New research has revealed the wide-ranging impact of the disorder attention deficit hyperactivity disorder (ADHD)highlighting mental health vulnerabilities, physical health risks and social implications, underlining the need for a holistic approach to adequately manage this condition.
Managing ADHD with a holistic approach
A comprehensive review conducted by experts from the University of Nottingham’s School of Psychology and Institute of Mental Health in collaboration with Nottingham Trent University analyzed more than 125 reviews. The findings highlight a spectrum of health and lifestyle risks associated with ADHD.
The review, published on Frontiers in Psychiatry constitutes a critical step towards improving the understanding and management of ADHD, paving the way for more targeted interventions and better outcomes for people living with the disorder.
The study identifies a number of mental health vulnerabilities associated with ADHD, including addiction, suicide, eating disorders, mood disorders and personality disorders, underlining the importance of interventions tailored to people with the condition.
The review also highlights significant physical health risks linked to attention deficit hyperactivity disorder, such as obesity, sleep disorders, oral hygiene problems, injuries and somatic diseases, underlining the need for integrated care models.
The three key symptoms of attention deficit hyperactivity disorder include hyperactivity, impulsivity and inattention and affects around 5% of the UK population and affects one child in every classroom and 3% of adults, affecting all aspects of life, home, education, work, relationships and health. People with attention deficit hyperactivity disorder are 60% more likely to divorce, 30% more likely to commit suicide, or 35% more likely to have accidents.
In addition to individual health, the study explores social implications, revealing impacts on offending behaviour, crime, violence, employment challenges, educational outcomes, quality of life, relationships and risk behaviours.
Dr Blandine French is an ADHD lived experience researcher at the School of Psychology and Institute for Mental Health at the University of Nottingham and led the study. Blandine previously worked in the hospitality industry as a restaurant manager for 13 years. But after being diagnosed with attention deficit hyperactivity disorder as an adult, she gained a deeper understanding of her learning styles and the need to study differently, which allowed her to go to college.
“The holistic perspective presented in the review highlights the need for a paradigm shift in the approach to ADHD. Moving beyond a narrow focus on symptom management, there is growing recognition of the need for comprehensive care models that include mental health, physical health, and social factors.
“Integrating this comprehensive understanding into the discourse on attention deficit hyperactivity disorder is considered crucial for the development of targeted interventions and the provision of care.
“By taking a holistic approach, stakeholders such as doctors, teachers or parents can better address the different challenges posed by ADHD and improve the overall well-being of those affected by this condition,” says Dr. French.
NHS England recently set up a taskforce to examine service provision and its impact on people with attention deficit hyperactivity disorder. The aim of the task force is to develop a joint approach to care that encompasses the education, care, health and criminal justice sectors.
Dr. French adds: “The development of this task force is a positive step forward in developing a better approach to caring for people with attention deficit hyperactivity disorder. We hope that our research can help inform some of this work and that services for people with attention deficit hyperactivity disorder can be implemented.” improved. For example, communication from health professionals about physical risks could help families seek timely support for these lesser-known related problems.”
“The range and severity of problems experienced by individuals with attention deficit hyperactivity disorder requires that assessment and treatment of ADHD become a priority,” says Professor David Daley, head of applied psychology practice at Nottingham Trent University , co-author of the article.
Response to ADHD treatment can be determined using neuroanatomy
New research from the Institute of Psychiatry, Psychology and Neuroscience (IoPPN) at King’s College London has found that the effectiveness of ADHD medications may be associated with an individual’s neuroanatomy.
The research, published in Nature Mental Health, suggests that the development of clinical interventions for attention deficit hyperactivity disorder could benefit from identifying how the brain anatomy of treatment-resistant individuals may differ from that of individuals who respond to drugs.
Researchers studied individual responses to two months’ treatment with methylphenidate (MPH), the prescription drug typically used to treat ADHD, in 60 adults with attention deficit hyperactivity disorder. Using MRI, they compared brain anatomy between individuals with attention deficit hyperactivity disorder and neurotypical controls and, among individuals with ADHD, between those who responded and those who did not respond to treatment.
Finally, to better understand their findings, they mapped anatomical group differences onto brain maps of genetic expressions.
The researchers found that adults with attention deficit hyperactivity disorder who did not respond to MPH had significant differences in brain anatomy compared to both those who responded and controls. These anatomical differences meant that their attention improved less during treatment.
Some group differences between individuals with attention deficit hyperactivity disorder and controls were associated with differences in the expression of genes related to norepinephrine transport, a known target of ADHD drugs.
Although MPH is generally effective in improving ADHD symptoms, these findings may help researchers and clinicians understand previous randomized, controlled trials that have reported that more than one-third of adults do not respond to MPH.
“These findings suggest that those who respond to MPH and those who do not may represent different biological subgroups within the adult attention deficit hyperactivity disorder population. This work may help us understand why treatments for ADHD are not universally effective, which will ultimately help advance the development of more targeted clinical interventions,” says Dr. Valeria Parlatini.
The study focused only on male individuals, with ADHD more commonly diagnosed in men and following preliminary evidence of sex differences in brain anatomy and biological response to stimulants.
“This is one of the first studies to investigate differences in neuroanatomy related to response to treatment focused exclusively on adults with attention deficit hyperactivity disorder. Anatomical studies to date comparing responders and non-responders have included only children or a mixed sample of children and adults, have not included neurotypical controls for comparison, and have relied primarily on volumetric measurements,” says Professor Declan Murphy.
The researchers stress that the findings need to be replicated and extended in further independent studies to increase understanding of why some individuals are resistant to treatment.
This in turn would help advance the development of clinical interventions by identifying treatment-resistant individuals in the context of clinical trials of new treatments.
ADHD drugs linked to reduction in psychiatric hospitalizations
For adolescents and adults with attention-deficit/hyperactivity disorder, use of ADHD medications is associated with fewer psychiatric and non-psychiatric hospitalizations, according to a study published online im in JAMA Network Open.
Heidi Taipale, Ph.D., of the Karolinska Institutet in Stockholm, and colleagues examined the association between the use of ADHD-specific medications and outcomes of hospitalization and work disability in a registry-based cohort study nationwide involving adolescents and adults with attention deficit hyperactivity disorder from 2006 to 2021. The study cohort included 221,714 people with attention deficit hyperactivity disorder.
The drug for attention deficit hyperactivity disorder. most commonly used was methylphenidate, followed by lisdexamfetamine (68.5 and 35.2%). The researchers found that amphetamine, lisdexamfetamine, polypharmacy for attention deficit hyperactivity disorder, dexamphetamine, and methylphenidate were associated with a reduced risk of psychiatric hospitalizations (adjusted hazard ratios, 0.74, 0. 80, 0.85, 0.88 and 0.93, respectively). No associations were observed for modafinil, atomoxetine, clonidine or guanfacine.
The use of dexamfetamine, lisdexamfetamine, and methylphenidate was associated with a reduced risk of suicidal behavior (adjusted hazard ratio, 0.69, 0.76, and 0.92, respectively). Amphetamine, lisdexamfetamine, polypharmacy, dexamphetamine, methylphenidate, and atomoxetine were associated with a reduced risk of nonpsychiatric hospitalization.
Regarding work disability, the results were significant only for the use of atomoxetine (adjusted hazard ratio, 0.89), especially for subjects aged 16 to 29 years (adjusted hazard ratio, 0.82) .
“Considering the high prevalence of psychiatric comorbidity in people with attention deficit hyperactivity disorder, these findings suggest that the use of ADHD medications may reduce morbidity in adolescents and adults with attention deficit hyperactivity disorder ”, the authors write.
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