Attention Deficit Hyperactivity Disorder (side study)


LASAG179 / LASAG379

Contact: Hannie Comijs

Background
It was long thought that Attention-Deficit/Hyperactivity Disorder (ADHD) was only present at childhood, but research in the last 20 years shows it persists into adolescence and adulthood (Barkley, Murphy, & Fischer, 2007; Kooij, 2010). ADHD is a developmental disorder and consists of problems with attention span, impulse control (impulsivity), and activity level (hyperactivity). The symptoms of ADHD are manifested in early childhood, before the age of twelve, and consist of, among others, forgetfulness, difficulty planning, restlessness and being overly active.

The world-wide prevalence of ADHD is estimated at 5.0% among children and 4.4% among adults (Polanczyk & Rohde, 2007). Since the symptoms tend to persist into adulthood, the disorder might also lead to significant impairment in older age. Little is known about how the symptoms manifest at older age and the difficulties older adults with ADHD have to deal with. Therefore, the ADHD side study focuses on ADHD in older adults and tries to add to the limited knowledge on the prevalence and potential psychosocial and physical consequences of the disorder in late life.

Measurement instruments in LASA
The ADHD side study started in 2008/2009. In the 2008/2009 wave of LASA, an ADHD screening list (Barkley et al, 2007) was part of the medical interview (N = 1,494). To limit the number of diagnostic interviews, a two-phase nonproportional stratified random sampling procedure was used. On the basis of the results of a screener (Phase 1), the sample was divided into tertiles with low (Group1), intermediate (Group 2), and high a priori likelihood of ADHD (Group 3). These tertiles were randomly, but non-proportionally sampled for respondents who were approached for the diagnostic interview (Phase 2). In Phase 2, all the participants in Group 3, and random samples of the participants in Groups 1 and 2  were approached for a diagnostic interview. The total study sample consisted in total of 231 older adults. Full details of the ADHD side study on sampling, measurements, and nonresponse are described elsewhere (Michielsen et al., 2012).

ADHD screening list
ADHD was screened using a questionnaire developed by Barkley et al. (2007). The questionnaire consists of seven items on inattention, one item on hyperactivity and one item on impulsivity. Using two response categories (no/yes), the sum score varied from 0 to 9, with 0 meaning no symptoms of ADHD and 9 meaning all symptoms of ADHD. This questionnaire was translated into Dutch and back translated into English by independent translators. Semeijn et al.(2013) found that the questionnaire had acceptable qualities, with good sensitivity and an area under the curve (AUC).

ADHD diagnosis
To diagnose ADHD, the Diagnostic Interview for ADHD in Adults, second edition, (Diagnostisch Interview Voor ADHD bij volwassenen, DIVA 2.0) was used (Kooij, 2010). This semistructured interview consists of two parts: one to assess the presence of all DSM-IV criteria in childhood (primary school, ages 6-12 years) and at present; the other to assess impairment in five areas of functioning (work, education, family, social/relationships, and self-confidence) in childhood and at present, related to the ADHD symptoms.

For the studies, the DIVA 2.0 was modified into a structured diagnostic interview because LASA works with lay interviewers. Examples of behaviour often reported by adults with ADHD were added with each symptom. When participants endorsed a symptom, either at the present time or in childhood, further questions where asked about the duration (“longer than six months? no/yes”), frequency (“more than once a week?(no/yes”), and whether the symptom persisted throughout their life. In part two it was asked if the symptoms led to impairment in different areas of functioning, both in adulthood and during childhood. A stem-question about impairment in one area was first asked and, when given a negative answer, several more specific examples of impairment were given. These questions also had to be answered with yes or no.

Questionnaires
LASAG179 (medical interview, in Dutch)

Variable information
LASA179;
LASA379 (total score)
(pdf)

Availability of information per wave1:

 

B

C

D

E

 
2B*

F

G

H

 

3B*

MB*

I*

ADHD screening list

-

-

-

-

-

-

Me

-

-

- -

1 More information about the LASA data collection waves is available on:
http://www.lasa-vu.nl/data/lasa/sampleLASAdatacollection.html

* 2B=baseline second cohort;
   3B=baseline third cohort;
   MB=migrants: baseline first cohort (Under Construction);
   I=Under Construction

Me=data collected in medical interview

Previous use in LASA
The prevalence and physical, cognitive and psychosocial functioning of ADHD among older adults was examined in several studies (Michielsen et al., 2012, 2013a, 2013b, 2014; Semeijn et al., 2013a, 2013b, 2015a, 2015b).

References

  1. Barkley, R. A., Murphy, K. R., & Fischer, M. (2007). ADHD in adults: What the science says. New York: Guilford.
  2. Kooij, J. J. S. (2010). Adult ADHD. Diagnostic Assessment and Treatment. Amsterdam: Pearson Assessment and Information.
  3. Michielsen, M., Comijs, H. C., Aartsen, M. J., Semeijn, E. J., Beekman, A. T., Deeg, D. J., & Kooij, J. S. (2013a). The Relationships Between ADHD and Social Functioning and Participation in Older Adults in a Population-Based Study. Journal of Attention Disorders, 1087054713515748.
  4. Michielsen, M., Comijs, H. C., Semeijn, E. J., Beekman, A. T. F., Deeg, D. J. H., & Kooij, J. J. S. (2014). Attention Deficit Hyperactivity Disorder and Personality Characteristics in Older Adults in the General Dutch Population. The American Journal of Geriatric Psychiatry, 22(12), 1623–1632. http://doi.org/10.1016/j.jagp.2014.02.005
  5. Michielsen, M., Comijs, H. C., Semeijn, E. J., Beekman, A. T. F., Deeg, D. J. H., & Sandra Kooij, J. J. (2013b). The comorbidity of anxiety and depressive symptoms in older adults with attention-deficit/hyperactivity disorder: A longitudinal study. Journal of Affective Disorders, 148(2–3), 220–227. http://doi.org/10.1016/j.jad.2012.11.063
  6. Michielsen, M., Semeijn, E., Comijs, H. C., van de Ven, P., Beekman, A. T. F., Deeg, D. J. H., & Kooij, J. J. S. (2012). Prevalence of attention-deficit hyperactivity disorder in older adults in The Netherlands. The British Journal of Psychiatry, 201, 298–305.
  7. Polanczyk, G., & Rohde, L. A. (2007). Epidemiology of attention-deficit/hyperactivity disorder across the lifespan. Current Opinion in Psychiatry, 20(4), 386.
  8. Semeijn, E. J., Comijs, H. C., Kooij, J. J. S., Michielsen, M., Beekman, A. T. F., & Deeg, D. J. H. (2015a). The role of adverse life events on depression in older adults with ADHD. Journal of Affective Disorders, 174, 574–579.
  9. Semeijn, E. J., Kooij, J. J. S., Comijs, H. C., Michielsen, M., Deeg, D. J. H., & Beekman, A. T. F. (2013a). Attention-Deficit/Hyperactivity Disorder, Physical Health, and Lifestyle in Older Adults. Journal of the American Geriatrics Society, 61(6), 882–887. http://doi.org/10.1111/jgs.12261.
  10. Semeijn, E. J., Korten, N. C. M., Comijs, H. C., Michielsen, M., Deeg, D. J. H., Beekman, A. T. F., & Kooij, J. J. S. (2015b). No lower cognitive functioning in older adults with attention-deficit/hyperactivity disorder. International Psychogeriatrics, 1–10.
  11. Semeijn, E. J., Michielsen, M., Comijs, H. C., Deeg, D. J. H., Beekman, A. T. F., & Kooij, J. J. S. (2013b). Criterion Validity of an Attention Deficit Hyperactivity Disorder (ADHD) Screening List for Screening ADHD in Older Adults Aged 60–94 years. The American Journal of Geriatric Psychiatry, 21(7), 631–635. http://doi.org/10.1016/j.jagp.2012.08.003