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Subtype differences in adults with attention-deficit/hyperactivity disorder (ADHD) with regard to ADHD-symptoms, psychiatric comorbidity and psychosocial adjustment

Published online by Cambridge University Press:  16 April 2020

Esther Sobanski ,
Daniel Brüggemann ,
Barbara Alm ,
Sebastian Kern ,
Alexandra Philipsen ,
Hannah Schmalzried ,
Bernd Heßlinger ,
H. Waschkowski  and
Marcella Rietschel
Esther Sobanski*
Affiliation:
Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J 5, 68159Mannheim, Germany
Daniel Brüggemann
Affiliation:
Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J 5, 68159Mannheim, Germany
Barbara Alm
Affiliation:
Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J 5, 68159Mannheim, Germany
Sebastian Kern
Affiliation:
Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J 5, 68159Mannheim, Germany
Alexandra Philipsen
Affiliation:
Department of Psychiatry and Psychotherapy, University of Freiburg, Hauptstr. 5, 79104Freiburg, Germany
Hannah Schmalzried
Affiliation:
Department of Psychiatry and Psychotherapy, University of Freiburg, Hauptstr. 5, 79104Freiburg, Germany
Bernd Heßlinger
Affiliation:
Department of Psychiatry and Psychotherapy, University of Freiburg, Hauptstr. 5, 79104Freiburg, Germany
H. Waschkowski
Affiliation:
Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J 5, 68159Mannheim, Germany
Marcella Rietschel
Affiliation:
Division of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, J 5, 68159Mannheim, Germany
*
*Corresponding author. Tel.: +49 621 1703 2852; fax: +49 621 1703 2855. E-mail address: esther.sobanski@zi-mannheim.de (E. Sobanski).
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Abstract

Background

To date, nearly all research of subtype differences in ADHD has been performed in children and only two studies, with conflicting results, have covered this subject in adults with ADHD.

Objective

This study examined subtype differences in the clinical presentation of ADHD-symptoms, related psychopathological features, psychosocial functioning and comorbid psychiatric disorders in adults with ADHD.

Method

One hundred and eighteen adults with ADHD, diagnosed according to DSM-IV criteria, and a population based control group underwent diagnostic evaluations with clinical interviews for ADHD, DSM-IV disorders and demographic features. Comparisons were made between ADHD combined type (n = 64), predominantly inattentive type (n = 30) and predominantly inattentive type, anamnestically combined type (n = 24), relative to each other and to a community control group (n = 70).

Results

The four groups did not differ in age and gender composition. All ADHD groups had significantly less education, were significantly more often unemployed and reported significantly more lifetime psychiatric comorbidity than controls. In comparison to each other, the three ADHD groups differed mainly in core symptoms and the pattern of comorbid psychiatric disorders, whereas no prominent differences in associated psychopathological features and most of the assessed psychosocial functions could be found. Patients with ADHD combined type and inattentive, anamnestically combined type both presented with significantly more hyperactive symptoms and also showed more impulsive symptoms than those with the predominantly inattentive type. With a similar overall lifetime psychiatric comorbidity in the three groups, patients with ADHD combined type and inattentive, anamnestically combined type suffered significantly more from lifetime substance use disorders than patients with predominantly inattentive type.

Conclusion

Our results clearly show impaired psychosocial adjustment and elevated risk for additional psychiatric disorders in adults with all subtypes of ADHD, compared to healthy controls. They provide preliminary evidence that in adult ADHD there might be a subgroup of patients, which is classified as predominantly inattentive subtype according to current diagnostic criteria, but which in its clinical presentation is in between ADHD combined and inattentive type. Further studies are needed to evaluate this finding and to gain a clear picture of its validity.

Keywords

Attention-deficit/hyperactivity disorderAdultsPsychiatric disorder
Type
Original articles
Information
European Psychiatry , Volume 23 , Issue 2 , March 2008 , pp. 142 - 149
Copyright
Copyright © Elsevier Masson SAS 2008

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