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

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ADHD Attention Deficit and Hyperactivity Disorders

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.

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Acknowledgments

The data for this paper came from two clinical trials supported by McNeil Consumer and Specialty Pharmaceuticals and Shire Pharmaceutical Development.

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Authors and Affiliations

  1. Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, 84103, USA

    Fred W. Reimherr & Paul H. Wender

  2. Psychiatric and Behavioral Solutions, L.L.C., 1522 South 1100 East, Salt Lake City, UT, 84105, USA

    Fred W. Reimherr, Barrie K. Marchant & Tammy A. Steans

  3. Department of Psychiatry, University of Rochester, 1522 South 1100 East, Salt Lake City, UT, 84105, USA

    Thomas E. Gift

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  1. Fred W. Reimherr
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  2. Barrie K. Marchant
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  3. Thomas E. Gift
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  5. Paul H. Wender
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Correspondence to Barrie K. Marchant.

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Reimherr, F.W., Marchant, B.K., Gift, T.E. et al. Types of adult attention-deficit hyperactivity disorder (ADHD): baseline characteristics, initial response, and long-term response to treatment with methylphenidate. ADHD Atten Def Hyp Disord 7, 115–128 (2015). https://doi.org/10.1007/s12402-015-0176-z

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