Tag: ADHD

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Validation of a criterion-based screening and triage pathway for adult ADHD: a prospective observational study of safety and operational efficiency

BackgroundThe increasing demand for adult attention-deficit hyperactivity disorder (ADHD) assessments has required the development of efficient triage pathways. This study provides a formal assessment of a criterion-based screening model designed to prioritise patient safety and operational efficiency within a National Health Service (NHS) specialist secondary care setting.MethodsA prospective observational validation design was employed, involving 49 consecutive adults referred for ADHD assessment none of whom had a previous ADHD diagnosis. The Comprehensive ADHD Screening Questionnaire (CASQ), a clinician-administered instrument based on DSM-5 criteria, was utilised by four trained Physician Assistants. To ensure an assessment of triage safety, a universal assessment model was adopted: all participants received a blinded, gold-standard diagnostic assessment (NICE-compliant) regardless of the initial triage recommendation thereby eliminating verification bias. The primary outcome measure was the Number Needed to Harm (NNH), defined as the number of people screened before a single false-negative result occurs.ResultsOf the 48 participants who completed the diagnostic process, six (12.5%) received an ADHD diagnosis. The triage pathway correctly identified all six cases, resulting in a sensitivity of 100.0% (95% CI: 61.0%–100.0%) and an infinite NNH. Specificity was 45.2% (95% CI: 31.2%–59.9%), with a positive predictive value of 20.7%. The pathway permitted 39.6% (n = 19) of referrals to be triaged to alternative pathways rather than full ADHD assessment, potentially saving significant specialist clinician time. Exploratory analyses indicated that score magnitude did not reliably distinguish between true and false positives within the group triaged as appropriate for further assessment.ConclusionsThese preliminary findings suggest that criterion-based screening conducted by appropriately trained non-specialist clinicians can achieve high levels of safety whilst improving service efficiency. The findings support the feasibility of task-shifting models in adult ADHD services, provided that triage thresholds are calibrated to prioritise sensitivity. These results require replication in adequately powered multi-site studies before firm conclusions regarding pathway safety can be drawn. Further research is required to establish inter-rater reliability and cost-effectiveness across diverse clinical settings.
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[Comment] How much is enough in ADHD pharmacotherapy?

The evidence base for ADHD pharmacotherapy has answered one question more confidently than any other: whether medications are effective, on average, in reducing core ADHD symptoms. We know that several stimulant and non-stimulant treatments, including methylphenidate, amphetamines, atomoxetine, and guanfacine, improve symptoms at the patient-group level.1 What has remained harder to identify is where titration should stop: the point at which further dose escalation is unlikely to yield meaningful additional benefit and might instead worsen tolerability.

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Noise, air pollution exposure and attention-deficit/hyperactivity disorder: a meta-analysis

ObjectiveThis meta-analysis evaluated the associations between noise exposure, air pollutants, and attention-deficit/hyperactivity disorder (ADHD) in children, aiming to inform future prevention strategies.MethodsStudies were systematically retrieved from CNKI, Wanfang, PubMed, Web of Science, Embase, and the Cochrane Library, covering publications from inception to November 2025. Heterogeneity was assessed using Cochran’s Q test and the I² statistic. Subgroup analyses, meta-regression, and sensitivity analyses were performed to evaluate the robustness of the findings.ResultsNoise exposure was associated with a small increase in ADHD risk (odds ratio [OR] = 1.03, 95% confidence interval [CI]: 1.01–1.05), with stronger associations for childhood exposure, whereas prenatal exposure showed no significant effect. Given the modest effect size, this finding should be interpreted cautiously. Particulate matter (PM2.5 and PM10) was significantly associated with ADHD in continuous-exposure models—PM2.5 (OR = 1.32, 95% CI: 1.16–1.50) and PM10 (OR = 1.47, 95% CI: 1.15–1.87). In dichotomous models, PM2.5 was not significant, while PM10 remained positively associated (OR = 1.58, 95% CI: 1.11–2.26). Elevated nitrogen dioxide (NO2) exposure was also associated with a modest increase in ADHD risk (OR = 1.11, 95% CI: 1.02–1.20), whereas nitrogen oxides (NOx), ozone (O3), and sulfur dioxide (SO2) did not show significant associations.ConclusionsNoise and several air pollutants (PM2.5, PM10, and NO2) were significantly associated with increased ADHD risk, particularly during childhood exposure. Other pollutants, including O3 and SO2, did not demonstrate significant effects. These findings suggest that environmental noise and several air pollutants may be associated with ADHD; however, some observed associations, particularly for noise and NO2, were modest in magnitude and should be interpreted cautiously. These results reflect observational associations rather than evidence of a strong or causal effect, while the evidence for some pollutants remains limited or inconclusive. Further research is needed to clarify pollutant-specific associations and the role of exposure timing.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024593274, identifier CRD42024593274; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025632899, identifier CRD42025632899.
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Biomarkers of ASD/ADHD and Factors Affecting Anxiety and Depression in Children and Young Adults

Conditions: ADHD – Attention Deficit Disorder With Hyperactivity; Autism Spectrum Disorder (ASD); Developmental Coordination Disorder (DCD)

Sponsors: University of Exeter; University of Southampton; University of Dublin, Trinity College; Carol Davila University of Medicine and Pharmacy; Jimma University; FUNDACION PARA LA INVESTIGACION HOSPITAL CLINICO SAN CARLOS; The International Centre for Diarrhoeal Disease Research, Bangladesh; University of Bari Aldo Moro

Not yet recruiting
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Stigma in adults with ADHD: a systematic review of types, experiences, and potential implications for quality of life

BackgroundAttention deficit hyperactivity disorder (ADHD) is a disorder characterized by hyperactive, impulsive, and/or inattentive symptoms. Adults with ADHD often report reduced quality of life (QoL) across social, educational, and occupational functioning. Part of these deficits may be attributed to stigma, which includes stereotypes, prejudices, discrimination, and negative labelling. While stigma’s effects on QoL have been extensively documented in other mental health conditions, the specific types and impacts of stigma experienced by adults with ADHD remain underexplored in recent reviews.AimsTo identify and describe the different types of stigmas experienced by adults with ADHD, while exploring how stigma may impact QoL’s key domains as defined by WHO (physical domain, psychological domain, level of independence, social relationships, environment, and spirituality/religion/personal beliefs).MethodsA literature search was conducted across APA PsycArticles, Embase, and Ovid MEDLINE(R) for ADHD AND stigma-related keywords. Eligible studies were English, peer-reviewed articles from the past decade involving adults (≥18) and describing or specifying at least one type of stigma.ResultsA total of 17 papers met the inclusion criteria. Stigma types included self-stigma and/or internalized stigma, perceived stigma, public stigma, and structural stigma. QoL domains affected included the psychological domain, social relationships, environment, and level of independence. Greater ADHD symptomatology was positively correlated with more internalized stigma, which in turn was linked to functional impairment, worse self-esteem, and poorer QoL. Self-stigma manifested as self-deprecating labels and ADHD devaluation. Perceived stigma hindered treatment seeking, medication compliance, and diagnostic disclosure, although associations with QoL were insignificant. Public stigma was the most investigated and related to negative societal attitudes, notably in academic contexts. Few studies looked at structural stigma; those that did identified structural barriers to care, though none directly assessed QoL outcomes.ConclusionStigma remains pervasive, though direct effects on QoL domains are less widely investigated. Future studies should investigate structural stigma in more depth and explore causal relationships between stigma and QoL.Systematic Review Registrationhttps://doi.org/10.17605/OSF.IO/Y52HK
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Electrophysiological and morphological alteration in the visual pathway of children with attention-deficit/hyperactivity disorder

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. Optical Coherence Tomography (OCT) and Visual evoked potentials (VEP) are common non-invasive diagnostic techniques. Researchers can use these techniques to identify possible biomarkers and explore the neurodevelopmental mechanisms underlying ADHD.MethodsThe ADHD group (37 cases, average age 8.81 ± 1.44 years) and the healthy controls (38 cases, average age 8.97 ± 1.43 years), had the OCT and VEP. The retinal nerve fibre layer (RNFL), optic disc parameters, and macular parameters were measured through OCT. The latencies of P100 and the amplitudes of N75-P100 and P100-N135 waves at three different spatial frequencies (visual angles of 15’, 30’, and 60’) were tested through VEP.ResultsThe average RNFL and RNFL in each quadrant between the two groups were no statistically significant (all p > 0.05). The optic disc area, average cup-to-disc ratio, and cup volume in the ADHD group were all significantly larger than those in the control group (all p < 0.05). At three visual angles (15’, 30’, 60’), P100-latency in the ADHD group were all more significant than those in the control group (all p < 0.05). The amplitudes of N75-P100 and P100-N135 in the ADHD group were all statistically significantly lower than those in the control group (all p ≤ 0.001).DiscussionFrom the perspective of electroencephalophysiology, children with ADHD may have early visual information processing disorders. This provides a theoretical and practical basis for further early intervention in children with ADHD from the field of visual perception. The study protocol followed the tenets of the Declaration of Helsinki, was approved by the local ethics committee (No 2023-2240), and was registered on ClinicalTrials.gov (ChiCTR2400086223).