Symptomatological Variants and Related Clinical Features in Adult Attention Deficit Hyperactive Disorder

Abstract

A large amount of the current literature has focused on the characteristic symptoms of attention deficit hyperactivity disorder (ADHD) in children and adolescents. In contrast, less attention has been devoted to ADHD clinical subtypes in adult patients. We evaluated 164 consecutive adult ADHD (A-ADHD) outpatients using DSM-5 criteria and many specific rating scales and questionnaires. A principal component factor analysis was performed on clinical and symptomatological variables to describe potential clinical variants. We sought to determine different A-ADHD variants focusing on demographic and clinical features. A four-factor solution was identified, and patients were clustered, according to their z-score, in 4 subgroups. The first was marked out by Emotional Dysregulation (ED), the second by Substance Use (SU), the third by Core-ADHD Symptoms (Co-ADHD) and the fourth by Positive Emotionality (PE). Predominantly ED patients showed worse overall function, early treatment with antidepressants and a greater presence of borderline personality disorder than predominantly Co-ADHD patients. Predominantly SU patients reported high rates of bipolar disorder and severe general psychopathology. The PE factor was related to hyperthymic temperament and hypomania and showed a higher level of functioning. Females with A-ADHD showed a lower risk of being included in SU, and A-ADHD patients with co-occurring delayed sleep phase had less risk of being included in the SU factor than the prevailing Co-ADHD group. Our empirically based description of four clinical A-ADHD variants shows several aspects beyond the definition given by the DSM-5 diagnostic criteria.

Identifying different patterns of emotional dysregulation in adult ADHD

“…Our results are therefore in line with those of prior studies using factor analysis which suggest that inattention, associated with executive dysfunction, is a robust feature of ADHD (26, 35,67,76,93,94). However, ED is at least as prominent as inattention among adults with ADHD.…”

“…Indeed, increased physical energy leads patients to engage in physical activities, which may, in turn, contribute to their well-being. In line with the positive emotionality factor identi ed by Pallucchini et al (93), consisting of few emotional control di culties, the hyperthymic temperament was part of our "overactivation" factor. Individuals presenting with hyperthymic temperament display exuberance, tirelessness, sensation seeking and a high level of energy (81).…”

“…The third cluster, labelled "overactivation", encompasses several strengths of functioning of adults with ADHD, including hyperthymic temperament traits, racing thoughts and creativity. This factor is akin to the positive emotionality factor recently highlighted in the literature (93). The other two factors were independent of emotional di culties.…”

“…behavioral, academic and social impairment (37,93,(96)(97)(98). For instance, in a recent factor analysis study, Pallucchini et al,(93) also identify an ED factor, and patients with ED presented with the most severe impairments. In addition to the contribution of ED to the functional impairment associated with adult ADHD, our results suggest a weak, albeit signi cant contribution of childhood maltreatment to ED and sleep problems.…”

Re-Thinking the Mediating Role of Emotional Valence and Arousal between Personal Factors and Occupational Safety Attention Levels

“…Attention is a psychological function accompanied by mental processes that result in the concentration of mental activities on a certain task or object [ 1 ]. In the field of occupational safety and public health research, safety attention usually refers to “the concentration of employees’ psychological activities on safety issues in their working environment” [ 2 ].…”