ADHD and its relationship to comorbidity and gender - Research database - University of Groningen
Keywords: ADHD, Gender, Comorbidity, Executive functions, BRIEF have shown to be weakly related to the severity of ADHD symptoms . TY - THES. T1 - ADHD and its relationship to comorbidity and gender. AU - Jónsdóttir,Sólveig. N1 - date_submitted Rights: University of Groningen. ADHD and its relationship to comorbidity and gender/Sólveig Jónsdóttir Thesis. Rijksuniversiteit Groningen, Groningen, The Netherlands, with.
Elevated raw-scores indicate a higher degree of situational and temporal anxiety. In a quantitative review by Seligman and colleagues [ 49 ], the authors argue that the STAIC possess satisfactory psychometric properties.
A net score was generated based on the 13 items with elevated raw-scores indicating a higher degree of depression symptoms.
The test consists of ten items. Each item contains three trials with the same number of digits and letters. The test administrator reads aloud each trial and asks the child to recall the numbers in ascending order and the letters in alphabetical order. In the present study, total correct recalled trials were examined. Lower scaled scores indicated difficulties with the task.
The colour - word interference test, condition 3 The Colour - Word Interference Test, Condition 3 CW 3 [ 5556 ] was used as a measure of inhibition. The examinee needs to inhibit an overlearned verbal response when naming the dissonant ink colours in which the words are printed.
For the present study, completion time in seconds was examined. The colour - word interference test, condition 4 The Colour - Word Interference Test, Condition 4 CW 4 [ 56 ] was used as a measure of cognitive flexibility. The examinee is asked to switch back and forth between naming the dissonant ink colours and reading the words. The examinee is asked to draw a line interchangeably between numbers and letters in the right order. For the present study, time to complete task was examined.
The design fluency test, condition 3 The Design Fluency Test, condition 3 DF [ 56 ] was used as a measure of cognitive flexibility.
Gender differences in ADHD subtype comorbidity.
The examinee is asked to draw as many different designs as possible using four straight lines connecting five filled and empty dots interchangeably. For the present study, total correct responses were examined. The tower test The Tower Test [ 56 ] was used as a measure of planning. The effect of alcohol yielded inconclusive and contradictory results whereas exposure to caffeine had too many other confounds Linnet et al. In contrast to Linnet, Davis et al.
- Gender differences in ADHD subtype comorbidity.
- ADHD in girls and boys – gender differences in co-existing symptoms and executive function measures
Ultimately, alcohol is transformed into sugar and therefore a diet which is high in refined sugar could also have a result similar to alcohol exposure. An American longitudinal study found that nicotine exposure in the womb was associated with ADHD Hyperactive Impulsive to a far greater degree than to the Inattentive presentation of the disorder Gard et al.
Similarly, in a Scandinavian study over 12, children and their mothers were observed and it was found that higher rates of obesity in the mothers were directly associated with ADHD-I in their children Rodriguez et al. A possible explanation is presented by Davis et al. Coincidentally, and as will be later described in more detail, obesity is one of the most common comorbidity of ADHD along with food addiction, with obesity starting in childhood and food addiction, respectively, at adolescence and early adulthood Davis et al.
Reviews of longitudinal data from studies on adopted babies that were brought to Scandinavia from ex-Soviet countries indicate a wide range of problems derived from prenatal alcohol exposure such as fetal alcohol syndrome and neurodevelopmental disorders. Acetaminophen is one of the most common over the counter drugs administered for fever reduction and for its mild analgesic properties. A direct correlation between acetaminophen taken by mothers during their pregnancy and higher rates of hyperkinetic disorders and ADHD in their children was found in a Danish study.
The researchers reviewed the records of as many as 64, children born between and and found consistent positive correlations with acetaminophen exposure and ADHD. Acetaminophen was unsurprisingly also found to have endocrine disrupting properties Liew et al. One of the most recent studies on the topic found that prenatal exposure to acetaminophen is associated with adverse effects on neurodevelopment and raised the risk of autism as well as ADHD.
This study was based on parental interviews and frequency of administration of the drug by the mother, a positive correlation between exposure and various adverse effects was found Avella-Garcia et al. Parenting Styles and ADHD The way parents raise their offspring is crucial to understanding most aspects of mental health as well as later lifestyles. It can be argued that each type of comorbidity and lifestyle can be at least to some degree influenced by parenting.
From very early on, individuals who later develop ADHD show an irritable temperament. Ineffective, inconsistent, and especially negligent parenting were found to exacerbate ADHD symptoms and be predictive of later disruptive behavior disorders such as Conduct Disorder; furthermore, children who had more positive and involved parenting manifested an improvement of symptoms Ullsperger et al.
ADHD in its childhood presentations is not only directly influenced by parenting styles but also by parental perception. Generally speaking, there are predictive and protective factors linking substance abuse and parenting.
One of the most widely recommended parenting style with respect to ADHD is authoritative parenting. This parenting style includes warmth, communication, and clear boundaries for the child. This style of parenting is compared with authoritarian which is less warm, with strict boundaries, low communication, and strict rules.
Permissive parenting consists of low boundaries and varying levels of communication where the parental role is not clearly defined; finally, there is negligent parenting laissez-fairewhere the child is not being properly taken care of and the parents are often missing from the households Briesmeister and Schaefer, ; Schaefer, In a South African study, authoritative mothers in families with children with ADHD had much better communicating styles and better educational outcomes for their children Tancred and Greeff, Similarly, severity of symptoms as well as academic and social well-being of children aged 7—11 years with ADHD Inattentive presentation, were directly correlated with parenting: One of the most classically acclaimed examples is the Baumrind study that found that children raised with an authoritative parenting style in the United States not only had lower drug and alcohol abuse incidences but were more competitive and successful in their academic careers.
In the United States, authoritative parenting is consistently advised and considered ideal for healthy outcomes in psychological development as well as a good preventive measure for substance abuse and addiction. Interestingly, European scholars favor a contrasting attitude: Strict authoritarian parenting as well as negligent parenting were the most widely implicated parenting styles associated with drug and alcohol abuse Calafat et al.
Hostility and parental conflicts were correlated with ADHD as well as single parent households Williamson and Johnston, However, correlational studies usually cannot exclude a reverse causality, i.
Studies looking into the parenting behaviors of adults with ADHD found significant differences in self-reports and observations about their own relationship and parental style with their children. ADHD Inattentive parents were most likely to self-report negative parenting, as they were consistently ignoring their children and getting easily annoyed with them.
In the Hyperactive Impulsive group much more positive interactions were observed, in the self-report ADHD parents had a tendency to conflate their positive parenting to higher self-esteem or a result of exaggeration due to other comorbid mental illnesses often seen in ADHD-HI like Antisocial Personality Disorder Lui et al.
A functional and supportive family can help to prevent ADHD onset and in case ADHD cannot be prevented, family members may mitigate the severity of symptoms. Societal Factors — Socioeconomic, Cultural and Political Aspects While suffering from ADHD appears as a highly individualized private matter, the intervening factors may be of a general societal nature.
Poverty and lack of access to resources are at the forefront of societal phenomena quoted in the literature. Lower SES and trends toward non-traditional single parent households Klein et al.
Individuals with lower SES have less access to resources, including proper food, lack of economic means to pay for decent education. Poverty is stressful and stress, as mentioned in the beginning of this section, is a general ADHD risk factor. While particularly noxious during the early stages of development, stress has been associated consistently with a later onset of ADHD as well as comorbid asthma Grizenko et al.
Lower SES is often associated with poor family cohesiveness and frequent family conflicts Conger et al. This creates an unhealthy environment for children to grow up in and puts them at risk of a variety of problems including ADHD. These are associated with low SES and lack of resources which the study showed are predictive factors, too Pheula et al. When compared to children from middle income families, those from poor families were 1. Still, the issue of poverty, status and ADHD is not without controversy.
ADHD appears to be almost a fashionable, trendy label in advanced societies. The rest of the world is trying to catch up with the United States; e. Conrad—was quoted by the Huffington Post article by Gregoire This may be more insidious than the globalization of American fast food or pop music, in that it comes in the name of proper mental health and behavior.
We are facing a moral dilemma: Environmental, Social and Societal Factors in Interaction The question still remains to what degree the poor economic status is the result of societal factors the economic system, structural racism, structural violence, lack of resources, etc.
A consensus tends to be in a conclusion that multiple factors are important at the same time Russell et al. Extensive reviews confirm this assumption by finding consistent correlations between socioeconomic factors and ADHD both in children and their families Bernfort et al.
Lifestyles related to ADHD are easily acquired within the family as social learning would entail. Furthermore, this was associated with parental behaviors that are easily learned such as higher rates of smoking and eating junk food as a normal staple food Russell et al. In a cross national review focusing on a smoking cessation program in Europe, it was found that higher rates of smoking were much more frequent in individuals from a lower socioeconomic background Bosdriesz et al.
It is therefore clear that the associations between class and social factors have a strong implication in ADHD development and its associated lifestyles. Higher rates of smoking, drug abuse, and poor diet are all included as lifestyles and at times comorbidities associated with ADHD Nigg, In summary, it is important to keep a holistic point of view and not to underestimate the extrinsic factors influencing this disorder such as SES and the effect of certain lifestyles mothers had before the individual was born.
The above mentioned effects are all significant and at times preventable but it is important to keep in mind that these lifestyles and higher exposure to toxic chemicals and pollution are also generally associated with lower SES and the social problems that are associated with poverty Duncan and Brooks-Gunn, ; Woolf et al.
Lifestyles and Comorbidities Associated with ADHD Attention Deficit Hyperactivity Disorder is associated with various peculiarities in lifestyle and resulting comorbidities which vary with the different manifestations of the disorder and present themselves in various developmental stages of life.
From the neonatal stage there is an association between certain particularly irritable temperaments and later negative emotive expression in pre-school. The genetic and behavioral differences between Inattentive, Hyperactive and Combined ADHD patients were so vast to lead some researchers to see them as separate diagnoses with differences even in reactions to methylphenidate which is universally prescribed for all presentations of the disorder Grizenko et al.
Others have differentiated the dopaminergic functions and GABAergic effects on the different symptoms such as impulsivity and hyperactivity Sagvolden et al. In the Hyperactive Impulsive presentation of ADHD, comorbidities such as conduct disorder in childhood and antisocial personality traits in late adolescence were more common.
The Inattentive presentation of the disorder showed different comorbidities like depression and anxiety.
Aims of the study We aimed at determining whether gender modified associations between ADHD and psychiatric comorbidities. We also aimed at determining the proportion of psychiatric disorders among men and women in the population that could be attributed to a comorbid ADHD. Record linkage was established using the national identification number unique to every Norwegian resident.
No informed consent was required for the analysis of anonymized registry data. The ADHD medications identified were the central stimulants: To evaluate how risk factors for both ADHD and other psychiatric disorders influenced the prevalence ratios, we ran two regression models, including the following covariates that all have been documented as risk factors for ADHD and psychiatric disorders 34353637383940 Significance of interaction by gender on the additive scale was evaluated using relative excess risk due to interaction RERI To examine the association between ADHD and other psychiatric disorders on a multiplicative scale, we estimated prevalence ratios PR using Poisson regression with robust standard errors Significance of interaction by gender on the multiplicative scale was evaluated by comparing Poisson regression models with and without the interaction term gender x ADHD included, as tested by likelihood ratio tests.
We repeated analyses including only individuals with one psychiatric comorbid diagnosis alone.