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Screening for attention deficit–hyperactivity disorder (ADHD) symptomatology in adult mental health clinics

Published online by Cambridge University Press:  28 September 2017

D. Adamis Open the ORCID record for D. Adamis [Opens in a new window] ,
I. Graffeo ,
R. Kumar ,
D. Meagher ,
D. O’Neill ,
O. Mulligan ,
S. Murthy ,
E. O’Mahony ,
G. McCarthy  and
B. Gavin
...Show all authors
D. Adamis*
Affiliation:
Department of Psychiatry, Sligo Mental Health Services, Sligo, Ireland Department of Psychiatry, Research and Academic Institute of Athens, Athens, Greece Department of Psychiatry, University of Limerick, Limerick, Ireland
I. Graffeo
Affiliation:
Department of Psychiatry, Sligo Mental Health Services, Sligo, Ireland
R. Kumar
Affiliation:
Department of Psychiatry, Sligo Mental Health Services, Sligo, Ireland
D. Meagher
Affiliation:
Department of Psychiatry, University of Limerick Medical School, Limerick, Ireland
D. O’Neill
Affiliation:
Department of Psychiatry, Sligo Mental Health Services, Sligo, Ireland
O. Mulligan
Affiliation:
Department of Psychiatry, Sligo Mental Health Services, Sligo, Ireland
S. Murthy
Affiliation:
Department of Psychiatry, Sligo Mental Health Services, Sligo, Ireland
E. O’Mahony
Affiliation:
Department of Psychiatry, Sligo Mental Health Services, Sligo, Ireland
G. McCarthy
Affiliation:
Sligo Medical Academy, NUI Galway and Sligo Mental Health Services, Sligo, Ireland
B. Gavin
Affiliation:
Department of Psychiatry, University College Dublin, Ireland
F. McNicholas
Affiliation:
Department of Psychiatry, University College Dublin, Ireland
*
*Address for correspondence: Dr Dimitrios Adamis, Consultant Psychiatrist, Department of Psychiatry, Sligo Mental Health Services, Clarion Road, Sligo F91 CD34, Ireland. (Email: dimaadamis@yahoo.com)
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Abstract

Objectives

This study estimates the symptomatology of attention deficit–hyperactivity disorder (ADHD) in adult mental health services (AMHS) outpatient clinics.

Methods

All consecutive patients attending any of the outpatients’ clinics in Sligo/Leitrim AMHS were invited to participate. Participants completed the Adult ADHD Self-Report Scale (ASRS) and the Wender Utah Rating Scale (WURS) self-report. Clinical notes were reviewed to identify those with a pre-existing ADHD diagnosis.

Results

From 822 attending the clinics, 62 did not meet inclusion criteria, 97 declined to participate and 29 had incomplete data in either of the screening scales, leaving 634 (77%) eligible for full study analysis. Mean age was 40.38 (s.d.: 12.85), and 326 (51.4%) were females. In total, 215 (33.9%) screened positive on the WURS for childhood onset ADHD and 219 (34.5%) participants scored positive on the ASRS. Applying a more stringent criteria of scoring above cut-offs on both scales, suggested 131 (20.7%) screened positive on both. Only three (2.3%) had a prior clinical diagnosis.

Conclusions

This preliminary study suggests the possibility of relatively higher rates of ADHD in a general AMHS than previously thought, however, given the possibility of overlapping symptoms with other major psychiatric disorders in adulthood and recall bias further research is needed before drawing firm conclusions.

Keywords

Adultattention deficit–hyperactivity disorder (ADHD)epidemiologyprevalence
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 35 , Special Issue 3: Attention Deficit Hyperactivity Disorder , September 2018 , pp. 193 - 201
Copyright
© College of Psychiatrists of Ireland 2017 

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References

Able, SL, Johnston, JA, Adler, LA, Swindle, RW (2007). Functional and psychosocial impairment in adults with undiagnosed ADHD. Psychological Medicine 37, 97–107.Google Scholar
Agresti, A (2013). Categorical Data Analysis, 3rd edition. John Wiley & Sons: Hoboken, New Jersey, USA.Google Scholar
Almeida Montes, LG, Hernandez Garcia, AO, Ricardo-Garcell, J (2007). ADHD prevalence in adult outpatients with nonpsychotic psychiatric illnesses. Journal of Attention Disorders 11, 150–156.Google Scholar
Alpert, JE, Maddocks, A, Nierenberg, AA, O’Sullivan, R, Pava, JA, Worthington, JJ 3rd, Biederman, J, Rosenbaum, JF, Fava, M (1996). Attention deficit hyperactivity disorder in childhood among adults with major depression. Psychiatry Research 62, 213–219.Google Scholar
Asherson, P, Chen, W, Craddock, B, Taylor, E (2007). Adult attention-deficit hyperactivity disorder: recognition and treatment in general adult psychiatry. British Journal of Psychiatry 190, 4–5.Google Scholar
Barkley, RA, Fischer, M, Smallish, L, Fletcher, K (2002). The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Psychology 111, 279–289.Google Scholar
Beirne, M, McNamara, N, O’Keeffe, G, McNicholas, F (2013). Survey examining the views of Adult Psychiatry Consultants and Senior Registrars regarding ADHD. Irish Journal of Psychological Medicine 30, 197–203.Google Scholar
Biederman, J (2005). Attention-deficit/hyperactivity disorder: a selective overview. Biological Psychiatry 57, 1215–1220.Google Scholar
Biederman, J, Petty, CR, Evans, M, Small, J, Faraone, SV (2010). How persistent is ADHD? A controlled 10-year follow-up study of boys with ADHD. Psychiatry Research 177, 299–304.Google Scholar
Coghill, D (2015). Services for adults with ADHD: work in progress: commentary on . . . Specialist adult ADHD clinics in East Anglia. BJPsych Bulletin 39, 140–143.Google Scholar
Deberdt, W, Thome, J, Lebrec, J, Kraemer, S, Fregenal, I, Ramos-Quiroga, JA, Arif, M (2015). Prevalence of ADHD in nonpsychotic adult psychiatric care (ADPSYC): a multinational cross-sectional study in Europe. BMC Psychiatry 15, 242.Google Scholar
Faraone, SV, Biederman, J, Mick, E (2006). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine 36, 159–165.Google Scholar
Fayyad, J, De Graaf, R, Kessler, R, Alonso, J, Angermeyer, M, Demyttenaere, K, De Girolamo, G, Haro, JM, Karam, EG, Lara, C, Lepine, JP, Ormel, J, Posada-Villa, J, Zaslavsky, AM, Jin, R (2007). Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. British Journal of Psychiatry 190, 402–409.Google Scholar
Fischer, M (1997). Persistence of ADHD into adulthood: it depends on whom you ask. The ADHD Report 5, 8–10.Google Scholar
Gaub, M, Carlson, CL (1997). Gender differences in ADHD: a meta-analysis and critical review. Journal of the American Academy of Child and Adolescent Psychiatry 36, 1036–1045.Google Scholar
Ginsberg, Y, Quintero, J, Anand, E, Casillas, M, Upadhyaya, HP (2014). Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. Primary Care Companion for CNS Disorders 16, doi: 10.4088/PCC.13r01600.Google Scholar
Hall, CL, Newell, K, Taylor, J, Sayal, K, Hollis, C (2015). Services for young people with attention deficit/hyperactivity disorder transitioning from child to adult mental health services: a national survey of mental health trusts in England. Journal of Psychopharmacology 29, 39–42.Google Scholar
Hechtman, L (1992). Long-term outcome in attention-deficit hyperactivity disorder. Psychiatric Clinics of North America 1, 553–565.Google Scholar
Kessler, RC, Adler, L, Ames, M, Demler, O, Faraone, S, Hiripi, E, Howes, MJ, Jin, R, Secnik, K, Spencer, T, Ustun, TB, Walters, EE (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological Medicine 35, 245–256.Google Scholar
Kessler, RC, Adler, L, Barkley, R, Biederman, J, Conners, CK, Demler, O, Faraone, SV, Greenhill, LL, Howes, MJ, Secnik, K, Spencer, T, Ustun, TB, Walters, EE, Zaslavsky, AM (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry 163, 716–723.Google Scholar
Klein, RG, Mannuzza, S (1991). Long-term outcome of hyperactive children: a review. Journal of the American Academy of Child and Adolescent Psychiatry 30, 383–387.Google Scholar
Knight, TK, Kawatkar, A, Hodgkins, P, Moss, R, Chu, LH, Sikirica, V, Erder, MH, Nichol, MB (2014). Prevalence and incidence of adult attention deficit/hyperactivity disorder in a large managed care population. Current Medical Research and Opinion 30, 1291–1299.Google Scholar
Kooij, SJ, Bejerot, S, Blackwell, A, Caci, H, Casas-Brugue, M, Carpentier, PJ, Edvinsson, D, Fayyad, J, Foeken, K, Fitzgerald, M, Gaillac, V, Ginsberg, Y, Henry, C, Krause, J, Lensing, MB, Manor, I, Niederhofer, H, Nunes-Filipe, C, Ohlmeier, MD, Oswald, P, Pallanti, S, Pehlivanidis, A, Ramos-Quiroga, JA, Rastam, M, Ryffel-Rawak, D, Stes, S, Asherson, P (2010). European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 10, 67.Google Scholar
Lomas, B, Gartside, P (1999). ADHD in adult psychiatric outpatients. Psychiatric Services 50, 705.Google Scholar
Mannuzza, S, Klein, RG, Bessler, A, Malloy, P, LaPadula, M (1993). Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status. Arch Gen Psychiatry 50, 565–576.Google Scholar
Marchant, BK, Reimherr, FW, Robison, D, Robison, RJ, Wender, PH (2013). Psychometric properties of the Wender-Reimherr Adult Attention Deficit Disorder Scale. Psychological Assessment 25, 942.Google Scholar
McCann, BS, Roy-Byrne, P (2004). Screening and diagnostic utility of self-report attention deficit hyperactivity disorder scales in adults. Comprehensive Psychiatry 45, 175–183.Google Scholar
McCarthy, S, Wilton, L, Murray, M, Hodgkins, P, Asherson, P, Wong, IC (2013). Management of adult attention deficit hyperactivity disorder in UK primary care: a survey of general practitioners. Health and Quality of Life Outcomes 11, 22.Google Scholar
McNicholas, F, Adamson, M, McNamara, N, Gavin, B, Paul, M, Ford, T, Barry, S, Dooley, B, Coyne, I, Cullen, W (2015). Who is in the transition gap? Transition from CAMHS to AMHS in the Republic of Ireland. Irish Journal of Psychological Medicine 32, 61–69.Google Scholar
McNamara, N, McNicholas, F, Ford, T, Paul, M, Gavin, B, Coyne, I, Cullen, W, O’Connor, K, Ramperti, N, Dooley, B, Barry, S, Singh, S (2013). Transition from child and adolescent to Adult Mental Health Services in the Republic of Ireland: an investigation of process and operational practice. Early Intervention in Psychiatry 8, 291–297.Google Scholar
Moncrieff, J, Timimi, S (2010). Is ADHD a valid diagnosis in adults? No. BMJ 340, c547.Google Scholar
National Institute for Health and Clinical Excellence. (2008). Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults, Clinical Guideline CG72. National Institute for Health Care and Excellence, UK (https://www.nice.org.uk/guidance/cg72). Accessed 12 August 2016.Google Scholar
Nutt, DJ, Fone, K, Asherson, P, Bramble, D, Hill, P, Matthews, K, Morris, KA, Santosh, P, Sonuga-Barke, E, Taylor, E, Weiss, M, Young, S, British Association for Psychopharmacology (2007). Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 21, 10–41.Google Scholar
Nylander, L, Holmqvist, M, Gustafson, L, Gillberg, C (2009). ADHD in adult psychiatry. Minimum rates and clinical presentation in general psychiatry outpatients. Nordic Journal of Psychiatry 63, 64–71.Google Scholar
Oerbeck, B, Overgaard, K, Pripp, AH, Aase, H, Reichborn-Kjennerud, T, Zeiner, P (2015). Adult ADHD symptoms and satisfaction with life: does age and sex matter? Journal of Attention Disorders, doi: 10.1177/1087054715612257.Google Scholar
Rao, P, Place, M (2011). Prevalence of ADHD in four general adult outpatient clinics in North East England. Progress in Neurology and Psychiatry 15, 7–10.Google Scholar
Rasmussen, P, Gillberg, C (2000). Natural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study. Journal of the American Academy of Child and Adolescent Psychiatry 39, 1424–1431.Google Scholar
Rossini, ED, O’Connor, MA (1995). Retrospective self-reported symptoms of attention-deficit hyperactivity disorder: reliability of the Wender Utah Rating Scale. Psychological Reports 77, 751–754.Google Scholar
Rucklidge, JJ (2010). Gender differences in attention-deficit/hyperactivity disorder. Psychiatric Clinics of North America 33, 357–373.Google Scholar
Schroder, R, Sellman, D, Frampton, C, Deering, D (2009). Youth retention: factors associated with treatment drop‐out from youth alcohol and other drug treatment. Drug and Alcohol Review 28, 663–668.Google Scholar
Simon, V, Czobor, P, Balint, S, Meszaros, A, Bitter, I (2009). Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. British Journal of Psychiatry 194, 204–211.Google Scholar
Singh, SP, Paul, M, Ford, T, Kramer, T, Weaver, T, McLaren, S, Hovish, K, Islam, Z, Belling, R, White, S (2010). Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study. British Journal of Psychiatry 197, 305–312.Google Scholar
Syed, H, Masaud, TM, Nkire, N, Iro, C, Garland, MR (2010). Estimating the prevalence of adult ADHD in the psychiatric clinic: a cross-sectional study using the adult ADHD self-report scale (ASRS). Irish Journal of Psychological Medicine 27, 195–197.Google Scholar
Tatlow-Golden, M, Neary, M, Farrelly, N, Reulbach, U, McNicholas, F (2015). ADHD young adult service innovations: a combined child and adult psychiatry-led pilot university-based ADHD service. European Child & Adolescent Psychiatry 24, S88–S89.Google Scholar
Taylor, A, Deb, S, Unwin, G (2011). Scales for the identification of adults with attention deficit hyperactivity disorder (ADHD): a systematic review. Research in Developmental Disabilities 32, 924–938.Google Scholar
Thorley, G (1984). Review of follow-up and follow-back studies of childhood hyperactivity. Psychological Bulletin 96, 116–132.Google Scholar
Toone, B (2004). Attention deficit hyperactivity disorder in adulthood. Journal of Neurology, Neurosurgery, and Psychiatry 75, 523–525.Google Scholar
Turgay, A, Goodman, DW, Asherson, P, Lasser, RA, Babcock, TF, Pucci, ML, Barkley, R, Group, ATPMW (2012). Lifespan persistence of ADHD: the life transition model and its application. Journal of Clinical Psychiatry 73, 192–201.Google Scholar
Valdizan, JR, Izaguerri-Gracia, AC (2009). Attention deficit hyperactivity disorder in adults. Revista de Neurologia 48 (Suppl. 2): S95–S99.Google Scholar
van de Glind, G, van den Brink, W, Koeter, MW, Carpentier, PJ, van Emmerik-van Oortmerssen, K, Kaye, S, Skutle, A, Bu, ET, Franck, J, Konstenius, M, Moggi, F, Dom, G, Verspreet, S, Demetrovics, Z, Kapitany-Foveny, M, Fatseas, M, Auriacombe, M, Schillinger, A, Seitz, A, Johnson, B, Faraone, SV, Ramos-Quiroga, JA, Casas, M, Allsop, S, Carruthers, S, Barta, C, Schoevers, RA, Group, IR, Levin, FR (2013). Validity of the Adult ADHD Self-Report Scale (ASRS) as a screener for adult ADHD in treatment seeking substance use disorder patients. Drug and Alcohol Dependence 132, 587–596.Google Scholar
van Emmerik-van Oortmerssen, K, van de Glind, G, van den Brink, W, Smit, F, Crunelle, CL, Swets, M, Schoevers, RA (2012). Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug and Alcohol Dependence 122, 11–19.Google Scholar
Wierzbicki, M (2005). Reliability and validity of the Wender Utah Rating Scale for college students. Psychological Reports 96, 833–839.Google Scholar