Types of adult attention-deficit hyperactivity disorder (ADHD): baseline characteristics, initial response, and long-term response to treatment with methylphenidate

Abstract

Much recent research describes the importance of emotional symptoms in ADHD. While there is no accepted system for including emotionality in diagnosing ADHD, the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) provides a tool to facilitate this. It assesses a range of adult ADHD symptoms which load on two factors: inattentive and emotional dysregulation. The consistently high inattentive factor was used to define significant elevation on the more variable emotional dysregulation factor (which contains four WRAADDS domains: hyperactivity/restlessness, temper, affective lability, and emotional over-reactivity) allowing the definition of two ADHD diagnostic types. We compared these two types on a broad range of adult subject characteristics, including response to methylphenidate (MPH) treatment assessed during two clinical trials. Marked impairment in three of the four emotional domains reflected a symptom severity level equivalent to that of the inattentive factor. 59 % met this threshold, defining them as ADHD emotion dysregulation presentation, as opposed to 41 % with ADHD inattentive presentation. Cluster analysis validated these groups by generating similar clusters with 85 % agreement regarding membership. ADHD emotional dysregulation presentation subjects showed more childhood ADHD symptoms, adult symptoms of oppositional defiant disorder, and evidence of personality disorder. Both types showed similar improvement during the double-blind MPH arm of the trials and during a 6-month open-label phase. Based on the presence of symptoms of emotional dysregulation, ADHD in adults can be conceptualized as two types. Impairment and comorbidity in adults with ADHD are largely concentrated in ADHD emotional dysregulation presentation patients.

Practitioner Review: Emotional dysregulation in attention‐deficit/hyperactivity disorder – implications for clinical recognition and intervention

“…This extended‐release MPH was superior to placebo in reducing emotional symptoms associated with ADHD in adults. Reimherr, Marchant, Gift, Steans, and Wender () assessed two distinct categories of adults with ADHD: those with a high Inattentive Factor, and those with a high Emotional Dysregulation Factor. Over two long‐term clinical trials with extended‐release MPH, emotional dysregulation was acutely responsive to MPH treatment, and symptoms continued to improve during 6‐month open‐label follow‐up periods.…”

How do adolescents with ADHD perceive and experience stress? An interview study

“…Given the high prevalence of emotional symptoms in ADHD, an emotion dysregulation presentation of ADHD has also been suggested, represented by a low temper control, emotional lability, emotional over-reactivity, as well as hyperactivity/restlessness [30]. Emotional dysregulation may further diminish the individuals ability to handle typical life stresses, and negatively impact social and interpersonal relationships [3].…”

Personality Disorder in Adult Attention-Deficit/Hyperactivity Disorder

“…Subjects were then divided into 3 groups: those with no PD (PD negative), those with 1 PD (PD positive), and those with 2 or more PDs (PD plus). Earlier research has shown this tripartite classification to have utility (Reimherr et al, 2015).…”

“…It has 2 factors, one containing the domains of attention and disorganization and the other containing hyperactivity, temper problems, mood lability, and emotional overreactivity, with impulsivity split between the 2 factors (Marchant et al, 2013). We have also used the scale to determine whether ADHD adults have "ADHD inattentive presentation" defined by marked impairment or more in both the attention and organization domains or "ADHD emotional dysregulation presentation," defined by also having a rating of marked impairment on 3 of the 4 WRAADDS domains of restlessness/hyperactivity, temper, affective lability, and emotional overreactivity (Reimherr et al, 2015).…”

“…The Selfreport WRAADDS is a questionnaire that assesses the 7 domains of the WRAADDS (Reimherr et al, 2015) plus the domain of ODD (Marchant et al, 2011).…”