Prevalence of attention-deficit/hyperactivity disorder in older adults: A systematic review and meta-analysis

Dobrosavljevic, Maja; Solares, Carmen; Cortese, Samuele; Andershed, Henrik; Larsson, Henrik

doi:10.1016/j.neubiorev.2020.07.042

Cited by 54 publications

(47 citation statements)

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“…Adult ADHD only became a commonly diagnosed disorder in Sweden in the past decade, which probably explains the lower prevalence in our study (1·3%) than in previous survey studies in adults. 3 , 4 The resulting misclassification of ADHD cases might dilute the estimated associations, especially in middle and late adulthood, potentially underestimating associations with late-onset conditions the most. Furthermore, ADHD is associated with premature mortality.…”

Section: Discussionmentioning

confidence: 99%

“…ADHD is a neurodevelopmental disorder with an estimated worldwide prevalence of 3–7% in childhood and adolescence, 1 , 2 and around 3% in adulthood. 3 , 4 Twin and family studies have shown that ADHD has a high heritability, of around 70–80%, 5 and molecular genetic studies have estimated that common genetic variants account for almost one-third of this heritability. 6 Although there is a plethora of research that has shown the frequent co-occurrence of psychiatric disorders with ADHD, 7 associations with physical health conditions have been less studied, despite health-care costs in ADHD being substantially driven by both psychiatric and physical comorbid conditions.…”

Section: Introductionmentioning

confidence: 99%

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Mapping phenotypic and aetiological associations between ADHD and physical conditions in adulthood in Sweden: a genetically informed register study

Rietz

Brikell

Butwicka

et al. 2021

The Lancet Psychiatry

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Background Emerging evidence suggests increased risk of several physical health conditions in people with ADHD. Only a few physical conditions have been thoroughly studied in relation to ADHD, and there is little knowledge on associations in older adults in particular. We aimed to investigate the phenotypic and aetiological associations between ADHD and a wide range of physical health conditions across adulthood. MethodsWe did a register study in Sweden and identified full-sibling and maternal half-sibling pairs born between Jan 1, 1932, and Dec 31, 1995, through the Population and Multi-Generation Registers. We excluded individuals who died or emigrated before Jan 1, 2005, and included full-siblings who were not twins and did not have half-siblings. ICD diagnoses were obtained from the National Patient Register. We extracted ICD diagnoses for physical conditions, when participants were aged 18 years or older, from inpatient (recorded 1973-2013) and outpatient (recorded 2001-13) services. Diagnoses were regarded as lifetime presence or absence. Logistic regression models were used to estimate the associations between ADHD (exposure) and 35 physical conditions (outcomes) in individuals and across sibling pairs. Quantitative genetic modelling was used to estimate the extent to which genetic and environmental factors accounted for the associations with ADHD. Findings 4 789 799 individuals were identified (2 449 146 [51%] men and 2 340 653 [49%] women), who formed 4 288 451 unique sibling pairs (3 819 207 full-sibling pairs and 469 244 maternal half-sibling pairs) and 1 841 303 family clusters (siblings, parents, cousins, spouses). The mean age at end of follow-up was 47 years (range 18-81; mean birth year 1966); ethnicity data were not available. Adults with ADHD had increased risk for most physical conditions (34 [97%] of 35) compared with adults without ADHD; the strongest associations were with nervous system disorders (eg, sleep disorders, epilepsy, dementia; odds ratios [ORs] 1•50-4•62) and respiratory diseases (eg, asthma, chronic obstructive pulmonary disease; ORs 2•42-3•24). Sex-stratified analyses showed similar patterns of results in men and women. Stronger cross-disorder associations were found between full-siblings than between half-siblings for nervous system, respiratory, musculoskeletal, and metabolic diseases (p<0•007). Quantitative genetic modelling showed that these associations were largely explained by shared genetic factors (60-69% of correlations), except for associations with nervous system disorders, which were mainly explained by non-shared environmental factors.Interpretation This mapping of aetiological sources of cross-disorder overlap can guide future research aiming to identify specific mechanisms contributing to risk of physical conditions in people with ADHD, which could ultimately inform preventive and lifestyle intervention efforts. Our findings highlight the importance of assessing the presence of physical conditions in patients with ADHD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mapping phenotypic and aetiological associations between ADHD and physical conditions in adulthood in Sweden: a genetically informed register study

Rietz

Brikell

Butwicka

et al. 2021

The Lancet Psychiatry

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“…Epidemiological studies indicate that ADHD is one of the most common mental disorders affecting children [3,4], with prevalence in the childhood-adolescent community ranging between 2% and 8% globally [5,6]. High prevalence rates persist in adult ADHD patients, into the range of 2.6% to 6.8% [7,8].…”

Section: Introductionmentioning

confidence: 99%

The Role of Iron and Zinc in the Treatment of ADHD among Children and Adolescents: A Systematic Review of Randomized Clinical Trials

et al. 2021

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Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder common from childhood to adulthood, affecting 5% to 12% among the general population in developed countries. Potential etiological factors have been identified, including genetic causes, environmental elements and epigenetic components. Nutrition is currently considered an influencing factor, and several studies have explored the contribution of restriction and dietary supplements in ADHD treatments. Iron is an essential cofactor required for a number of functions, such as transport of oxygen, immune function, cellular respiration, neurotransmitter metabolism (dopamine production), and DNA synthesis. Zinc is also an essential trace element, required for cellular functions related to the metabolism of neurotransmitters, melatonin, and prostaglandins. Epidemiological studies have found that iron and zinc deficiencies are common nutritional deficits worldwide, with important roles on neurologic functions (poor memory, inattentiveness, and impulsiveness), finicky appetite, and mood changes (sadness and irritability). Altered levels of iron and zinc have been related with the aggravation and progression of ADHD. Objective: This is a systematic review focused on the contribution of iron and zinc in the progression of ADHD among children and adolescents, and how therapies including these elements are tolerated along with its effectiveness (according to PRISMA guidelines). Method: The scientific literature was screened for randomized controlled trials published between January 2000 to July 2021. The databases consulted were Medline, PsycINFO, Web of Science, and Google Scholar. Two independent reviewers screened studies, extracted data, and assessed quality and risk of bias (CONSORT, NICE, and Cochrane checklists used). Conclusion: Nine studies met the eligibility criteria and were selected. Evidence was obtained regarding the contribution of iron-zinc supplementation in the treatment of ADHD among young individuals. The discussion was focused on how the deficits of these elements contribute to affectation on multiple ADHD correlates, and potential mechanisms explaining the mediational pathways. Evidence also suggested that treating ADHD with diet interventions might be particularly useful for specific subgroups of children and adolescents, but further investigations of the effects of these diet interventions are needed.

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“…W badaniu kohortowym obejmującym ponad 3500 osób obserwowanych przez trzy dekady ADHD rozpoznano: przy zastosowaniu wszystkich kryteriów DSM-5 (American Psychiatric Association, 2013) ADHD -u 2,1% uczestników, a z pominięciem kryterium wieku pojawienia się objawów -u 5,8% (Vitola et al, 2017). W innym badaniu (metaanalizie) zauważono, że rozpowszechnienie zaburzenia wśród osób po 50. roku życia można oszacować na nieco ponad 2% (jeśli używa się zwalidowanych narzędzi psychometrycznych) lub zaledwie 0,2% (jeśli polega się na diagnozie klinicznej z wykorzystaniem standardowych kryteriów) (Dobrosavljevic et al, 2020). Autorzy potwierdzili też znaną obserwację kliniczną, zgodnie z którą u osób dorosłych dominują deficyty uwagi, a nadruchliwość występuje relatywnie rzadko.…”

Section: Wprowadzenieunclassified

Late-onset ADHD: does it exist?

Cholewa¹,

Sobów²

2021

Psychiatr Psychol Kli

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According to current classification systems, attention-deficit/hyperactivity disorder (ADHD) cannot be diagnosed unless its symptoms have been present already in childhood. Recently, this view has begun to be challenged with the thesis that the disorder may have its onset later in life (adolescence or young adulthood). The Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for ADHD are more liberal than those of the International Classification of Disease (ICD). Moreover, reports have begun to emerge demonstrating a different clinical picture in patients diagnosed with ADHD according to current guidelines and in a cohort with the onset in adulthood. The symptomatology of the disease in adults differs from that presented by children. Additionally, theories on the different etiopathogenesis of these entities have been advanced. These data have led to the proposal of distinguishing late-onset ADHD. There are also critical voices in the literature that question the possibility of developing ADHD symptoms in adulthood. Despite insufficient data and arguments to support the thesis of late-onset ADHD, there is a need for discussion and further exploration of the age at which ADHD may appear.

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Prevalence of attention-deficit/hyperactivity disorder in older adults: A systematic review and meta-analysis

Cited by 54 publications

References 40 publications

Mapping phenotypic and aetiological associations between ADHD and physical conditions in adulthood in Sweden: a genetically informed register study

Mapping phenotypic and aetiological associations between ADHD and physical conditions in adulthood in Sweden: a genetically informed register study

The Role of Iron and Zinc in the Treatment of ADHD among Children and Adolescents: A Systematic Review of Randomized Clinical Trials

Late-onset ADHD: does it exist?

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