Attention deficit-hyperactivity disorder (ADHD) consists of symptoms of both inattention and hyperactivity/impulsivity that cause significant functional impairment (APA, 1994). Approximately 4.7% of adults are diagnosed with ADHD; however, there are few empirically-informed interventions that are specifically designed for adults. Instead, many of the common interventions for adults are derived from work done with children with ADHD and may not be appropriate for their particular needs (Weiss & Weiss, 2004). Given that adults with ADHD typically experience more symptoms of inattention rather than hyperactivity, an investigation of the effectiveness of an intervention that specifically targets their inattentive symptoms is warranted (Weiss & Weiss, 2004; Weiss et al., 2002). Therefore, the goal of this study was to evaluate the efficacy of an attention-specific intervention for adults with ADHD. The intervention used in this study, Attention Process Training (APT; Sohlberg & Mateer, 1987), has never been applied to adults with ADHD. The underlying assumption behind this intervention is that attentional functioning can be improved through the use of tasks that are designed to re-train various aspects of attention. More specifically, this study addressed sustained, alternating, and selective/divided attention during the intervention. A non-concurrent multiple baseline design was used in order to assess the effectiveness of the APT among a sample of adults with ADHD. A sample of four adults, aged 21-37 years (M = 27.75) participated in this study and demonstrated minimal changes in their attentional ability after the intervention. In addition, the findings suggest that the different components of attention addressed in this intervention are not distinct and likely have a reciprocal affect on one another. / Ph. D.

Magister Artium (Psychology) - MA(Psych) / The diagnosis of adult ADHD is a complex process that requires information from different sources. Instruments are used to screen or diagnose adult ADHD. The aim of the study was to identify instruments measuring adult ADHD from good quality research. This systematic review was executed following the recommended PRISMA steps. A comprehensive search was conducted across identified databases. The SFS scoring system was used to critically appraise for methodological rigour and coherence. Meta-synthesis was used to summarize extracted data from 26 articles included in the final summation. Ethics clearance was issued by the UWC Senate Research Committee. Sixteen instruments measuring adult ADHD were identified. Screening instruments measure core symptoms whereas diagnostic instruments assess all criteria. Fourteen instruments were based on DSM-IV criteria and four were based on DSM-V criteria for adult ADHD including rival explanations for the symptoms. The lack of adoption of DSM-V criteria remains a concern given criticism against DSV-IV criteria for adult ADHD. Overall instruments presented acceptable psychometric properties. However, the performance of the instruments was study dependent. A cautionary note is that these indices must be interpreted carefully. Further research must explore the reasons underlying the lack of adoption of DSM-V criteria in research, and the lack of revision of instruments measuring adult ADHD.

ADHD, attention deficit hyperactive disorder was first described as such in the diagnostic and statistical manual of mental disorders, the DSM in 1987. Since then the disorder has had great interest from research but also from society. The amount of ADHD diagnoses has increased every year since the disorder has been established by the American Psychiatric Association and is in recent years the most established mental illness among children and adults. The goal of this paper is to explore how people diagnosed with ADHD subjectively define and experience the abstract object of ADHD. Previous research focuses on mapping the problems and impairments resulting from this “illness”, to gain more insight into the differences between people diagnosed with ADHD, and people who do not possess the described symptoms, often focused on the problems people experience. Social constructionists look upon ADHD as socially constructed; a socially valued dysfunction, a deviant pattern of behaviour was once observed and categorised into what we now call symptoms. The word symptom demonstrates indication or evidence, and the abstract object takes on disease like properties. The object becomes reified, which means as much as become real. The result is that ADHD is seen as the cause of problems, instead of a group of problems that was once labelled ADHD. The informants used for this research seem to have problems with controlling their impulses, which besides negatively influencing executive functioning, causes problems with social interaction. The informants often express feeling misunderstood by their environment, they feel different. They feel discriminated against by the structures of school, work and society as a whole which, they feel, impairs their abilities and missuses their talents. They express to feel at ease when they are fully occupied with something interesting and seem to call for understanding for their inabilities and space to develop their talents.

Adults with attention-deficit/hyperactivity disorder (ADHD) experience impairment in cognitive, scholastic/vocational and interpersonal domains. The goal of this study was to gain more information how adult ADHD symptomatology impacts parenting behaviors, specifically, overreactivity and laxness. This study found that parental ADHD symptoms were associated with greater overreactive parenting behavior. Differences between mothers and fathers were assessed and no significant difference in ADHD symptomatology or parenting behaviors were found. The combination of adult ADHD symptoms and child behavior, above and beyond parental depression, was found to be a statistically significant predictor of parental overreactive behavior, while this was not the case for parental lax behavior.

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Bakgrund: Många vuxna med ADHD avbryter sin behandling av okända orsaker. Därför är det viktigt att undersöka hur vuxna med ADHD upplever sina möjligheter att vara delaktiga i behandlingen och på vilket sätt sjuksköterskan kan vara till stöd för dem. Syfte: Att beskriva vuxna ADHD patienters upplevelse av delaktighet och behov av sjuksköterskans stöd vid behandling inom öppenvårdspsykiatrin. Metod: Kvalitativ studie som baseras på åtta semistrukturerade intervjuer. Intervjumaterialet analyserades med innehållsanalys. Resultat: Många upplevde att de saknade information om diagnos och behandling och att de därför inte kunde vara med och påverka. Sjuksköterskan upplevdes vara lättare att nå än läkaren och kunde erbjuda tätare uppföljningar. Sjuksköterskan upplevdes också ha en samordnande funktion mellan olika yrkeskategorier. Att bli sedd som person och inte bli reducerad till en patient med ADHD var viktigt. Slutligen framkom betydelsen av att även involvera närstående i behandlingen. Slutsats: En del av sjuksköterskans arbete är att föra ut kunskap och information till patienterna på ett sätt som patienterna förstår utifrån varje persons specifika behov för att öka patienternas möjlighet till delaktighet. Specialistsjuksköterskan kan också utgöra ett stöd genom möjligheten att erbjuda tätare kontakt och mer uppföljning, samordning med andra yrkesgrupper och samhällsinstanser. Stöd kan också handla om att se människan bakom diagnosen. / Background: Many adults with ADHD drop out of treatment for unknown reasons. Therefore it is important to investigate how adults with ADHD experience their possibilities to be involved in their treatment and the way in which the nurse can be supportive to them. Objective: Describe the experience by adult ADHD patients of their participation and the need of support by the nurse in outpatient psychiatry treatment. Method: Qualitative study based on eight semi-structured interviews. The interview material was analyzed with the use of content analysis. Results: Many of the participants felt that they lack information about their diagnosis and treatment, and that they therefore could not participate and influence their treatment. The nurse was perceived easier to reach than the doctor and also to offer more frequent follow-up. Their experience was also that the nurse can play a coordinating role between the different professions. To be seen as a person and not be reduced to a patient with ADHD was considered important. Finally, the interviews revealed the importance of involving relatives in treatment. Conclusion: The specialist nurse can bring knowledge and information to patients in a way that makes it possible for patients to understand on the basis of each person's specific needs in order to increase the possibilities for patients to participate. The specialist nurse can also provide support through the ability to offer more frequent contact and more follow-up and coordination with other professionals and social organization community agencies. Support may also be about seeing the person behind the diagnosis.

Attention-deficit/hyperactivity disorder (ADHD) is surrounded by confusion and controversy regarding its definition, course, etiology and treatment. Among adults, ADHD is rarely considered a diagnostic reality of primary importance and is often overlooked. This study provides descriptive validity for adult ADHD in distinguishing it from controls, and identifying both a pure condition and one wrought with comorbidity.

Einleitung: Methylphenidat (MPH) als Medikament der ersten Wahl bei Patienten mit einem Aufmerksamkeitsdefizit- /Hyperaktivitätssyndrom (ADHS) ist für die Therapie von Kindern aber auch von Erwachsenen weit verbreitet. Weil es immer noch Sicherheitsbedenken gegen dieses Medikament gibt, wurde in der vorliegenden Studie untersucht, ob die Langzeiteinnahme von MPH unschädlich hinsichtlich eines zytogenetischen Effektes ist. Ein weiteres Ziel war die Beurteilung von chronischer psychosozialer Stressbelastung von Patienten im Vergleich zu Kontrollprobanden und zu beurteilen ob die Medikation einen Einfluss auf die Höhe des Stresses hat. Nicht zuletzt war das dritte Ziel der Studie zu untersuchen, ob Stress selbst zu zytogenetischen Schäden führt. Material und Methoden: Lymphozyten von 72 (42 ADHS- und 28 gesunde Kontrollprobanden) geschlechts- und altersgematchte Probanden im Alter von 18-28 Jahren, wurden aus venösem Blut für den Mikronukleusassay isoliert. Hauptendpunkt der Studie war die Mikrokernanzahl in binukleären Zellen. Die psychosoziale Stressbelastung der letzten drei Monate wurde mit dem Trier Inventar zum chronischen Stress (TICS) gemessen. Zusätzlich wurden Speichelproben für eine Cortisolmessung gesammelt. Ergebnisse: Ein Einfluss der MPH-Einnahme auf die Mikrokernfrequenz konnte nicht gefunden. ADHS-Patienten wiesen eine signifikant höhere Stressbelastung im Vergleich zu den Kontrollprobanden auf. Ein signifikanter positiver Einfluss auf das chronische Stresserleben unter MPH-Einnahme konnte bei Einnahme von mehr als 1 Jahr beobachtet werden. Die Stressbelastung der ADHS-Patienten und Kontrollprobanden zeigte keine Korrelation zu zytogenetischen Endpunkten. Eine kleine Untergruppe, ADHS-Patienten mit Komorbidität Depression, zeigte jedoch signifikante erhöhte Mikrokernfrequenzanzahlen unter stark erhöhtem chronischen Stress. Aussichten: Aus unserer Sicht kann MPH auch in der Langzeittherapie sicher hinsichtlich eines Krebsrisikos in gewichts- und symptomadaptierter Dosis eingesetzt werden. Weitere Studien sind nötig um das Krebsrisiko bei chronischer erhöhter Stressbelastung abzuschätzen. / Introduction: Methylphenidate (MPH) as first line treatment for patients with attention deficit hyperactivity disorder (ADHD) is widely used not only for therapy in children but also in adults. Because there are still safety concerns for this medication this study investigated if the long term treatment of MPH is harmless regarding to cytogenetic effects. A further aim was to compare the psychosocial stress levels of ADHD patients to those in control subjects and to investigate if MPH medication has an influence on self-perceived stress levels in ADHD. The third aim of this study was to explore if psychosocial stress leads to cytogenetic damage. Materials and methods: Lymphocytes of 72 subjects (42 ADHD and 28 healthy control subjects), matched in age and gender(aged 18-28 years) were isolated from venous blood for micronucleus assay. Main endpoint was the micronucleus frequency in binucleated cells. Psychosocial stress exposure of the last three month was measured by Trier Inventory for Chronic Stress (TICS). Additionally saliva samples were collected for cortisol measurement. Results: An influence of MPH intake on cytogenetic markers could not be found. ADHD patients showed significantly higher stress levels in comparison to control subjects. Patients taking MPH for more than one year displayed significantly lower chronic psychosocial stress levels than patients taking it less than one year or not-treated patients. Stress exposure of ADHD patients and control subjects showed no correlations to cytogenetic endpoints. A small subgroup of ADHD patients with comorbid depression showed significantly higher micronuclei frequencies and reported greater increased chronic stress. Views: We conclude that MPH in weight - and symptom - adjusted dose can be safely used also for long term treatment regarding to cancer risk. Further studies are necessary to estimate cancer risk for increased chronic stress exposure.