Adult ADHD and comorbid disorders: clinical implications of a dimensional approach

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Abstract

Attention-deficit/hyperactivity disorder (ADHD) in the adult population is frequently associated with comorbid psychiatric diseases that complicate its recognition, diagnosis and management.

The prevalence of ADHD in the general adult population is 2.5% and it is associated with substantial personal and individual burden. The most frequent comorbid psychopathologies include mood and anxiety disorders, substance use disorders, and personality disorders. There are strong familial links and neurobiological similarities between ADHD and the various associated psychiatric comorbidities. The overlapping symptoms between ADHD and comorbid psychopathologies represent challenges for diagnosis and treatment. Guidelines recommend that when ADHD coexists with other psychopathologies in adults, the most impairing condition should generally be treated first.

Early recognition and treatment of ADHD and its comorbidities has the potential to change the trajectory of psychiatric morbidity later in life. The use of validated assessment scales and high-yield clinical questions can help identify adults with ADHD who could potentially benefit from evidence-based management strategies.

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Conflict monitoring by the anterior cingulate cortex (ACC) has been posited to signal a need for greater cognitive control, producing neural and behavioral adjustments. However, the very occurrence of behavioral adjustments after conflict has been questioned, along with suggestions that there is no direct evidence of ACC conflict-related activity predicting subsequent neural or behavioral adjustments in control. Using the Stroop color-naming task and controlling for repetition effects, we demonstrate that ACC conflict-related activity predicts both greater prefrontal cortex activity and adjustments in behavior, supporting a role of ACC conflict monitoring in the engagement of cognitive control.

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The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies.

Stephen V Faraone, Joseph Biederman, Eric Mick (2006)

This study examined the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood. We analyzed data from published follow-up studies of ADHD. To be included in the analysis, these additional studies had to meet the following criteria: the study included a control group and it was clear from the methods if the diagnosis of ADHD included subjects who did not meet full criteria but showed residual and impairing signs of the disorder. We used a meta-analysis regression model to separately assess the syndromatic and symptomatic persistence of ADHD. When we define only those meeting full criteria for ADHD as having 'persistent ADHD', the rate of persistence is low, approximately 15% at age 25 years. But when we include cases consistent with DSM-IV's definition of ADHD in partial remission, the rate of persistence is much higher, approximately 65%. Our results show that estimates of ADHD's persistence rely heavily on how one defines persistence. Yet, regardless of definition, our analyses show that evidence for ADHD lessens with age. More work is needed to determine if this reflects true remission of ADHD symptoms or is due to the developmental insensitivity of diagnostic criteria for the disorder.

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Author and article information

Contributors

Martin A. Katzman: 416-598-9344 , mkatzman@startclinic.ca

Timothy S. Bilkey: drtimbilkey@yahoo.ca

Pratap R. Chokka: pratapchokka@chokkacenter.com

Angelo Fallu: fallu.a@videotron.ca

Larry J Klassen: larryjklassen@hotmail.com

Journal

Journal ID (nlm-ta): BMC Psychiatry

Journal ID (iso-abbrev): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-244X

Publication date (Electronic): 22 August 2017

Publication date PMC-release: 22 August 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 302

Affiliations

[1 ]START Clinic for Mood and Anxiety Disorders, 32 Park Road, Toronto, ON M4W 2N4 Canada

[2 ]Adler Graduate Professional School, Toronto, ON Canada

[3 ]ISNI 0000 0001 0687 7127, GRID grid.258900.6, Northern Ontario School of Medicine, , Laurentian and Lakehead University, ; Thunder Bay, ON Canada

[4 ]ISNI 0000 0001 0687 7127, GRID grid.258900.6, Department of Psychology, , Lakehead University, ; 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada

[5 ]Ontario Bilkey ADHD Clinics, 400 Bayfield Street, Suite 245, Barrie, ON L4M 5A1 Canada

[6 ]Chokka Center for Integrative Health, 2603 Hewes Way NW #201, Edmonton, Alberta T6L 6W6 Canada

[7 ]GRID grid.17089.37, , University of Alberta, 1E1 Walter Mackenzie Centre, ; Edmonton, AB T6G 2R7 Canada

[8 ]Clinique Woodward, 717 rue Woodward, DIEX Research Inc., Sherbrooke, Quebec, J1G 1W4 Canada

[9 ]Eden Mental Health Centre, 1500 Pembina Ave, Winkler, MB R6W 1T4 Canada

Article

Publisher ID: 1463

DOI: 10.1186/s12888-017-1463-3

PMC ID: 5567978

PubMed ID: 28830387

SO-VID: fdb8d83a-3e06-4e97-bf9c-01ca61a64ec7

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.