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The Relationship Between Specific Adult Attention-Deficit/Hyperactivity Disorder Symptoms and Anxiety Using Self-Report Diagnostic Scales

  • Hee Youn Won (Department of Psychiatry, Ewha Womans University Mokdong Hospital) ;
  • MinA Park (Department of Psychiatry, Ewha Womans University Mokdong Hospital) ;
  • Ga Eun Kim (Department of Psychiatry, Ewha Womans University Mokdong Hospital) ;
  • Eui-Jung Kim (Department of Psychiatry, Ewha Womans University Mokdong Hospital)
  • Received : 2024.07.19
  • Accepted : 2024.09.23
  • Published : 2024.10.01

Abstract

Objectives: This study aimed to investigate the relationship between adult attention-deficit/hyperactivity disorder (ADHD) and anxiety symptoms. Methods: A total of 52 patients diagnosed with adult ADHD completed self-report assessment scales. The clinical features of ADHD were assessed using the Adult ADHD Self-Report Scale (ASRS) and Korean Adult ADHD Rating Scale (K-AARS). The State-Trait Anxiety Inventory (STAI) was used to assess anxiety-related symptoms. Correlation and linear regression analyses were conducted to examine the relationships between the diagnostic scales of adult ADHD and anxiety. Results: Higher scores on the ASRS were related to higher scores on the STAI-S (r=0.482) and STAI-T (r=0.573), which assess state anxiety and trait anxiety, respectively. Subscales of inattention (STAI-S, r=0.485; STAI-T, r=0.648), impulsivity (STAI-S, r=0.404; STAI-T, r=0.491), emotional dysregulation (STAI-S, r=0.498; STAI-T, r=0.639), disorganization (STAI-S, r=0.427; STAI-T, r=0.545) on the KAARS, and the subtotal of K-AARS clinical subscales (STAI-S, r=0.517; STAI-T, r=0.540) had significant correlations with both STAI-S and STAI-T scores. After adjusting for demographic characteristics, there were significant associations between ASRS total scores (β=0.299) and STAI-S scores, and between inattention (β=0.297), impulsivity (β=0.560), emotional dysregulation (β=0.393), disorganization (β=0.817), subtotal scores on the K-AARS subscales (β=0.114), and STAI-S scores. The multivariate regression analysis also showed significant associations between ASRS total scores (β=0.409) and STAI-T scores. Associations between K-AARS subscales of inattention (β=0.468), impulsivity (β=0.817), emotional dysregulation (β=0.598), disorganization (β=1.120), subtotal scores on the K-AARS subscales (β=0.134), and STAI-T scores remained significant after adjusting demographic variables. Conclusion: Comprehensive assessment of ADHD symptoms related to anxiety would be important for the evaluation and treatment of anxiety in adult ADHD patients.

Keywords

Acknowledgement

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2020R1A6A1A03043528).

References

  1. Simon V, Czobor P, Bitter I. Is ADHD severity in adults associated with the lifetime prevalence of comorbid depressive episodes and anxiety disorders? Eur Psychiatry 2013;28:308-314. https://doi.org/10.1016/j.eurpsy.2012.05.002
  2. Choi WS, Woo YS, Wang SM, Lim HK, Bahk WM. The prevalence of psychiatric comorbidities in adult ADHD compared with non-ADHD populations: a systematic literature review. PLoS One 2022;17:e0277175.
  3. Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med 2006;36:159-165. https://doi.org/10.1017/S003329170500471X
  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5-TR). 5th ed. Arlington: American Psychiatric Association Publishing;2022.
  5. World Health Organization. International classification of diseases 11th revision (ICD-11): the global standard for diagnostic health information. Geneva: World Health Organization;2019.
  6. Anbarasan D, Kitchin M, Adler LA. Screening for adult ADHD. Curr Psychiatry Rep 2020;22:72.
  7. Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry 2000;157:816-818. https://doi.org/10.1176/appi.ajp.157.5.816
  8. Adler LA, Faraone SV, Spencer TJ, Berglund P, Alperin S, Kessler RC. The structure of adult ADHD. Int J Methods Psychiatr Res 2017;26:e1555.
  9. Kessler RC, Green JG, Adler LA, Barkley RA, Chatterji S, Faraone SV, et al. Structure and diagnosis of adult attention-deficit/hyperactivity disorder: analysis of expanded symptom criteria from the adult ADHD clinical diagnostic scale. Arch Gen Psychiatry 2010;67:1168-1178. https://doi.org/10.1001/archgenpsychiatry.2010.146
  10. Knouse LE, Zvorsky I, Safren SA. Depression in adults with attention-deficit/hyperactivity disorder (ADHD): the mediating role of cognitive-behavioral factors. Cognit Ther Res 2013;37:1220-1232. https://doi.org/10.1007/s10608-013-9569-5
  11. Faraone SV, Biederman J, Spencer T, Wilens T, Seidman LJ, Mick E, et al. Attention-deficit/hyperactivity disorder in adults: an overview. Biol Psychiatry 2000;48:9-20. https://doi.org/10.1016/S0006-3223(00)00889-1
  12. Gjervan B, Torgersen T, Nordahl HM, Rasmussen K. Functional impairment and occupational outcome in adults with ADHD. J Atten Disord 2012;16:544-552. https://doi.org/10.1177/1087054711413074
  13. Halmoy A, Fasmer OB, Gillberg C, Haavik J. Occupational outcome in adult ADHD: impact of symptom profile, comorbid psychiatric problems, and treatment: a cross-sectional study of 414 clinically diagnosed adult ADHD patients. J Atten Disord 2009;13:175-187. https://doi.org/10.1177/1087054708329777
  14. Knouse LE, Mitchell JT, Brown LH, Silvia PJ, Kane MJ, Myin-Germeys I, et al. The expression of adult ADHD symptoms in daily life: an application of experience sampling methodology. J Atten Disord 2008;11:652-663. https://doi.org/10.1177/1087054707299411
  15. Skirrow C, Asherson P. Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. J Affect Disord 2013;147:80-86. https://doi.org/10.1016/j.jad.2012.10.011
  16. Reimherr FW, Marchant BK, Strong RE, Hedges DW, Adler L, Spencer TJ, et al. Emotional dysregulation in adult ADHD and response to atomoxetine. Biol Psychiatry 2005;58:125-131. https://doi.org/10.1016/j.biopsych.2005.04.040
  17. Surman CB, Biederman J, Spencer T, Miller CA, McDermott KM, Faraone SV. Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: a controlled study. Atten Defic Hyperact Disord 2013;5:273-281. https://doi.org/10.1007/s12402-012-0100-8
  18. Katzman MA, Bilkey TS, Chokka PR, Fallu A, Klassen LJ. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry 2017;17:302.
  19. Philipsen A, Graf E, Jans T, Matthies S, Borel P, Colla M, et al. A randomized controlled multicenter trial on the multimodal treatment of adult attention-deficit hyperactivity disorder: enrollment and characteristics of the study sample. Atten Defic Hyperact Disord 2014;6:35-47. https://doi.org/10.1007/s12402-013-0120-z
  20. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the national comorbidity survey replication. Am J Psychiatry 2006;163:716-723. https://doi.org/10.1176/ajp.2006.163.4.716
  21. Grogan K, Gormley CI, Rooney B, Whelan R, Kiiski H, Naughton M, et al. Differential diagnosis and comorbidity of ADHD and anxiety in adults. Br J Clin Psychol 2018;57:99-115. https://doi.org/10.1111/bjc.12156
  22. Bramham J, Murphy DG, Xenitidis K, Asherson P, Hopkin G, Young S. Adults with attention deficit hyperactivity disorder: an investigation of age-related differences in behavioural symptoms, neuropsychological function and co-morbidity. Psychol Med 2012;42:2225-2234. https://doi.org/10.1017/S0033291712000219
  23. Zhang SY, Qiu SW, Pan MR, Zhao MJ, Zhao RJ, Liu L, et al. Adult ADHD, executive function, depressive/anxiety symptoms, and quality of life: a serial two-mediator model. J Affect Disord 2021;293:97-108. https://doi.org/10.1016/j.jad.2021.06.020
  24. Kim JH, Lee EH, Joung YS. The WHO adult ADHD self-report scale: reliability and validity of the Korean version. Psychiatry Investig 2013;10:41-46. https://doi.org/10.4306/pi.2013.10.1.41
  25. Kang T, Kim JW, Bahn GH, Song SH, Kim J, Kim JH, et al. [Development of Korean adult ADHD rating scale]. J Korean Acad Child Adolesc Psychiatry 2015;26:295-310. Korean https://doi.org/10.5765/jkacap.2015.26.4.295
  26. Lee K, Bae H, Kim D. [Factor analysis of the Korean version of the state-trait anxiety inventory in patients with anxiety disorders]. Anxiety Mood 2008;4:104-110. Korean
  27. Spielberger CD, Gorsuch RL, Lushene RE. STAI manual for the state-trait anxiety inventory ("self-evaluation questionnaire"). Palo Alto: Consulting Psychologists Press;1970.
  28. Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization adult ADHD self-report scale (ASRS): a short screening scale for use in the general population. Psychol Med 2005;35:245-256. https://doi.org/10.1017/S0033291704002892
  29. Heo S, Kim JH, Joung YS, Lee WI, Kim JJ, Sohn SH, et al. Clinical utility of the Korean version of the WHO adult attention-deficit/hyperactivity disorder self-report scale screener. Psychiatry Investig 2018;15:325-329. https://doi.org/10.30773/pi.2017.07.10
  30. Hong M, Lee YS, Kim B, Joung YS, Yoo HK, Kim EJ, et al. Clinical utility and cut-off scores of the Korean adult attention-deficit/hyperactivity disorder rating scale. J Korean Acad Child Adolesc Psychiatry 2019;30:116-120. https://doi.org/10.5765/jkacap.190022
  31. Kooij SJ, Bejerot S, Blackwell A, Caci H, Casas-Brugue M, Carpentier PJ, et al. European consensus statement on diagnosis and treatment of adult ADHD: the European network adult ADHD. BMC Psychiatry 2010;10:67.
  32. Kooij JJ, Huss M, Asherson P, Akehurst R, Beusterien K, French A, et al. Distinguishing comorbidity and successful management of adult ADHD. J Atten Disord 2012;16(5 Suppl):3S-19S. https://doi.org/10.1177/1087054711435361
  33. Reimherr FW, Marchant BK, Gift TE, Steans TA. ADHD and anxiety: clinical significance and treatment implications. Curr Psychiatry Rep 2017;19:109.
  34. Asherson P, Buitelaar J, Faraone SV, Rohde LA. Adult attention-deficit hyperactivity disorder: key conceptual issues. Lancet Psychiatry 2016;3:568-578. https://doi.org/10.1016/S2215-0366(16)30032-3
  35. Weibel S, Menard O, Ionita A, Boumendjel M, Cabelguen C, Kraemer C, et al. Practical considerations for the evaluation and management of attention deficit hyperactivity disorder (ADHD) in adults. Encephale 2020;46:30-40. https://doi.org/10.1016/j.encep.2019.06.005
  36. Jarrett MA, Ollendick TH. A conceptual review of the comorbidity of attention-deficit/hyperactivity disorder and anxiety: implications for future research and practice. Clin Psychol Rev 2008;28:1266-1280. https://doi.org/10.1016/j.cpr.2008.05.004
  37. Malloy-Diniz L, Fuentes D, Leite WB, Correa H, Bechara A. Impulsive behavior in adults with attention deficit/ hyperactivity disorder: characterization of attentional, motor and cognitive impulsiveness. J Int Neuropsychol Soc 2007;13:693-698. https://doi.org/10.1017/S1355617707070889
  38. Babinski LM, Hartsough CS, Lambert NM. Childhood conduct problems, hyperactivity-impulsivity, and inattention as predictors of adult criminal activity. J Child Psychol Psychiatry 1999;40:347-355. https://doi.org/10.1111/1469-7610.00452
  39. Salvi V, Migliarese G, Venturi V, Rossi F, Torriero S, Vigano V, et al. ADHD in adults: clinical subtypes and associated characteristics. Riv Psichiatr 2019;54:84-89.
  40. Soendergaard HM, Thomsen PH, Pedersen E, Pedersen P, Poulsen AE, Winther L, et al. Associations of age, gender, and subtypes with ADHD symptoms and related comorbidity in a Danish sample of clinically referred adults. J Atten Disord 2016;20:925-933. https://doi.org/10.1177/1087054713517544
  41. Schatz DB, Rostain AL. ADHD with comorbid anxiety: a review of the current literature. J Atten Disord 2006;10:141-149. https://doi.org/10.1177/1087054706286698
  42. Kooij JJS, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balazs J, et al. Updated European consensus statement on diagnosis and treatment of adult ADHD. Eur Psychiatry 2019;56:14-34. https://doi.org/10.1016/j.eurpsy.2018.11.001
  43. Beheshti A, Chavanon ML, Christiansen H. Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC Psychiatry 2020;20:120.
  44. Keyes KM, McLaughlin KA, Vo T, Galbraith T, Heimberg RG. Anxious and aggressive: the co-occurrence of IED with anxiety disorders. Depress Anxiety 2016;33:101-111. https://doi.org/10.1002/da.22428
  45. Skirrow C, Ebner-Priemer U, Reinhard I, Malliaris Y, Kuntsi J, Asherson P. Everyday emotional experience of adults with attention deficit hyperactivity disorder: evidence for reactive and endogenous emotional lability. Psychol Med 2014;44:3571-3583. https://doi.org/10.1017/S0033291714001032
  46. Brown TE. ADD/ADHD and impaired executive function in clinical practice. Curr Psychiatry Rep 2008;10:407-411. https://doi.org/10.1007/s11920-008-0065-7
  47. Hunt RD. Nosology, neurobiology, and clinical patterns of ADHD in adults. Psychiatr Ann 1997;27:572-581. https://doi.org/10.3928/0048-5713-19970801-10
  48. Oscarsson M, Nelson M, Rozental A, Ginsberg Y, Carlbring P, Jonsson F. Stress and work-related mental illness among working adults with ADHD: a qualitative study. BMC Psychiatry 2022;22:751.
  49. Mohamed SMH, Borger NA, van der Meere JJ. Executive and daily life functioning influence the relationship between ADHD and mood symptoms in university students. J Atten Disord 2021;25:1731-1742. https://doi.org/10.1177/1087054719900251
  50. Bloch Y, Aviram S, Segev A, Nitzan U, Levkovitz Y, Braw Y, et al. Methylphenidate reduces state anxiety during a continuous performance test that distinguishes adult ADHD patients from controls. J Atten Disord 2017;21:46-51. https://doi.org/10.1177/1087054712474949