Prevalence of ADHD and Its Subtypes in Male and Female Adult Prison Inmates

There are few published studies of attention-deficit/hyperactivity disorder (ADHD) in adult inmates, and even fewer studies that have considered ADHD in adult inmates by gender. The present study examined the prevalence of ADHD, its subtypes, and associated psychological and neuropsychological comorbidity as a function of gender in a sample of 3,962 inmates (3,439 men and 523 women; mean age =33.6 years, range 17–73) who had completed the 250-item, self-report, Diagnostic and Statistical Manual of Mental Disorders, 4th edition (Text Revision) (DSM-IV-TR)-aligned Coolidge Correctional Inventory (CCI). The overall ADHD prevalence rate found was 10.5%, which is substantially higher than the rate among adults in the general population (2–5%). The female inmate ADHD prevalence rate (15.1%) was higher than the male inmate ADHD rate (9.8%), consistent with some previous studies. The most prevalent ADHD subtype for both genders was the hyperactive-impulsive subtype. The combined and inattentive ADHD subtypes had higher levels of comorbid psychopathology than the hyperactive-impulsive ADHD subtype. As the presence of ADHD and associated gender differentials may impact the success of rehabilitation and educative programs with inmates, the assessment of ADHD and comorbid psychopathology should be a priority in initial inmate screening and evaluation.

Cross-validating the Dot Counting Test Among an Adult ADHD Clinical Sample and Analyzing the Effect of ADHD Subtype and Comorbid Psychopathology

This study cross-validated the dot counting test (DCT) as a performance validity test (PVT) in an adult attention-deficit/hyperactivity disorder (ADHD) clinical population and examined the effect of ADHD subtype and psychiatric comorbidity on accuracy for detecting invalidity. DCT performance was assessed among 210 consecutive adult ADHD referrals who underwent neuropsychological evaluation and were classified into valid ( n = 175) or invalid ( n = 35) groups based on seven independent criterion PVTs. The invalid group had significantly worse DCT performance than the valid group using both the standard and unrounded scoring procedure ([Formula: see text]). Classification accuracy was excellent, with 54.3% sensitivity/92% specificity at optimal cut-scores of ≥14 (rounded) and ≥13.38 (unrounded). Nonsignificant DCT performance differences emerged based on ADHD subtype or the presence/absence of comorbid psychopathology. The DCT functions well as a nonmemory-based PVT in an ethnoracially diverse ADHD population, supporting its clinical utility for detecting invalid neurocognitive performance during ADHD evaluations.

Does Cannabis, Cocaine and Alcohol Use Impact Differently on Adult Attention Deficit/Hyperactivity Disorder Clinical Picture?

While the association between adult Attention Deficit/Hyperactivity Disorder (A-ADHD) and Substance Use Disorders (SUDs) has been widely explored, less attention has been dedicated to the various substance use variants. In a previous paper, we identified two variants: type 1 (use of stimulants/alcohol) and type 2 (use of cannabinoids). In this study, we compared demographic, clinical and symptomatologic features between Dual Disorder A-ADHD (DD/A-ADHD) patients according to our substance use typology, and A-ADHD without DD (NDD/A-ADHD) ones. NDD patients were more frequently diagnosed as belonging to inattentive ADHD subtype compared with type 1 DD/A-ADHD patients, but not with respect to type 2 DD/ADHD. NDD/A-ADHD patients showed less severe symptoms of hyperactivity/impulsivity than DD/A-ADHD type 1, but not type 2. Type 1 and type 2 patients shared the feature of displaying higher impulsiveness than NDD/A-ADHD ones. General psychopathology scores were more severe in type 2 DD/ADHD patients, whereas type 1 patients showed greater similarity to NDD/A-ADHD. Legal problems were more strongly represented in type 1 than in type 2 patients or NDD/A-ADHD ones. Our results suggest that type 1 and type 2 substance use differ in their effects on A-ADHD patients—an outcome that brings with it different likely implications in dealing with the diagnostic and therapeutic processes.

censusADHD Study: An Australian-wide medication-based recruitment study for Attention-Deficit/Hyperactivity Disorder

Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) affects around 5% of children and is characterised by a persistent pattern of problems with focussing or maintaining attention and/or hyperactivity-impulsivity. The censusADHD Study is a richly-phenotyped nation-wide cohort of Australian children with ADHD that aims to examine the impact of children’s attention and behavioural problems on the financial, emotional, and psychological wellbeing of parents and caregivers. Methods: Families of potential ADHD cases aged between 6 and 11 years old were identified using Pharmaceutical Benefits Scheme (PBS) prescription records for ADHD medications held by the Department of Human Services and sent a study information letter. Data were collected from 1,574 primary caregivers via online survey from June-September 2015, including the behavioural profile of the index child, the child’s medication use and experiences with side-effects, and the impact of the child’s behaviour on the caregiver. Approximately 81% of caregivers also consented to record linkage of the child’s PBS and Medicare Benefits Schedule claims.Results: Boys were diagnosed with ADHD earlier (P=0.021) and more likely to present as the combined and predominantly hyperactive subtypes (P=0.001). Boys were also at higher risk for experiencing a school suspension (P<0.001) or expulsion (P=0.043). Overall, children presenting as the combined subtype had higher rates of psychiatric comorbidities (P<0.001). Finally, prescription costs for each family and the PBS significantly increased in the year following ADHD diagnosis (P<0.001).Conclusion: Research examining the psychosocial and financial impact of ADHD on Australian children and their families in population-representative cohorts is needed. Our findings demonstrate the importance of examining both gender and ADHD subtype presentation in future studies.

ADHD subtype-specific cognitive correlates and association with self-esteem: a quantitative difference

Background Attention-deficit hyperactivity disorder (ADHD) is a major neurodevelopmental disorder with heterogeneous symptoms, subtypes, and cognitive deficits. Cognitive deficits are central to ADHD pathophysiology and one potential source of heterogeneity in ADHD. Subtype-specific cognitive correlates are not, however, well-studied. We explored cognitive correlates of ADHD subtypes based on the Wechsler Intelligence Scale for Children (WISC-IV) scores. We also assessed subtype-specific self-esteem rating in ADHD subtypes and explored its association with cognitive correlates. Methods One hundred thirty-nine children with ADHD (80.6% boy, 19.4% girl) were categorized into the predominantly “hyperactive (ADHD-H)”, “inattentive (ADHD-I)” and “combined (ADHD-C)” subtype based on their symptoms and scores on the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) and Conners Parent-Rating Scale (CPRS-RS). They were then individually administrated the WISC-IV and completed a self-esteem inventory. Group differences in the WISC-IV indices and their predictability in discriminating ADHD subtypes were analyzed. Results We found a quantitative differentiation of cognitive abilities among ADHD subtypes with “working memory” as the most compromised cognitive domain. ADHD-I had the poorest cognitive profile while ADHD-H scored highest in all cognitive domains. Importantly, cognitive abilities were negatively correlated with inattention and positively correlated with hyperactive symptoms. Moreover, self-esteem ratings were positively correlated with the cognitive domains and were rated differently based on the subtypes. ADHD-H, with the highest cognitive strength, reported the highest level of self-esteem among all subtypes. Conclusions ADHD subtype-specific symptoms, cognitive deficits, and self-esteem problems should be considered for precise diagnosis and effective and personalized treatment in ADHD in light of further supporting evidence and assessments. Cognitive interventions might be more compatible with and effective in inattentive and combined subtypes of ADHD. Working memory improving-based interventions can benefit all ADHD subtypes. A supportive educational system in school and providing adjunct supportive interventions should be considered for children with ADHD as well.

Cognitive correlates of ADHD subtypes and its association with self-esteem: A quantitative difference

Background : Attention-deficit hyperactivity disorder (ADHD) is a major neurodevelopmental disorder with heterogeneous symptoms, subtypes and cognitive deficits. Cognitive deficits are central to ADHD pathophysiology and one potential source of heterogeneity in ADHD. Subtype-specific cognitive correlates are not, however, well-studied. We explored cognitive correlates of ADHD subtypes based on the Wechsler Intelligence Scale for Children (WISC-IV) scores. We also assessed subtype-specific self-esteem ratings and its association with subtype-specific cognitive correlates. Methods : 139 ADHD children (80.6% boy, 19.4% girl) were categorized into the predominantly “hyperactive (ADHD-H)”, “inattentive (ADHD-I)” and “combined (ADHD-C)” subtype based on their symptoms and scores on the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) and Conners Parent-Rating Scale (CPRS-RS). They were then individually administrated the WISC-IV and completed a self-esteem inventory. Group differences in the WISC-IV indices and their predictability in discriminating ADHD subtypes were analyzed. Results : We found a quantitative differentiation of cognitive abilities among ADHD subtypes with “working memory” as the most compromised cognitive domain. ADHD-I had the poorest cognitive profile while ADHD-H scored highest in all cognitive domains. Importantly, cognitive abilities were negatively correlated with inattention and positively correlated with hyperactive symptoms. Moreover, self-esteem ratings were positively correlated with the cognitive domains and were rated differently based on the subtype. ADHD-H, with the highest cognitive strength, reported the highest level of self-esteem among all subtypes. Conclusions : ADHD subtype-specific symptoms, cognitive deficits, and social functioning should be considered for precise diagnosis and effective treatment. Our findings have implications for diagnosis precision and personalized intervention in ADHD. Cognitive interventions might be more compatible with and effective in inattentive and combined subtypes of ADHD. Working memory improving-based interventions can benefit all ADHD subtypes.

A-33 Visuospatial Working Memory Performance and Adult ADHD Symptom Severity

Objective Working memory performance among adults with Attention-Deficit/Hyperactivity Disorder (ADHD) demonstrates variable results across literature. This investigation evaluated performance on a visuospatial working memory task relative to scores on measures of ADHD subtype and severity. Method A community sample aged 18 to 77 (n = 31; n men = 15) completed neuropsychological testing and measures of ADHD. The sample was predominantly White (64%; n = 20) and highly educated (Myears = 15.6). Participants were eligible if they were 18 or older, regardless of ADHD symptoms/diagnosis, and excluded if they had neuromedical/neuropsychiatric disorders. Spatial Addition (SA) from the Wechsler Memory Scale (WMS-IV) assessed working memory; the Adult ADHD Clinical Diagnostic Scale (ACDS) and Adult ADHD Investigator Symptom Rating Scale (AISRS) assessed ADHD subtype and burden. Results AISRS scores did not explain any variance in SA scores, R2 = 00, p = .970 (β = -.020, p = .970). A one-way between subjects ANOVA demonstrated no significant differences on SA scores between groupings based on ACDS: ADHD (n = 9, M = 13, SD = 4.12), and non-ADHD (n = 20, M = 13.95, SD = 5.27), (F(3,25) = .592, p = .626); ADHD (Inattentive (n = 2, M = 14.4, SD = .707); Hyperactive (n = 1, M = 18.00); Combined (n = 6, M = 11.7, SD = 4.8)). Adjustment for age and education did not change these findings. Conclusions Results failed to indicate any association between visuospatial working memory scores and ADHD symptoms but a larger, diversified sample is necessary to corroborate this null finding.