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1.
OBJECTIVE: While it is increasingly recognized that attention deficit hyperactivity disorder (ADHD) persists into adulthood, there is no consensus on diagnostic criteria for adult ADHD. In this article the authors describe and contrast competing approaches for diagnosis of adult ADHD used in clinical and research practice. METHOD: The authors review the Wender Utah criteria, DSM criteria, and laboratory assessment strategies for adult ADHD. Advantages and disadvantages of each approach are described, and recommendations are made as a basis for clinical assessment and future research. RESULTS: Both the Wender Utah criteria and DSM-based approaches identify significantly impaired ADHD adults with neurocognitive, biological, and treatment response patterns similar to pediatric ADHD patients. The Wender Utah criteria established the need for retrospective childhood diagnosis and recognize developmental differences in adult symptom expression. The Wender Utah criteria fail to identify patients with predominantly inattentive symptoms, exclude some patients with significant comorbid psychopathology, and diverge significantly from the DSM conception of ADHD. The DSM criteria have never been validated in adults, do not include developmentally appropriate symptoms and thresholds for adults, and fail to identify some significantly impaired adults who are likely to benefit from treatment. There are insufficient scientific data to justify use of laboratory assessment measures, including neuropsychological tests and brain imaging, in diagnosing adult ADHD. CONCLUSIONS: Adult ADHD remains a clinical diagnosis. Clinicians should be flexible in application of the current ADHD criteria to adults. Additional research is required to validate adult diagnostic criteria. 相似文献
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Mahmut Bulut Salih Selek Yasin Bez Mehmet Cemal Kaya Mehmet Gunes Fatih Karababa Hakim Celik Haluk Asuman Savas 《Psychiatry research》2013
Malondialdehyde (MDA) is a reliable marker of lipid peroxidation where paraoxonase and arylesterase are two enzymes against it. Although increased MDA has been previously shown in adults with attention deficit/hyperactivity disorder (A-ADHD), levels of paraoxonase and arylesterase enzymes have not been studied yet. We aimed to determine the status of both MDA level and paraoxonase and arylesterase enzyme activities in A-ADHD patients. A total of 35 adults with ADHD diagnosis according to Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria and 29 healthy volunteers were included in the study. Serum MDA, paraoxonase and arylesterase levels of the participants were measured. The disease severity of the patients was determined by using Turgay's Adult Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) DSM IV Based Diagnostic Screening and Rating Scale. The serum MDA level of patients was significantly higher than that of healthy control subjects, whereas their paraoxonase and arylesterase levels were significantly lower. There was no correlation between the levels of biochemical parameters (MDA, paraoxonase and arylesterase) and the disease severity. Sub-types of A-ADHD were similar in terms of these biochemical parameters. Increased lipid peroxidation, a part of oxidative stress, in adults with ADHD appears to be unbuffered by antioxidant enzymes, namely paraoxonase and arylesterase. 相似文献
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In two experiments, we examined the ability of adults with attention deficit hyperactivity disorder (ADHD) to process multiple targets appearing in a rapid serial visual presentation (RSVP) stream. Using a standard attentional blink (AB) task, subjects were required to both identify a target in the RSVP stream and detect a probe appearing in one of several posttarget serial positions. In Experiment 1, ADHD adults exhibited a protracted AB compared to controls, in that their probe detection did not improve as a function of increasing probe-to-target intervals (450-720 msec). In Experiment 2, the ADHD group performed as well as controls in detecting probes appearing immediately (i.e., 90 msec) after the target. Taken together, the results demonstrate that adults with ADHD exhibit a selective deficit in rapidly shifting attention between the target and the probe, when the two appear several hundred milliseconds apart. These results suggest that adults with ADHD can use automatic (reflexive) attention to detect items in close temporal proximity in the RSVP stream, but have difficulty allocating controlled attention to multiple stimuli separated by several hundred milliseconds. 相似文献
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Joo EJ Lee KY Choi KS Kim SH Song JY Bang YW Ahn YM Kim YS 《Comprehensive psychiatry》2012,53(3):217-223
A significant overlap between childhood mood disorders and many aspects of attention deficit hyperactivity disorder (ADHD) has been established. High rates of co-occurrence, familial aggregation, and more severe clinical manifestations of the illnesses when they are comorbid suggest that common genetic and environmental factors may contribute to the development of both disorders. Research on the co-occurrence of childhood ADHD and mood disorders in childhood has been conducted. We retrospectively investigated childhood ADHD features in adults with mood disorders. Childhood ADHD features were measured with the Korean version of the Wender Utah Rating Scale (WURS). The sample consisted of 1305 subjects: 108 subjects were diagnosed with bipolar disorder type I, 41 with bipolar disorder type II, 101 with major depressive disorder, and 1055 served as normal controls. We compared total WURS scores as well as scores on 3 factors (impulsivity, inattention, and mood instability and anxiety) among the 4 different diagnostic groups. The 4 groups differed significantly from one another on all scores. The group with bipolar disorder type II obtained the highest total scores on the WURS. The impulsivity and inattention associated with childhood ADHD were more significantly related to bipolar disorder type II than with bipolar disorder type I. The mood instability and anxiety associated with childhood ADHD seem to be significantly related to major depressive disorder in adulthood. In conclusion, multifactorial childhood ADHD features were associated with mood disorders of adulthood. 相似文献
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Unaltered dopamine transporter availability in adult attention deficit hyperactivity disorder 总被引:3,自引:0,他引:3
van Dyck CH Quinlan DM Cretella LM Staley JK Malison RT Baldwin RM Seibyl JP Innis RB 《The American journal of psychiatry》2002,159(2):309-312
OBJECTIVE: The authors examined whether patients with attention deficit hyperactivity disorder (ADHD) have altered striatal dopamine transporter levels, which may explain psychostimulant effects in this disorder. METHOD: Single photon emission computed tomography and [(123)I]2beta-carbomethoxy-3beta-(4-iodophenyl)tropane ([(123)I]beta-CIT) were used to assess dopamine transporter availability in nine adult patients with ADHD (eight of whom were stimulant naive) and nine age- and gender-matched healthy comparison subjects. RESULTS: Striatal [(123)I]beta-CIT binding did not differ significantly between the ADHD and comparison subjects. CONCLUSIONS: The findings suggest that a hypothesized dysregulation of dopamine function in ADHD does not entail altered dopamine transporter levels. 相似文献
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E. Perlov M. Buechert S. Matthies B. Hesslinger 《Journal of psychiatric research》2010,44(14):938-943
Introduction
Neurobiological research has implicated the cerebellum as one possible site of neurophysiological dysfunction in ADHD. Latest theoretical conceptualizations of the cerebellum as core site of the brain to model motor as well as cognitive behavior puts further weight to the assumption that it might play a key role in ADHD pathophysiology.Methods
30 medication free adult ADHD patients and 30 group matched (gender, age and education) healthy controls were investigated using the method of chemical shift imaging (CSI) of the cerebellum. The vermis, left and right cerebellar hemispheres were processed separately.Results
We found significantly increased glutamate-glutamine (Glx) to creatine (Cre) ratios in the left cerebellar hemisphere. No other differences in measured metabolite concentrations were observed.Discussion
To our knowledge this is the first evidence for neurochemical alterations in cerebellar neurochemistry in adult ADHD. They relate well to recent hypotheses that the cerebellum might control mental activities by internal models. 相似文献9.
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Kovner R Budman C Frank Y Sison C Lesser M Halperin J 《The International journal of neuroscience》1998,96(3-4):225-235
Diagnosing adult ADHD is frequently problematic because behavioral information from the patient's childhood, and multiple informants who can delineate the patient's current behavior, are often unavailable. This preliminary study was designed to explore whether objective neuropsychological testing may be a useful adjunct in the diagnosis of adult ADHD. Nineteen adults diagnosed with ADHD according to DSM-IV criteria, along with 10 controls, were assessed using a neuropsychological battery which comprised tests assessing linguistic, visual-spatial perceptual, academic, attentional and inhibitory control, mnestic and executive functions. Following preliminary analyses, designed to determine which variables best discriminated the groups, receiver operating characteristic (ROC) curves were constructed to determine the sensitivity and specificity of the best measures both alone and in combination. Only three measures significantly (p < 0.01) distinguished the groups; Digits Backwards from the WAIS-R and two reaction time measures from a computerized task modeled after Luria's Competing Motor Programs. ROC curve analyses indicated that in combination these measures had greater than 90% accuracy for classifying ADHD and non-ADHD patients. While further research is necessary these preliminary findings suggest that neuropsychological testing may be a useful adjunct in the differential diagnosis of adult ADHD. 相似文献
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Leitner Y Barak R Giladi N Peretz C Eshel R Gruendlinger L Hausdorff JM 《Journal of neurology》2007,254(10):1330-1338
Abstract
Background
Cognitive function and the loading of attention presumably play an important role in gait as well as in fall risk, but previous
work has not demonstrated this in any cause-and-effect way.
Objectives
To gain insight into the relationship between gait and cognitive function, we sought: (1) To compare the gait rhythmicity
(stride time variability) of children with attention deficit hyperactivity disorder (ADHD) to controls, (2) To test the hypothesis
that dual tasking leads to increased stride-to-stride variability in ADHD, and (3) To test whether pharmacological treatment
that relieves ADHD symptoms reduces stride-to-stride variability.
Patients and Methods
Gait was quantified in children with ADHD and in age-matched healthy controls under single task and dual task conditions on
three occasions: off medications (both groups) and, in the ADHD group, after double blinded, randomized administration of
methylphenidate (MPH) or placebo.
Results
At baseline, children with ADHD tended to walk with increased stride-to-stride variability compared to the controls during
the single task condition (p = 0.09). During dual task walking, stride time variability was significantly reduced in the children
with ADHD (p < 0.004), but not in the controls. In the children with ADHD, the placebo did not significantly affect stride-to-stride
variability or the dual tasking response. In contrast, stride time variability was significantly reduced on MPH (p < 0.001)
such that dual tasking no longer affected variability.
Conclusions
The present findings demonstrate alterations in the gait of children with ADHD, support a cause and effect link between cognitive
function and gait, and suggest that enhancement of attention abilities may, in certain populations, improve gait rhythmicity. 相似文献
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Patients with Attention Deficit Hyperactivity Disorder (ADHD) suffer not only from inability to focus but also from inability to shift attention for events that trigger their interests. This phenomenon is called “hyperfocusing”. Previous literature about hyperfocusing is scarce and relies mainly on case reports. The study aimed to investigate and compare the severity of hyperfocusing in adult ADHD with and without psycho-stimulant use. ADHD (DSM-IV-TR) patients either psycho-stimulant naive (n = 53) or on psycho-stimulants (n = 79) from two ADHD clinics were recruited. The control group (n = 65) consisted of healthy university students. A socio-demographic form, the Beck Depression Inventory, the Wender-Utah Rating Scale, the Adult ADHD Self- Report Scale and the Hyperfocusing Scale were applied to the participants. There was no difference between total Hyperfocusing Scale and Adult ADHD Self- Report Scale scores of two patient groups, but both have higher scores than controls (p < 0.001). Hyperfocusing is higher in adult ADHD and there was no difference between stimulant-naive patients or patients on stimulants. Hyperfocusing can be defined as a separate dimension of adult ADHD. 相似文献
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Mannuzza S Klein RG Klein DF Bessler A Shrout P 《The American journal of psychiatry》2002,159(11):1882-1888
OBJECTIVE: Although reports of childhood status are necessary for making a diagnosis of adult attention deficit hyperactivity disorder (ADHD), systematic investigation of the accuracy of retrospective self-reports has been limited. This study examined accuracy of adult recall of childhood ADHD. METHOD: Participants were from a controlled, prospective 16-year follow-up of children with ADHD. At a mean age of 25 years, 176 probands (85% of the 207 subjects in the initial cohort) and 168 non-ADHD comparison subjects were interviewed by clinicians who were unaware of the subjects' childhood status. Subjects were asked about specific childhood ADHD behaviors, and the diagnosis of childhood ADHD was retrospectively established. RESULTS: Seventy-eight percent of the probands and 11% of the comparison subjects were identified as having childhood ADHD. Six symptoms demonstrated high discriminating power in differentiating the subject groups: distractibility, concentration difficulties, complaints of inattention, acting before thinking, being on the go, and fidgeting/squirming. When findings were adjusted for the prevalence of ADHD in the general population, the power of prediction was low. Positive predictive value was 0.27, i.e., of all adults retrospectively given a diagnosis of childhood ADHD, only 27% would be correctly identified. As expected, positive predictive value increased with increases in the estimated prevalence of ADHD. CONCLUSIONS: Retrospective diagnoses of childhood ADHD made on the basis of self-reports will in most cases be invalid in settings such as epidemiological surveys and primary care facilities. Greater accuracy can be expected in settings in which childhood ADHD is frequent. The results stress the importance of obtaining contemporaneous information on childhood symptoms in establishing a childhood history of ADHD. Future directions and implications for DSM-V are discussed. 相似文献
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OBJECTIVE: This paper aims to discuss the relationship between morbid jealousy, stalking behaviour, and psychodynamic issues. Comment will be made on the risk associated with diagnosis of adult attention deficit hyperactivity disorder (ADHD) and use of psychostimulants. CLINICAL PICTURE: A man born in the former Yugoslavia charged with stalking was referred for assessment. He presented with a history of treatment for ADHD with dexamphetamine and delusions regarding his wife's fidelity. TREATMENT: The patient was treated with neuroleptics and counselling for himself and his family. OUTCOME: The patient was returned to the community. He separated from his wife but retains the abnormal belief. CONCLUSIONS: The diagnosis of adult ADHD appears to be increasing in Western Australia. Treatment with stimulants is common. The misdiagnosis of ADHD and consequent misuse of stimulants, can lead to the development of morbid jealousy, stalking behaviour and arrest. 相似文献
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The aim of this study was to examine the specific aspects of attention, such as selective attention, sustained attention, and short-term memory in children with attention deficit hyperactivity disorder, combined subtype (ADHD-C). A total of 40 children with a diagnosis of ADHD from the 4th edition of the Diagnostic and Statistical Manual, aged 6-11 years old were compared with 40 controls matched for age and gender on a battery of tests. Short-term memory span and attention was measured by Visual Aural Digit Span Test-Revised. Stroop test and the Turkish version of Cancellation Test were used to assess selective and sustained attention, respectively. In order to check for factor structure in two groups on the test scores, principal component analysis was conducted for both groups separately. Relative to the comparison children, children with ADHD showed significant deficits on tests that are related to different aspects of attention. The results are consistent with the theories explaining the biological basis of ADHD by scattered attention networks in the brain, which have reciprocal dynamic interactions. Further comparative studies are needed to elucidate whether the cognitive processes that are known to be assessed by these tests are specific to ADHD. 相似文献
16.
Marc-Andreas Edel Björn Enzi Henning Witthaus Martin Tegenthoff Sören Peters Georg Juckel Silke Lissek 《Journal of psychiatric research》2013
Objectives
Abnormalities in reward processing have been found in adolescents and adults with ADHD using the ‘Monetary Incentive Delay’ (MID) task. However, ADHD groups in previous studies were heterogeneous regarding ADHD subtype, gender and, in part, drug treatment status.This study sought to compare neural activations in the ventral striatum (VS) and prefrontal regions during reward processing in homogenous ADHD subtype groups and healthy adults, using the MID task.Methods
In total, 24 drug-naïve, right-handed male adults with ADHD (12 subjects with combined type (ADHD-ct) and 12 subjects with predominantly inattentive (ADHD-it) type ADHD), and twelve healthy right-handed male control subjects were included.Results
Compared to ADHD-ct and healthy subjects, ADHD-it subjects showed a bilateral ventral striatal deficit during reward anticipation. In contrast, ADHD-ct subjects showed orbitofrontal hyporesponsiveness to reward feedback when compared with ADHD-it and healthy subjects.Conclusions
This is the first fMRI study that delineates dysfunctional and subtype-divergent neural and behavioural reward processing in adults with ADHD. 相似文献17.
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Neuropsychological tests were used to evaluate different memory systems in the three subgroups of adult Attention Deficit Hyperactivity Disorder (ADHD) (n=105) using analysis of means, factor analysis, and GLM analysis with covariance of gender, estimated IQ, and level of anxiety and depression measured with the Hospital anxiety and depression scale. A higher IQ level was found in the neuropsychological background tests for the predominantly inattentive subtype (ADD). In the memory tests the dual-task memory/simultaneous capacity tests "Brown-Peterson" Consonant Trigram and Benton Visual Retention Test (BVRT) were the most sensitive and were severely reduced in all three subgroups, but only the BVRT revealed a difference between the three ADHD groups. In learning and delayed recall measured with Rey Auditory Verbal learning test and modified Diagnosticum für Cerebralsch?digung (mDCS), the Attention Deficit Disorder subgroup had the best learning and delayed capacity of the three groups. A good agreement was found between the interviewed DSM-IV-TR criteria, Conners CAARS S:S scale, and Wender WURS 25-item scales. Despite the difference in number of ADHD criteria for the three ADHD subgroups, the results in the neuropsychological memory tests indicate a severe reduction in all three subgroups of adult ADHD in simultaneous capacity. 相似文献
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Kieling C Goncalves RR Tannock R Castellanos FX 《Child and adolescent psychiatric clinics of North America》2008,17(2):285-307, viii
This article addresses the current understanding of the neurobiological bases of attention deficit hyperactivity disorder (ADHD), focusing on empiric research findings that connect genetic and environmental factors to structural and functional brain abnormalities, ultimately leading to a set of age-dependent behavioral manifestations. Section one presents evidence for genetic risk factors for ADHD and discusses the role of potential environmental factors in the etiology of the disorder. Section two focuses on brain imaging studies and how they have helped generate different hypotheses regarding the pathophysiology of ADHD. Finally, the article addresses the longitudinal course of symptoms in ADHD from infancy to adulthood in an attempt to place biological findings for this complex brain disorder in the context of maturation and development. 相似文献
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Mick E Faraone SV 《Child and adolescent psychiatric clinics of North America》2008,17(2):261-84, vii-viii
Results of behavioral genetic and molecular genetic studies have converged to suggest that both genetic and nongenetic factors contribute to the development of attention deficit hyperactivity disorder (ADHD). Family, twin, and adoption studies provide compelling evidence that genes play a strong role in mediating susceptibility to ADHD. In contrast to a handful of genome-wide scans conducted thus far, many candidate gene studies of ADHD have produced substantial evidence implicating several genes in the etiology of the disorder. Yet, even these associations are small and consistent with the idea that the genetic vulnerability to ADHD is mediated by many genes of small effects. These small effects emphasize the need for future candidate gene studies to implement strategies that will provide enough statistical power to detect such small effects. 相似文献