The relationships between ADHD and social functioning and participation in older adults in a population-based study.

OBJECTIVE: To examine the associations between ADHD and social functioning and participation among older adults. METHOD: Data were used from the Longitudinal Aging Study Amsterdam (LASA). In 2008/2009, respondents were asked about social functioning and participation. A diagnostic interview to diagnose ADHD was administered among a subsample (N = 231, age 60-94 years). ADHD diagnosis and level of ADHD symptoms were assessed. RESULTS: ADHD diagnosis was associated with being divorced/never married, having less family members in their network, and emotional loneliness. Level of ADHD symptoms was associated with more emotional support given, emotional and social loneliness, greater recreational social participation, and lower income level. CONCLUSION: ADHD in old age is related to being divorced/never married and loneliness but not to work participation. Psycho geriatric practices should direct their attention to loneliness when treating ADHD.

Attention deficit hyperactivity disorder and personality characteristics in older adults in the general Dutch population.

OBJECTIVE: The authors wanted to examine the association between attention deficit hyperactivity disorder (ADHD) and personality characteristics and the potential mediating role of these characteristics in the relationship between ADHD and depression in older adults in the general Dutch population. METHODS: Data from the Longitudinal Aging Study Amsterdam in 2008/2009 were used in a cross-sectional design on 231 participants with and without ADHD aged 60-94 years. Questionnaires assessing self-esteem, self-efficacy, mastery, neuroticism, and social inadequacy were administered. ADHD was measured by means of ADHD diagnosis and level of ADHD symptoms. Linear regression analyses were performed to assess the association between ADHD (symptoms) and personality characteristics. Single and multivariate mediation analyses were performed to examine the mediating role of personality characteristics in the relationship between ADHD (symptoms) and depressive symptoms. RESULTS: ADHD was significantly negatively associated with sense of mastery (B = -2.44, t = -3.14, df = 228, p = 0.002), self-esteem (B = -1.16, t = -2.27, df = 228, p = 0.02), and self-efficacy (B = -2.33, t = -2.02, df = 228, p = 0.045) and positively associated with neuroticism (B = 0.99, t = 4.90, df = 228, p <0.001) and social inadequacy (B = 0.65, t = 3.32, df = 229, p = 0.001). In the single mediation analyses, all personality characteristics were mediators in the relationship between ADHD symptoms and depressive symptoms. In the multivariate analysis only mastery and self-esteem were mediators. CONCLUSION: Older adults with ADHD reported lower self-esteem and sense of mastery and higher levels of neuroticism and social inadequacy than older adults without ADHD. Mastery and self-esteem partly explained the association between ADHD and depressive symptoms in old age. The results implicate that in treatment clinicians should pay attention to the personality characteristics of older adults with ADHD.

Attention-deficit/hyperactivity disorder, physical health, and lifestyle in older adults.

OBJECTIVES: To increase insight into the effect of attention-deficit/hyperactivity disorder (ADHD) on health in general in older adults. DESIGN: Two-phase sampling side-study. SETTING: Longitudinal Aging Study Amsterdam (LASA). PARTICIPANTS: Two hundred twenty-three randomly selected LASA respondents. MEASUREMENTS: Information was collected during home visits on physical health, medication use, and lifestyle characteristics in Phase 1 and on ADHD diagnosis in Phase 2. The associations between independent variables and ADHD were examined with linear and logistic regression analyses. RESULTS: The adjusted regression estimates of the linear regression analysis showed that the number of ADHD symptoms was positively associated with the presence of chronic nonspecific lung diseases (CNSLD) (B = 2.58, P = .02), cardiovascular diseases (B = 2.18, P = .02), and number of chronic diseases (B = 0.69, P = .04) and negatively associated with self-perceived health (B = -2.83, P = .002). Lifestyle is not a mediator of the association between ADHD and physical health. CONCLUSION: Attention-deficit/hyperactivity disorder in older adults was associated with chronic physical illness and poorer self-perceived health. Contrary to expectations, there were no associations between symptoms of ADHD and lifestyle variables.

Criterion validity of an Attention Deficit Hyperactivity Disorder (ADHD) screening list for screening ADHD in older adults aged 60-94 years.

OBJECTIVE: To identify Attention Deficit Hyperactivity disorder (ADHD) in older adults, a validated screener is needed. This study evaluates the reliability and criterion validity of an ADHD screener for younger adults on its usefulness in a population-based sample of older adults. METHODS: Data were collected as a side study in the Longitudinal Aging Study Amsterdam. In a two-phase design the validity of the screener was tested against a structured diagnostic interview (DIVA 2.0). In Phase 1, 1,494 respondents (60-94 years) were assessed with the ADHD screener. In Phase 2, 231 respondents participated in the diagnostic interview. RESULTS: Internal consistency (Cronbach's α) and reliability (ICC) of the screener were 0.71 and 0.56, respectively. The area under the curve was 0.82. The optimal cut-point was found at 2 (sensitivity: 0.80; specificity: 0.77; PPV: 0.13; NPV: 0.99). CONCLUSION: Despite its low ICC, the ADHD screener may serve as a useful contribution to measure ADHD in the older population.

The comorbidity of anxiety and depressive symptoms in older adults with attention-deficit/hyperactivity disorder: a longitudinal study.

BACKGROUND: Comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and depression and anxiety disorders in children and young to middle-aged adults has been well documented in the literature. Yet, it is still unknown whether this comorbidity persists into later life. The aim of this study is therefore to examine the comorbidity of anxiety and depressive symptoms among older adults with ADHD. This is examined both using cross-sectional and longitudinal data. METHODS: Data were used from the Longitudinal Aging Study Amsterdam (LASA). Participants were examined in three measurement cycles, covering six years. They were asked about depressive and anxiety symptoms. To diagnose ADHD, the DIVA 2.0, a diagnostic interview was administered among a subsample (N=231, age 60-94). In addition to the ADHD diagnosis, the association between the sum score of ADHD symptoms and anxiety and depressive symptoms was examined. Data were analyzed by means of linear regression analyses and linear mixed models. RESULTS: Both ADHD diagnosis and more ADHD symptoms were associated with more anxiety and depressive symptoms cross-sectionally as well as longitudinally. The longitudinal analyses showed that respondents with higher scores of ADHD symptoms reported an increase of depressive symptoms over six years whereas respondents with fewer ADHD symptoms remained stable. LIMITATIONS: The ADHD diagnosis is based on the DSM-IVcriteria, which were developed for children, and have not yet been validated in (older) adults. CONCLUSIONS: It appears that the association between ADHD and anxiety/depression remains in place with aging. This suggests that, in clinical practice, directing attention to both in concert may be fruitful.