Combined impact of ADHD and insomnia symptoms on quality of life, productivity, and health care use in the general population.

BACKGROUND: Both attention-deficit/hyperactivity disorder (ADHD) and insomnia have been independently related to poorer quality of life (QoL), productivity loss, and increased health care use, although most previous studies did not take the many possible comorbidities into account. Moreover, ADHD and insomnia often co-occur. Symptoms of ADHD and insomnia together may have even stronger negative effects than they do separately. We investigated the combined effects of symptoms of ADHD and insomnia, in addition to their independent effects, on QoL, productivity, and health care use, thereby controlling for a wide range of possible comorbidities and confounders. METHODS: Data from the third wave of the Netherlands Mental Health Survey and Incidence Study-2 were used, involving N = 4618 from the general population. Both the inattention and the hyperactivity ADHD symptom dimensions were studied, assessed by the ASRS Screener. RESULTS: Mental functioning and productivity were negatively associated with the co-occurrence of ADHD and insomnia symptoms, even after adjusting for comorbidity and confounders. The results show no indication of differences between inattention and hyperactivity. Poorer physical functioning and health care use were not directly influenced by the interaction between ADHD and insomnia. CONCLUSIONS: People with both ADHD and sleep problems have increased risk for poorer mental functioning and productivity loss. These results underscore the importance of screening for sleep problems when ADHD symptoms are present, and vice versa, and to target both disorders during treatment.

The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder.

BACKGROUND: Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. METHODS: We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. RESULTS: We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. CONCLUSIONS: Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.

Objective QbTest and subjective evaluation of stimulant treatment in adult attention deficit-hyperactivity disorder.

PURPOSE: To evaluate the QbTest as an objective measure versus self-reported ADHD Rating Scale (ADHD-RS) before and during stimulant treatment in adults with ADHD. PATIENTS AND METHODS: We used the subjective ADHD Rating Scale (ADHD-RS), and the objective computerized QbTest, which is a 20-minute unconditional identical pairs test that measures attention, impulsivity, and also hyperactivity using a motion-tracking system. Patients were assessed before (baseline) and during medical treatment with stimulants (follow-up) in an observational study design. RESULTS: Data of n=145 patients at baseline and n=82 patients at follow-up were analyzed. There were significant symptom reductions on all symptom domains, but correlations between the tests were weak. Improvement on the QbTest was independent of the patient's age, gender, educational level, ADHD subtype, co-morbid disorders, and use of other medications. Patients with worst QbTest results at baseline showed most improvement at follow-up. The QbTest was more sensitive to medication effects than the ADHD-RS. QbTest objectified clinical significant medication effect in 54% of patients who subjectively did not report any clinical effects. DISCUSSION: Symptoms dimensions of objective and subjective tests refer to different psychological constructs. CONCLUSION: The QbTest is a valuable addition to existing subjective measures to assess medication effects in ADHD patients who have difficulties reporting treatment effects.

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.

Validity of conners' adult attention-deficit/hyperactivity disorder rating Scale-investigator rated: screening version in patients from within and outside of Europe.

In adult patients with attention-deficit/hyperactivity disorder from within and outside of Europe, Conners' Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale-Investigator Rated: Screening Version showed good internal consistency (Cronbach's α=0.930 and 0.938, respectively) and convergent validity with the Clinical (Pearson's correlation coefficients: 0.65-0.82, P<0.001) Global Impression-ADHD-Severity scale over 12 weeks of pharmacological treatment.

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.

Efficacy and safety of prolonged-release OROS methylphenidate in adults with attention deficit/hyperactivity disorder: a 13-week, randomized, double-blind, placebo-controlled, fixed-dose study.

OBJECTIVES: Methylphenidate (MPH) is effective for adults with attention-deficit/hyperactivity disorder (ADHD). This study aimed to evaluate the efficacy and safety of OROS MPH in adults with ADHD. METHODS: Randomized, double-blind study; 279 subjects received OROS MPH 54 or 72 mg/day, or placebo, for 13 weeks. Primary endpoint was the Conners' Adult ADHD Rating Scale - Screening Version (CAARS-O:SV). Secondary outcomes included CAARS Self Report - Short Version (CAARS-S:S), Sheehan Disability Scale (SDS) and ADHD Impact Module - Adult (AIM-A). RESULTS: Improvements in CAARS-O:SV were significantly greater with OROS MPH 72 mg vs. placebo (P = 0.0024). CAARS-S:S scores decreased significantly vs. placebo in both OROS MPH arms (P < 0.05). There was no significant change in SDS score from baseline in either treatment arm, although significant benefit vs. placebo was observed on several AIM-A subscales. Treatment was well tolerated. CONCLUSIONS: OROS MPH provided overall benefits in the treatment of adults with ADHD.

Reliability, validity, and utility of instruments for self-report and informant report concerning symptoms of ADHD in adult patients.

OBJECTIVE: To study the correlation between symptoms of ADHD in adults, obtained with different methods and from different sources. METHOD: Information was obtained from 120 adults with ADHD, their partners, and their parents, using the ADHD Rating Scale, the Conners' Adult ADHD Rating Scales (CAARS), the Brown Attention-Deficit Disorder Scale (BADDS), and the structured interview Diagnostic Interview Schedule-IV, section L (DIS-L). RESULTS: All self-report rating scales can be used to assess ADHD symptoms in clinical samples of adults. The BADDS and the ADHD Rating Scale proved best in predicting the clinical diagnosis. The DSM-IV factors, originally developed for children, achieve lower patient-informant agreement than the other factors. CONCLUSION: Adults with ADHD appear to be the best informants with regard to their symptoms but tend to underreport the severity of their symptoms. Informant report may be used to get additional information on symptoms and impairment.