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A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults.

Das D, Cherbuin N, Butterworth P, Anstey KJ, Easteal S - PLoS ONE (2012)

Bottom Line: No significant gender difference in the distribution of ASRS scores was observed.Compared to the hyperactivity component, the inattention trait was particularly strongly associated and remained significant after controlling for depression/anxiety symptoms.Our study confirms previous findings and significantly adds to existing literature especially for an age-group that has not been well-studied.

View Article: PubMed Central - PubMed

Affiliation: John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia. debjani.das@anu.edu.au

ABSTRACT
Attention deficit/hyperactivity disorder (ADHD) is the most prevalent childhood psychiatric condition. It frequently persists into adulthood and can have serious health and other adverse consequences. The majority of previous adult ADHD studies have focused on young adults so that relatively little is known about ADHD symptoms and their effects in mid and late life. In addition, effects of subclinical levels of attention deficit and hyperactivity have not been studied in detail. In this study we investigated ADHD symptoms and related impairment in a large population-based sample of middle-aged Australian adults (n = 2091; 47% male). Applying the WHO adult ADHD Self Report Screener (ASRS) we observed that 6.2% of participants had scores that were previously associated with ADHD diagnosis. No significant gender difference in the distribution of ASRS scores was observed. Multiple regression analyses indicated strong positive correlations between symptoms of ADHD and depression/anxiety and significant negative associations (p<0.01) with employment, financial stress, relationship quality, health and well-being measures in this age group. Importantly, associations were highly significant even when few ADHD symptoms were reported. Compared to the hyperactivity component, the inattention trait was particularly strongly associated and remained significant after controlling for depression/anxiety symptoms. Our study confirms previous findings and significantly adds to existing literature especially for an age-group that has not been well-studied. Our results suggest that ADHD symptoms continue to be associated with ill-health and functional impairment in mid-life and are, therefore, likely to be a major, previously unrecognized source of late-life morbidity with associated social and economic costs. Thus, there is a compelling need for better understanding and development of age-appropriate approaches to the diagnosis and treatment of ADHD in mid- to late-life.

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Distribution of ASRS score, HTS and ITS.A) ASRS total score shown separately for males and females. B) HTS shown if responses to all inatention-related ASRS items were “often” or “very often”; C) ITS shown if responses to all hyperactivity-related ASRS items were “often” or “very often”.
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pone-0031500-g001: Distribution of ASRS score, HTS and ITS.A) ASRS total score shown separately for males and females. B) HTS shown if responses to all inatention-related ASRS items were “often” or “very often”; C) ITS shown if responses to all hyperactivity-related ASRS items were “often” or “very often”.

Mentions: For each individual item on the ASRS questionnaire, the frequency of participants responding to each point of the response scale is shown in Table 1. The proportion of participants reporting “often” or “very often” varied for individual items, ranging from 6–17%. The ASRS total score followed an approximate normal distribution in this sample (Figure 1A) with a mean score of 8.2 and a standard deviation of 3.4. To distinguish possible ADHD cases from non-cases at the individual level we applied both the dichotomous and the four-strata classification schemes as suggested by Kessler et al (2007) [35]. Using the dichotomous classification scheme, 6.2% of participants had scores equal to or above the cut-off score of 14, which has been previously associated with ADHD diagnosis. When the four-strata classification scheme was applied, 67.3%, 26.5%, 5.2% and 1% of participants were present in strata I, II, III and IV, respectively. The four-strata classification was reported to have strong concordance with clinical diagnosis with stratum IV most likely and stratum I least likely to contain ADHD cases. Strata II and III represents those with few and/or mild ADHD symptoms and might represent subthreshold cases. We also found no significant difference between males and females in either the continuous or categorical ASRS measures (Table 2).


A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults.

Das D, Cherbuin N, Butterworth P, Anstey KJ, Easteal S - PLoS ONE (2012)

Distribution of ASRS score, HTS and ITS.A) ASRS total score shown separately for males and females. B) HTS shown if responses to all inatention-related ASRS items were “often” or “very often”; C) ITS shown if responses to all hyperactivity-related ASRS items were “often” or “very often”.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3275565&req=5

pone-0031500-g001: Distribution of ASRS score, HTS and ITS.A) ASRS total score shown separately for males and females. B) HTS shown if responses to all inatention-related ASRS items were “often” or “very often”; C) ITS shown if responses to all hyperactivity-related ASRS items were “often” or “very often”.
Mentions: For each individual item on the ASRS questionnaire, the frequency of participants responding to each point of the response scale is shown in Table 1. The proportion of participants reporting “often” or “very often” varied for individual items, ranging from 6–17%. The ASRS total score followed an approximate normal distribution in this sample (Figure 1A) with a mean score of 8.2 and a standard deviation of 3.4. To distinguish possible ADHD cases from non-cases at the individual level we applied both the dichotomous and the four-strata classification schemes as suggested by Kessler et al (2007) [35]. Using the dichotomous classification scheme, 6.2% of participants had scores equal to or above the cut-off score of 14, which has been previously associated with ADHD diagnosis. When the four-strata classification scheme was applied, 67.3%, 26.5%, 5.2% and 1% of participants were present in strata I, II, III and IV, respectively. The four-strata classification was reported to have strong concordance with clinical diagnosis with stratum IV most likely and stratum I least likely to contain ADHD cases. Strata II and III represents those with few and/or mild ADHD symptoms and might represent subthreshold cases. We also found no significant difference between males and females in either the continuous or categorical ASRS measures (Table 2).

Bottom Line: No significant gender difference in the distribution of ASRS scores was observed.Compared to the hyperactivity component, the inattention trait was particularly strongly associated and remained significant after controlling for depression/anxiety symptoms.Our study confirms previous findings and significantly adds to existing literature especially for an age-group that has not been well-studied.

View Article: PubMed Central - PubMed

Affiliation: John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia. debjani.das@anu.edu.au

ABSTRACT
Attention deficit/hyperactivity disorder (ADHD) is the most prevalent childhood psychiatric condition. It frequently persists into adulthood and can have serious health and other adverse consequences. The majority of previous adult ADHD studies have focused on young adults so that relatively little is known about ADHD symptoms and their effects in mid and late life. In addition, effects of subclinical levels of attention deficit and hyperactivity have not been studied in detail. In this study we investigated ADHD symptoms and related impairment in a large population-based sample of middle-aged Australian adults (n = 2091; 47% male). Applying the WHO adult ADHD Self Report Screener (ASRS) we observed that 6.2% of participants had scores that were previously associated with ADHD diagnosis. No significant gender difference in the distribution of ASRS scores was observed. Multiple regression analyses indicated strong positive correlations between symptoms of ADHD and depression/anxiety and significant negative associations (p<0.01) with employment, financial stress, relationship quality, health and well-being measures in this age group. Importantly, associations were highly significant even when few ADHD symptoms were reported. Compared to the hyperactivity component, the inattention trait was particularly strongly associated and remained significant after controlling for depression/anxiety symptoms. Our study confirms previous findings and significantly adds to existing literature especially for an age-group that has not been well-studied. Our results suggest that ADHD symptoms continue to be associated with ill-health and functional impairment in mid-life and are, therefore, likely to be a major, previously unrecognized source of late-life morbidity with associated social and economic costs. Thus, there is a compelling need for better understanding and development of age-appropriate approaches to the diagnosis and treatment of ADHD in mid- to late-life.

Show MeSH
Related in: MedlinePlus