September 22, 2023
There is a well-documented gap between the known prevalence of adult ADHD and rates of diagnosis and treatment. In Germany, epidemiological studies of nationally representative community samples have found prevalence rates ranging from 3.1% to 4.7%. Yet, studies of publicly insured individuals aged 18 to 69 years old report rates of diagnosed ADHD between 0.04% and 0.4%. So, even in a country with universal health insurance, more than nine out of ten adults with ADHD go undiagnosed.
Many factors contribute to under-diagnosis: stigma, culturally influenced perceptions, and lack of motivation by those affected. Another crucial factor is the lack of recognition of ADHD symptoms by clinicians.
A research team surveyed 144 psychologists, 32 physicians, and two occupational therapists. Almost three in five participants were psychotherapists, a quarter were neuropsychologists, and one in seven were psychiatrists.
Four out of five clinicians stated they had received only a few hours of ADHD-specific training. One in four stated they had not examined guidelines for diagnosing ADHD. A lack of formal training among the vast majority, and unfamiliarity with current diagnostic guidelines in a significant minority, were surprising findings among clinicians who regularly work with adults with ADHD.
Many clinicians had difficulty identifying core features of adult ADHD as defined by the DSM-5 and International Classification of Diseases, Tenth Revision (ICD-10). Roughly one in five stated that hyperactivity had little relevance to adult ADHD. The only core feature correctly identified by more than half the respondents was having difficulties concentrating. Impairments in social behavior or aggression and memory impairment were not identified as being clearly relevant or irrelevant to adult ADHD.
The authors concluded that these findings appear to indicate some uncertainty or at least a lack of consensus among clinicians about what symptoms are relevant to ADHD in adulthood, and it is likely that this uncertainty contributes to diagnostic inaccuracy.
Most respondents reported using self-report scales of ADHD symptoms and using unstructured interviews. While slightly more than half agreed that collateral reports are important to diagnosis, only about a third reported regularly using them. This is a problem given the limited accuracy of self-reported childhood symptoms for documenting the childhood-onset of the disorder. Semi-structured interviews are also known to improve the accuracy of diagnosis, but are rarely used in clinical practice.
Over half of psychologists and a quarter of physicians reported using cognitive or neuropsychological testing, even though this is at variance with German (and other) guidelines, which specify that such testing is suitable for clarifying strengths and weaknesses, but not for ruling out or confirming a diagnosis of ADHD. The European Consensus Statement also states that cognitive/neuropsychological testing should only be used as a secondary or supplementary assessment tool.
While three out of four clinicians recommended stimulant drug treatment, psychologists tended to be more hesitant to do so. This is likely because German psychologists receive little training in pharmacotherapy, and do not have prescription privileges. Given the demonstrated efficacy of stimulant treatment, this points to a need to better educate psychologists in this regard.
Almost three in four respondents cited a lack of clinician knowledge and experience as a barrier to ADHD diagnosis. Most clinicians also stated they were either uncertain or only somewhat certain of their ability to diagnose ADHD. That suggests that more extensive ADHD-specific training is needed.
A limitation of the survey was the relatively low participation by physicians. It is also likely that the findings are not reflective of practices in ADHD specialty clinics.
The authors concluded, Further training is needed to improve clinicians' understanding of ADHD in adulthood and to align diagnostic practices with guideline recommendations. Whereas discrepancies between respondents regarding the relative importance of peripheral symptoms (e.g., memory problems) were most common, a lack of consensus was found even for core symptoms listed by diagnostic criteria. Particularly among psychologists improved awareness regarding the benefits of stimulant medications is needed to bring their treatment recommendations in line with evidence-based guidelines.
Brooke C. Schneider, Daniel Schöttle, BirgitHottenrott, Jürgen Gallinat, and Steffen Moritz, "Assessment of Adult ADHD in clinical Practice: Four Letters-40 Opinions," Journal of Attention Disorders(2019) DOI: 10.1177/1087054719879498.
A recent study published in Alpha Psychiatry sheds light on the connection between ADHD, empathy, and narcissistic traits. Researchers aimed to evaluate how pharmacological treatments—specifically psychostimulants—affect empathy deficits and pathological narcissism in adults with ADHD. These findings could have important implications for enhancing treatment outcomes and improving social functioning.
Study Overview
The study involved 75 adult ADHD patients who were treated with either methylphenidate or atomoxetine. Researchers assessed levels of narcissistic traits and empathy using validated tools such as the Pathological Narcissism Inventory (PNI) and the Empathy Quotient (EQ). Measurements were taken before treatment and after three months of therapy.
Key Findings
Why It Matters
Adults with ADHD often struggle with social interactions, partly due to empathy deficits and personality traits like narcissism. By addressing these challenges through psychostimulant treatment, patients may experience better social and emotional well-being. This study underscores the importance of viewing ADHD treatment as not just a way to manage symptoms but also a means to improve overall quality of life.Takeaway
Effective ADHD treatment goes beyond managing attention and hyperactivity. By improving empathy and reducing narcissistic traits, psychostimulants can foster healthier relationships and enhance social functioning. This research highlights the need for comprehensive care that considers the broader psychological and interpersonal effects of ADHD.
According to Fosco et al. (2019), “Inhibitory control has long been considered a central neurocognitive process in ADHD, with ADHD groups typically showing medium-sized impairments relative to their typically-developing peers on common inhibition paradigms.”
Learning to play a musical instrument requires effective coordination of physical movements and sound signals to produce music. Musical training involves repetitive practice, perfecting connections between perceptions, muscular actions, and cognition.
Noting that listening to music activates the brain’s reward circuits in both children and adults, that “Being internally motivated during learning experiences increases learning capacity and efficiency, and this greater engagement is reflected in increased electrical brain activity following musical training,” and that “Training music in a social environment increases positive feelings of bonding through shared emotions and group synchrony,” a Montreal-based research team carried out a systematic review and meta-analysis of the peer-reviewed medical literature from 1980 to 2023 to learn what effect music training might have on inhibition control.
Outcomes:
The team found eight randomized controlled trials (RCTs) and 14 other longitudinal studies that met search criteria, including:
Meta-analysis of all 22 longitudinal studies with a combined total of 1,734 participants yielded a small-to-medium effect size improvement in inhibitory control. Variation (heterogeneity) in outcomes between individual studies was small, and there was no sign of publication bias. Restricting the analysis to the eight RCTs with a combined total of 641 participants, however, yielded a medium-to-large effect size improvement, with negligible heterogeneity, meaning the outcome was consistent across RCTs.
The Take-Away: The team concluded, “Music training plays a privileged role compared to other activities (sports, visual arts, drama) in improving children’s executive functioning, with a particular effect on inhibition control.” I cannot, however, recommend this as a therapy for ADHD until RCTs show it reduces symptoms of ADHD and/or real world impairments associated with the disorder.
Organic farming aims to protect biodiversity, promote animal welfare, and avoid using pesticides and fertilizers made from petrochemicals. Some pesticides are designed to target insects’ nervous systems but can also affect brain development and health in larger animals, including humans.
Many people believe organic food is healthier than conventionally produced food, which might be true for certain foods and health factors. But does eating organic food during pregnancy impact the chances of a child developing ADHD or autism spectrum disorder (ASD)?
In Norway, researchers can use detailed national health records to study these connections on a population-wide level, thanks to the country’s single-payer healthcare system and national registries.
The Norwegian Mother, Father, and Child Cohort Study (MoBa) invites parents to participate voluntarily and has a 41% participation rate. The study includes:
For this research, a team tracked 40,707 mother-child pairs from children born between 2002 and 2009. They used questionnaires to measure how much organic food mothers consumed during pregnancy. ADHD and ASD symptoms in children were assessed using validated rating scales.
The final analysis included:
The researchers adjusted for factors like maternal age, education, previous pregnancies, BMI before pregnancy, smoking and alcohol use during pregnancy, birth year and season, and the child’s sex.
The researchers concluded that eating organic food during pregnancy has no meaningful effect on the likelihood of a child developing ADHD or ASD. They stated, “The results do not indicate any clinically significant protective or harmful effects of eating organic food during pregnancy on symptoms of ADHD and ASD in the offspring. Based on these findings, we do not recommend any specific advice regarding intake of organic food during pregnancy.”
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