since individuals with ADHD seem to be at an increased risk of some peculiarities in sexual behavior, sexuality-related issues should be routinely addressed during clinical consultations to provide more holistic treatment in order to enhance individual well-being and quality of life.

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

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

ADHD symptom profiles, intermittent explosive disorder, adverse childhood experiences, and internalizing/externalizing problems in young offenders.

Attention-deficit/hyperactivity disorder (ADHD) and co-existing psychiatric/psychological impairments as well as adverse childhood experiences (ACEs) are common among young offenders. Research on their associations is of major importance for early intervention and crime prevention. Intermittent explosive disorder (IED) warrants specific consideration in this regard. To gain sophisticated insights into the occurrence and associations of ADHD, IED, ACEs, and further psychiatric/psychological impairments in young (male and female) offenders, we used latent profile analysis (LPA) to empirically derive subtypes among 156 young offenders who were at an early stage of crime development based on their self-reported ADHD symptoms, and combined those with the presence of IED. We found four distinct ADHD subtypes that differed rather quantitatively than qualitatively (very low, low, moderate, and severe symptomatology). Additional IED, ACEs, and further internalizing and externalizing problems were found most frequently in the severe ADHD subtype. Furthermore, females were over-represented in the severe ADHD subtype. Finally, ACEs predicted high ADHD symptomatology with co-existing IED, but not without IED. Because ACEs were positively associated with the occurrence of ADHD/IED and ADHD is one important risk factor for on-going criminal behaviors, our findings highlight the need for early identification of ACEs and ADHD/IED in young offenders to identify those adolescents who are at increased risk for long-lasting criminal careers. Furthermore, they contribute to the debate about how to best conceptualize ADHD regarding further emotional and behavioral disturbances.

The role of stress coping strategies for life impairments in ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is commonly accompanied by functional impairments within personal, professional, and social context as well as further psychological distress. The role of perceived stress has been examined in this regard, although little is known about the influence of stress coping strategies. We examined the dynamics between ADHD symptomatology, stress coping strategies, and life impairments in a sample of 230 clinical and non-clinical adult individuals. ADHD was associated with low probability of choosing adaptive but high probability of implementing maladaptive stress coping strategies as well as with increased life impairments. Adaptive stress coping showed little effects beyond the associations between ADHD and life impairments, whereas some maladaptive coping strategies increased current life impairments over and above the effects of ADHD and further psychological distress. The present findings emphasize the need of professional support in adults with ADHD and the necessity to include stress coping strategies in respective treatment approaches aimed at reducing life impairments.

Attention-Deficit/Hyperactivity Disorder (ADHD), antisociality and delinquent behavior over the lifespan.

Attention-Deficit/Hyperactivity Disorder (ADHD) is closely linked to the development of conduct problems during socialization in early life and to an increased risk for antisocial activities and delinquency over the lifespan. The interaction between ADHD and common comorbid disorders like substance use disorders as well as changing environmental conditions could mediate the course of antisocial and delinquent behavior with increasing age. However, this complex interaction is only partially understood so far. This review presents current knowledge about the association of ADHD with antisociality and the development of delinquent behavior. Thereby, the relationships between ADHD, conduct disorder and antisocial personality disorder in offenders are discussed, as well as the impact of comorbid psychiatric disorders and psychosocial conditions on offending behavior. Also, treatment studies in offender populations with ADHD are presented. Although our understanding of the role of ADHD in the development of criminal behavior has substantially improved during the last two decades, more research is needed to further elucidate the mechanisms generating unfavorable outcomes and to engender adequate treatment strategies for this population at risk. Moreover, more attention is needed on children with conduct problems in order to avoid antisocial or delinquent behaviors over the lifespan.

Long-term Effects of Multimodal Treatment on Adult Attention-Deficit/Hyperactivity Disorder Symptoms: Follow-up Analysis of the COMPAS Trial.

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

ADHD modulates the course of delinquency: a 15-year follow-up study of young incarcerated man.

There is growing evidence of an association between ADHD and rule-breaking behaviour and that subjects with ADHD are more likely to be involved in the legal system. However, the research on ADHD as a risk factor not only for delinquency but also for recidivism is scarce and findings are controversial. Therefore, we explored the impact of ADHD on the course of delinquency in a sample of incarcerated young men. We conducted a 15-year follow-up study by investigating the criminal records of 106 former youth prisoners. Criminal recidivism was operationalized through three variables: criminal recidivism; frequency of recidivism; and time to recidivism. The incremental predictive validity of ADHD was analysed using survival analysis and controlled for confounders associated with recidivism. Offenders with ADHD (n = 74) reoffended 2.5 times faster and showed a higher rate of recidivism and further incarcerations compared to non-ADHD offenders (n = 33), even when controlling for general risk factors such as antisocial personality disorder. Median survival rate ranged between 6 and 7 months in the ADHD groups and 25 months in the non-ADHD group. Our results revealed that ADHD has an incremental predictive power on criminal recidivism, even above general risk factors. Moreover, the criminogenic influence of ADHD appeared to be crucial in terms of the interplay of childhood ADHD, irrespectively of the persistence of the symptomatology into later life. Our findings therefore highlight the importance of early intervention and consequently prevention.

Emotional facial recognition in proactive and reactive violent offenders.

The purpose of this study is to analyse individual differences in the ability of emotional facial recognition in violent offenders, who were characterised as either reactive or proactive in relation to their offending. In accordance with findings of our previous study, we expected higher impairments in facial recognition in reactive than proactive violent offenders. To assess the ability to recognize facial expressions, the computer-based Facial Emotional Expression Labeling Test (FEEL) was performed. Group allocation of reactive und proactive violent offenders and assessment of psychopathic traits were performed by an independent forensic expert using rating scales (PROREA, PCL-SV). Compared to proactive violent offenders and controls, the performance of emotion recognition in the reactive offender group was significantly lower, both in total and especially in recognition of negative emotions such as anxiety (d = -1.29), sadness (d = -1.54), and disgust (d = -1.11). Furthermore, reactive violent offenders showed a tendency to interpret non-anger emotions as anger. In contrast, proactive violent offenders performed as well as controls. General and specific deficits in reactive violent offenders are in line with the results of our previous study and correspond to predictions of the Integrated Emotion System (IES, 7) and the hostile attribution processes (21). Due to the different error pattern in the FEEL test, the theoretical distinction between proactive and reactive aggression can be supported based on emotion recognition, even though aggression itself is always a heterogeneous act rather than a distinct one-dimensional concept.

[Psychometric Properties of the Self- and Observer-Ratings ADHD-SR and Wender-Reimherr-Interview in the Assessment of ADHD Symptoms in Old Age]. / Psychometrische Güte der Selbst- und Fremdbeurteilungsinstrumente ADHS-SB und Wender-Reimherr-Interview bei Senioren mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung.

Objective and Methods The aim of the study was to explore the psychometric properties of the ADHD self-rating ADHD-SR and the observer-rating Wender-Reimherr-Interview WRI for the assessment of ADHD symptoms in old age by using a sample of 324 subjects between 60 and 99 years. Results In the sample of older people the psychometric properties of the ADHD-SR and the WRI were adequate. Evidence for construct validity is provided through the WRI. Results of logistic analysis's showed a good discrimination of ADHD for both, the ADHD-SR (89.5 % correct classification; OR = 25.91) and the WRI (86.1 % correct classification; OR = 4.7); specificity ranged between 81 % and 94 %. Conclusion The study shows that both, the ADHD-SR and the WRI, are reliable and valid as tools for the assessment of ADHD in older adults.

Association of attention-deficit/hyperactivity disorder with gambling disorder.

Attention-deficit/hyperactivity disorder (ADHD) is a frequent mental disorder with childhood onset and high persistence into adulthood. There is much evidence that ADHD increases the risk for the development of other psychiatric disorders and functional problems in several domains of everyday life. In this study, the association of ADHD with gambling disorder (GD) was investigated. 163 adult subjects suffering from GD were examined for childhood and current ADHD according to DSM-5 as well as co-morbid psychiatric disorders. Moreover, characteristics of gambling behavior have been evaluated. The prevalence of lifetime ADHD was 28.8 %, with 25.2 % of the study population presenting ADHD as a full syndrome according to DSM-5. The prevalence of co-morbid substance use disorders and adjustment disorders and cluster B personality disorders was higher in GD patients with current ADHD than in the group without. Also, an increased rate of suicide attempts was detected in gamblers with ADHD. In contrast with gamblers without ADHD, those with ADHD were reported to spend more time with gambling, a sedative effect of gambling and a faster development of GD. The high prevalence of ADHD in patients with GD indicates that childhood ADHD is a risk factor for the development of GD in later life. Moreover, treatment of patients with GD and ADHD is complicated by a high rate of co-morbid disorders. Regarding therapeutic approaches, it should be considered that functional aspects of gambling differ in GD patients with and without ADHD.

The intraindividual impact of ADHD on the transition of adulthood to old age.

The aim of the study was to explore whether the individual burden of ADHD is the same in the elderly as in younger ages even though the symptomatological impact of ADHD seems to remain stable over the lifespan. To assess ADHD symptoms and ADHD-associated problems in daily life, standardised questionnaires were conducted. To assess the subjectively experienced course of disease over the lifespan, all participants were interviewed regarding symptoms of ADHD in childhood as well as before and after the fiftieth year of life. In the sample of 296 respondents with a mean age of 69.55 years, 11 fulfilled the criteria of adult ADHD. Retrospectively, the ADHD subjects reported negative impacts due to ADHD-associated behaviour over the life span. These impairments remained stable over time with 18 % of subjects reporting impairments in family life, 46 % in social relationships, 18 % in dealing with money, and 36 % in organisation of daily life in the presence. Thus, the ADHD subjects reported problems with stability over time caused by low self-confidence, being quick-tempered, and due to defiantness. Although this is pilot study, our results reflect the burden of ADHD not only in young and middle adulthood, but also in seniority. The findings indicate the lifelong impact of ADHD as the explored seniors with ADHD reported the negative impact of ADHD remaining stable over the lifespan.

[ADHD: Burden of Disease According to Subtypes in Adult Patients]. / Der Einfluss des ADHS-Subtyps auf den Leidensdruck bei erwachsenen ADHS-Patienten.

OBJECTIVES: In consideration of ADHD subtype we assessed burden of disease of adult ADHD patients and neuroticism. METHODS: 511 adult ADHD patients were enrolled in the study. We measured ADHD symptoms categorically and dimensionally by the "Homburger ADHS-Skalen für Erwachsene (HASE)". All participants rated their ADHD associated level of suffering. To assess personality traits, the psychometric instrument NEO-PI-R was used. RESULTS: In patients with higher levels of neuroticism, there was no significant difference in the level of suffering between the ADHD subtypes. In the group of ADHD patients which scored low on the neuroticism scale, ADHD combined patients are significant more affected compared to the predominantly hyperactive-impulsive or the predominantly inattentive type. CONCLUSIONS: These results underline the hypothesis that the burden of disease is not only related to the level of ADHD symptoms and subtype but also moderated by neuroticism.

[Deficits in Facial Expression Recognition in Adult Attention-Deficit Hyperactivity Disorder]. / Defizite in der fazialen Emotionserkennung bei der adulten Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung.

OBJECTIVE: General and specific deficits in the recognition of facial expressed emotions of ADHD and controls were examined. METHODS: Affect recognition abilities were assessed with the FEEL-Test in a sample of 138 adults with ADHD and 40 healthy controls. RESULTS: Adults with ADHD showed deficits in recognition of the negative emotions anger, disgust, and sadness. CONCLUSION: Deficits in recognition of negative facial expressed emotions might be associated with the development of social problems in the daily life of adults with ADHD and might also provide an approach for therapeutical interventions.