A Cognitive Therapy Approach for Adult Attention Deficit/Hyperactivity Disorder

2003 ◽  
Vol 17 (4) ◽  
pp. 319-334 ◽  
Author(s):  
Russell J. Ramsay ◽  
Anthony L. Rostain
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Cognitive Therapy ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Behavioral Disorder ◽  
Clinical Population ◽  
Psychological Issues ◽  
Therapy Approach ◽  
Case Examples ◽  
Hyperactivity Disorder

While attention deficit/hyperactivity disorder (ADHD) is the most prevalent behavioral disorder of childhood, the past decade has seen a rise in the number of adults presenting for treatment with difficulties related to ADHD. Few treatments (particularly psychosocial treatments) offered to adult patients with ADHD, however, have been empirically tested, much less been grounded in an overarching treatment model that captures the complexity of the various neurobiological, developmental, and psychological issues germane to this clinical population. The purpose of this article is to introduce a cognitive therapy approach for treating adults with ADHD. To do so we will describe the nature of ADHD, discuss some of the clinical issues unique to this diagnosis, and outline a cognitive therapy approach for conceptualizing and treating adult ADHD, integrating a number of case examples.

Epidemiology, Impairments, and Differential Diagnosis in Adult ADHD: Introduction

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S12) ◽  
pp. 4-5 ◽  
Author(s):  
Lenard A. Adler
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Differential Diagnosis ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Hyperactivity Disorder ◽  
Childhood Disorder

In the mid-1970s, attention-deficit/hyperactivity disorder (ADHD) was still believed to be a childhood disorder that disappeared with the onset of adolescence. At this time, Wender studied a cohort of adults presenting with ADHD-like symptoms, all of whom had been diagnosed with ADHD in childhood. Wender prescribed psycho-stimulants, which successfully produced a response in the adults, thus fostering research into adult ADHD.

Medical Mimics and Differential Diagnosis in Adult ADHD

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S15) ◽  
pp. 14-16 ◽  
Author(s):  
Mark A. Stein
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Differential Diagnosis ◽  
Adult Patient ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Diagnostic Evaluation ◽  
Response To Treatment ◽  
Hyperactivity Disorder ◽  
Rule Out

When performing a diagnostic evaluation for an adult patient with possible adult attention-deficit/hyperactivity disorder (ADHD), clinicians must pay particular attention to possible mimics. ADHD mimics are conditions responsible for the symptoms or impairments that superficially resemble, and may be confused with ADHD. These mimics may produce symptoms and impairments similar to those seen in adults with ADHD, but differ in etiology, course, or response to treatment of ADHD. When evaluating someone for ADHD, clinicians should first rule out the possibility of medical, psychiatric, and social mimics of ADHD.

Pharmacotherapy of ADHD in Adults

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S8) ◽  
pp. 11-13 ◽  
Author(s):  
Timothy E. Wilens
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Therapeutic Options ◽  
Major Depressive ◽  
Children With Adhd ◽  
Hyperactivity Disorder

There is a complex overlap between major depressive disorder (MDD) and attention-deficit/hyperactivity disorder (ADHD). The different therapeutic options for adult ADHD mirror those used for children with ADHD. Both stimulant and nonstimulant medications are used to treat the disorder.

scholarly journals Shared alterations in resting-state brain connectivity in adults with attention-deficit/hyperactivity disorder and their unaffected first-degree relatives

2019 ◽  
pp. 1-11
Author(s):  
Valentino Antonio Pironti ◽  
Deniz Vatansever ◽  
Barbara Jacquelyn Sahakian
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Resting State ◽  
Adult Adhd ◽  
External Validation ◽  
Negative Consequences ◽  
Default Mode ◽  
Hyperactivity Disorder ◽  
First Degree Relatives ◽  
Human Connectome Project

Abstract Background Attention-deficit/hyperactivity disorder (ADHD) is a developmental condition that often persists into adulthood with extensive negative consequences on quality of life. Despite emerging evidence indicating the genetic basis of ADHD, investigations into the familial expression of latent neurocognitive traits remain limited. Methods In a group of adult ADHD probands (n = 20), their unaffected first-degree relatives (n = 20) and typically developing control participants (n = 20), we assessed endophenotypic alterations in the default mode network (DMN) connectivity during resting-state functional magnetic resonance imaging in relation to cognitive performance and clinical symptoms. In an external validation step, we also examined the dimensional nature of this neurocognitive trait in a sample of unrelated healthy young adults (n = 100) from the Human Connectome Project (HCP). Results The results illustrated reduced anti-correlations between the posterior cingulate cortex/precuneus and right middle frontal gyrus that was shared between adult ADHD probands and their first-degree relatives, but not with healthy controls. The observed connectivity alterations were linked to higher ADHD symptoms that was mediated by performance in a sustained attention task. Moreover, this brain-based neurocognitive trait dimensionally explained ADHD symptom variability in the HCP sample. Conclusions Alterations in the default mode connectivity may represent a dimensional endophenotype of ADHD, hence a significant aspect of the neuropathophysiology of this disorder. As such, brain network organisation can potentially be employed as an important neurocognitive trait to enhance statistical power of genetic studies in ADHD and as a surrogate efficacy endpoint in the development of novel pharmaceuticals.

Vortioxetine for attention deficit hyperactivity disorder in adults: A randomized, double-blind, placebo-controlled, proof-of-concept study

2019 ◽  
Vol 33 (4) ◽  
pp. 511-521 ◽  
Author(s):  
Joseph Biederman ◽  
Annika Lindsten ◽  
Lasse B Sluth ◽  
Maria Louise Petersen ◽  
Anders Ettrup ◽  
...  
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Rating Scale ◽  
Stage I ◽  
Proof Of Concept ◽  
Double Blind ◽  
Patient Functioning ◽  
Concept Study ◽  
Hyperactivity Disorder

Background: Stimulants remain the mainstay of treatment for attention-deficit hyperactivity disorder (ADHD) but are often associated with insufficient response or poor tolerability, leading to many patients not wishing to be treated with controlled substances. Aims: This randomized, placebo-controlled, proof-of-concept study (NCT02327013) evaluated the efficacy of a multimodal antidepressant, vortioxetine, in the treatment of ADHD, using a two-stage sequential parallel comparison design. Methods: Patients aged 18–55 years with a diagnosis of ADHD (DSM-5) and a total score ⩾24 on the Adult ADHD Investigator Symptom Rating Scale (AISRS) were randomized in study stage I with a 1:1:3 ratio to six weeks of treatment with vortioxetine 10 or 20 mg/day, or placebo ( n = 227). In study stage II, placebo non-responders (AISRS total score reduction <30% from stage I baseline) were re-randomized with a 1:1:1 ratio to six weeks of vortioxetine 10 or 20 mg/day, or placebo ( n = 59). Results: Across the two study stages combined, ADHD symptoms improved by approximately eight AISRS points in all treatment groups, showing no difference from placebo for either dose of vortioxetine, the study thus failing to meet its primary endpoint. However, both doses of vortioxetine separated from placebo in improving overall patient functioning, as measured by the Sheehan Disability Scale. Conclusion: Studies are warranted to further investigate this suggested benefit of a multimodal antidepressant for patient functioning in ADHD while addressing issues of non-adherence and placebo response. The study confirmed vortioxetine 10 mg and 20 mg as generally well-tolerated.

scholarly journals Temporal reproduction and its neuroanatomical correlates in adults with attention deficit hyperactivity disorder and their unaffected first-degree relatives

2016 ◽  
Vol 46 (12) ◽  
pp. 2561-2569 ◽  
Author(s):  
V. A. Pironti ◽  
M.-C. Lai ◽  
S. Morein-Zamir ◽  
U. Müller ◽  
E. T. Bullmore ◽  
...  
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Grey Matter ◽  
Grey Matter Volume ◽  
Typically Developing ◽  
Time Reproduction ◽  
Hyperactivity Disorder ◽  
First Degree Relatives ◽  
Temporal Reproduction

BackgroundLittle is known about time perception, its putative role as cognitive endophenotype, and its neuroanatomical underpinnings in adults with attention deficit hyperactivity disorder (ADHD).MethodTwenty adults with ADHD, 20 unaffected first-degree relatives and 20 typically developing controls matched for age and gender undertook structural magnetic resonance imaging scans. Voxel-based morphometry with DARTEL was performed to obtain regional grey-matter volumes. Temporal processing was investigated as a putative cognitive endophenotype using a temporal reproduction paradigm. General linear modelling was employed to examine the relationship between temporal reproduction performances and grey-matter volumes.ResultsADHD participants were impaired in temporal reproduction and unaffected first-degree relatives performed in between their ADHD probands and typically developing controls. Increased grey-matter volume in the cerebellum was associated with poorer temporal reproduction performance.ConclusionsAdults with ADHD are impaired in time reproduction. Performances of the unaffected first-degree relatives are in between ADHD relatives and controls, suggesting that time reproduction might be a cognitive endophenotype for adult ADHD. The cerebellum is involved in time reproduction and might play a role in driving time performances.

Attention-deficit/hyperactivity disorder (ADHD) in adults: Specific clinical and therapeutic issues

2015 ◽  
Vol 30 (S2) ◽  
pp. S27-S28
Author(s):  
B. Rolland ◽  
D. Da Fonseca ◽  
M. Fatseas ◽  
N. Simon
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Clinical Features ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Adhd Symptoms ◽  
Addiction Medicine ◽  
Global Functioning ◽  
Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) was initially considered as a childhood psychiatric disorder. However, longitudinal observations have revealed that ADHD symptoms may persist in adulthood among approximately 50% of the patients . Adult ADHD is associated with impaired social outcome and frequent comorbidities such as mood disorders, personality disorders, and substance use disorders [2,3]. Correctly identifying and treating ADHD can significantly improve the global functioning and cognition of adult subjects, and reduce the intensity and frequency of the comorbid states [2,3]. Nonetheless, the clinical features of adult ADHD are clearly different from the youth form [1,2], and ADHD symptoms are easily mixed up in adults with symptoms of the comorbid conditions [2,3]. These clinical intricacies can make the diagnosis of ADHD difficult in adults. Moreover, the management of methylphenidate in adult subjects is also associated with specific risks and pitfalls, such as abuse and tampering behaviors, and additional safety risks . Put together, it appears crucial to identify and treat ADHD in adults, but the clinical and therapeutic complexities of adult ADHD require improved expertise and caution from adult psychiatrists and addiction specialists. In this thematic session of the 2015 French Psychiatry Congress, three French leading experts of adult ADHD will address the aforementioned clinical and therapeutic issues of the adulthood form of this disorder. David Da Fonseca, professor of child psychiatry in Marseille, will disentangle the clinical features of adult ADHD from the typical symptoms observed in the youth form. Mélina FATSEAS, associate professor of psychiatry and addiction medicine in Bordeaux, will specifically focus on the many and complex relationships observed between adult ADHD and substance use disorders. Last, Nicolas Simon, professor of addiction medicine and psychopharmacology in Marseille, will synthesize what are the very risks and issues with prescribing methylphenidate in adults.

scholarly journals Understudied and underrecognised

2004 ◽  
Vol 10 (5) ◽  
pp. 338-340 ◽  
Author(s):  
Dave Coghill
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Longitudinal Studies ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Diagnostic Validity ◽  
Children With Adhd ◽  
Hyperactivity Disorder

That Zwi & York (2004) have opened the discussion on adult attention-deficit hyperactivity disorder (ADHD) is to be applauded. Their main conclusion is that the diagnostic validity of adult ADHD remains uncertain and that further study is needed. This is based on a review of the ADHD concept in childhood and the longitudinal studies that have followed children with ADHD into adulthood.

scholarly journals Adult attention-deficit hyperactivity disorder: A database analysis of South African private health insurance

2017 ◽  
Vol 23 ◽  
Author(s):  
Renata Schoeman ◽  
Manie De Klerk
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Health Insurance ◽  
Attention Deficit ◽  
Private Health Insurance ◽  
Adult Adhd ◽  
Cost Effective ◽  
Database Analysis ◽  
Access To Treatment ◽  
Hyperactivity Disorder ◽  
Funding Model

Background: Adult attention-deficit hyperactivity disorder (ADHD) is a chronic, costly and debilitating disorder. In South Africa (SA), access to funding for care and treatment of ADHD is limited, and research is lacking.Aim: This study aimed to establish the current situation with regard to the psychiatric management of and funding for treatment of adult ADHD in the private sector in SA.Methods: A diagnostically refined retrospective claims database analysis was conducted. We examined the prevalence, costs and funding profile of claims over a 2-year period for adult beneficiaries with possible ADHD of a large medical administrator in SA.Results: The prevalence of adult ADHD was lower than published international rates. The presence of adult ADHD increased the prevalence of comorbidity and doubled the health care costs of beneficiaries. Contrary to public belief, comorbidities (including their medicine costs) rather than psychiatric services or medicines were the main cost drivers.Conclusion: The current private health insurance funding model for ADHD limits access to funding. This affects early diagnosis and optimal treatment, thereby escalating long-term costs. Improved outcomes are possible if patients suffering from ADHD receive timely and accurate diagnosis, and receive chronic and comprehensive care. Balanced regulation is proposed to minimise the risk to both medical schemes and patients. A collaborative approach between stakeholders is needed to develop an alternative cost-effective funding model to improve access to treatment and quality of life for adults with ADHD in SA.

Large-scale neocortical dynamic function and EEG: Use of theory and methods in clinical research on children with Attention Deficit Hyperactivity Disorder

2000 ◽  
Vol 23 (3) ◽  
pp. 411-411
Author(s):  
Michael Murias ◽  
James M. Swanson
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Large Scale ◽  
Dynamic Theory ◽  
Clinical Population ◽  
Hyperactivity Disorder ◽  
Age Related ◽  
Dynamic Function ◽  
Eeg Data ◽  
Regional Specificity

We used Nunez's physiologically based dynamic theory of EEG to make predictions about a clinical population of children with Attention Deficit Hyperactivity Disorder (ADHD) known to have neuronanatomical abnormalities. Analysis of high-density EEG data (long-range coherence) showed expected age-related differences and surprising regional specificity that is consistent with some of the literature in this clinical area.

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