7 Evidence-Based Insights About ADHD

February 21, 2019

This collection summarizes ADHD as it relates to bipolar disorder and borderline personality disorders; culturally competent care for the African-American population; issues with sleep disorders; and more.

ADHD is a neurodevelopmental disorder characterized by inappropriate levels of inattention and/or hyperactivity-impulsivity and occurs in children, adolescents, and adults. Scroll through the slides for the Psychiatric Times collection of evidence-based information to guide assessment, diagnosis, and treatment of ADHD across the lifespan.

The Evolution of ADHD. It has taken decades of research to show that some children with ADHD will continue to have symptoms into adulthood (DSM-5 provides a description of the symptoms in adults). First documented in DSM-II, ADHD disorder was referred to as Hyperkinetic Reaction of Childhood and described in one sentence. With DSM-III, the classification of mental disorders progressed from a simple description to the definition of disorders with specific diagnostic criteria. Hyperkinetic Reaction of Childhood was renamed Attention Deficit Disorder and the subtypes of “with and without Hyperactivity” were introduced. The term as we know it today, Attention Deficit Hyperactivity Disorder, was not introduced until DSM-III-R, with the controversial elimination of ADD without Hyperactivity. Subsequent editions of DSM further described specific subtypes/presentations of ADHD (predominantly Inattentive, predominantly Hyperactive-Impulsive, and Combined) with modifiers, 18 primary symptoms, and symptom thresholds necessary for a diagnosis of ADHD. DSM-5 addresses adults with ADHD to help guide psychiatrists and other mental health providers in the diagnosis and treatment of ADHD.

Issues Pertaining to Misuse of ADHD Prescription Medications. Studies attest to the effectiveness of prescription stimulants for ADHD symptoms in children and adults and more recent data show that stimulants often lead to improvements in self-regulation, planning, and organizational skills (ie, executive functions). However, studies also suggest that those who report difficulties with attention, executive functions, and internal restlessness are more likely to misuse prescription stimulants. Equally important to recognize is that adult patients who seek an ADHD diagnosis for themselves or for their children may be malingering in order to receive a prescription. Indeed, research shows that adults are highly successful at feigning ADHD when coached about symptoms. These scenarios emphasize the importance of obtaining a thorough childhood history, impairment information, and informant data (parents, teachers, significant others) when evaluating patients for ADHD and not rely only on self-report. Differential diagnosis is also crucial.

Do Diet and Nutrition Affect ADHD? Facts and Clinical Considerations. A patient’s diet represents a modifiable target for improving mental health, and for some people, changing one’s diet may improve ADHD symptoms. This topic comes up frequently in the clinical setting, especially by parents who are leery of treatment with psychotropic medications such as stimulants. This article examines the contributory role of diet on ADHD symptoms, including how the elimination of certain foods and additives, as well as the consumption of other foods or nutrients, may impact symptoms.

Culturally Competent Approaches to ADHD: Issues in African-American Populations. Mental health stigma has been found to be a significant factor in African-American treatment engagement. For this reason, taking steps to understand cultural considerations is key. ADHD is a common disorder, yet treatment disparities exist. Treatment decisions can be affected by misperceptions when working with minority youth and families. Gaining a better understanding of cultural factors can significantly improve patient engagement and outcomes. A comprehensive diagnostic assessment is essential and comorbidities must be assessed and addressed. Trauma can have an impact on attention, concentration, and impulsivity and questions related to trauma exposure should be asked. Structural barriers such as access to care, adequate follow-up, and concerns regarding stigma should also be identified.

ADHD: A 24-Hour Disorder. Sleep difficulties and sleep disorders are the most common comorbidities reported in individuals with ADHD. A multidirectional relationship is commonly present between ADHD and sleep issues. Practicing psychiatrists are on the front line to identify and assure optimal management. of both conditions. Screening for sleep difficulties prior to and during ADHD treatment is essential. Management strategies include sleep hygiene training, medication adjustments, or the use of melatonin or other hypnotic medications.

ADHD Neuroimaging: What’s New? Neuroimaging can provide rich insights into the biology of ADHD, particularly with the rise of large collaborative studies that examine brain structure and function in thousands of affected individuals. Neuroimaging has also expanded its focus to include adults to identify the mechanisms that might underpin adult remission as opposed to persistence. ranslating these insights into clinically useful tools is challenging but may benefit from novel analytic tools (based on machine learning) and the integration of imaging with genetic data. Here: Three recent trends in ADHD neuroimaging may lead to objective tools for diagnosis as well as stimulate discovery of novel therapeutics.

ADHD, Bipolar Disorder, and Borderline Personality Disorder. ADHD can present with symptoms such as irritability, mood lability, low frustration tolerance and low self-esteem, making it easily confused with mood disorders and personality disorders. This article summarizes the differential diagnosis between ADHD, bipolar disorder, and borderline personality disorders, highlighting similarities and differences in onset, course, clinical picture, and treatment. Each disorder is highly prevalent in juveniles and young adults. Comorbidity between these disorders is frequent and impairs symptoms and functional recovery as well as treatment response. For an accurate differential diagnosis, the clinician should rely on age of onset, psychiatric family history, treatment response, caregiver reports, and objective signs such as locomotor activity and sleep pattern.