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Journal ArticleDOI

Attention-deficit/hyperactivity disorder in adults: an overview

TL;DR: Assessment of clinical, family, psychopharmacologic, neurobiological, and outcome studies found multiple reports describing adults with clinical features highly reminiscent of the childhood ADHD, suggesting converging lines of evidence support the validity of ADHD in adults.
About: This article is published in Biological Psychiatry.The article was published on 2000-07-01. It has received 650 citations till now. The article focuses on the topics: Attention deficit hyperactivity disorder & Developmental disorder.
Citations
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Journal ArticleDOI
TL;DR: Family, twin, and adoption studies provide compelling evidence that genes play a strong role in mediating susceptibility to ADHD, and seven genes for which the same variant has been studied in three or more case-control or family-based studies show statistically significant evidence of association with ADHD.

2,087 citations

Journal ArticleDOI
TL;DR: The association between executive function deficits (EFDs) and functional outcomes were examined among children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and these results support screening children with ADHD for EFDs to prevent academic failure.
Abstract: The association between executive function deficits (EFDs) and functional outcomes were examined among children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Participants were children and adolescents with (n = 259) and without (n = 222) ADHD, as ascertained from pediatric and psychiatric clinics. The authors defined EFD as at least 2 executive function measures impaired. Significantly more children and adolescents with ADHD had EFDs than did control participants. ADHD with EFDs was associated with an increased risk for grade retention and a decrease in academic achievement relative to (a) ADHD alone, (b) controlled socioeconomic status, (c) learning disabilities, and (d) IQ. No differences were noted in social functioning or psychiatric comorbidity. Children and adolescents with ADHD and EFDs were found to be at high risk for significant impairments in academic functioning. These results support screening children with ADHD for EFDs to prevent academic failure.

844 citations

Journal ArticleDOI
TL;DR: Findings indicate that overall cognitive ability is significantly lower among persons with ADHD and that FSIQ may show as large a difference between ADHD and control participants as most other measures.
Abstract: Cognitive measures are used frequently in the assessment and diagnosis of attention-deficit/hyperactivity disorder (ADHD). In this meta-analytic review, the authors sought to examine the magnitude of differences between ADHD and healthy participants on several commonly used intellectual and neuropsychological measures. Effect sizes for overall intellectual ability (Full Scale IQ; FSIQ) were significantly different between ADHD and healthy participants (weighted d =.61). Effect sizes for FSIQ were significantly smaller than those for spelling and arithmetic achievement tests and marginally significantly smaller than those for continuous performance tests but were comparable to effect sizes for all other measures. These findings indicate that overall cognitive ability is significantly lower among persons with ADHD and that FSIQ may show as large a difference between ADHD and control participants as most other measures.

736 citations

Journal ArticleDOI
TL;DR: The results suggest that the brain is altered in a more widespread manner than has been previously hypothesized, and developmental studies are needed to address the evolution of this brain disorder into adulthood.

642 citations

Journal ArticleDOI
TL;DR: A meta-analysis of the neuropsychological effects of MA abuse/dependence revealed broadly medium effect sizes, showing deficits in episodic memory, executive functions, information processing speed, motor skills, language, and visuoconstructional abilities.
Abstract: This review provides a critical analysis of the central nervous system effects of acute and chronic methamphetamine (MA) use, which is linked to numerous adverse psychosocial, neuropsychiatric, and medical problems. A meta-analysis of the neuropsychological effects of MA abuse/dependence revealed broadly medium effect sizes, showing deficits in episodic memory, executive functions, information processing speed, motor skills, language, and visuoconstructional abilities. The neuropsychological deficits associated with MA abuse/dependence are interpreted with regard to their possible neural mechanisms, most notably MA-associated frontostriatal neurotoxicity. In addition, potential explanatory factors are considered, including demographics (e.g., gender), MA use characteristics (e.g., duration of abstinence), and the influence of common psychiatric (e.g., other substance-related disorders) and neuromedical (e.g., HIV infection) comorbidities. Finally, these findings are discussed with respect to their potential contribution to the clinical management of persons with MA abuse/dependence.

605 citations

References
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03 Nov 2005
TL;DR: Barkley et al. as discussed by the authors discussed the nature of ADHD, primary symptoms, diagnosis criteria, prevalence, and gender differences, and the treatment of ADHD in adults.
Abstract: Part I: The Nature of ADHD. Barkley, History. Barkley, Primary Symptoms, Diagnostic Criteria, Prevalence, and Gender Differences. Barkley, Associated Cognitive, Developmental, and Health Problems. Barkley, Comorbid Disorders, Social and Family Adjustment, and Subtyping. Barkley, Etiologies. Barkley, ADHD in Adults: Developmental Course and Outcome of Children with ADHD, and ADHD in Clinic-referred Adults. Barkley, A Theory of ADHD. Part II: Assessment. Barkley, Edwards, Diagnostic Interview, Behavior Rating Scales, and the Medical Examination.Gordon, Barkley, Lovett, Tests and Observational Measures. Hathaway, Dooling-Litfin, Edwards, Integrating the Results of an Evaluation: Ten Clinical Cases. Murphy, Gordon, Assessment of Adults with ADHD. Part III: Treatment. Anastopoulos, Rhoads, Farley, Counseling and Training Parents. Cunningham, COPE: Large-group, Community-based, Family-centered Parent Training. Robin, Training Families with Adolescents with ADHD. Pfiffner, Barkley, DuPaul, Treatment of ADHD in School Settings. Cunningham, Cunningham, Student-mediated Conflict Resolution Programs. Connor, Stimulants. Spencer, Antidepressant and Specific Norepinephrine Reuptake Inhibitor Treatments. Connor, Other Medications. Smith, Barkley, Shapiro, Combined Child Therapies. Murphy, Psychological Counseling of Adults with ADHD. Prince, Wilens, Spencer, Biederman, Pharmacotherapy of ADHD in Adults.

4,151 citations

Journal ArticleDOI
TL;DR: It is revealed that EF deficits are consistently found in both ADHD and autism but not in CD (without ADHD) or in TS, and both the severity and profile of EF deficits appears to differ across ADHD and Autism.
Abstract: In this paper, we consider the domain of executive functions (EFs) and their possible role in developmental psychopathologies. We first consider general theoretical and measurement issues involved in studying EFs and then review studies of EFs in four developmental psychopathologies: attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), autism, and Tourette syndrome (TS). Our review reveals that EF deficits are consistently found in both ADHD and autism but not in CD (without ADHD) or in TS. Moreover, both the severity and profile of EF deficits appears to differ across ADHD and autism. Molar EF deficits are more severe in the latter than the former. In the few studies of more specific EF tasks, there are impairments in motor inhibition in ADHD but not in autism, whereas there are impairments in verbal working memory in autism but not ADHD. We close with a discussion of implications for future research.

3,108 citations

Journal ArticleDOI
TL;DR: It was shown by follow-up and family studies that poor prognosis cases can be validly separated clinically from good prediction cases, and the authors conclude that good prognosis "schizophrenia" is not mild schizophrenia, but a different illness.
Abstract: A method for achieving diagnostic validity in psychiatric illness is described, consisting of five phases: clinical description, laboratory study, exclusion of other disorders, follow-up study, and family study. The method was applied in this paper to patients with the diagnosis of schizophrenia, and it was shown by follow-up and family studies that poor prognosis cases can be validly separated clinically from good prognosis cases. The authors conclude that good prognosis "schizophrenia" is not mild schizophrenia, but a different illness.

1,989 citations

Journal ArticleDOI
TL;DR: The literature supports considerable comorbidity of attention deficit hyperactivity disorder with conduct disorder, oppositional defiant disorder, mood disorders, anxiety disorders, learning disabilities, and other disorders, such as mental retardation, Tourette's syndrome, and borderline personality disorder.
Abstract: Objective Attention deficit hyperactivity disorder is a heterogeneous disorder of unknown etiology Little is known about the comorbidity of this disorder with disorders other than conduct Therefore, the authors made a systematic search of the psychiatric and psychological literature for empirical studies dealing with the comorbidity of attention deficit hyperactivity disorder with other disorders Data collection The search terms included hyperactivity, hyperkinesis, attention deficit disorder, and attention deficit hyperactivity disorder, cross-referenced with antisocial disorder (aggression, conduct disorder, antisocial disorder), depression (depression, mania, depressive disorder, bipolar), anxiety (anxiety disorder, anxiety), learning problems (learning, learning disability, academic achievement), substance abuse (alcoholism, drug abuse), mental retardation, and Tourette's disorder Findings The literature supports considerable comorbidity of attention deficit hyperactivity disorder with conduct disorder, oppositional defiant disorder, mood disorders, anxiety disorders, learning disabilities, and other disorders, such as mental retardation, Tourette's syndrome, and borderline personality disorder Conclusions Subgroups of children with attention deficit hyperactivity disorder might be delineated on the basis of the disorder's comorbidity with other disorders These subgroups may have differing risk factors, clinical courses, and pharmacological responses Thus, their proper identification may lead to refinements in preventive and treatment strategies Investigation of these issues should help to clarify the etiology, course, and outcome of attention deficit hyperactivity disorder

1,728 citations


"Attention-deficit/hyperactivity dis..." refers result in this paper

  • ...Although these findings were not fully replicated in a similar PET study of adolescents (Zametkin et al 1993), which used siblings of ADHD children as control subjects, they are consistent with brain single photon emission computed tomography (SPECT) imaging in ADHD adolescents (Amen et al 1993). Ernst et al (1998) used PET with F18-DOPA to compare 17 ADHD adults and 23 healthy control adults. They used the ratio of the isotope concentration of specific regions to that of nonspecific regions to index DOPA decarboxylase activity and dopamine storage processes. Of three composite regions (prefrontal cortex, striatum, and midbrain), only the prefrontal cortex showed significantly lower F18-DOPA ratios in ADHD adults compared with control adults. The medial and left prefrontal areas were the most altered. Anterior cingulate cortex (ACC), lying on the medial surface of the frontal lobe, has strong connections to dorsolateral prefrontal cortex. Bush et al (1999) used a Stroop task to compare ACC activation in ADHD and non-ADHD adults....

    [...]

  • ...Although these findings were not fully replicated in a similar PET study of adolescents (Zametkin et al 1993), which used siblings of ADHD children as control subjects, they are consistent with brain single photon emission computed tomography (SPECT) imaging in ADHD adolescents (Amen et al 1993). Ernst et al (1998) used PET with F18-DOPA to compare 17 ADHD adults and 23 healthy control adults. They used the ratio of the isotope concentration of specific regions to that of nonspecific regions to index DOPA decarboxylase activity and dopamine storage processes. Of three composite regions (prefrontal cortex, striatum, and midbrain), only the prefrontal cortex showed significantly lower F18-DOPA ratios in ADHD adults compared with control adults. The medial and left prefrontal areas were the most altered. Anterior cingulate cortex (ACC), lying on the medial surface of the frontal lobe, has strong connections to dorsolateral prefrontal cortex. Bush et al (1999) used a Stroop task to compare ACC activation in ADHD and non-ADHD adults. In contrast to control subjects, the ADHD adults failed to activate the ACC. Notably, in the prior study by Zametkin et al (1990), cingulate cortex was one of only four (out of 60) regions evaluated that still showed regional hypoactivity after global normalization. Because the stimulant medications are the treatment of choice for ADHD, several studies of ADHD adults examined changes in brain metabolism due to stimulant administration. They have not, however, produced consistent results (Ernst et al 1994; Matochik et al 1994; Matochik et al 1993). One study has used SPECT to assess dopamine transporter (DAT) activity in ADHD and control adults (Dougherty et al 1999). This study found DAT to be elevated by 70% in the ADHD adults compared with control adults, which is consistent with molecular genetic studies implicating DAT in ADHD (Faraone and Biederman 1999). In summary, the available data suggest that ADHD adults show frontal dopaminergic hypoactivity. In contrast, studies of adolescents show weaker results. Ernst et al (1998) offered two explanations of the differences between the adolescent and adult data....

    [...]

  • ...Although these findings were not fully replicated in a similar PET study of adolescents (Zametkin et al 1993), which used siblings of ADHD children as control subjects, they are consistent with brain single photon emission computed tomography (SPECT) imaging in ADHD adolescents (Amen et al 1993). Ernst et al (1998) used PET with F18-DOPA to compare 17 ADHD adults and 23 healthy control adults....

    [...]

  • ...Although these findings were not fully replicated in a similar PET study of adolescents (Zametkin et al 1993), which used siblings of ADHD children as control subjects, they are consistent with brain single photon emission computed tomography (SPECT) imaging in ADHD adolescents (Amen et al 1993). Ernst et al (1998) used PET with F18-DOPA to compare 17 ADHD adults and 23 healthy control adults. They used the ratio of the isotope concentration of specific regions to that of nonspecific regions to index DOPA decarboxylase activity and dopamine storage processes. Of three composite regions (prefrontal cortex, striatum, and midbrain), only the prefrontal cortex showed significantly lower F18-DOPA ratios in ADHD adults compared with control adults. The medial and left prefrontal areas were the most altered. Anterior cingulate cortex (ACC), lying on the medial surface of the frontal lobe, has strong connections to dorsolateral prefrontal cortex. Bush et al (1999) used a Stroop task to compare ACC activation in ADHD and non-ADHD adults. In contrast to control subjects, the ADHD adults failed to activate the ACC. Notably, in the prior study by Zametkin et al (1990), cingulate cortex was one of only four (out of 60) regions evaluated that still showed regional hypoactivity after global normalization....

    [...]

  • ...Although these findings were not fully replicated in a similar PET study of adolescents (Zametkin et al 1993), which used siblings of ADHD children as control subjects, they are consistent with brain single photon emission computed tomography (SPECT) imaging in ADHD adolescents (Amen et al 1993). Ernst et al (1998) used PET with F18-DOPA to compare 17 ADHD adults and 23 healthy control adults. They used the ratio of the isotope concentration of specific regions to that of nonspecific regions to index DOPA decarboxylase activity and dopamine storage processes. Of three composite regions (prefrontal cortex, striatum, and midbrain), only the prefrontal cortex showed significantly lower F18-DOPA ratios in ADHD adults compared with control adults. The medial and left prefrontal areas were the most altered. Anterior cingulate cortex (ACC), lying on the medial surface of the frontal lobe, has strong connections to dorsolateral prefrontal cortex. Bush et al (1999) used a Stroop task to compare ACC activation in ADHD and non-ADHD adults. In contrast to control subjects, the ADHD adults failed to activate the ACC. Notably, in the prior study by Zametkin et al (1990), cingulate cortex was one of only four (out of 60) regions evaluated that still showed regional hypoactivity after global normalization. Because the stimulant medications are the treatment of choice for ADHD, several studies of ADHD adults examined changes in brain metabolism due to stimulant administration. They have not, however, produced consistent results (Ernst et al 1994; Matochik et al 1994; Matochik et al 1993). One study has used SPECT to assess dopamine transporter (DAT) activity in ADHD and control adults (Dougherty et al 1999). This study found DAT to be elevated by 70% in the ADHD adults compared with control adults, which is consistent with molecular genetic studies implicating DAT in ADHD (Faraone and Biederman 1999). In summary, the available data suggest that ADHD adults show frontal dopaminergic hypoactivity. In contrast, studies of adolescents show weaker results. Ernst et al (1998) offered two explanations of the differences between the adolescent and adult data. First, the adolescent samples studied may have been more heterogeneous than the adult samples. Whereas all of the adults had persistent ADHD, some of the adolescent cases might have remitted by adulthood. Thus, frontal dopaminergic hypoactivity may be associated with persistent ADHD only. Alternatively, Ernst et al (1998) speculated that, because of brain maturation, the locus of ADHD’s dopamine abnormality might shift from the midbrain in childhood to the prefrontal cortex in adults....

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Journal ArticleDOI
TL;DR: In this paper, the authors reviewed concepts and measurement issues surrounding externalizing behavior problems and academic underachievement, the strength and specificity of the covariation between these domains, and the viability of explanatory models that link these areas.
Abstract: Conceptual and measurement issues surrounding externalizing behavior problems and academic underachievement, the strength and specificity of the covariation between these domains, and the viability of explanatory models that link these areas are reviewed. In childhood, inattention and hyperactivity are stronger correlates of academic problems than is aggression; by adolescence, however, antisocial behavior and delinquency are clearly associated with underachievement. Whereas investigations with designs that allow accurate causal inference are scarce, unidirectional paths from 1 domain to the other have received little support. Indeed, the overlap of externalizing problems with cognitive and readiness deficits early in development suggests the influence of antecedent variables. Low socioeconomic status, family adversity, subaverage IQ, language deficits, and neurodevelopmental delay are explored as possible underlying factors.

1,443 citations