Impairment Assessment in Adult ADHD and Related Disorders: Current Opinions From Clinic and Research.

OBJECTIVES: Assessing functional impairment is one of the essential components in the clinical evaluation of ADHD in adulthood, serving both diagnostic and outcome evaluation purposes. However, clinicians and researchers may face challenges in selecting suitable instruments due to variations in accessibility and quality of instruments. METHODS: We conducted an online survey involving an international group of 92 respondents engaged in clinical practice and/or research on ADHD. The survey aimed to evaluate current practices in assessing impairment in adult ADHD and related disorders, while also identifying areas requiring adaptation or potential new developments. RESULTS: Our findings revealed that clinicians and researchers utilize a diverse range of instruments for assessing impairment in adults with ADHD, including some that may lack adequate properties for this purpose. Notably, dissatisfaction with current practice standards was expressed, underscoring the need for novel assessment approaches and improved psychometric properties. CONCLUSION: It is evident that research endeavors are warranted to either refine existing measures or devise new ones for assessing functional impairment in adult ADHD. Emphasis should be placed on disseminating instruments that enhance accessibility in both research and clinical settings, and facilitate streamlined administration and interpretation.

Financial capability of people living with Parkinson's disease - A case-control study.

Parkinson's disease (PD) is a neurodegenerative disorder affecting 1% of people older than 60 years. One of the abilities that seems vulnerable to the cognitive impairments associated with PD is financial capability. This explorative study aimed to evaluate the extent and type of problems in financial capability of people with PD without a diagnosis of dementia. Participants were 31 people with PD and 62 matched controls. Participants completed an extensive test-battery, including measures for financial capability and cognitive functioning. Compared to controls, the PD-group performed significantly poorer on two financial competence tasks and showed a comparable performance on the other financial capability measures. For 45% of the PD-group, cognitive test performance was indicative of mild cognitive impairment, yet no significant difference was observed in overall cognitive functioning between the PD and control group. In the total sample, only small or medium correlations were found between financial competence and cognition, and between financial capability and the contextual factors of income and financial experience. The findings suggest that in the earlier stages of PD, when cognitive impairments are relatively mild, some problems may be observed in financial competence, yet other domains of financial capability appear less affected. The absence of strong correlations between financial competence and overall cognitive functioning indicates that standard neuropsychological assessments seem inadequate to make financial capability determinations. By offering insight into the financial capability of people in the milder stages of PD, the findings of the present study may aid in the development and provision of tailored support.

Subjective Complaints and Coping Strategies of Individuals with Reported Low-Frequency Noise Perceptions.

Background: Subjective everyday hindrances associated with low-frequency noise (LFN) can be high; however, there is still a lot unknown about experienced complaints. This study aims to investigate (1) subjective complaints and (2) coping strategies of individuals reporting everyday hindrances from LFN. Methods: Cognition, depressive symptoms, sleeping, fatigue, stress, and coping questionnaires were administered to participants sampled for their LFN complaints (LFN1 = 181), LFN complainants derived from a community sample (LFN2 = 239), and a comparison group without LFN complaints (CG = 410). Results: Individuals reporting LFN perceptions reported complaints in all domains and showed a higher proportion of above average symptom severity compared to the CG. Most complaints were reported by the LFN1 group, the least by the CG. However, on some sleeping, fatigue, and stress-related variables, a similar or even higher symptom severity was observed in the LFN2 group. Further, all groups used a similar combination of multiple coping strategies, although the LFN1 group scored higher on support seeking. Conclusions: There might be differences in the complaint severity between different LFN subgroups and future investigations of primary and secondary complaints are necessary. Also, more research about the use and success of coping strategies for LFN-related hindrances are needed for clear conclusions.

Let Us Talk Money: Subjectively Reported Financial Performance of People Living with Neurodegenerative Diseases-A Systematic Review.

Neurodegenerative diseases (NDDs) form a heterogeneous, widespread group of disorders, generally characterized by progressive cognitive decline and neuropsychiatric disturbances. One of the abilities that seems particularly vulnerable to the impairments in neurodegenerative diseases is the capability to manage one's personal finances. Indeed, people living with neurodegenerative diseases were shown to consistently present with more problems on performance-based financial tasks than healthy individuals. While objective, performance-based tasks provide insight into the financial competence of people living with neurodegenerative diseases in a controlled, standardized setting; relatively little can be said, based on these tasks, about their degree of success in dealing with the financial demands, issues, or questions of everyday life (i.e., financial performance). The aim of this systematic review is to provide an overview of the literature examining self and informant reports of financial performance in people living with neurodegenerative diseases. In total, 22 studies were included that compared the financial performance of people living with mild cognitive impairment (MCI), Alzheimer's disease (AD), Parkinson's disease, or multiple sclerosis to a (cognitively) normal control group. Overall, the results indicate that people living with neurodegenerative diseases are more vulnerable to impairments in financial performance than cognitively normal individuals and that the degree of reported problems seems to be related to the severity of cognitive decline. As the majority of studies however focused on MCI or AD and made use of limited assessment methods, future research should aim to develop and adopt more comprehensive assessments to study strengths and weaknesses in financial performance of people living with different neurodegenerative diseases.

Long-term improvements in executive functions after frontal-midline theta neurofeedback in a (sub)clinical group.

Impairments in executive functions (EFs) are common across disorders and can greatly affect daily functioning. Frontal-midline (FM) theta neurofeedback (NF) has been shown effective in enhancing EFs in healthy adults, prompting interest in exploring its potential as an alternative treatment for EFs in (sub)clinical samples. This study aims to determine the effects of FM theta NF on EFs in a sample of 58 adults (aged 20-60 years) with pronounced subjective EF complaints in daily life. Using a pre/post/follow-up design with a sham NF group, the present study assessed upregulation of FM theta in an eight-session individualized FM theta NF training and its immediate and long-term transfer effects on objective and subjective measures of EFs. These included behavioral performance on EF tasks assessing working memory updating (N-back task), set-shifting (Switching task), conflict monitoring (Stroop task), and response inhibition (Stop-signal task), as well as FM theta power during these tasks, and subjective EFs in daily life (BRIEF-A). The results indicate that there are only differences in FM theta self-upregulation between the NF group and sham group when non-responders are excluded from the analysis. Regarding behavioral transfer effects, NF-specific improvements are found in working memory updating reaction time (RT) and conflict monitoring RT variability at 6-month follow-up, but not immediately after the NF training. The effects on FM theta power during the EF tasks and subjective changes in EFs in daily life were not specific to the NF training. As a next step, research should identify the best predictors to stratify NF training, as well as explore ways to improve NF responsiveness, for instance by increasing neuroplasticity.

Risky Decision-Making in Adults with Alcohol Use Disorder-A Systematic and Meta-Analytic Review.

Alcohol use disorder (AUD) forms a major health concern and is the most common substance use disorder worldwide. The behavioural and cognitive deficits associated with AUD have often been related to impairments in risky decision-making. The aim of this study was to examine the magnitude and type of risky decision-making deficits of adults with AUD, as well as to explore the potential mechanisms behind these deficits. To this end, existing literature comparing risky decision-making task performance of an AUD group to a control group (CG) was systematically searched and analysed. A meta-analysis was performed to address overall effects. In total, 56 studies were included. In the majority of studies (i.e., 68%), the performance of the AUD group(s) deviated from the CG(s) on one or more of the adopted tasks, which was confirmed by a small to medium pooled effect size (Hedges' g = 0.45). This review therefore provides evidence of increased risk taking in adults with AUD as compared to CGs. The increased risk taking may be due to deficits in affective and deliberative decision-making. Making use of ecologically valid tasks, future research should investigate whether risky decision-making deficits predate and/or are consequential to the addiction of adults with AUD.

The riddle of deliberate self-harm: Physiological and subjective effects of self-cutting cues in patients with borderline personality disorder and healthy controls.

Self-harming behavior is a core symptom of borderline personality disorder. Self-report studies show a correlation between a lack of self-reported negative feelings toward self-cutting cues and the likelihood of future self-destructive behavior. Despite these findings, there has so far been insufficient investigation into the implicit emotional processes evoked by this stimulus type. Forty patients with borderline personality disorder and 35 healthy controls between 20 and 50 years of age were confronted with pictures of self-cutting cues and affective reference pictures. A startle reflex paradigm was used for measuring implicit emotional responses, and the Self-Assessment Manikin was used for subjective responses. In line with previous studies, the patients rated the self-cutting pictures significantly less negatively than healthy individuals. On the physiological level, a significant startle inhibition was observed, indicating an activation of the behavioral approach system. A more detailed analysis showed that this startle inhibition effect was specific to scary pictures, whereas no such effect was observed for bloody wounds and self-cutting instruments. For pleasant standard pictures, in contrast, no startle reflex inhibition and no increase in emotional arousal parameters were found. The data replicate the findings of previous studies, demonstrating a generally diminished emotional reactivity to pleasant stimuli in patients with borderline personality disorder. In addition, a physiological approach reaction to self-cutting pictures was found, especially for the scary pictures. These results might indicate a positive identification with the long-lasting consequences of self-cutting behavior in the patients. Implications for therapy are discussed.

Feigning Adult ADHD on a Comprehensive Neuropsychological Test Battery: An Analogue Study.

The evaluation of performance validity is an essential part of any neuropsychological evaluation. Validity indicators embedded in routine neuropsychological tests offer a time-efficient option for sampling performance validity throughout the assessment while reducing vulnerability to coaching. By administering a comprehensive neuropsychological test battery to 57 adults with ADHD, 60 neurotypical controls, and 151 instructed simulators, we examined each test's utility in detecting noncredible performance. Cut-off scores were derived for all available outcome variables. Although all ensured at least 90% specificity in the ADHD Group, sensitivity differed significantly between tests, ranging from 0% to 64.9%. Tests of selective attention, vigilance, and inhibition were most useful in detecting the instructed simulation of adult ADHD, whereas figural fluency and task switching lacked sensitivity. Five or more test variables demonstrating results in the second to fourth percentile were rare among cases of genuine adult ADHD but identified approximately 58% of instructed simulators.

Low-Frequency Noise: Experiences from a Low-Frequency Noise Perceiving Population.

Although low-frequency noise (LFN) is associated with various complaints, there is still much unknown about this phenomenon. This research aims to provide an extensive description of (1) LFN perceptions, (2) LFN-related complaints, and (3) the characteristics of LFN complainants. In an explorative observational cross-sectional survey study, a sample of Dutch adults reporting to experience LFN (n = 190) and a group not experiencing LFN (n = 371) completed a comprehensive questionnaire. Descriptions of LFN perceptions varied individually and were dependent on different circumstances, although some common patterns were observed. Complaints were wide-ranging and individual, with a reported high impact on daily living. Common complaints included sleeping difficulties, fatigue, or annoyance. Societal consequences were described regarding housing, work, and relationships. Attempts to stop or escape the perception were manifold but often unsuccessful. The LFN sample differed regarding sex, education level, and age from the Dutch adult population, indicating more frequent inability to work, less full-time work, and less years lived in their homes. No further differences in occupational or marital status or living circumstances were found. Although this research supports some previous findings and identifies common patterns, it also highlights the individual nature of LFN-related experiences and the heterogeneity of this group. It is advised to pay attention to the complaints of affected individuals, to inform concerned authorities, and to conduct more systematic and multidisciplinary research using standardized and validated measuring instruments.

Strengths and Weaknesses of Everyday Financial Knowledge and Judgment Skills of Adults with ADHD.

Adequate financial capability is crucial in everyday life. This capability might, however, not be given to adults with ADHD. The present study aims to determine strengths and weaknesses regarding everyday financial knowledge and judgment skills in adults with ADHD. In addition, the impact of income is explored. Forty-five adults with ADHD (Mage = 36.6, SDage = 10.2) and 47 adults without ADHD (Mage = 38.5, SDage = 13.0) were included and were assessed with the Financial Competence Assessment Inventory. Adults with ADHD showed decreased scores regarding awareness of the arrival of bills, knowledge of own income, having a reserve fund for unexpected expenses, the ability to state long-term financial goals, own preferences for estate management, understanding of assets, legal action for debt, access to financial advice/counseling, and the ability to compare medical insurance plans as compared with adults without ADHD (all p < 0.001). However, no effect of income was found. In conclusion, adults with ADHD have difficulties with many aspects of everyday financial knowledge and skills, which might result in a plethora of personal and legal consequences. It is, therefore, of the utmost importance that professionals who support adults with ADHD proactively ask about everyday financial functioning so that assessment, financial support, and coaching can be provided.

Networks of Neuropsychological Functions in the Clinical Evaluation of Adult ADHD.

This study applied network analysis to explore the relations between neuropsychological functions of individuals in the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. A total of 319 participants from an outpatient referral context, that is, 173 individuals with ADHD (ADHD group) and 146 individuals without ADHD (n-ADHD group), took part in this study and completed a comprehensive neuropsychological assessment. A denser network with stronger global connectivity was observed in the ADHD group compared to the n-ADHD group. The strongest connections were consistent in both networks, that is, the connections between selective attention and vigilance, and connections between processing speed, fluency, and flexibility. Further centrality estimation revealed attention-related variables to have the highest expected influence in both networks. The observed relationships between neuropsychological functions, and the high centrality of attention, may help identify neuropsychological profiles that are specific to ADHD and optimize neuropsychological assessment and treatment planning of individuals with cognitive impairment.

Stability of Attention Performance of Adults with ADHD over Time: Evidence from Repeated Neuropsychological Assessments in One-Month Intervals.

Neuropsychological assessments of attention are valuable sources of information in the clinical evaluation of adults with attention-deficit/hyperactivity disorder (ADHD). However, it is unclear whether the attention performance of adults with ADHD is stable or fluctuates over time, which is of great importance in the interpretation of clinical assessments. This study aimed to explore the stability of attention performance of adults with ADHD in repeated assessments at one-month intervals. Twenty-one adults diagnosed with ADHD took part in this study by completing selective attention and vigilance tests three times, each one month apart. Test scores of participants were compared with and interpreted based on test norms. A considerable proportion of 'below average' performance scores were observed in most of the variables of selective attention and vigilance in all three assessments. Further, selective attention and vigilance performance scores did not differ significantly between the three repeated assessments. Finally, the majority of participants received consistent test score interpretations across the three repeated assessments. This study confirms previous research and highlights abnormal selective attention and vigilance performance in adults with ADHD. Further, this study preliminarily demonstrates relatively stable attention performance across repeated assessments, which has the potential to support clinical assessment, treatment planning, and evaluation.

Constant installation of present orientation and safety (CIPOS) - subjective and physiological effects of an ultrashort-term intervention combining both stabilizing and confrontational elements.

Objectives: Constant Installation of Present Orientation and Safety (CIPOS) is a Eye Movements Desensitization and Reprocessing (EMDR)-derived technique, which is often used to prepare for the treatment of post-traumatic stress disorder (PTSD). It differs from the latter by involving cyclically recurring exercises in reorientation to the present, interspersed between brief periods of exposure to the traumatic material.While EMDR is well established as a therapeutic method, the efficacy and mechanisms of action of CIPOS have not been investigated so far. In this pilot study, an experimental setting was used to record the subjective and physiological effects of the CIPOS intervention compared to a control condition with pure mental exposition. Methods: The study was performed on 30 healthy volunteers aged from 20 to 30 years. Distress was induced using audio files of subjectively stressful situations. Subjective distress was measured via the Subjective Units of Distress Scale (SUD), while physiological indicators (noise-induced startle reflex, skin conductance level) were used as measures for objective stress. For each condition, pre- and post-intervention comparisons were calculated. Results: In both groups, startle reflex potentiation and mean skin conductance level significantly decreased. In the group with CIPOS intervention, but not in the control group, a significant decrease in the SUD value was found. Conclusion and significance: The results show that the CIPOS technique is as effective as pure mental exposition in reducing physiological stress. In addition, a superiority in reducing subjective distress (indicating a simplified reassessment of the stressful material) was found compared to pure mental exposition. Possible explanations of these effects are discussed.

Symptom and performance validity in samples of adults at clinical evaluation of ADHD: a replication study using machine learning algorithms.

INTRODUCTION: Research has shown non-trivial base rates of noncredible symptom report and performance in the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. The goal of this study is to estimate and replicate base rates of symptom and performance validity test failure in the clinical evaluation of adult ADHD and derive prediction models based on routine clinical measures. METHODS: This study reuses data of a previous publication of 196 adults seeking ADHD assessment and replicates the findings on an independent sample of 700 adults recruited in the same referral context. Measures of symptom and performance validity (one SVT, two PVTs) were applied to estimate base rates. Prediction models were developed using machine learning. RESULTS: Both samples showed substantial rates of noncredible symptom report (one SVT failure: 35.7% - 36.6%), noncredible test performance (one PVT failure: 32.1% - 49.3%; two PVT failures: 18.9% - 27.3%), or both (each one SVT and PVT failure: 13.3% - 22.4%; one SVT and two PVT failures: 9.7% - 13.7%). Machine learning algorithms resulted in generally moderate to weak prediction models, with advantages of the reused sample compared to the independent replication sample. Associations between measures of symptom and performance validity were negligible to small. CONCLUSIONS: This study highlights the necessity to include measures of symptom and performance validity in the clinical evaluation of adult ADHD. Further, this study demonstrates the difficulty to characterize the group failing symptom or performance validity assessment.

It Takes Time: Vigilance and Sustained Attention Assessment in Adults with ADHD.

Objectives: The present study compares the utility of eight different tests of vigilance and sustained attention in the neuropsychological examination of adults with Attention-deficit/hyperactivity disorder (ADHD). Methods: Thirty-one adults diagnosed with ADHD performed eight tests for vigilance and sustained attention, spread over three assessment days. Results: Adults with ADHD showed cognitive impairments in most tests and test variables, even though their sensitivity differed greatly. No specific type of test variable stands out to be the most sensitive, and no evidence for a differential deterioration of performance over time was observed. Conclusion: This study underscores the role of vigilance and sustained attention tests in the assessment of adult ADHD. It is further concluded that summary scores over the entire test duration are sufficient, but that all variables of a test should be considered. Finally, we hypothesize that reassessment on a different day may benefit a more accurate clinical assessment of adults with ADHD, in order to adequately take intraindividual fluctuations and limitations regarding test reliability into account.

COVID-19 and Physical Distancing Measures: Experience of Psychiatric Professionals in Europe.

A The COVID-19 pandemic has had a considerable impact on the organization of psychiatric care. The present study examines how care professionals experienced this period and faced these new constraints weighing on their professional practices. Based on a qualitative research methodology, 13 group interviews with healthcare professionals working in psychiatric wards were conducted in five countries in western Europe. To complement this, 31 individual interviews were carried out in Belgium and France. Public health measures hindered certain therapeutic activities, jeopardized communication, and obliged healthcare professionals to modify and adapt their practices. Confronted with a transformation of their usual roles, healthcare professionals feared a deterioration in the quality of care. Impossible to continue in-person care practices, they resorted to online videoconferencing which went against their idea of care in which the encounter holds an essential place. The lockdown contradicted efforts to co-build care pathways toward readaptation, social reintegration, and recovery, thus reviving the perception of psychiatric hospitalization based on isolation.

Molecular Link between Circadian Rhythmicity and Mood Disorders.

BACKGROUND: The internal clock is driven by circadian genes [e.g., Clock, Bmal1, Per1-3, Cry1-2], hormones [e.g., melatonin, cortisol], as well as zeitgeber ['synchronisers']. Chronic disturbances in the circadian rhythm in Objectives: The aim of this review is to summarise the current knowledge and literature regarding circadian rhythms in the context of mood disorders, focussing on the role of circadian genes, hormones, and neurotransmitters. METHODS: The review presents the current knowledge and literature regarding circadian rhythms in mood disorders using the Pubmed database. Articles with a focus on circadian rhythms and mood disorders [n=123], particularly from 1973 to 2020, were included. RESULTS: The article suggests a molecular link between disruptions in the circadian rhythm and mood disorders. Circadian disturbances, caused by the dysregulation of circadian genes, hormones, and neurotransmitters, often result in a clinical picture resembling depression. CONCLUSION: The article suggests a molecular link between disruptions in the circadian rhythm and mood disorders. Circadian disturbances, caused by the dysregulation of circadian genes, hormones, and neurotransmitters, often result in a clinical picture resembling depression.

Look who is complaining: Psychological factors predicting subjective cognitive complaints in a large community sample of older adults.

Subjective cognitive complaints (SCCs) are not directly related to objective impairments in cognition. This study examines the role of psychological factors in predicting SCCs in the domains of executive functioning, memory, and attention in older adults. A community sample of 1,219 Dutch adults, aged 40 year or older, completed the BRIEF-A, MSEQ, FEDA, NEO-FFI, DASS-21, and a demographic questionnaire. Participants were randomly divided into exploratory (n = 813) and confirmatory samples (n = 406). In the exploratory sample, we analyzed whether personality factors, symptoms of depression and anxiety, perceived stress, and demographics could predict SCCs in the different cognitive domains. For this purpose, a two-step regression approach with bootstrapping was used. To independently validate the results, these analyses were repeated in the confirmatory sample. Concerning executive functioning, complaints regarding the ability to regulate behavior and emotional responses were predicted by lower agreeableness levels and higher levels of neuroticism and perceived stress. Complaints regarding the ability to actively solve problems in different circumstances were predicted by a lower conscientiousness level, higher agreeableness level, and more depressive symptoms. Attentional complaints were predicted by lower levels of conscientiousness and extraversion, together with a higher level of neuroticism. For memory, no significant predictors were consistently found. Psychological factors are of influence on the subjective experience of cognitive complaints. In particular personality factors, perceived stress, and symptoms of depression, seem to predict SCCs in the domains of executive functioning and attention. Clinicians should take these factors into account in older adults who have SCCs.

Reporting Guidelines for Whole-Body Vibration Studies in Humans, Animals and Cell Cultures: A Consensus Statement from an International Group of Experts.

Whole-body vibration (WBV) is an exercise modality or treatment/prophylaxis method in which subjects (humans, animals, or cells) are exposed to mechanical vibrations through a vibrating platform or device. The vibrations are defined by their direction, frequency, magnitude, duration, and the number of daily bouts. Subjects can be exposed while performing exercises, hold postures, sitting, or lying down. Worldwide, WBV has attracted significant attention, and the number of studies is rising. To interpret, compare, and aggregate studies, the correct, complete, and consistent reporting of WBV-specific data (WBV parameters) is critical. Specific reporting guidelines aid in accomplishing this goal. There was a need to expand existing guidelines because of continuous developments in the field of WBV research, including but not limited to new outcome measures regarding brain function and cognition, modified designs of WBV platforms and attachments (e.g., mounting a chair on a platform), and comparisons of animal and cell culture studies with human studies. Based on Delphi studies among experts and using EQUATOR recommendations, we have developed extended reporting guidelines with checklists for human and animal/cell culture research, including information on devices, vibrations, administration, general protocol, and subjects. In addition, we provide explanations and examples of how to report. These new reporting guidelines are specific to WBV variables and do not target research designs in general. Researchers are encouraged to use the new WBV guidelines in addition to general design-specific guidelines.