Skip to main content
SpringerLink
Log in

The Diagnosis of Adult ADHD Toward a Precision Psychiatry Approach

  • Chapter
  • First Online:
The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders

  • 1376 Accesses

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a disorder affecting all aspects of the individual’s life, from preschool years until senescence. It exerts an impact that is not limited to the individual, but involves relatives, offspring, and the community. Since the phenotypic expression of ADHD is highly heterogeneous, and due to the very frequent co-occurrence of other psychiatric disorders, the diagnostic assessment of ADHD can be very difficult. Moreover, despite the ever-increasing scientific evidence supporting the real existence of ADHD as a syndrome, some prejudices still exist around this diagnosis. These are mainly due to treatment with stimulant drugs, for which clinicians making such diagnosis may appear to be partners in crime with drug seekers.

The diagnosis of ADHD is made on the basis of criteria included in the current classification systems, that are the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders—5th Edition (DSM-5™) and International Classification of Mental and Behavioral Disorders–11th revision (ICD-11). Although there are more similarities between these two diagnostic manuals than in the past, they are different in the importance given to comorbid disorders as exclusion criteria.

The diagnostic assessment of adult ADHD includes several stages, starting with a comprehensive clinical interview and finishing with the ascertainment of comorbid conditions. There are several screening tools and diagnostic interviews that can be used by the clinician to get a clearer picture of the presence of adult ADHD, and to investigate the symptoms onset in the developmental period. Despite the substantial evidence supporting the existence of executive function deficits in people with ADHD, we still lack a neuropsychological test with the sufficient positive predictive power to allow clinicians to confidently discriminate people with ADHD from those with other disorders. However, although they are not relevant for the diagnosis, neuropsychological testing and neurological examination can add useful information regarding the individual’s cognitive strengths and weaknesses, and can help detect the presence of other conditions in comorbidity. The data collected during the assessment are essential to formulate an accurate diagnosis and to guide the treatment selection, allowing a more personalized therapeutic approach.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  2. Asherson P, Akehurst R, Kooij JJ, Huss M, Beusterien K, Sasane R, et al. Under diagnosis of adult ADHD: cultural influences and societal burden. J Atten Disord. 2012;16(5 Suppl):20S–38S. https://doi.org/10.1177/1087054711435360. PMID: 22377849.

    Article  PubMed  Google Scholar 

  3. Ferrin M, Vance A. Examination of neurological subtle signs in ADHD as a clinical tool for the diagnosis and their relationship to spatial working memory. J Child Psychol Psychiatry. 2012;53(4):390–400. https://doi.org/10.1111/j.1469-7610.2011.02496.x.

    Article  PubMed  Google Scholar 

  4. Buderath P, Gärtner K, Frings M, Christiansen H, Schoch B, Konczak J. Postural and gait performance in children with attention deficit/hyperactivity disorder. Gait Posture. 2009;29(2):249–54.

    Article  PubMed  Google Scholar 

  5. Shorer Z, Becker B, Jacobi-Polishook T, Oddsson L, Melzer I. Postural control among children with and without attention deficit hyperactivity disorder in single and dual conditions. Eur J Pediatr. 2012;171(7):1087–94.

    Article  PubMed  Google Scholar 

  6. Ozomaro U, Wahlestedt C, Nemeroff CB. Personalized medicine in psychiatry: problems and promises. BMC Med. 2013;11:132.

    Article  PubMed Central  PubMed  Google Scholar 

  7. World Health Organization. International statistical classification of diseases and related health problems. 11th ed. ICD–11;2019.

    Google Scholar 

  8. World Health Organization. The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization 1992.

    Google Scholar 

  9. Applegate B, Lahey BB, Hart EL, Biederman J, Hynd GW, Barkley RA, Ollendick T, Frick PJ, Greenhill L, McBurnett K, Newcorn JH, Kerdyk L, Garfnkel B, Waldman I, Shaffer D. Validity of the age-of-onset criterion for ADHD: a report from the DSM-IV field trials. J Am Acad Child Adolesc Psychiatry. 1997;36:1211–21. [PubMed: 9291722].

    Article  CAS  PubMed  Google Scholar 

  10. Barkley RA, Murphy KR, Fischer M. ADHD in adults: what the science says. New York: Guilford Press; 2008.

    Google Scholar 

  11. Moffitt TE, Houts R, Asherson P, Belsky DW, Corcoran DL, Hammerle M, et al. Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study. Am J Psychiatry. 2015;172(10):967–77.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Katzman MA, Bilkey TS, Chokka PR, Fallu A, Klassen LJ. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry. 2017;17(1):1–15. https://doi.org/10.1186/s12888-017-1463-3.

    Article  Google Scholar 

  13. Caye A, Rocha TB-M, Anselmi L, Murray J, Menezes AMB, Barros FC, et al. Attention-deficit/hyperactivity disorder trajectories from childhood to young adulthood: evidence from a birth cohort supporting a late-onset syndrome. JAMA Psychiat. 2016;73:705–12.

    Article  Google Scholar 

  14. Agnew-Blais JC, Polanczyk GV, Danese A, Wertz J, Moffitt TE, Arseneault L. Evaluation of the persistence, remission, and emergence of attention-deficit/hyperactivity disorder in young adulthood. JAMA Psychiat. 2016;73:713–20.

    Article  Google Scholar 

  15. Faraone SV, Biederman J. Can attention-deficit/hyperactivity disorder onset occur in adulthood? JAMA Psychiat. 2016;73(7):655–6.

    Article  Google Scholar 

  16. Sibley MH, Rohde LA, Swanson JM, Hechtman LT, Molina BSG, Mitchell JT, et al. Late-onset ADHD reconsidered with comprehensive repeated assessments between ages 10 and 25. Am J Psychiatry. 2018;175(2):140–9.

    Article  PubMed  Google Scholar 

  17. Cooper M, Hammerton G, Collishaw S, Langley K, Thapar A, Dalsgaard S, et al. Investigating late-onset ADHD: a population cohort investigation. J Child Psychol Psychiatry Allied Discip. 2018;59(10):1105–13.

    Article  Google Scholar 

  18. Kooij JJS, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J. Updated European consensus statement on diagnosis and treatment of adult ADHD. Eur Psychiatry. 2019;56:14–34. https://doi.org/10.1016/j.eurpsy.2018.11.001.

    Article  CAS  PubMed  Google Scholar 

  19. Kessler R, Berglund P, Demler O, Jin R, Merikangas K, Walters E. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–602. [PubMed: 15939837].

    Article  PubMed  Google Scholar 

  20. Michielsen M, Semeijn E, Comijs HC, et al. Prevalence of attention-deficit hyperactivity disorder in older adults in the Netherlands. Br J Psychiatry. 2012;201(4):298–305.

    Article  PubMed  Google Scholar 

  21. Kooij JJ, Michielsen M, Kruithof H, Bijlenga D. ADHD in old age: a review of the literature and proposal for assessment and treatment. Expert Rev Neurother. 2016;16(12):1371–81. Epub 2016 Jul 4.

    Google Scholar 

  22. Ustun B, Adler LA, Rudin C, et al. The world health organization adult attention-deficit/hyperactivity disorder self-report screening scale for DSM-5. JAMA Psychiatry. 2017;74(5):520–27. https://doi.org/10.1001/jamapsychiatry.2017.0298.

  23. Adler LA, Kessler RC, Spencer T. Adult ADHD self‐report scale‐V1.1 (ASRS‐V1.1) screener from WHO composite international diagnostic interview. 2003. Available at: https://www.hcp.med.harvard.edu/ncs/ftpdir/adhd/6Q_ASRS_English.pdf. Accessed 28, 2018.

  24. Barkley RA. Barkley deficits in executive functioning scale (BDEFS). New York: Guilford Press; 2011a.

    Google Scholar 

  25. Barkley RA. Barkley functional impairment scale for adults (BFIS for adults). New York: Guilford Press; 2011b.

    Google Scholar 

  26. Barkley RA. Barkley adult ADHD rating scale-IV (BAARS-IV). New York: Guilford Press; 2011c.

    Google Scholar 

  27. Conners D, Erhardt MA, Sparrow. Conners’ adult ADHD rating scales (CAARS). New York: Multihealth Systems, Inc., 1999.

    Google Scholar 

  28. Brown TE. Brown attention-deficit disorder scales for adolescents and adults: Manual. San Antonio: The Psychological Corporation. 1996.

    Google Scholar 

  29. Kooij JJS. Diagnostic interview for ADHD in adults 2.0 (DIVA 2.0). Adult ADHD. Diagnostic assessment and treatment. Amsterdam: Pearson Assessment and Information BV; 2010.

    Google Scholar 

  30. Epstein JN, Johnson DE, Conners CK. CAADID: Conners’ adult ADHD diagnostic interview for DSM-IV. 2001. Copyright © 2001 Multi-Health Systems Inc 2001.

    Google Scholar 

  31. Young S. ACE+ (ADHD Evaluation for Adults), 2016. Available at https://www.psychology-services.uk.com/.

  32. Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt Impulsiveness Scale. J Clin Psychol. 1995;51:768–74.

    Article  CAS  PubMed  Google Scholar 

  33. Brod M, Johnston J, Able S, Swindle R. Validation of the adult attention-deficit/hyperactivity disorder quality-of-life scale (AAQoL): a disease-specific quality-of-life measure. Qual Life Res. 2006;15(1):117–29.

    Article  PubMed  Google Scholar 

  34. Barkley RA. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull. 1997;121:65–94.

    Article  PubMed  Google Scholar 

  35. Kessler RC, Green JG, Adler LA, et al. Structure and diagnosis of adult attention-deficit/hyperactivity disorder: analysis of expanded diagnostic criteria from the Adult ADHD Clinical Diagnostic Scale. Arch Gen Psychiatry. 2010;67(11):1168–78.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Ramsay JR. Assessment and monitoring of treatment response in adult ADHD patients: current perspectives. Neuropsychiatr Dis Treat. 2017;13:221–32.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Roth, Isquith PK, Gioia GA. BRIEF-A: behavior rating inventory of executive function-adult version manual. Odessa: Psychological Assessment Resources; 2005.

    Google Scholar 

  38. Malloy-Diniz LF, Fuentes D. Characterization of attentional, motor and cognitive impulsiveness impulsive behavior in adults with attention deficit/hyperactivity disorder. 2007. https://doi.org/10.1017/S1355617707070889

  39. Balint S, Czobor P, Komlosi S, Meszaros A, Simon V, Bitter I. Attention deficit hyperactivity disorder (ADHD): gender- and age-related differences in neurocognition. Psychol Med. 2009;39:1337–45.

    Article  CAS  PubMed  Google Scholar 

  40. Boonstra AM, Oosterlaan J, Sergeant JA, Buitelaar JK. Executive functioning in adult ADHD: a meta-analytic review. Psychol Med. 2005;35:1097–108.

    Article  PubMed  Google Scholar 

  41. Frazier TW, Demaree HA, Youngstrom EA. Meta-analysis of intellectual and neuropsychological test performance in attention-deficit/hyperactivity disorder. Neuropsychology. 2004;18:543–55.

    Article  PubMed  Google Scholar 

  42. Hervey AS, Epstein JN, Curry JF. Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review. Neuropsychology. 2004;18:485–503.

    Article  PubMed  Google Scholar 

  43. Schoechlin C, Engel RR. Neuropsychological performance in adult attention-deficit hyperactivity disorder: meta-analysis of empirical data. Arch Clin Neuropsychol. 2005;20:727–44.

    Article  PubMed  Google Scholar 

  44. Arnsten AFT, Castellanos FX. Neurobiology of attention regulation and its disorder. In: Mratin A, Scahill L, Charney D, Leckman J, editors. Textbook of child and adolescent pharmacology. New York: Oxford University Press; 2002. p. 99–109.

    Google Scholar 

  45. Goldman-Rakic PS. Cellular basis of working memory. Neuron. 1995;14:477–85.

    Article  CAS  PubMed  Google Scholar 

  46. Gathercole SE, Alloway TP. Practitioner review: short-term and working memory impairments in neurodevelopmental disorders: diagnosis and remedial support. J Child Psychol Psychiatry. 2006;47:4–15.

    Article  PubMed  Google Scholar 

  47. Wasserman T, Wasserman LD. The sensitivity and specificity of neuropsychological tests in the diagnosis of attention deficit hyperactivity disorder. Appl Neuropsychol Child. 2012;1(2):90–9. https://doi.org/10.1080/21622965.2012.702025.

    Article  PubMed  Google Scholar 

  48. Geffen J, Forster K. Treatment of adult ADHD: a clinical perspective. Ther Adv Psychopharmacol. 2018;8(1):25–32. https://doi.org/10.1177/2045125317734977.

    Article  PubMed  Google Scholar 

  49. Conners CK, Staff M. Conners’ continuous performance test II for windows: technical guide and software manual. Toronto: Multi-Health Systems, Inc; 2000/2004.

    Google Scholar 

  50. Egeland J, Kovalik-Gran I. Measuring several aspects of attention in one test: the factor structure of Conners’s Continuous Performance Test. J Atten Disord. 2010;13:339–46.

    Article  PubMed  Google Scholar 

  51. Pettersson R, So derstro m S, Nilsson KW. Diagnosing ADHD in adults: an examination of the discriminative validity of neuropsychological tests and diagnostic assessment instruments. J Atten Disord. 2018;22(11):1019–31. https://doi.org/10.1177/1087054715618788.

    Article  PubMed  Google Scholar 

  52. Knagenhjelm P, Ulberstad F. QbTest technical manual. Stockholm: Qbtech AB; 2010.

    Google Scholar 

  53. Shaffer D, Schonfeld I, O’Connor P. Neurological soft signs: their relationship to psychiatric disorder and intelligence in childhood and adolescence. Arch Gen Psychiatry. 1985;42:342–51.

    Article  CAS  PubMed  Google Scholar 

  54. Dazzan P, Murray RM. Neurological soft signs in first episode psychosis: a systematic review. Br J Psychiatry. 2002;181(Suppl 43):s50–7.

    Article  Google Scholar 

  55. Mostofsky SH, Newschaffer CJ, Denckla MB. Overflow movements predict impaired response inhibition in children with ADHD. Percept Mot Skills. 2003;97:1315–31.

    Article  PubMed  Google Scholar 

  56. Uslu R, Kapçi EG, Oztop D. Neurological soft signs in comorbid learning and attention deficit hyperactivity disorders. Turk J Pediatr. 2007;49:263–9.

    PubMed  Google Scholar 

  57. Rubia K, Overmeyer S, Taylor E, Brammer M, Williams SC, Simmons A, Bullmore ET. Hypofrontality in attention deficit hyperactivity disorder during higher-order motor control: a study with functional MRI. Am J Psychiatry. 1999;156(6):891–6.

    Google Scholar 

  58. Pitcher TM, Piek JP, Hay DA. Fine and gross motor ability in males with ADHD. Dev Med Child Neurol. 2003;45(8);525–35. Health & Medical Complete.

    Google Scholar 

  59. Piek JP, Pitcher TM, Hay DA. Motor coordination and kinaesthesis in boys with attention deficit-hyperactivity disorder. Dev Med Child Neurol. 1999;41:159–65.

    Article  CAS  PubMed  Google Scholar 

  60. Rasmussen P, Gillberg C, Waldenstrom E, Svenson B. Perceptual, motor and attentional deficits in seven-year-old children: neurological and neurodevelopmental aspects. Dev Med Child Neurol. 1983;25:315–33.

    Article  CAS  PubMed  Google Scholar 

  61. Watemberg N, Waiserberg N, Zuk L, Lerman-Sagie T. Developmental coordination disorder in children with attention-deficit-hyperactivity disorder and physical therapy intervention. Dev Med Child Neurol. 2007;49:920–5.

    Article  PubMed  Google Scholar 

  62. Patankar VC, Sangle JP, Shah HR, Dave M, Kamath RM. Neurological soft signs in children with attention deficit hyperactivity disorder. Indian J Psychiatry. 2012;54:159–65.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  63. Pasini A, D’agati E. Pathophysiology of NSS in ADHD. World J Biol Psychiatry. 2009;10:495–502.

    Article  PubMed  Google Scholar 

  64. Foodman A, McPhillips K. ADD and soft signs. J Am Child Adolesc Psychiatry. 1996;35:841–2.

    Article  CAS  Google Scholar 

  65. Spreen O, Risser AT, Edgell D. Developmental neuropsychology. New York: Oxford University Press; 1995. p. 347–82.

    Google Scholar 

  66. Taylor E, Everitt B, Schachar R, Thorley G, Rutter M, Wieselberg M. Conduct disorder and hyperactivity: II. A cluster analytic approach to the identification of a behavioural syndrome. Br J Psychiatry. 1986a;149:768–77.

    Article  CAS  PubMed  Google Scholar 

  67. Taylor E, Sandberg S, Thorley G, Giles S. The epidemiology of childhood hyperactivity. Institute of Psychiatry Maudsley Monograph. London: Oxford University Press; 1991.

    Google Scholar 

  68. Taylor E, Schachar R, Thorley G, Wieselberg M. Conduct disorder and hyperactivity: I. Separation of hyper-activity and antisocial conduct in British child psychiatric patients. Br J Psychiatry. 1986b;149:760–7.

    Article  CAS  PubMed  Google Scholar 

  69. Touwen BC, Sporrel T. Soft signs and MBD. Dev Med Child Neurol. 1979;21:528–30.

    Article  CAS  PubMed  Google Scholar 

  70. Hrtanek I, Ondrejka I, Tonhajzerova I, Snircova E, Kulhan T, Farsky I, Nosalova G. The effect of methylphenidate on neurological soft signs in ADHD. Psychiatry Investig. 2015;12(4):545–50. https://doi.org/10.4306/pi.2015.12.4.545. Epub 2015 Sep 30.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  71. Hove MJ, Zeffiro TA, Biederman J, Li Z, Schmahmann J, Valera EM. Postural sway and regional cerebellar volume in adults with attention-deficit/hyperactivity disorder. Neuroimage Clin. 2015;8:422–8. https://doi.org/10.1016/j.nicl.2015.05.005. eCollection 2015.

    Article  PubMed Central  PubMed  Google Scholar 

  72. Jansen I, Philipsen A, Dalin D, Wiesmeier IK, Maurer C. Gait & Posture Postural instability in adult ADHD—a pilot study. Gait Posture. 2019;67:284–9. https://doi.org/10.1016/j.gaitpost.2018.10.016. (October 2018).

    Article  PubMed  Google Scholar 

  73. Donchin E, Coles M. Is the P300 component a manifestation of context updating? 1988;11:355–425.

    Google Scholar 

  74. Polich J. Updating P300: an integrative theory of P3a and P3b. Clin Neurophysiol. 2007;118:2128–48.

    Google Scholar 

  75. Ford JM. Decomposing P300 to identify its genetic basis. Psychophysiology. 2014;51(12):1325–6. https://doi.org/10.1111/psyp.12353.

    Article  PubMed  Google Scholar 

  76. Szuromi P, Czobor S, Komlósi S, Bitter I. P300 deficits in adults with attention deficit hyperactivity disorder: a meta-analysis. Psychol Med. 2011;41(7):1529–38. https://doi.org/10.1017/S0033291710001996.

    Article  CAS  PubMed  Google Scholar 

  77. Jasper HH, Solomon P, Bradley C. Electroencephalographic analyses of behavior problem children. Am J Psychiatr. 1938;95(3):641–58.

    Article  Google Scholar 

  78. Lenartowicz A, Koo SK. Use of EEG to diagnose ADHD. Curr Psychiatry Rep. 2014;16(11):498. https://doi.org/10.1007/s11920-014-0498-0.

    Article  PubMed Central  PubMed  Google Scholar 

  79. Barry RJ, Clarke AR, Johnstone SJ. A review of electrophysiology in attention-deficit/hyperactivity disorder: I. Qualitative and quantitative electroencephalography. Clin Neurophysiol. 2003;114(2):171–83. [PubMed: 12559224].

    Article  PubMed  Google Scholar 

  80. Lubar JF. Discourse on the development of EEG diagnostics and biofeedback for attention-deficit/ hyperactivity disorders. Biofeedback Self Regul. 1991;16(3):201–25. [PubMed: 1932259].

    Article  CAS  PubMed  Google Scholar 

  81. Snyder SM, Hall JR. A meta-analysis of quantitative EEG power associated with attention-deficit hyperactivity disorder. J Clin Neurophysiol. 2006;23(5):440–55. [PubMed: 17016156].

    Article  PubMed  Google Scholar 

  82. Boutros N, Fraenkel L, Feingold A. A four-step approach for developing diagnostic tests in psychiatry: EEG in ADHD as a test case. J Neuropsychiatry Clin Neurosci. 2005;17(4):455–64. [PubMed: 16387983].

    Article  PubMed  Google Scholar 

  83. Arns M, Conners CK, Kraemer HC. A decade of EEG Theta/Beta Ratio Research in ADHD: a meta-analysis. J Atten Disord. 2013;17(5):374–83. Key meta-analysis that showed inconsistency of theta/beta ratio in distinguishing between ADHD and controls and highlighted that this metric decreased linearly with year of pulication. [PubMed: 23086616].

    Article  PubMed  Google Scholar 

  84. Ogrim G, Kropotov J, Hestad K. The quantitative EEG theta/beta ratio in attention deficit/hyperactivity disorder and normal controls: sensitivity, specificity, and behavioral correlates. Psychiatry Res. 2012;198(3):482–8. [PubMed: 22425468].

    Article  PubMed  Google Scholar 

  85. van Dongen-Boomsma M, Lansbergen MM, Bekker EM, Kooij JJ, et al. Relation between resting EEG to cognitive performance and clinical symptoms in adults with attention-deficit/hyperactivity disorder. Neurosci Lett. 2010;469(1):102–6. [PubMed: 19945506].

    Article  CAS  PubMed  Google Scholar 

  86. Loo SK, Hale TS, Macion J, Hanada G, et al. Cortical activity patterns in ADHD during arousal, activation and sustained attention. Neuropsychologia. 2009;47(10):2114–9. [PubMed: 19393254].

    Article  PubMed Central  PubMed  Google Scholar 

  87. Buyck I, Wiersema JR. Resting electroencephalogram in attention deficit hyperactivity disorder: developmental course and diagnostic value. Psychiatry Res. 2014;216(3):391–7. [PubMed: 24656956].

    Article  PubMed  Google Scholar 

  88. Liechti MD, Valko L, Muller UC, Dohnert M, et al. Diagnostic value of resting electroencephalogram in attention-deficit/hyperactivity disorder across the lifespan. Brain Topogr. 2013;26(1):135–51. [PubMed: 23053601].

    Article  PubMed  Google Scholar 

  89. Loo SK, Cho A, Hale TS, McGough J, et al. Characterization of the theta to beta ratio in ADHD: identifying potential sources of heterogeneity. J Atten Disord. 2013;17(5):384–92. One of the largerst studies to theta/beta ratio to date, including 871 participants—595 youth and 276 adults—and reporting diagnostic inconsistency of theta/beta ratio. [PubMed: 23264365].

    Article  PubMed  Google Scholar 

  90. Torgersen T, Gjervan B, Rasmussen K. ADHD in adults: a study of clinical characteristics, impairment and comorbidity. Nord J Psychiatry. 2006;60(1):38–43.

    Article  PubMed  Google Scholar 

  91. Sobanski E, Bruggemann D, Alm B, Kern S, Deschner M, Schubert T, et al. Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci. 2007;257(7):371–7.

    Article  PubMed  Google Scholar 

  92. First MB, Williams JBW, Karg RS, Spitzer RL. Structured clinical interview for DSM-5 disorders, clinician version (SCID-5-CV). Arlington: American Psychiatric Association; 2016.

    Google Scholar 

  93. First MB, Williams JBW, Benjamin LS, Spitzer RL. User’s guide for the SCID-5-PD (structured clinical interview for DSM-5 personality disorder). Arlington: American Psychiatric Association; 2015.

    Google Scholar 

  94. American Psychiatric Association. DSM-5: online assessment measures. (n.d.). http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures.

  95. Narrow WE, Clarke DE, Kuramoto SJ, et al. DSM-5 field trials in the United States and Canada, part III: development and reliability testing of a cross-cutting symptom assessment for DSM-5. Am J Psychiatry. 2013;170:71–9.

    Article  PubMed  Google Scholar 

  96. Narrow WE, Kuhl EA. Dimensional approaches to psychiatric diagnosis in DSM-5. J Ment Health Policy Econ. 2011;14:115–23.

    Google Scholar 

  97. Helzer JE, Kraemer HC, Krueger RF, et al., editors. Dimensional approaches in diagnostic classification: refining the research agenda for DSM-V. Washington: American Psychiatric Association; 2008.

    Google Scholar 

  98. Hyman SE. The diagnosis of mental disorders: the problem of reification. Annu Rev Clin Psychol. 2010;6:155–79.

    Article  PubMed  Google Scholar 

  99. Landheim A, Bakken K, Vaglum P. Impact of comorbid psychiatric disorders on the outcome of substance abusers: a six year prospective follow-up in two Norwegian counties. BMC Psychiatry. 2006;6:44. [PMC free article] [PubMed] [Google Scholar].

    Article  PubMed Central  PubMed  Google Scholar 

  100. Myrick H, Brady K. Editorial Review: current review of the comorbidity of affective, anxiety and substance use disorders. Curr Opin Psychiatry. 2003;16(3):261–70.

    Google Scholar 

  101. Loga S, Loga-Zec S. Comorbidity in psychiatry: its impact on psychopharmacological treatment. Psychiatr Danub. 2009;21:347–9.

    PubMed  Google Scholar 

  102. Clarke DE, Kuhl EA. DSM-5 cross-cutting symptom measures: a step towards the future of psychiatric care? World Psychiatry. 2014;13(3):314–6. https://doi.org/10.1002/wps.20154.

    Article  PubMed Central  PubMed  Google Scholar 

  103. Schredl M, Alm B, Sobanski E. Sleep quality in adult patients with attention deficit hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci. 2007;257:164–8.

    Article  PubMed  Google Scholar 

  104. Chiang HL, Gau SSF, Ni HC, et al. Association between symptoms and subtypes of attention-deficit hyperactivity disorder and sleep problems/disorders. J Sleep Res. 2010;19:535–45.

    Article  PubMed  Google Scholar 

  105. Van Veen MM, Kooij JJ, Boonstra AM, et al. Delayed circadian rhythm in adults with attention-deficit/hyperactivity disorder and chronic sleep-onset insomnia. Biol Psychiatry. 2010;67:1091–6.

    Article  PubMed  Google Scholar 

  106. Cortese S, Konofal E, Lecendreux M. The relationship between attention-deficit-hyperactivity disorder and restless legs syndrome. Eur Neurol Rev. 2008;3:111–4.

    Article  Google Scholar 

  107. Bijlenga D, Van Der Heijden KB, Breuk M, et al. Associations between sleep characteristics, seasonal depressive symptoms, lifestyle, and ADHD symptoms in adults. J Atten Disord. 2013a;17:261–74.

    Article  PubMed  Google Scholar 

  108. Bijlenga D, Van Someren EJW, Gruber R, et al. Body temperature, activity and melatonin profiles in adults with attention-deficit/hyperactivity disorder and delayed sleep: a case-control study. J Sleep Res. 2013b;22:607–16.

    Article  PubMed  Google Scholar 

  109. Weiss MD, Salpekar J. Sleep problems in the child with attention-deficit hyperactivity disorder: defining aetiology and appropriate treatments. CNS Drugs. 2010;24:811–28.

    Article  CAS  PubMed  Google Scholar 

  110. Trenkwalder C, Paulus W, Walters AS. The restless legs syndrome. Lancet Neurol. 2005;4:465–75.

    Article  CAS  PubMed  Google Scholar 

  111. Salerno L, Makris N, Pallanti S. Sleep disorders in adult ADHD: a key feature. J Psychopathol. 2016;22:135–40.

    Google Scholar 

  112. Faraone SV, Rostain AL, Blader J, Busch B, Childress AC, Connor DF, Newcorn JH. Practitioner review: emotional dysregulation in attention-deficit/hyperactivity disorder—implications for clinical recognition and intervention. J Child Psychol Psychiatry. 2019;60(2):133–50. https://doi.org/10.1111/jcpp.12899. Epub 2018 Apr 6.

    Article  PubMed  Google Scholar 

  113. Corbisiero S, Beatrice M, Bitto H, Stieglitz R. Emotional dysregulation in adults with attention-deficit/hyperactivity disorder—validity, predictability, severity, and comorbidity. J Clin Psychol. 2017;73(1):99–112. https://doi.org/10.1002/jclp.22317.

    Article  PubMed  Google Scholar 

  114. Skirrow C, Asherson P. Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. J Affect Disord. 2013;147(1–3):80–6.

    Article  PubMed  Google Scholar 

  115. Surman CB, Biederman J, Spencer T, Miller CA, McDermott KM, Faraone SV. Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: a controlled study. Atten Defic Hyperact Disord. 2013;5(3):273–81. https://doi.org/10.1007/s12402-012-0100-8.

    Article  PubMed Central  PubMed  Google Scholar 

  116. Mitchell JT, Robertson CD, Anastopoulos AD, Nelson-Gray RO, Kollins SH. Emotion dysregulation and emotional impulsivity among adults with attention-deficit/hyperactivity disorder: results of a preliminary study. J Psychopathol Behav Assess. 2012;34:510–9. https://doi.org/10.1007/s10862-012-9297-2.

    Article  Google Scholar 

  117. Barkley RA, Fischer M. The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. J Am Acad Child Adolesc Psychiatry. 2010;49(5):503–13.

    PubMed  Google Scholar 

  118. Barkley RA, Murphy KR. Deficient emotional self-regulation in adults with attention-deficit/hyperactivity disorder (ADHD): the relative contributions of emotional impulsiveness and ADHD symptoms to adaptive impairments in major life activities. J ADHD Relat Disord. 2010;1(4):5–28.

    Google Scholar 

  119. Rösler M, Retz W, Fischer R, et al. Twenty-four-week treatment with extended release methylphenidate improves emotional symptoms in adult ADHD. World J Biol Psychiatry. 2010;11(5):709–18.

    Article  PubMed  Google Scholar 

  120. Reimherr FW, Marchant BK, Olson JL, Halls C, Kondo DG, Williams ED, Robison RJ. Emotional dysregulation as a core feature ofadult ADHD: its relationship with clinical variables and treatment response in two methylphenidate trials. J ADHD Relat Disord. 2010;4:53–64.

    Google Scholar 

  121. Retz W, Rösler M, Ose C, Scherag A, Alm B, Philipsen A, et al. Multiscale assessment of treatment efficacy in adults with ADHD: a randomized placebo-controlled, multicentre study with extended-release methylphenidate. World J Biol Psychiatry. 2012;13:48–59. https://doi.org/10.3109/15622975.2010.540257.

    Article  PubMed  Google Scholar 

  122. Rostain AL, Ramsay R. A combined treatment approach for adults with ADHD–results ofan open study of 43 patients. J Attent Disord. 2006;10:150–9. https://doi.org/10.1177/1087054706288110.

    Article  Google Scholar 

  123. Solanto MV, Marks DJ, Mitchell KJ, Wasserstein J, Kofman MD. Development of a new psychosocial treatment for adult ADHD. J Atten Disord. 2008;11:728–36. https://doi.org/10.1177/1087054707305100.

    Article  PubMed  Google Scholar 

  124. Virta M, Vedenpää A, Grönroos N, Chydenius M, Partinen M, Vataja R, et al. Adults with ADHD benefit from cognitive-behaviorally oriented group rehabilitation. J Attent Disord. 2008;12:218–26. https://doi.org/10.1177/1087054707311657.

    Article  Google Scholar 

  125. Wender PH. Attention deficit hyperactivity disorder in adults. Oxford: Oxford University Press; 1995.

    Google Scholar 

  126. Marchant BK, Reimherr FW, Robison D, Robison RJ, Wender PH. Psychometric properties of the Wender-Reimherr adult attention deficit disorder scale. Psychol Assess. 2013;25(3):942–50.

    Article  PubMed  Google Scholar 

  127. Merwood A, Chen W, Rijsdijk F, et al. Genetic associations between the symptoms of attention-deficit/hyperactivity disorder and emotional lability in child and adolescent twins. J Am Acad Child Adolesc Psychiatry. 2014;53(2):209–20 e4.

    Article  PubMed  Google Scholar 

  128. Judd LL, Schettler PJ, Akiskal HS, Maser J, Coryell W, Solomon D, et al. Long-term symptomatic status of bipolar I vs. bipolar II disorders. Int. J. Neuropsychopharmacol. 2003;6:127–37.

    Google Scholar 

  129. Kitsune GL, Kuntsi J, Costello H, Frangou S, Hosang GM, McLoughlin G, Asherson P. Delineating ADHD and bipolar disorder: a comparison of clinical profiles in adult women. J Affect Disord. 2016;192:125–33. https://doi.org/10.1016/j.jad.2015.12.024.

    Article  PubMed  Google Scholar 

  130. Smallwood J, Schooler JW. The science of mind wandering: empirically navigating the stream of consciousness. Annu Rev Psychol. 2015;66:487–518. [PubMed: 25293689].

    Article  PubMed  Google Scholar 

  131. Smallwood J, Schooler JW. The restless mind. Psychol Bull. 2006;132(6):946–58. [PubMed: 17073528].

    Article  PubMed  Google Scholar 

  132. Mowlem FD, Skirrow C, Reid P, Maltezos S, Nijjar SK, Merwood A, et al. Validation of the mind excessively wandering scale and the relationship of mind wandering to impairment in adult ADHD. J Attent Disord. 2019;23(6):624–34. https://doi.org/10.1177/1087054716651927. [PMCID: PMC6429624] [PubMed: 27255536].

    Article  Google Scholar 

  133. Barkley RA. Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: executive functioning, impairment, and comorbidity. J Clin Child Adolesc Psychol. 2013;42(2):161–73. https://doi.org/10.1080/15374416.2012.734259. Epub 2012 Oct 24.

    Article  PubMed  Google Scholar 

  134. Becker SP, Leopold DR, Burns GL, Matthew A, Langberg JM, Marshall SA, et al. The internal, external, and diagnostic validity of sluggish cognitive tempo: a meta-analysis and critical review. J Am Acad Child Adolesc Psychiatry. 2016;55(3):163–78. https://doi.org/10.1016/j.jaac.2015.12.006.

    Article  PubMed  Google Scholar 

  135. Kamradt JM, Momany AM, Nikolas MA. Sluggish cognitive tempo symptoms contribute to heterogeneity in adult attention-deficit hyperactivity disorder. J Psychopathol Behav Assess. 2018;40(2):206–23. https://doi.org/10.1007/s10862-017-9631-9.

    Article  PubMed  Google Scholar 

  136. Froehlich TE, Becker SP, Nick TG, Brinkman WB, Stein MA, Peugh J, Epstein JN. Sluggish cognitive tempo as a possible predictor of methylphenidate response in children with ADHD: a randomized controlled trial. J Clin Psychiatry. 2018;79(2):17m11553. https://doi.org/10.4088/JCP.17m11553.

    Article  PubMed Central  PubMed  Google Scholar 

  137. Milich R, Balentine AC, Lynam DR. ADHD combined type and ADHD predominantly inattentive type are distinct and unrelated disorders. Clin Psychol Res Pract. 2001;8:463–88.

    Article  Google Scholar 

  138. Instanes JT, Klungsoyr K, Halmoy A, Fasmer OB, Haavik J. Adult ADHD and comorbid somatic disease: a systematic literature review. J Atten Disord. 2018;22(3):203–28. https://doi.org/10.1177/1087054716669589.

    Article  PubMed  Google Scholar 

  139. Nielsen PR, Benros ME, Dalsgaard S. Associations between autoimmune diseases and attention-deficit/hyperactivity disorder: a Nationwide Study. J Am Acad Child Adolesc Psychiatry. 2017;56(3):234–240.e231. https://doi.org/10.1016/j.jaac.2016.12.010.

    Article  PubMed  Google Scholar 

  140. Chen MH, Su TP, Chen YS, Hsu JW, Huang KL, Chang WH, Chen TJ, Bai YM. Comorbidity of allergic and autoimmune diseases among patients with ADHD. J Atten Disord. 2017;21(3):219–27. https://doi.org/10.1177/1087054712474686.

    Article  PubMed  Google Scholar 

  141. Butwicka A, Lichtenstein P, Frisen L, Almqvist C, Larsson H, Ludvigsson JF. Celiac disease is associated with childhood psychiatric disorders: a population-based study. J Pediatr. 2017;184:87–93.e1. https://doi.org/10.1016/j.jpeds.2017.01.043.

    Article  PubMed  Google Scholar 

  142. Instanes JT, Halmoy A, Engeland A, Haavik J, Furu K, Klungsoyr K. Attention-deficit/hyperactivity disorder in offspring of mothers with inflammatory and immune system diseases. Biol Psychiatry. 2017;81(5):452–9. https://doi.org/10.1016/j.biopsych.2015.11.024.

    Article  PubMed  Google Scholar 

  143. Misener VL, Schachar R, Ickowicz A, Malone M, Roberts W, Tannock R, et al. Replication test for association of the IL-1 receptor antagonist gene, IL1RN, with attention-deficit/hyperactivity disorder. Neuropsychobiology. 2004;50(3):231–4. https://doi.org/10.1159/000079976.

    Article  CAS  PubMed  Google Scholar 

  144. Lasky-Su J, Neale BM, Franke B, Anney RJ, Zhou K, Maller JB, et al. Genome-wide association scan of quantitative traits for attention deficit hyperactivity disorder identifies novel associations and confirms candidate gene associations. Am J Med Genet B Neuropsychiatr Genet. 2008;147B(8):1345–54. https://doi.org/10.1002/ajmg.b.30867.

    Article  CAS  PubMed  Google Scholar 

  145. Oades RD, Dauvermann MR, Schimmelmann BG, Schwarz MJ, Myint AM. Attention-deficit hyperactivity disorder (ADHD) and glial integrity: S100B, cytokines and kynurenine metabolism—effects of medication. Behav Brain Funct. 2010a;6:29. https://doi.org/10.1186/1744-9081-6-29.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  146. Oades RD, Myint AM, Dauvermann MR, Schimmelmann BG, Schwarz MJ. Attention-deficit hyperactivity disorder (ADHD) and glial integrity: an exploration of associations of cytokines and kynurenine metabolites with symptoms and attention. Behav Brain Funct. 2010b;6:32. https://doi.org/10.1186/1744-9081-6-32.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  147. Oades RD. An exploration of the associations of pregnancy and perinatal features with cytokines and tryptophan/kynurenine metabolism in children with attention-deficit hyperactivity disorder (ADHD). Atten Defic Hyperact Disord. 2011;3(4):301–18. https://doi.org/10.1007/s12402-011-0062-2.

    Article  PubMed  Google Scholar 

  148. Ribases M, Hervas A, Ramos-Quiroga JA, Bosch R, Bielsa A, Gastaminza X, et al. Association study of 10 genes encoding neurotrophic factors and their receptors in adult and child attention-deficit/hyperactivity disorder. Biol Psychiatry. 2008;63(10):935–45. https://doi.org/10.1016/j.biopsych.2007.11.004.

    Article  CAS  PubMed  Google Scholar 

  149. Pasquin S, Sharma M, Gauchat JF. Ciliary neurotrophic factor (CNTF): new facets of an old molecule for treating neurodegenerative and metabolic syndrome pathologies. Cytokine Growth Factor Rev. 2015;26(5):507–15. https://doi.org/10.1016/j.cytogfr.2015.07.007.

    Article  CAS  PubMed  Google Scholar 

  150. Andrade C. Use of acetaminophen (paracetamol) during pregnancy and the risk of attention-deficit/hyperactivity disorder in the offspring. J Clin Psychiatry. 2016;77(3):e312–4. https://doi.org/10.4088/JCP.16f10721. PMID: 27046315.

    Article  PubMed  Google Scholar 

  151. Brandlistuen RE, Ystrom E, Nulman I, Koren G, Nordeng H. Prenatal paracetamol exposure and child neurodevelopment: a sibling-controlled cohort study. Int J Epidemiol. 2013;42(6):1702–13. https://doi.org/10.1093/ije/dyt183. Epub 2013 Oct 24.

    Article  PubMed Central  PubMed  Google Scholar 

  152. Liew Z, Ritz B, Virk J, Olsen J. Maternal use of acetaminophen during pregnancy and risk of autism spectrum disorders in childhood: a Danish national birth cohort study. Autism Res. 2016;9(9):951–8. https://doi.org/10.1002/aur.1591. Epub 2015 Dec 21.

    Article  PubMed  Google Scholar 

  153. Stergiakouli E, Thapar A, Davey Smith G. Association of acetaminophen use during pregnancy with behavioral problems in childhood: evidence against confounding. JAMA Pediatr. 2016;170(10):964–70. https://doi.org/10.1001/jamapediatrics.2016.1775.

    Article  PubMed Central  PubMed  Google Scholar 

  154. Patrick RP, Ames BN. Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2: relevance of aDHD, bipolar disorder, schizophrenia, and impulsive behavior. FASEB J. 2015;29:2207–22.

    Article  CAS  PubMed  Google Scholar 

  155. Goksugur SB, Tufan AE, Semiz M, Gunes C, Bekdas M, et al. Vitamin D status in children with attention-deficit-hyperactivity disorder. Pediatr Int. 2014;56:515–9.

    Article  CAS  PubMed  Google Scholar 

  156. Kamal M, Bener A, Ehlayel MS. Is high prevalence of vitamin D deficiency a correlate for attention deficit hyperactivity disorder? Atten Defic Hyperact Disord. 2014;6:73–8.

    Article  PubMed  Google Scholar 

  157. Meyer T, Becker A, Sundermann J, Rothenberger A, Herrmann-Lingen C. Attention deficit-hyperactivity disorder is associated with reduced blood pressure and serum vitamin D levels: results from the nationwide German health interview and examination survey for children and adolescents (KiGGS). Eur Child Adolesc Psychiatry. 2017;26:165–75.

    Article  PubMed  Google Scholar 

  158. Bloch MH, Qawasmi A. Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2011;50:991–1000. https://doi.org/10.1016/j.jaac.2011.06.008. S0890-8567(11)00484-9 [pii]. [PubMed: 21961774].

    Article  PubMed Central  PubMed  Google Scholar 

  159. Chovanova Z, Muchova J, Sivonova M, Dvorakova M, Zitnanova I, Waczulikova I, et al. Effect of polyphenolic extract, pycnogenol, on the level of 8-oxoguanine in children suffering from attention deficit/hyperactivity disorder. Free Radic Res. 2006;40:1003–10. WM44447X8027783L [pii]. DOI: 10.1080/10715760600824902 [PubMed: 17015282].

    Article  CAS  PubMed  Google Scholar 

  160. Garcia RJ, Francis L, Dawood M, Lai ZW, Faraone SV, Perl A. Attention deficit and hyperactivity disorder scores are elevated and respond to NAC treatment in patients with SLE. Arthritis Rheum. 2013;65:1313–8. https://doi.org/10.1002/art.37893. [PubMed: 23400548].

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  161. Prehn-kristensen A, Zimmermann A, Tittmann L, Lieb W, Schreiber S, Baving L, et al. Reduced microbiome alpha diversity in young patients with ADHD. PLoS One. 2018;13(7):e0200728. https://doi.org/10.1371/journal.pone.0200728. eCollection 2018.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  162. Aarts E, Ederveen THA, Naaijen J, Zwiers MP, Boekhorst J, Timmerman HM, et al. Gut microbiome in ADHD and its relation to neural reward anticipation. PLoS One. 2017;12:1–17. https://doi.org/10.1371/journal.pone.0183509.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. INS, INS, Istituto di Neuroscienze, Florence, Italy

    Stefano Pallanti & Luana Salerno

Authors
  1. Stefano Pallanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luana Salerno
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pallanti, S., Salerno, L. (2020). The Diagnosis of Adult ADHD Toward a Precision Psychiatry Approach. In: The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-39051-8_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-39051-8_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-39050-1

  • Online ISBN: 978-3-030-39051-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation