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Attention Deficit Hyperactivity Disorder (ADHD): Diagnosis, Treatment, and Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (25 September 2024) | Viewed by 13731

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Prof. Dr. Marios Adamou

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School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
Interests: ADHD; neurodevelopmental disorders; autism; AI in mental health; service development
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on adult ADHD, specifically focusing on the clinical pathway from pre-diagnosis, referral, and diagnostic and treatment approaches.

Adult ADHD is a rather new diagnostic category compared to other disorders, despite it being researched considerably. Areas of focus have been neuropsychology, biological markers, genetic markers, neuroanatomy, and neuroimaging.

Globally, there seems to be increased demand for assessments and treatments for ADHD, and in conjunction with this, there have been developments in the assessment and treatment methods used. In addition to the refinement of the construct of ADHD as it applies to women, the search is expanding to cover specific medical populations, for example, post-menopausal women, or finding associations with specific medical conditions such as cardiovascular diseases. The overlap in terms of types of impairments with other neurodevelopmental disorders continues to be elucidated.

In this context, the use of technology in the diagnosis of ADHD, either using AI or wearable devices, has been emerging. The pace of innovation in this field is enormous, with several technological solutions being put forward to aid the diagnosis of ADHD.

Regarding treatment approaches, several new pharmacological approaches have been studied, and different psychological and other types of methods are being developed to achieve a more holistic approach to therapeutics than medication.

This Special Issue is designed to collect articles focusing on new populations in which ADHD can be found, new approaches to diagnostics, and new treatment approaches. It welcomes input from different disciplines who feel they can contribute to this discussion.

Prof. Dr. Marios Adamou
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

adult ADHD
neurodevelopmental disorders
clinical diagnostics
digital diagnostics
artificial intelligence
multimodal treatments

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Published Papers (9 papers)

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20 pages, 1423 KiB

Open AccessArticle

The Creative Awareness Theory: A Grounded Theory Study of Inherent Self-Regulation in Attention Deficit Hyperactivity Disorder

by Rebecca E. Champ, Marios Adamou, Warren Gillibrand, Sally Arrey and Barry Tolchard

J. Clin. Med. 2024, 13(19), 5963; https://doi.org/10.3390/jcm13195963 - 7 Oct 2024

Viewed by 1456

Abstract

Objectives: The aim of this study was to determine why and how adults with attention deficit hyperactivity disorder (ADHD) experience variable impairment and identify the processes and strategies adults with ADHD use to develop positive self-regulation skills. Methods: A mixed cohort of 11 participants (6 female and 5 male) from a university, an adult ADHD clinic and an ADHD support group in the UK were interviewed online between September 2021 and February 2022. Data were collected and analysed simultaneously, inspired by a constructivist grounded theory methodology. Results: Participants described a “polar awareness of difference” from others in terms of engagement and ADHD characteristics, and a “polar awareness of consciousness” experienced as the states of chaotic attention and hyperfocus, both of which impact core perceptions of self. Using an infinity paradigm, the results demonstrate unskilled attempts to self-regulate within and between these states using self-absorption or self-transcendence strategies, including their inherent challenges and energetic cost. Our results further indicate that at the centre of this dynamic paradigm, creative awareness strategies exist, which exemplify polarity awareness and the regulation of that awareness supported by an authentic inner compass (AIC). Conclusions: This paper presents the empirical foundation for the ADHD Creative Awareness Theory (CAT)—a new theory for understanding the experience of ADHD consciousness and environmental engagement. Practical implications are explored, and recommendations include use of the CAT as a framework for understanding and development of inherent self-regulation skills for adults with ADHD. Full article

(This article belongs to the Special Issue Attention Deficit Hyperactivity Disorder (ADHD): Diagnosis, Treatment, and Management)

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15 pages, 258 KiB

Open AccessArticle

Neurodevelopmental Impairments in Adult Psychosomatic Patients

by Nils Christensen, Michael Linden and Beate Muschalla

J. Clin. Med. 2024, 13(18), 5566; https://doi.org/10.3390/jcm13185566 - 19 Sep 2024

Viewed by 409

Abstract

Background/Objectives: Neuropsychological, neurodevelopmental, or minimal cerebral dysfunctions (MCD) can be found in many patients with mental disorders. They can be masked by other symptoms, impair the course of the illness, and impair work and social participation. Despite a long history of research, there is still a lack of data on the spectrum, prevalence, and consequences of these dysfunctions in patients with chronic illness. In this study, we compared patients with and without a history of neurocognitive problems in childhood for present neuropsychological dysfunctions. Methods: A convenience sample of 1453 psychosomatic inpatients completed the MCD scale, assessing neurodevelopmental issues in childhood and current neuropsychological dysfunctions. Additional assessments were the Attention Deficit Hyperactivity Self Rating Scale (ADHS-SB) and the Symptom Checklist 90 (SCL-90). Results: Significant early neurodevelopmental problems were reported by 8.87% of the patients. This group also reported a significantly higher rate of MCD symptoms and general psychosomatic symptoms (SCL-90) as compared with other patients. Conclusions: There is a notable prevalence of neuropsychological dysfunctions in psychosomatic patients in general, and especially in those with early neurodevelopmental problems. To adequately address specific potentially participation-relevant impairments, a broader diagnostic approach is necessary, including exploration of MCD history and present neuropsychological dysfunctions. Full article

(This article belongs to the Special Issue Attention Deficit Hyperactivity Disorder (ADHD): Diagnosis, Treatment, and Management)

10 pages, 1313 KiB

Open AccessArticle

What Is the Link between Attention-Deficit/Hyperactivity Disorder (ADHD) and Dyslipidemia in Adults? A German Retrospective Cohort Study

by Sarah Krieg, Marcel Konrad, Andreas Krieg and Karel Kostev

J. Clin. Med. 2024, 13(15), 4460; https://doi.org/10.3390/jcm13154460 - 30 Jul 2024

Viewed by 856

Abstract

Background: Alterations in the serum lipid profile have been suspected in many psychiatric disorders, such as schizophrenia and depression. However, studies on lipid status in attention-deficit/hyperactivity disorder (ADHD) are sparse and inconsistent. Methods: Using the nationwide, population-based IQVIA Disease Analyzer database, this retrospective cohort study included 5367 outpatients from general practices in Germany aged ≥18 years with a documented first diagnosis of ADHD between January 2005 and December 2021 and 26,835 propensity score-matched individuals without ADHD. Study outcomes were the first diagnosis of lipid metabolism disorders as a function of ADHD within up to 10 years of the index date. The cumulative 10-year incidence was analyzed using Kaplan–Meier curves and compared using the log-rank test. In addition, univariate Cox regression analyses were performed. Results: In the regression analysis, there was no significant association between ADHD and subsequent lipid metabolism disorders in the total population (HR: 0.94; 95% CI: 0.83–1.08), among women (HR: 1.04; 95% CI: 0.84–1.28), and among men (HR: 0.89; 95% CI: 0.74–1.06). In addition, no significant association was observed in the disease-stratified analyses. Conclusions: The findings of this study indicate that ADHD does not exert an influence on lipid metabolism. However, further investigation is warranted, particularly with respect to pharmacological interventions. Full article

(This article belongs to the Special Issue Attention Deficit Hyperactivity Disorder (ADHD): Diagnosis, Treatment, and Management)

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14 pages, 1465 KiB

Open AccessArticle

Push–Pull Mechanism of Attention and Emotion in Children with Attention Deficit Hyperactivity Disorder

by Ji-Hyun Song and So-Yeon Kim

J. Clin. Med. 2024, 13(14), 4206; https://doi.org/10.3390/jcm13144206 - 18 Jul 2024

Viewed by 718

Abstract

Background/Objectives: While deficits in executive attention and alerting systems in children with attention deficit hyperactivity disorder (ADHD) are well-documented, findings regarding orienting attention in ADHD have been inconsistent. The current study investigated the mechanism of attentional orienting in children with ADHD by examining their attentional bias towards threatening stimuli. Furthermore, we explored the modulating role of anxiety levels in ADHD on this attentional bias. Methods: In Experiment 1, 20 children with ADHD and 26 typically developing children (TDC) performed a continuous performance task that included task-irrelevant distractions consisting of angry faces and neutral places. In Experiment 2, 21 children with ADHD and 25 TDC performed the same task, but with angry and neutral faces as distractors. To measure children’s anxiety levels, the State-Trait Anxiety Inventory was administered before each experiment. Results: In Experiment 1, results revealed no attentional bias effects in children with ADHD, whereas TDC exhibited attentional capture effects by both types of distractors. However, in Experiment 2, ADHD children demonstrated an attentional bias towards angry faces, which revealed a significant positive correlation with their trait anxiety levels (r = 0.61, p < 0.05). Further analyses combining all ADHD children showed that trait anxiety levels in Experiment 2 were significantly higher than those in Experiment 1. Finally, a significant positive correlation was found between anxiety levels and attentional bias towards angry faces in all ADHD children (r = 0.36, p < 0.01). Conclusions: Children with ADHD exhibited atypical attentional-orienting effects to threats, and their levels of trait anxiety appeared to modulate such attentional-orienting mechanisms. Full article

(This article belongs to the Special Issue Attention Deficit Hyperactivity Disorder (ADHD): Diagnosis, Treatment, and Management)

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8 pages, 224 KiB

Open AccessArticle

Attention-Deficit Hyperactivity Disorder Symptoms in Adults Diagnosed with Multiple Sclerosis: Prevalence and Correlates

by Mariam Al-Ameri, Hanan Abu-Shaikh, Mohammad Mansour, Suha Al-Habahbeh, Feras Weshah, Wail Ennab, Ammena Y. Binsaleh, Sireen Abdul Rahim Shilbayeh and Omar Gammoh

J. Clin. Med. 2024, 13(13), 3844; https://doi.org/10.3390/jcm13133844 - 29 Jun 2024

Viewed by 2411

Abstract

Background: The relationship between adult ADHD symptoms in People with Multiple Sclerosis (PwMS) is understudied. This study aimed to answer two questions: are PwMS more likely to experience higher ADHD symptoms versus healthy subjects? And what are the correlates of severe ADHD symptoms in PwMS? Methods: This study followed a cross-sectional design with predefined inclusion criteria. The Adult ADHD Self-Report Scale-V1.1 (ASRS) was used to assess the ADHD symptoms severity. Results: Data were analyzed from 171 PwMS and 200 controls. Regression analysis revealed that PwMS were at a significantly (B = 3.05, t = 2.24, 95% CI = 0.37–5.73, p = 0.02) higher risk to report higher ADHD scores versus controls. In addition, PwMS with relapses in the last 6 months and PwMS reporting smartphone addiction were at a significantly higher risk for severe ADHD (B = 7.19, t = 269, 95% CI = 1.91–12.48, p = 0.008) and (B = 9.18, t = 3.47, 95% CI = 3.97–14.41, p = 0.001), respectively. In conclusion, diagnosis with MS in our study was identified as a risk for higher ADHD symptoms. Conclusions: Further research is required to establish this relationship, and holistic medical and psychological interventions are required to improve the cognitive status of PwMS. Full article

(This article belongs to the Special Issue Attention Deficit Hyperactivity Disorder (ADHD): Diagnosis, Treatment, and Management)

10 pages, 234 KiB

Open AccessArticle

Attention Deficit Hyperactivity Disorder: A Risk Factor for Premature Discontinuation of Inpatient Opioid Withdrawal Treatment

by Nikolas Gaspar, Laura Luisa Kilarski, Helena Rosen, Maximilian Huppertz, Alexandra Philipsen and Henrik Rohner

J. Clin. Med. 2024, 13(11), 3301; https://doi.org/10.3390/jcm13113301 - 3 Jun 2024

Viewed by 734

Abstract

Background: Substance use disorders present a tremendous challenge within contemporary healthcare systems. Specifically, in the domain of opioid use disorders (OUDs), several foundational elements are crucial for the efficacious management of afflicted individuals. Regrettably, the premature discontinuation of inpatient opioid withdrawal treatment is a prevalent phenomenon. This study aims to elucidate the prevalence of the premature termination of inpatient opioid withdrawal treatment among patients with comorbid ADHD. Methods: We conducted a comprehensive assessment of all participants currently undergoing inpatient opioid withdrawal treatment. Our assessment protocol included the administration of the ADHD Self-Report Scale (ADHD-SR) and the Wender Utah Rating Scale (WURS-k). Additionally, participants who met the thresholds on one or both questionnaires underwent further evaluation using the Diagnostic Interview for ADHD in Adults (DIVA-2.0). Results: The prevalence of individuals diagnosed with ADHD within the studied cohort was determined to be 29.3%. Among the subset of participants identified as ADHD-positive, a notable 54.5% prematurely ceased therapy. In contrast, among those identified as ADHD-negative, the premature discontinuation rate was substantially lower at 28.3%. Conclusions: In summary, the impact of ADHD as a comorbid condition on the efficacy of inpatient opioid withdrawal treatment has been underscored. By identifying comorbid ADHD early in the treatment process, tailored therapeutic approaches may help to maximize the effectiveness of interventions and may improve patient outcomes. This underscores the importance of proactive screening for ADHD as a psychiatric comorbidity in optimizing the management of individuals undergoing inpatient opioid withdrawal treatment. Full article

(This article belongs to the Special Issue Attention Deficit Hyperactivity Disorder (ADHD): Diagnosis, Treatment, and Management)

13 pages, 1725 KiB

Open AccessArticle

A Nomogram for Predicting ADHD and ASD in Child and Adolescent Mental Health Services (CAMHS)

by Hilario Blasco-Fontecilla, Chao Li, Miguel Vizcaino, Roberto Fernández-Fernández, Ana Royuela and Marcos Bella-Fernández

J. Clin. Med. 2024, 13(8), 2397; https://doi.org/10.3390/jcm13082397 - 19 Apr 2024

Viewed by 1199

Abstract

Objectives: To enhance the early detection of Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) by leveraging clinical variables collected at child and adolescent mental health services (CAMHS). Methods: This study included children diagnosed with ADHD and/or ASD (n = 857). Three logistic regression models were developed to predict the presence of ADHD, its subtypes, and ASD. The analysis began with univariate logistic regression, followed by a multicollinearity diagnostic. A backward logistic regression selection strategy was then employed to retain variables with p < 0.05. Ethical approval was obtained from the local ethics committee. The models’ internal validity was evaluated based on their calibration and discriminative abilities. Results: The study produced models that are well-calibrated and validated for predicting ADHD (incorporating variables such as physical activity, history of bone fractures, and admissions to pediatric/psychiatric services) and ASD (including disability, gender, special education needs, and Axis V diagnoses, among others). Conclusions: Clinical variables can play a significant role in enhancing the early identification of ADHD and ASD. Full article

(This article belongs to the Special Issue Attention Deficit Hyperactivity Disorder (ADHD): Diagnosis, Treatment, and Management)

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21 pages, 1659 KiB

Open AccessArticle

A Female-Specific Treatment Group for ADHD—Description of the Programme and Qualitative Analysis of First Experiences

by M. de Jong, D. S. M. R. Wynchank, M. Michielsen, A. T. F. Beekman and J. J. S. Kooij

J. Clin. Med. 2024, 13(7), 2106; https://doi.org/10.3390/jcm13072106 - 4 Apr 2024

Viewed by 2446

Abstract

Background: The diagnostics and treatment of attention-deficit/hyperactivity disorder (ADHD) in women remain insufficient. Fluctuations of reproductive hormones during the premenstrual period, postpartum period, and (peri)menopause are neglected, even though they impact ADHD symptoms and associated mood disorders. Therefore, we created a female-specific treatment group for women with ADHD and premenstrual worsening of ADHD and/or mood symptoms. Methods: We describe the group programme and underlying rationale, offering a qualitative analysis of the participants’ evaluation. Results: The seven bi-weekly sessions foreground the menstrual cycle and address several ADHD-specific topics in relation to this cyclical pattern. Concurrently, women track their menstrual cycle and (fluctuating) ADHD and mood symptoms with an adjusted premenstrual calendar. In total, 18 women (25–47 years) participated in three consecutive groups. We analysed the evaluation of the last group. Participants experienced the group as a safe and welcoming space. Recognition was valued by all. The topics discussed were deemed valuable, and the structure suited them well. Completing the premenstrual calendar augmented the awareness and recognition of individual cyclical symptoms. A lifespan approach increased self-understanding. Participants took their menstrual cycle more seriously, prioritising self-acceptance and self-care. Conclusions: Exploring a cyclical approach in a group setting seems to be a positive addition to treatment for female ADHD. Full article

(This article belongs to the Special Issue Attention Deficit Hyperactivity Disorder (ADHD): Diagnosis, Treatment, and Management)

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17 pages, 2188 KiB

Open AccessSystematic Review

Systematic Review of Executive Function Stimulation Methods in the ADHD Population

by Carlos Ramos-Galarza, Deyaneira Brito, Brayan Rodríguez, Brenda Guerrero, Jorge Cruz-Cárdenas and Mónica Bolaños-Pasquel

J. Clin. Med. 2024, 13(14), 4208; https://doi.org/10.3390/jcm13144208 - 19 Jul 2024

Viewed by 2542

Abstract

Background/Objectives: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by elevated motor activity, impulsivity, and attention deficit. Approximately 5% of the population suffers from this disorder. Among the key explanations of ADHD, executive functions play an important role in understanding the symptomatology present in this disorder and in determining the main treatment strategies for affected patients. We present a systematic review that seeks to identify the treatment methods developed to support executive functions in individuals with ADHD. Methods: Articles were analyzed in the SCOPUS, PUBMED, and Science Direct databases. Initially, 739 articles were found. After applying inclusion and exclusion criteria, 30 articles remained and were included in the data extraction process. Results: Among the primary treatments identified, 14 studies propose psychological training for executive functions, 9 studies recommend medication, 5 studies suggest digital interventions, and 1 study advocates for sports as beneficial for executive functions. Conclusions: The data are discussed around the need to develop new proposals to enhance the executive functions of individuals with ADHD, thereby improving their performance in educational, personal, social, and family activities impacted by this disorder. Full article

(This article belongs to the Special Issue Attention Deficit Hyperactivity Disorder (ADHD): Diagnosis, Treatment, and Management)

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