همراهی و مشخصات روانی بزرگسالان مبتلا به اختلال نقص توجه/بیش فعالی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|32711||2003||13 صفحه PDF||سفارش دهید||5850 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Personality and Individual Differences, Volume 35, Issue 4, September 2003, Pages 743–755
The objective of the study was to investigate the comorbid problems and the psychosocial profile of Attention Deficit Hyperactivity Disorder (ADHD) adults. It was hypothesised that, compared with a community control group, the ADHD group would have a history of academic underachievement, poor occupational adjustment, antisocial behaviour, relationship difficulties, substance misuse, mood and affective problems and personality disorder. Compared with a clinic control group, it was hypothesised that the ADHD group would report an earlier onset of problems. Two clinical groups were drawn from referrals to an adult ADHD assessment clinic and a normal control group was recruited from the community. Groups were matched for age, sex and social class. The ADHD group (N=30) was compared with the clinic control group (N=30) and the normal control group (N=30) on measures of anxiety, depression and personality. Psychosocial variables were measured by the ADHD-Adult Functioning Interview, a semi-structured interview of childhood and adulthood functioning. The hypotheses were largely supported with the ADHD group being significantly more impaired than the normal control group on all psychosocial domains and comorbidity. The ADHD group was more impaired than the clinical control group on childhood measures of academic underachievement, antisocial and criminal behaviour. It was concluded that ADHD is a risk for the development of multiple problems and comorbidity in adulthood. Results emphasise the need to take a developmental perspective when diagnosing ADHD in adulthood.
Attention Deficit Hyperactivity Disorder (ADHD) is a common disorder of childhood. Extrapolating from US data, it is estimated that approximately 0.5–1% of the young adult population continues to have symptoms associated with ADHD (Toone & van der Linden, 1997). DSM-IV criteria (American Psychiatric Association, 1994) for diagnosis state inattentive, impulsive and hyperactive behaviours must be pervasive across two or more settings before age 7. There must be clear evidence of significant impairment in social, academic or occupational functioning. Exclusions include symptoms that occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia or other Psychotic disorder. ADHD in adulthood is more frequently diagnosed in the UK than in the past as clinicians are becoming increasingly aware that as children grow up they may continue to need treatment (Toone & van der Linden, 1997). Despite growing recognition of the legitimacy of the ADHD diagnosis in adulthood, it is not a commonly researched, diagnosed or treated adult psychiatric disorder. Clinicians in child services rarely follow-up patients into adulthood and adult ADHD is rarely considered in psychiatric settings. Throughout the world there is relatively little research reported on ADHD adults compared with the plethora of information about childhood ADHD. Yet prospective investigations suggest around one-quarter of ADHD children continue to meet criteria in young adulthood (Gittelman et al., 1985 and Taylor et al., 1996) and two-thirds retain at least one disabling symptom at age 25 years (Weiss, Hechtman, Milroy, & Perlman, 1985). (For a comprehensive review see Young, 2000). A key difficulty may be that ADHD has been misdiagnosed in the past. Comorbidity is commonly reported in adulthood, especially antisocial personality disorder, substance abuse disorder, and anxiety disorders (Biederman et al., 1993, Loney et al., 1983, Mannuzza et al., 1991, Mannuzza et al., 1993 and Weiss et al., 1985). ADHD is a risk for the development of antisocial and criminal behaviour. Court records suggest that ADHD adolescent youths are four to five times more likely to be arrested, and to have multiple arrests and convictions (Hechtman and Weiss, 1986, Lambert, 1988, Mannuzza et al., 1989, Satterfield et al., 1982 and Satterfield et al., 1994). Reports from the USA and Sweden suggest that 25% of prison inmates meet ADHD criteria in adulthood (Dalteg et al., 1999 and Eyestone and Howell, 1994). In adulthood alcohol and substance misuse are also significantly related to the persistence of the ADHD syndrome, especially when it is comorbid with antisocial behaviours (Biederman et al., 1993, Hechtman et al., 1984 and Weiss et al., 1985). Adults with a history of childhood ADHD complete less education, have poorer marks, fail more grades and are more commonly expelled from school compared with controls (Biederman et al., 1993 and Klein and Mannuzza, 1991). In adulthood they may be gainfully employed, but experience more employment-related problems than controls or reach a lower than expected occupational status compared with family members (Mannuzza et al., 1993, Weiss et al., 1978 and Weiss et al., 1979). Social maladjustment is well documented from childhood (Berry et al., 1985, Borland and Heckman, 1976, Milich and Landau, 1989 and Riddle and Rapoport, 1976) and interpersonal relationship problems are likely to persist in adulthood. One study suggests ADHD adults experience greater disruption to their intimate partnerships than controls, resulting in higher rates of divorce or separation (Biederman et al., 1993). The persistence of the ADHD syndrome beyond childhood gives rise to an increasing need for the development of reliable and valid systematic assessment procedures in adulthood. A childhood history strongly suggestive of ADHD is mandatory for adult diagnosis and some individuals may continue to satisfy the full complement of ADHD criteria. Others may remain symptomatic but fall short of formal criteria. It is clear from the problems of adults with ADHD summarised above that clinical assessment of ADHD adults should not focus purely on current symptomatology but needs to include an assessment of associated comorbidity and psychological problems. ADHD comorbidity with affective disorders, substance abuse disorder and/or personality disorder gives rise to subgroups with greater psychiatric morbidity and disability. To summarise, follow-up studies suggest that a substantial proportion of children diagnosed with ADHD will remain symptomatic as adults. Comorbid problems may complicate presentation in adulthood, yet there is a dearth of research on clinically referred ADHD adults. Clinical assessment of ADHD in adulthood is heavily dependent upon instruments that have been loosely adapted from measures used in childhood diagnosis. This study therefore aimed to examine the psychosocial profile of clinically referred ADHD adults using a semi-structured interview developed for this purpose (the ADHD Adult Functioning Interview), to examine the presence of comorbid substance use, anxiety, depression and personality disorder, and compare them with a clinic control group and a normal control group. It was hypothesised that, compared with a normal control group, the ADHD group would have a history of academic underachievement, poor occupational adjustment, antisocial and criminal behaviour, poor social interaction and relationships difficulties, substance misuse, mood and affective problems, and personality disorder. Compared with the clinic control group, it was hypothesised that the ADHD group would report more long-standing difficulties, i.e. earlier onset of problems reflecting the developmental nature of the disorder.