What would you like to find today?

60% to 90% of youth with ADHD continue to have symptoms as adults. In older adults, about 2.5% are believed to have ADHD, but it often goes unnoticed because research is limited and current diagnosis methods are based mostly on studies of young people.

Our commentary discusses key points about ADHD in older adults.  Although 2 to 3 percent of older adults have ADHD when using proper diagnostic tools, only 0.23% are diagnosed in medical records. This shows that ADHD is greatly underdiagnosed in older adults. Even worse, less than 40% of those who are diagnosed receive any treatment, which highlights the need for doctors to be better educated about ADHD in this age group. Current ways of diagnosing ADHD need to be improved for people over 50. Also, there isn’t much research on ADHD medications for people over 60, with most studies excluding them, which raises concerns about how safe and effective these treatments are for older adults, especially since stimulant medications can affect the heart.

There are also biases among doctors that make it harder to diagnose and treat ADHD in older adults. Many doctors aren’t trained to recognize ADHD in this age group and still see it as a condition that only affects young people. Some think that if a person hasn’t been treated for ADHD by this stage in life, they don’t need treatment now. But this ignores the fact that untreated ADHD can cause lifelong struggles and reduce the person’s quality of life. Some doctors are also worried about the risks of ADHD medications for older patients, even though research shows that these medications are usually safe when properly monitored.

Diagnosing ADHD in older adults can be tricky because its symptoms can look similar to other conditions, like mild cognitive impairment or dementia. This makes it important for doctors to do a thorough assessment that looks at medical, psychiatric, and psychological factors. Since older adults often have other health issues, it’s crucial for doctors to tell the difference between ADHD symptoms and those caused by other conditions.

In the end, we need more awareness, training, and research on ADHD in older adults. Doctors need to push past biases and consider the benefits of treating ADHD in this age group, carefully weighing the risks and rewards. As the population of older adults grows, so does the need for studies and guidelines to provide better care for older people with ADHD. Filling these gaps will ensure that older adults with ADHD get the attention and treatment they need.

‍

A large international research team has just released a detailed analysis of studies looking at the connection between parents' mental health conditions and their children's mental health, particularly focusing on ADHD (Attention Deficit Hyperactivity Disorder). This analysis, called a meta-analysis, involved carefully examining previous studies on the subject. By September 2022, they had found 211 studies, involving more than 23 million people, that could be combined for their analysis.

Most of the studies focused on mental disorders other than ADHD. However, when they specifically looked at ADHD, they found five studies with over 6.7 million participants. These studies showed that children of parents with ADHD were more than eight times as likely to have ADHD compared to children whose parents did not have ADHD. The likelihood of this result happening by chance was extremely low, meaning the connection between parental ADHD and child ADHD is strong.

Understanding the Numbers: How Likely Is It for a Child to Have ADHD?

The researchers wanted to figure out how common ADHD is among children of parents both with and without ADHD. To do this, they first analyzed 65 studies with about 2.9 million participants, focusing on children whose parents did not have ADHD. They found that around 3% of these children had ADHD.

Next, they analyzed five studies with over 44,000 cases where the parents did have ADHD. In this group, they found that 32% of the children also had ADHD, meaning about one in three. This is a significant difference—children of parents with ADHD are about ten times more likely to have the condition than children whose parents who do not have ADHD.

How Does This Compare to Other Mental Disorders in Parents?

The researchers also wanted to see if other mental health issues in parents, besides ADHD, were linked to ADHD in their children. They analyzed four studies involving 1.5 million participants and found that if a parent had any mental health disorder (like anxiety, depression, or substance use issues), the child’s chances of having ADHD increased by 80%. However, this is far less than the 840% increase seen in children whose parents specifically had ADHD. In other words, ADHD is much more likely to be passed down in families compared to other mental disorders.

Strengths and Weaknesses of the Research

The study had a lot of strengths, mainly due to the large number of participants involved, which helps make the findings more reliable. However, there were also some limitations:

• The researchers did not look into "publication bias," which means they didn’t check whether only certain types of studies were included (those showing stronger results, for example), which could make the findings seem more extreme.
• The team reported that differences between the studies were measured, but they didn’t explain clearly how these differences affected the results.
• Most concerning, the researchers admitted that 96% of the studies they included had a "high risk of bias," meaning that many of the studies might not have been entirely reliable.

Conclusion

Despite these limitations, the research team concluded that their analysis provides strong evidence that children of parents with ADHD or other serious mental health disorders are at a higher risk of developing mental disorders themselves. While more research is needed to fill in the gaps, the findings suggest that it would be wise to carefully monitor the mental health of children whose parents have these conditions to provide support and early intervention if needed

‍

Meta-analysis finds vocal emotion recognition accuracy is significantly lower in ADHD

Emotion dysregulation (ED) refers to the difficulty someone has in managing their emotions. People with ED might experience strong reactions like anger, irritability, emotional outbursts, or even excessive happiness. This issue affects 25% to 45% of children with ADHD and 30% to 70% of adults with ADHD. ED may come from challenges in recognizing emotions—like anger, sadness, fear, or happiness—based on facial expressions or tone of voice. People with ADHD struggle to control their emotions in a similar way that they have trouble controlling their attention and behavior.

Emotion Recognition in ADHD

One way researchers study ED in people with ADHD is by testing how well they recognize emotions. In these studies, participants are shown faces or hear voices expressing different emotions, and they are asked to identify which emotion is being shown. This helps measure how accurately people with ADHD recognize emotions compared to people without ADHD (referred to as typically developing, or TD, individuals).

Research Findings

A group of psychologists from the UK reviewed many studies that compared how well people with ADHD and TD individuals performed on emotion recognition tasks. They focused on studies that looked specifically at how well participants could recognize emotions through vocal expressions (such as changes in tone of voice).

They combined the results of 20 different studies, which together included 1,651 participants, and found that people with ADHD had more difficulty recognizing emotions than those without ADHD. The overall difference between the two groups was moderate, meaning the ADHD group consistently had more trouble, but the differences weren’t extreme. Only two of the 20 studies showed slightly different results, and there was no sign that the studies were biased. Whether or not participants were taking medication for ADHD didn’t change the outcomes.

Recognizing Positive and Negative Emotions

The study found that people with ADHD had more trouble recognizing both positive and negative emotions compared to the TD group:

• Anger and sadness: People with ADHD showed a moderate level of difficulty in recognizing these emotions.
• Happiness: There was a small-to-moderate level of difficulty in recognizing happiness.
• Overall: There was no clear pattern showing that ADHD participants struggled more with certain types of emotions; instead, their errors seemed random. This suggests that their difficulties in recognizing emotions may be linked to their general attention problems.

Age Differences

The study found that emotion recognition difficulties were more pronounced in children with ADHD than in adults. Among children, the deficit was large, while among adults, the difference was moderate.

Conclusion

The psychologists concluded that their analysis provides strong evidence that people with ADHD struggle with recognizing emotions, particularly through vocal expressions. They also found that these difficulties aren’t specific to certain emotions (like only anger or sadness), but rather seem to affect emotion recognition in general. This supports the idea that ED in ADHD is partly due to the same attention problems that make it difficult for people with ADHD to focus or control their behavior. The findings highlight that emotion dysregulation in ADHD may be a secondary problem caused by these underlying attention issues.

‍

ADHD (Attention-Deficit/Hyperactivity Disorder) has often been seen as a condition that mainly affects boys, especially when it comes to hyperactivity. However, a new study challenges this idea by showing that hyperactivity is also common in women with ADHD, pointing out the need for better diagnoses.

The study included 13,179 adults with ADHD and 1,910 adults without it. Researchers measured how active participants were using a special test, looking at both "provoked" activity (activity triggered by specific tasks that puts the brain “online”) and "basal" activity (resting or natural activity levels when the brain is “offline”). The study included almost an equal number of men and women, with the goal of finding out if there were any differences between the sexes in ADHD diagnosis, particularly in hyperactivity.

The results were eye-opening. Although men generally showed higher levels of activity when the brain was online, both men and women with ADHD had much higher levels of both offline and online activity compared to people without ADHD. Specifically, those with ADHD had about twice the resting activity and three times the provoked activity compared to those without the disorder.

A key finding was that women with ADHD had hyperactivity levels similar to men with ADHD. This goes against the common belief that women with ADHD don’t show hyperactivity or show it less. It suggests that hyperactivity in women may be missed or misunderstood due to societal expectations or differences in behavior.

These findings have big implications. They suggest that the way we currently understand ADHD, especially hyperactivity in women, might be wrong. By recognizing that women with ADHD can have significant hyperactivity, doctors can diagnose ADHD more accurately. This could lead to earlier treatment and better management of ADHD in women, which might also lower the chances of related problems like anxiety or depression.

The study highlights the importance of thinking about gender differences when diagnosing and treating ADHD. By realizing that hyperactivity isn't just a "male" trait, we can better support everyone with ADHD and ensure they get the right care. As research on ADHD continues, it’s important to challenge old assumptions and take a more inclusive approach to understanding and treating the disorder.

‍

Congenital heart disease (CHD) is a common birth defect where the heart’s blood vessels don’t develop normally before birth. This condition affects about 9% of all births worldwide, meaning about one in eleven babies is born with CHD. A recent analysis found that children with CHD have three times the risk of developing ADHD compared to children without CHD. However, that study only included five smaller studies, and almost 90% of the results varied between studies, making the findings less reliable. To improve on this, a team of researchers conducted a new, more thorough analysis.

Key Findings of the New Study

The updated analysis combined eleven studies, involving nearly 300,000 people. This larger study also confirmed that children with CHD are three times more likely to develop ADHD than those without CHD. Importantly, there was no evidence that the results were biased by only including studies that showed stronger results ("publication bias"). The variation between the studies (heterogeneity) was lower in this new analysis, down to a more manageable 60%.

Breaking Down the Study Types

The researchers looked at two types of studies: cohort studies and cross-sectional studies, and found different levels of risk:

• Cohort studies: These studies followed groups of people over time. In this case, researchers compared children with CHD to those without it to see if ADHD developed later on. These five studies, with over 19,000 participants, found that children with CHD were 3.5 times more likely to develop ADHD.
• Cross-sectional studies: These studies collected data at a single point in time, looking at children who already had CHD and checking if they had ADHD. The six cross-sectional studies, with more than 277,000 participants, found a lower, but still significant, 2.1 times higher risk of ADHD in children with CHD.

While both types of studies suggest a strong link between CHD and ADHD, cohort studies are more reliable because they track children over time, which helps researchers establish that CHD occurred before ADHD, suggesting a stronger cause-and-effect relationship. Both types of studies are observational.  In any observational study, researchers look at data without actively changing or controlling anything in the study environment. Because they aren't conducting controlled experiments, it's possible that some important factors, known as "confounding factors," aren't being measured or accounted for. These factors can influence both the exposure (what the study is investigating, like CHD) and the outcome (ADHD) in a way that creates an association that is apparent but not rea.

Adjustments for Other Factors

Nine of the studies, which included almost 300,000 participants, adjusted their findings to account for "confounding factors"—things like age, gender, or other health conditions that could also influence whether a child develops ADHD. Even after making these adjustments, the risk of ADHD in children with CHD was still three times higher.

Other Study Details

The researchers also found that the way ADHD was diagnosed—whether through clinical assessments or standardized symptom checklists—didn’t change the results much. Additionally, there was no major difference between studies done in the U.S. and those conducted in other countries, or between higher- and lower-quality studies.

Conclusion

The research team concluded that children born with congenital heart disease are at a much higher risk of developing ADHD than children without CHD. They suggested that children with CHD should be monitored more closely for ADHD as they grow up to ensure early intervention if needed.

‍

Potentially traumatic experiences (PTEs) refer to events where someone is exposed to situations that involve threats to life, serious injury, or danger to themselves or others. These events can include things like accidents, violence, or the death of someone close. PTEs are significant because they can have lasting effects on a person's mental health.

A research team from Norway, working with a collaborator from the U.S., used their country’s universal health care system to study how PTEs affect the mental health of children and adolescents in Hordaland County, which includes the city of Bergen. They wanted to see how experiencing PTEs influenced the likelihood of these young people seeking help from child and adolescent mental health services (CAMHS) or being diagnosed with psychiatric disorders, including ADHD.

In 2012, the study invited all 19,439 teenagers born between 1993 and 1995 in Hordaland County to participate. These teens were 16 to 19 years old at the time. Out of this group, 9,555 teens agreed to let the researchers link their personal data with the National Patient Registry (NPR), which keeps track of health records. There was no significant difference in the types or number of PTEs between those who agreed to this data sharing and those who did not.

After removing participants with incomplete information, the researchers were left with 8,755 teens. These teens’ psychiatric diagnoses, including ADHD, were taken from the NPR. The researchers asked the participants if they had ever experienced specific traumatic events, such as:

• A serious accident or disaster
• Violence from an adult
• Witnessing violence against someone they cared about
• Unwanted sexual actions
• The death of someone close to them

If a participant reported experiencing the death of someone close, they were asked to specify who it was (a parent, sibling, grandparent, other family member, close friend, or romantic partner). One limitation of the study was that it did not ask about bullying, which could also be a traumatic experience.

Key Findings

The researchers divided the teens into three trauma groups based on their experiences:

1. Low Trauma Group (88% of participants): These teens had not experienced anything more traumatic than the death of a grandparent.
2. Interpersonal Trauma Group (6% of participants): These teens had experienced or witnessed violence, and some had also been exposed to sexual abuse, accidents, or the death of family members.
3. Situational Trauma Group (6% of participants): These teens had experienced accidents and multiple deaths (including of close friends), but had less exposure to violence.

Other Important Factors

Teens in the situational and interpersonal trauma groups were more likely to see their economic situation as worse than those in the low trauma group. For example, 11% of the situational trauma group and 17% of the interpersonal trauma group considered themselves economically worse off, compared to just 6.1% of the low trauma group. Also, fewer parents of teens in the two higher trauma groups had higher levels of education, which can impact family support and resources.

ADHD and Trauma

After adjusting for gender and parental education, the researchers found that:

• Teens in the situational trauma group were more than twice as likely to be diagnosed with ADHD compared to those in the low trauma group.
• Teens in the interpersonal trauma group (who had experienced or witnessed more violence) were more than twice as likely to be diagnosed with ADHD compared to those in the situational trauma group.

The effect was even stronger when comparing the interpersonal trauma group to the low trauma group. Teens in the interpersonal trauma group were almost five times more likely to be diagnosed with ADHD than those in the low trauma group.

Study Limitations

One limitation of the study is that while the researchers acknowledged that sex and socioeconomic status (SES) are important factors in the relationship between trauma and psychiatric disorders, they did not directly adjust for SES. However, they did indirectly account for it by considering the education levels of the parents, which is closely related to SES.

Conclusion

The study showed that adolescents who experience more interpersonal trauma (like violence or sexual abuse) are at a significantly higher risk of being diagnosed with ADHD. The findings suggest that it’s important to pay special attention to teens who experience both situational and interpersonal traumas, especially those exposed to interpersonal violence. Early intervention and support could be key to helping these adolescents manage their mental health.

‍

A large international research team has just released a detailed analysis of studies looking at the connection between parents' mental health conditions and their children's mental health, particularly focusing on ADHD (Attention Deficit Hyperactivity Disorder). This meta-analysis involved carefully examining 211 previous studies, involving more than 23 million people.

Most of the studies focused on mental disorders other than ADHD; however, when they specifically looked at ADHD, they found five studies with over 6.7 million participants. These studies showed that children of parents with ADHD were more than eight times as likely to have ADHD compared to children whose parents did not have ADHD. The likelihood of this result happening by chance was extremely low, meaning the connection between parental ADHD and child ADHD is strong.

Understanding the Numbers: How Likely Is It for a Child to Have ADHD?

The researchers wanted to figure out how common ADHD is among children of parents both with and without ADHD. To do this, they first analyzed 65 studies with about 2.9 million participants, focusing on children whose parents did not have ADHD. They found that around 3% of these children had ADHD.

Next, they analyzed five studies with over 44,000 cases where the parents did have ADHD. In this group, they found that 32% of the children also had ADHD, meaning about one in three. This is a significant difference—children of parents with ADHD are about ten times more likely to have the condition than children whose parents are free of ADHD.

How Does This Compare to Other Mental Disorders in Parents?

The researchers also wanted to see if other mental health issues in parents, besides ADHD, were linked to ADHD in their children. They analyzed four studies involving 1.5 million participants and found that if a parent had any mental health disorder (like anxiety, depression, or substance use issues), the child’s chances of having ADHD increased by 80%. However, this is far less than the 840% increase seen in children whose parents specifically had ADHD. In other words, ADHD is much more likely to be passed down in families compared to other mental disorders.

Strengths and Weaknesses of the Research

The study had a lot of strengths, mainly due to the large number of participants involved, which helps make the findings more reliable. However, there were also some limitations:

• The researchers did not look into "publication bias," which means they didn’t check whether only certain types of studies were included (those showing stronger results, for example), which could make the findings seem more extreme.
• The team reported that differences between the studies were measured, but they didn’t explain clearly how these differences affected the results.
• Most concerning, the researchers admitted that 96% of the studies they included had a "high risk of bias," meaning that many of the studies might not have been entirely reliable.

Conclusion

Despite these limitations, the research team concluded that their analysis provides strong evidence that children of parents with ADHD or other serious mental health disorders are at a higher risk of developing mental disorders themselves. While more research is needed to fill in the gaps, the findings suggest that it would be wise to carefully monitor the mental health of children whose parents have these conditions to provide support and early intervention if needed.

‍

Our research team conducted a study, published in the Journal of the American Academy of Child & Adolescent Psychiatry, to understand how COVID-19 (SARS-CoV-2) affects the mental health of young people. We used a method called Kaplan-Meier survival analysis to figure out how likely kids were to develop new mental health problems, including suicidal thoughts, within two years after being infected. We looked at medical records of 7.5 million children and 5.3 million teenagers who were part of the TriNetX Research Network. Importantly, we focused only on those who didn’t have any mental health issues before.

Of these young people, almost 300,000 children and over 220,000 teens had tested positive for COVID-19. The results were significant: children who had COVID-19 had a 15% chance of being diagnosed with a new mental health condition, compared to just 2.6% for children who didn’t get COVID-19. For teens, the chance was 19% for those infected and 5% for those not infected.

We found that the risk of developing new mental health issues was six times higher in children and four times higher in teens who had COVID-19. This shows that younger kids are more strongly affected.

The study also highlighted that COVID-19 was linked to higher rates of various mental health problems, especially in children. This means it’s really important to screen for mental health issues in young people after they’ve had COVID-19, particularly for those who had severe cases.

Overall, our findings point to the need for special support for kids and teens who may be more vulnerable after the pandemic. It’s clear that the mental health effects of COVID-19 go beyond just physical health, and it’s crucial that doctors and policymakers include mental health care in plans to help young people recover.

‍

A meta-analysis of short-term, placebo-controlled, randomized clinical trials (Cortese et al. 2018), looking at both efficacy and safety, supported prescribing stimulants – methylphenidate use in children and adolescents and amphetamine use in adults – as first-choice medications. 

However, these were short-term studies, and they focused on relieving ADHD symptoms. What about longer-term outcomes, especially looking more broadly at functional impairment and overall quality of life? 

Sweden has a single-payer health insurance system that encompasses virtually every resident and is linked to national registers that enable researchers to conduct nationwide population studies. 

A joint Finnish-Swedish research team used Sweden’s registers to study outcomes for all individuals of working age, 16 to 65 years old, living in Sweden who had received a diagnosis of ADHD from 2006 through 2021. The resulting study cohort encompassed 221,714 persons with ADHD. 

The team adjusted for the following confounding variables: Genetics, baseline severity of symptoms, baseline comorbidities, temporal order of treatments (which medication was used as first, second, third, and so forth, including also nonuse of ADHD medications), time since cohort entry, and time-varying use of psychotropic drugs, including antidepressants, anxiolytics, hypnotics, mood stabilizers (carbamazepine, valproic acid, and lamotrigine), lithium, antipsychotics, and drugs for addictive disorders. 

With these adjustments, they discovered that amphetamine treatment was associated with a roughly 25% reduction in psychiatric hospitalization relative to unmedicated ADHD. Lisdexamphetamine was associated with a roughly 20% reduction, dexamphetamine with a 12% reduction, and methylphenidate with a 7% reduction. All four medications are stimulants. 

None of the non-stimulant medications – atomoxetine, guanfacine, clonidine – had any significant effect on psychiatric hospitalization. Nor did modafinil a drug that is not FDA approved for ADHD but is sometimes used when other drugs fail. 

Amphetamine was also associated with the greatest reduction in suicide attempts or deaths, with a roughly 40% decline relative to unmedicated ADHD. Dexamphetamine was associated with a roughly 30% decline and lisdexamphetamine with a roughly 25% decline. The stimulant methylphenidate was only associated with an 8% reduction, and modafinil had no significant effect. 

Surprisingly, non-stimulant medications were associated with significant increases in suicide attempts or deaths: 20% for atomoxetine, 65% for guanfacine, and almost double for clonidine. 

Amphetamine and lisdexamphetamine also reduced the risk of nonpsychiatric hospitalization by more than a third compared to unmedicated ADHD. Dexamphetamine was associated with a risk reduction of more than 25%, methylphenidate with 20% lesser risk.  

The non-stimulant atomoxetine was associated with a roughly 15% reduction in risk of nonpsychiatric hospitalization. But neither guanfacine nor clonidine had any significant effect. 

Turning to work disability, atomoxetine was the only ADHD medication associated with a reduction – a roughly 10% improvement. All other medications had no significant effect. 

The team concluded, “In this cohort study of adolescents and adults with ADHD, the use of medications for ADHD, especially lisdexamphetamine and other stimulants, was associated with decreased risk of psychiatric hospitalizations, suicidal behavior, and nonpsychiatric hospitalizations during periods when they were used compared with periods when ADHD medication was not used. Non-stimulant atomoxetine use was associated with decreased risk of work disability.” 

‍

‍

Noting that “Oxidative stress disrupts the structure and function of neurons in the prefrontal lobe of the brain,” and “Structural and functional impairments in the prefrontal cortex have been shown to be highly correlated with behavioral and emotional problems of ADHD,” a Chinese team at Dalian University set out to systematically evaluate the safety and efficacy of antioxidant therapy in children and adolescents with ADHD. 

The team’s systematic search of the peer-reviewed medical literature identified a total of 48 randomized controlled trials (RCTs) or prospective studies involving 12 antioxidant agents (resveratrol, pycnogenol, omega-3, omega-6, quercetin, phosphatidylserine, almond, vitamin D, zinc, folic acid, ginkgo biloba, Acetyl-L-carnitine) that met criteria for inclusion: 

• Ages 18 or younger. 

• Clinical diagnoses of ADHD. 

• Minimum treatment duration of two weeks. 

• Experimental group received antioxidant treatment. 

• Control group received either a placebo, the stimulant medication methylphenidate, or a different antioxidant or combination of antioxidants. 

Treatment efficacy was measured through ADHD symptom scores using Conners’ parent rating scale (CPRS), Conners’ teacher rating scale (CTRS), ADHD rating scale-parent (ADHD RS-Parent), and ADHD rating scale-teacher (ADHD RS-Teacher), as well as secondary outcome indicators such as the Clinical Global Impressions scale (CGI) and Continuous Performance Test (CPT), relative to controls. 

None of the antioxidant therapies were significantly better than placebo.

One limitation is that no effort was made to assess publication bias. 

These results indicate that antioxidants should not be used for treating ADHD.

‍