Aversive inhibition in adult ADHD and its restoration by mindfulness-based cognitive therapy: A behavioral pilot study

Background: Control over the tendency to make or withhold responses based on contextual Pavlovian information, might play a key role in understanding impulsivity/hyperactivity in ADHD. Here we set out to assess (1) the understudied relation between Pavlovian inhibitory control and hyperactivity/impulsivity in adults with ADHD and (2) whether this inhibition can be enhanced by mindfulness based cognitive therapy (MBCT).Methods: 50 Adult ADHD patients were assessed before and after 8 weeks of treatment as usual (TAU) with (n=24) or without (n=26) MBCT. We employed a sophisticated, well-established Pavlovian-to-instrumental transfer task that quantifies Pavlovian control over instrumental behavior. Results: Task results revealed (1) less aversive Pavlovian inhibition in patients with clinical hyperactivity/impulsivity; and (2) enhanced inhibition after TAU+MBCT compared with TAU. Conclusions: Aversive Pavlovian inhibition plays a role in clinically relevant hyperactivity/impulsivity in adult ADHD and MBCT can be used to enhance this form of inhibition.

Rise, and pronounced regional variation, in methylphenidate, amphetamine, and lisdexamfetamine distribution in the United States

Background The prescription stimulants methylphenidate, amphetamine, and lisdexamfetamine are sympathomimetic drugs with therapeutic use. They are designated in the United States as Schedule II substances, defined by the 1970 Controlled Substances Act as having a “high potential for abuse”. Changing criteria for the diagnosis of Attention Deficit Hyperactivity Disorder in 2013 and the approval of lisdexamfetamine for binge eating disorder in 2015 may have impacted usage patterns. This report compared the pharmacoepidemiology of these stimulants in the United States from 2010–2017. Methods Distribution of amphetamine, methylphenidate, lisdexamfetamine were examined via weights extracted from the Drug Enforcement Administration’s (DEA) Automated Reports and Consolidated Ordering System (ARCOS). Median stimulant Daily Dosage per patient was determined for a regional analysis. The percent of cost and prescriptions attributable to each stimulant and atomoxetine in Medicaid from the “Drug Utilization 2018 - National Total” from the Centers for Medicare and Medicaid was determined. Results There was a rise in amphetamine (+67.5%) and lisdexamfetamine (+76.7%) from 2010–2017. The change in methylphenidate (−3.0%) was modest. Persons/day stimulant usage was lower in the West than in other US regions from 2014-2017. There was a negative correlation (r(48) = −0.43 to −0.65, p < .05) between the percent Hispanic population per state and the Daily Dosage/population per stimulant. Methylphenidate formulations accounted for over half (51.7%) of the $3.8 billion reimbursed by Medicaid and the plurality (45.4%) of the 22.0 million prescriptions. Amphetamine was responsible for less than one-fifth (18.4%) of cost but one-third of prescriptions (33.6%). Lisdexamfetamine’s cost (26.0%) exceeded prescriptions (16.3%). Conclusion The rising amphetamine and lisdexamfetamine distribution may correspond with a rise in adult ADHD diagnoses. Regional analysis indicates that stimulant distribution in the West may be distinct from that in other regions. The lower stimulant distribution in areas with greater Hispanic populations may warrant further study.

ADHD from Chıldhood to Adulthood

ttention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood, characterized by inattention, impulsivity, and hyperactivity. Recognizing and diagnosing ADHD in children is mostly during the school period. ADHD negatively affects children's skills necessary for academic success and social adaptation in the school environment. ADHD symptoms are at the forefront of the situations in which the child, not only the parents but also the teachers, directs the family to seek treatment or help. ADHD appears to affect 5-10% of children and 4.4% of adults worldwide. ADHD is a genetically inherited disease that emerges with the effect of genetic factors. For this reason, problems may arise in family functions when there is more than one person with ADHD at home. In this study, DSM-5 diagnostic criteria, models developed for the diagnosis of adult ADHD and what families can do when living with ADHD are shared.

An Observational Study of the Morning and Evening Behavior of Individuals With and Without Attention-Deficit/Hyperactivity Disorder

As individuals with ADHD move to young adulthood, the morning and evening times become of increased importance. Sixty individuals were enrolled in a 14-day study (30 with ADHD and 30 did not have ADHD). Participants provided self-reports of ADHD symptoms and impairment using ecological momentary assessments administered each morning and each evening. Participants also identified a collateral who could provide daily ratings of the participant during the same time. Driving data were also passively collected. Results indicated differences in self and collateral ratings of ADHD symptoms and impairment, with greater symptom endorsement and reports of impairment for the individuals with ADHD. Self-report indicated greater endorsement in the evening, relative to the morning, for individuals with ADHD. Collateral report did not interact with time of day. Passive evaluation of driving performance was not significantly different. Results indicate young adult ADHD symptoms and impairment can be reliably assessed in the morning/evening. Public Health Significance Evidence of ADHD symptoms and impairments were documented in the morning and evening hours for individuals diagnosed with ADHD. These results illustrate additional areas in need of attention in the refinement of treatments for adults with ADHD.

Creativity in the Predominantly Inattentive and Combined Presentations of ADHD in Adults

Objective: ADHD and its associated inhibition deficits might promote creativity. However, results in the literature are conflicting, possibly due to the heterogeneity of ADHD. To control for this heterogeneity, creativity, and inhibition were investigated in the predominantly inattentive (ADHD-I) and combined (ADHD-C) presentations. Method: Participants were males/females aged 18 to 51, diagnosed with ADHD-I ( n = 21), ADHD-C ( n = 19), or without ADHD ( n = 43). Self-rated Kaufman Domains of Creativity Scale and evaluator-rated figural Torrance Test of Creative Thinking (TTCT) were used for measuring creativity, Stroop task for inhibition, and Conners’ Adult ADHD Rating Scales for ADHD symptoms. Results: The ADHD-C group reported higher self-rated creativity than other groups and made more original drawings paired to more abstract titles in the figural TTCT than controls. Conclusion: ADHD-C participants were the most creative. This result was more importantly associated with higher degrees of ADHD symptoms rather than poorer inhibition.