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The burdened life of adults with ADHD: Impairment beyond comorbidity

Published online by Cambridge University Press:  15 April 2020

C.R. Garcia ,
C.H.D. Bau ,
K.L. Silva ,
S.M. Callegari-Jacques ,
C.A.I. Salgado ,
A.G. Fischer ,
M.M. Victor ,
N.O. Sousa ,
R.G. Karam  and
L.A. Rohde
...Show all authors
C.R. Garcia
Affiliation:
Adult ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
C.H.D. Bau*
Affiliation:
Adult ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil Department of Genetics, Instituto de Biociências, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
K.L. Silva
Affiliation:
Adult ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
S.M. Callegari-Jacques
Affiliation:
Department of Genetics, Instituto de Biociências, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil Department of Statistics, Instituto de Matemática, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
C.A.I. Salgado
Affiliation:
Adult ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
A.G. Fischer
Affiliation:
Adult ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
M.M. Victor
Affiliation:
Adult ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
N.O. Sousa
Affiliation:
Adult ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
R.G. Karam
Affiliation:
Adult ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
L.A. Rohde
Affiliation:
Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
P. Belmonte-de-Abreu
Affiliation:
Adult ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
E.H. Grevet
Affiliation:
Adult ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
*
*Corresponding author. Departamento de Genética, UFRGS, Campus do Vale, Av. Bento Gonçalves, 9500 91501-970 Porto Alegre, RS, Brazil. Tel.: +5551 3308 6718; fax: +5551 3308 7311. E-mail address: [email protected] (C.H.D. Bau).
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Abstract

Since approximately 70% of adult patients with attention-deficit/hyperactivity disorder (ADHD) have at least one comorbid disorder, rating of impairment specifically attributable to ADHD is a hard task. Despite the evidence linking environmental adversities with negative outcomes in ADHD, life events measures have not been used to rate the disorder impairment. The present study tested for the first time the hypothesis that increased ADHD severity is associated with an increase in negative recent life events, independently of comorbidity status. The psychiatric diagnoses of 211 adult ADHD outpatients were based on DSM-IV criteria assessed through structured interviews (K-SADS-E for ADHD and ODD, MINI for ASPD and SCID-IV-R for other comorbidities). ADHD severity was evaluated with the Swanson, Nolan and Pelham rating scale (SNAP-IV) and recent life events with the Life Experience Survey. Higher SNAP-IV inattention and hyperactivity scores, female gender, lower socioeconomic status and the presence of comorbid mood disorders were associated with negative life events. Poisson regression models with adjustment for possible confounders confirmed the effect of inattention and hyperactivity severity on negative life events. Our results suggest that the negative life events experienced by these patients are associated to the severity of ADHD independently from comorbid psychiatric disorders.

Keywords

ADHDLife eventsImpairmentSeverityComorbidity
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 5 , July 2012 , pp. 309 - 313
Copyright
Copyright © Elsevier Masson SAS 2012

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References

Able, S.L., Johnston, J.A., Adler, L.A., Swindle, R.W.Functional and psychosocial impairment in adults with undiagnosed ADHD. Psychol Med. 2007; 37: 97–107.10.1017/S0033291706008713CrossRefGoogle ScholarPubMed
Adler, L.A.Clinical presentations of adult patients with ADHD. J Clin Psychiatry. 2004; 65: 8–11.Google ScholarPubMed
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders: fourth edition text (DSM-IV). Washington, DC: American Psychiatric Association; 1994.Google Scholar
Applegate, B., Lahey, B., Hart, E., Biederman, J., Hynd, G., Barkley, R.et al.Validity of the age of onset criterion for attention-deficit/hyperactivity disorder: a report from the DSM-IV field trials. J Am Acad Child Adolesc Psychiatry. 1997; 36: 1211–1221.CrossRefGoogle ScholarPubMed
Barkley, R.A., Cox, D.A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance. J Safety Res. 2007; 38: 113–128.CrossRefGoogle ScholarPubMed
Bau, C.H., Almeida, S., Costa, F.T., Garcia, C.E., Elias, E.P., Ponso, A.C.et al.DRD4 and DAT1 as modifying genes in alcoholism: interaction with novelty seeking on level of alcohol consumption. Mol Psychiatry. 2001; 6: 7–9.CrossRefGoogle ScholarPubMed
Biederman, J., Milberger, S., Faraone, S.V., Kiely, K., Guite, J., Mick, E.et al.Impact of adversity on functioning and comorbidity in children with attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1995; 34: 1495–1503.CrossRefGoogle ScholarPubMed
Biederman, J., Faraone, S.V., Monuteaux, M.C.Differential effect of environmental adversity by gender: Rutter‘s index of adversity in a group of boys and girls with and without ADHD. Am J Psychiatry. 2002; 159: 1556–1562.CrossRefGoogle Scholar
Biederman, J., Faraone, S.V., Monuteaux, M.C., Bober, M., Cadogen, E.Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biol Psychiatry. 2004; 55: 692–700.CrossRefGoogle Scholar
Biederman, J., Monuteaux, M.C., Mick, E., Spencer, T., Wilens, T.E., Silva, J.M.et al.Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychol Med. 2006; 36: 67–79.CrossRefGoogle ScholarPubMed
Biederman, J., Wilens, T.E., Spencer, T.J., Adler, L.A.Diagnosis and treatment of adults with attention-deficit/hyperactivity disorder. CNS Spectr. 2007; 12: 1–15.Google Scholar
Boer, F., Markus, M.T., Maingay, R., Lindhout, I.E., Borst, S.R., Hoogendijk, T.H.Negative life events of anxiety disordered children: bad fortune, vulnerability, or reporter bias?. Child Psychiatry Hum Dev. 2002; 32: 87–99.CrossRefGoogle ScholarPubMed
Caspi, A., Sugden, K., Moffitt, T.E., Taylor, A., Craig, I.W., Harrington, H.et al.Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science. 2003; 30: 386–389.CrossRefGoogle Scholar
Cui, X.J., Vaillant, G.E.Does depression generate negative life events?. J Nerv Ment Dis. 1997; 185: 145–150.CrossRefGoogle ScholarPubMed
Dixon, W.A., Reid, J.K.Positive life events as a moderator of stress-related depressive symptoms. J Counsel Dev. 2000; 78: 343–347.CrossRefGoogle Scholar
Faraone, S.V., Biederman, J., Spencer, T.J., Mick, E., Murray, K., Petty, C.et al.Diagnosing adult ADHD: are late onset and subthreshold diagnoses valid?. Am J Psychiatry. 2006; 163: 1720–1729.CrossRefGoogle ScholarPubMed
Faraone, S.V., Biederman, J., Spencer, T., Wilens, T., Seidman, L.J., Mick, E.et al.Attention-deficit/hyperactivity disorder in adults: an overview. Biol Psychiatry. 2000; 48: 9–20.CrossRefGoogle ScholarPubMed
First MB, Spitzer RL, Gibbon M, Williams JB. Structured clinical interview for DSM-IV axis I disorders, patient edition (SCID-I/P, Version 2.0, 8/98 revision). New York: Biometric Research Department, New York State Psychiatric Institute; 1998.Google Scholar
Fischer, A.G., Bau, C.H., Grevet, E.H., Salgado, C.A., Victor, M.M., Kalil, K.L.et al.The role of comorbid major depressive disorder in the clinical presentation of adult ADHD. J Psychiatr Res. 2007; 41: 991–996.CrossRefGoogle ScholarPubMed
Freire, M.T., Hutz, M.H., Bau, C.H.D.The DBH 21021 C=T polymorphism is not associated with alcoholism but possibly with patients’ exposure to life events. J Neural Transm. 2005; 112: 1269–1274.CrossRefGoogle Scholar
Grevet, E.H., Bau, C.H.D., Salgado, C.A.I., Fischer, A., Victor, M.M., Garcia, C.et al.Interrater reliability for diagnosis in adults of attention deficit hyperactivity disorder and oppositional defiant disorder using K-SADS-E. Arq Neuropsiquiatria. 2005; 63: 307–310.CrossRefGoogle ScholarPubMed
Grevet, E.H., Bau, C.H., Salgado, C.A., Fischer, A.G., Kalil, K., Victor, M.M.et al.Lack of gender effects on subtype outcomes in adults with attention-deficit/hyperactivity disorder: support for the validity of subtypes. Eur Arch Psychiatry Clin Neurosci. 2006; 256: 311–319.CrossRefGoogle ScholarPubMed
Hammen, C.Stress and depression. Annu Rev Clin Psychol. 2006; 1: 293–319.CrossRefGoogle Scholar
Horan, W.P., Subotnik, K.L., Reise, S.P., Ventura, J., Nuechterlein, K.H.Stability and clinical correlates of personality characteristics in recent-onset schizophrenia. Psychol Med. 2005; 35: 995–1005.CrossRefGoogle ScholarPubMed
Hudziak, J.J., Derks, E.M., Althoff, R.R., Rettew, D.C., Boomsma, D.I.The genetic and environmental contributions to attention deficit hyperactivity disorder as measured by the Conners’ Rating Scales. Revised. Am J Psychiatry. 2005; 162: 1614–1620.CrossRefGoogle ScholarPubMed
Jacobs, N., Kenis, G., Peeters, F., Derom, C., Vlietinck, R., Van Os, J.Stress-related negative affectivity and genetically altered serotonin transporter function: evidence of synergism in shaping risk of depression. Arch Gen Psychiatry. 2006; 63: 989–996.CrossRefGoogle ScholarPubMed
Karam, R.G., Bau, C.H., Salgado, C.A., Kalil, K.L., Victor, M.M., Sousa, N.O.et al.Late-onset ADHD in adults: milder, but still dysfunctional. J Psychiatr Res. 2009; 43: 697–701.CrossRefGoogle ScholarPubMed
Kendler, K.S., Thornton, L.M., Gardner, C.O.Genetic risk, number of previous depressive episodes, and stressful life events in predicting onset of major depression. Am J Psychiatry. 2001; 158: 582–586.CrossRefGoogle ScholarPubMed
Kendler, K.S., Gardner, C.O., Prescott, C.A.Personality and the experience of environmental adversity. Psychol Med. 2003; 33: 1193–1202.CrossRefGoogle ScholarPubMed
Kendler, K.S., Kuhn, J., Prescott, C.A.The interrelationship of neuroticism, sex, and stressful life events in the prediction of episodes of major depression. Am J Psychiatry. 2004; 161: 631–636.CrossRefGoogle ScholarPubMed
Kendler, K.S., Kuhn, J.W., Vittum, J., Prescott, C.A., Riley, B.The interaction of stressful life events and a serotonin transporter polymorphism in the prediction of episodes of major depression: a replication. Arch Gen Psychiatry. 2005; 62: 529–535.CrossRefGoogle Scholar
Kendler, K.S., Baker, J.H.Genetic influences on measures of the environment: a systematic review. Psychol Med. 2007; 37: 615–626.CrossRefGoogle ScholarPubMed
Kessler, R.C., Adler, L.A., Barkley, R., Biederman, J., Conners, C.K., Faraone, S.V.et al.Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biol Psychiatry. 2005; 57: 1442–1451.CrossRefGoogle ScholarPubMed
Kessler, R.C., Adler, L., Barkley, R., Biederman, J., Conners, C.K., Demler, O.et al.The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006; 163: 716–723.CrossRefGoogle ScholarPubMed
Kieling, C., Kieling, R.R., Rohde, L.A., Frick, P.J., Moffitt, T., Nigg, J.T.et al.The age at onset of attention deficit hyperactivity disorder. Am J Psychiatry. 2010; 167: 14–16.CrossRefGoogle ScholarPubMed
Loe, I.M., Feldman, H.M.Academic and educational outcomes of children with ADHD. Ambul Pediatr. 2007; 7: 82–90.CrossRefGoogle ScholarPubMed
Mattos, P., Serra-Pinheiro, M.A., Rohde, L.A.A Brazilian version of the MTA-SNAP-IV for evaluation of symptoms of attention-deficit/hyperactivity disorder and oppositional-defiant disorder. J Psychiatry Rio Grande do Sul. 2006; 28: 290–297.Google Scholar
Mercadante, M.T., Asbahar, F., Rosário, M.C., Ayres, A.M., Karman, L., Ferrari, M.C.et al.K-SADS, entrevista semi-estruturada para diagnóstico em psiquiatria da infância versão epidemiológica. São Paulo: FMUSP; 1995.Google Scholar
Montano, B.Diagnosis and treatment of ADHD in adults in primary care. J Clin Psychiatry. 2004; 65: 18–21.Google ScholarPubMed
Müller, D.J., Mandelli, L., Serretti, A., DeYoung, C.G., De Luca, V., Sicard, T.et al.Serotonin transporter gene and adverse life events in adult ADHD. Am J Med Genet B Neuropsychiatr Genet. 2008; 147: 1461–1469.CrossRefGoogle Scholar
Murphy, K., Barkley, R.A.Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Compr Psychiatry. 1996; 37: 393–440.CrossRefGoogle ScholarPubMed
Murphy, K.R., Barkley, R.A., Bush, T.Young adults with attention deficit hiperactivity disorder: subtype differences in comorbidity, educational, and clinical history. J Nerv Ment Dis. 2002; 190: 147–157.CrossRefGoogle Scholar
Pagano, M.E., Skodol, A.E., Stout, R.L., Shea, M.T., Yen, S., Grilo, C.M.et al.Stressful life events as predictors of functioning: findings from the collaborative longitudinal personality disorders study. Acta Psychiatr Scand. 2004; 110: 421–429.CrossRefGoogle ScholarPubMed
Patton, G.C., Coffey, C., Posterino, M., Carlin, J.B., Bowes, G.Life events and early onset depression: cause or consequence?. Psychol Med. 2003; 33: 1203–1210.CrossRefGoogle ScholarPubMed
Polanczyk, G., De Lima, M.S., Horta, B.L., Biederman, J., Rohde, L.A.The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007; 164: 942–948.CrossRefGoogle ScholarPubMed
Rohde, L.A., Biederman, J., Zimmermann, H., Schmitz, M., Martins, S., Tramontina, S.Exploring ADHD age-of-onset criterion in Brazilian adolescents. Eur Child Adolesc Psychiatry. 2000; 9: 212–218.CrossRefGoogle ScholarPubMed
Sagvolden, T., Johansen, E.B., Aase, H., Russell, V.A.A dynamic developmental theory of attention-deficit/hyperactivity disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes. Behav Brain Sci. 2005; 28: 397–419.CrossRefGoogle ScholarPubMed
Sandberg, S.The biopsychosocial context of ADHD. Behav Brain Sci. 2005; 28: 441–442.CrossRefGoogle Scholar
Sarason, I.G., Johnson, J.H., Siegel, J.M.Assessing the impact of life changes: development of the Life Experiences Survey. J Consult Clin Psychol. 1978; 46: 932–946.CrossRefGoogle ScholarPubMed
Saudino, K.J., Pedersen, N.L., Lichtenstein, P., McClearn, G.E., Plomin, R.Can personality explain genetic influences on life events?. J Pers Soc Psychol. 1997; 72: 196–206.CrossRefGoogle ScholarPubMed
Savoia, M.G., Bernik, M.Adverse life events and coping skills in panic disorder. Revista do Hospital de Clinicas da Faculdade de Medicina de Sao Paulo. 2004; 59: 337–340.Google ScholarPubMed
Secnik, K., Swensen, A., Lage, M.J.Comorbidities and costs of adult patients diagnosed with attention-deficit hyperactivity disorder. Pharmacoeconomics. 2005; 23: 93–102.CrossRefGoogle ScholarPubMed
Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Amorim, P., Janavs, J., Weiller, E.et al.Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998; 59: 22–33.Google ScholarPubMed
Silberg, J., Rutter, M., Neale, M., Eaves, L.Genetic moderation of environmental risk for depression and anxiety in adolescent girls. Br J Psychiatry. 2001; 179: 116–121.CrossRefGoogle ScholarPubMed
Silva, I., Pais-Ribeiro, J., Cardoso, H., Ramos, H.Contributo para a adaptação da Life Events Survey (LES) à população diabética portuguesa. Revista Portuguesa de Saude Publica. 2003; 2: 49–60.Google Scholar
Silva, I., Pais-Ribeiro, J., Cardoso, H.Dificuldade em perceber o lado positivo da vida? Stresse em doentes diabéticos com e sem complicações crónicas da doença. Analise Psicologica. 2004; 3: 597–605.Google Scholar
Skarsater, I., Agren, H., Dencker, K.Subjective lack of social support and presence of dependent stressful life events characterize patients suffering from major depression compared with healthy volunteers. J Psychiatr Ment Health Nurs. 2001; 8: 107–114.CrossRefGoogle ScholarPubMed
Spencer, T.J., Biederman, J., Mick, E.Attention-deficit/hyperactivity disorder: diagnosis, lifespan, comorbidities, and neurobiology. Ambul Pediatr. 2007; 7: 73–81.CrossRefGoogle ScholarPubMed
Swanson, J.M., Kraemer, H.C., Hinshaw, S.P.Clinical relevance of the primary findings of the MTA: Success rate based on severity of ADHD and ODD symptoms at the end of treatment. J Am Acad Child Adolesc Psychiatry. 2001; 40: 168–179.CrossRefGoogle Scholar
Taylor, E., Rogers, J.W.Practitioner review: early adversity and developmental disorders. J Child Psychol Psychiatry. 2005; 46: 451–467.CrossRefGoogle ScholarPubMed
Thapar, A., Langley, K., Asherson, P., Gill, M.Gene-environment interplay in attention-deficit hyperactivity disorder and the importance of a developmental perspective. Br J Psychiatry. 2007; 190: 1–3.CrossRefGoogle ScholarPubMed
Tillman, R., Geller, B., Nickelsburg, M.J., Bolhofner, K., Craney, J.L., DelBello, M.P.et al.Life events in a prepubertal and early adolescent bipolar disorder phenotype compared to attention-deficit hyperactive and normal controls. J Child Adolesc Psychopharmacol. 2003; 13: 243–251.CrossRefGoogle Scholar
Weiss, M.D., Gadow, K., Wasdell, M.B.Effectiveness outcomes in attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2006; 67: 38–45.Google ScholarPubMed
Wilens, T.E., Faraone, S.V., Biederman, J.Attention-deficit/hyperactivity disorder in adults. JAMA. 2004; 292: 619–623.CrossRefGoogle ScholarPubMed
Wilhelm, K., Mitchell, P.B., Niven, H., Finch, A., Wedgwood, L., Scimone, A.et al.Life events, first depression onset and the serotonin transporter gene. Br J Psychiatry. 2006; 188: 210–215.CrossRefGoogle ScholarPubMed
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