Research roundup: ADHD
By Practice Research and Policy Staff
January 28, 2010 — Attention deficit/hyperactivity disorder (ADHD) receives a lot of coverage in the popular press, and adults entering psychotherapy often raise questions about whether or not they might have ADHD. Although ADHD is generally considered a childhood disorder, psychological knowledge about the symptom presentation in adults is growing, and many psychologists may find themselves helping their adult clients better understand their concerns. The following articles address aspects of ADHD in adults and may provide new insights to assist psychologists in providing effective and responsive care for their clients.
Amador-Campos, J., Balluerka, N., Caterino, L., Gómez-Benito, J., & Stock, W. (2009). Development and validation of a scale to assess the symptoms of attention-deficit/hyperactivity disorder in young adults. Psychological Assessment, 21(2), 152-161.
The Caterino Adult Attention Deficit-Hyperactivity Disorder Scale (CAADS) was recently developed to screen for ADHD in adults. It consists of two parallel forms, each containing 18 items and three subscales: inattentive, hyperactivity and impulsive. The instrument has satisfactory reliability and content relevance. This tool is designed to aid psychologists in their standard diagnostic practices to screen for the presence of ADHD in adults.
The developers created a computer scoring system, but the scale can be readily tallied manually. In addition to the three subscales, respondents are also asked to rate each item within three different settings (home, school/work and social), and the setting ratings are evaluated both individually and collectively. The two forms of the scale are contained in the article’s appendix.
Psychologists can utilize this tool to facilitate screening adults for symptoms of ADHD.
Ramsay, J. R., & Rostain, A. L. (2007). Psychosocial treatments for attention-deficit/hyperactivity disorder in adults: Current evidence and future directions. Professional Psychology: Research and Practice, 38, 338-346.
The authors conducted a comprehensive literature review on the effects of psychosocial interventions in the treatment of ADHD in adults. The studies reviewed were categorized into three methodologies: open clinical studies, nonrandomized clinical control designs, and randomized clinical control designs. The review suggests that there is both clinical and empirical evidence supporting the efficacy of psychosocial approaches in the treatment of adults with ADHD. Medication is often a front line treatment, but medication alone may not effectively treat many adults with ADHD. In fact, adults who present with complex symptom patterns may require psychosocial interventions, with or without medication. The reviewers conclude that psychosocial approaches are effective, and the best treatment option may be the combination of psychosocial and pharmacological interventions.
Psychologists may find the review article helpful when advocating for their adult patients with ADHD in obtaining effective care. The research literature suggests that psychosocial interventions have an important role in helping adults effectively manage ADHD symptoms, and psychologists may want to arm themselves with this information to advocate with payers.
Weafer, J., Fillmore, M.T., & Milich, R. (2009). Increased sensitivity to the disinhibiting effects of alcohol in adults with ADHD. Experimental and Clinical Psychopharmacology, 17, 113-121.
Alcohol is known to impair adults’ capacity to inhibit their behavior; however, in healthy adults, valid environmental cues are known to provide some protection from this effect. In this study, adults with ADHD were compared with adults without ADHD on a laboratory task after consuming one of three amounts of alcohol. When participants in either group were asked to perform the task and given invalid cues about how to respond, they made more errors inhibiting their responses when under the influence of alcohol. The adults without ADHD in the valid cue condition were able to successfully use that information to inhibit their responses regardless of alcohol condition. The adults with ADHD, however, had greater difficulty inhibiting responses as they consumed more alcohol. In other words, the valid cues did not have the same effect on moderating the alcohol impact for the adults with ADHD as for the adults without ADHD. The adults with ADHD appeared more impaired and the valid cues did not help them successfully inhibit behavior to the same degree as adults without ADHD. This suggests that the adults with ADHD may be more sensitive to the effect of alcohol, regardless of environmental cues.
While this is one laboratory study that bears further replication and evaluation, the results do suggest that adults with ADHD may be more susceptible to the disinhibitory effect of alcohol consumption, a feature clinicians have likely observed in practice. Psychologists working with adults with ADHD may want to discuss with their clients the potential added risk they may face when consuming alcohol, and help their clients identify and develop strategies to manage themselves in these circumstances.
Friedman, S. R., Rapport, L. J., Lumley, M., Tzelepis, A., VanVoorhis, A., Stettner, L., & Kakaati, L. (2003). Aspects of social and emotional competence in adult attention- deficit/Hyperactivity disorder. Neuropsychology, 17(1), 50-58.
Rasmussen, K., & Torgersen, T. (2008). Treatment of adult ADHD: Is current knowledge useful to clinicians? Neuropsychiatric Disease and Treatment, 4(1-B), 177-186.
Ramsay, J. R., & Rostain, A. L. (2005) Adapting psychotherapy to meet the needs of adults with attention-deficit/hyperactivity disorder. Psychotherapy: Theory, Research, Practice, Training, 42(1), 72-84.
Note: Subscribers to PsycNet can read articles published in APA journals. Other articles may be accessible through Medline or other databases.