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Delayed sleep phase syndrome (DSPS) is the most common sleep disturbance in adults with attention-deficit/hyperactivity disorder (ADHD). We previously showed that chronotherapy with melatonin effectively advanced the dim-light melatonin onset (DLMO), a biomarker for the internal circadian rhythm, by 1.5 h and reduced ADHD symptoms by 14%. Melatonin combined with bright light therapy (BLT) advanced the DLMO by 2 h, but did not affect ADHD symptoms. This article explores whether sleep times advanced along with DLMO, leading to longer sleep duration and better sleep in general, which might explain the working mechanism behind the reduction in ADHD symptoms after treatment with melatonin. This article presents exploratory secondary analysis on objective and self-reported sleep characteristics from a three-armed double-blind randomized placebo-controlled clinical trial (RCT), which included 49 adults (18-55 years) with ADHD and DSPS. Participants were randomized to receive sleep education and 3 weeks of (1) 0.5 mg/day placebo, (2) 0.5 mg/day melatonin, or (3) 0.5 mg/day melatonin plus 30 min of bright light therapy (BLT) between 0700 and 0800 h. Sleep was assessed at baseline, directly after treatment, and 2 weeks after the end of treatment. Objective measures were obtained by actigraphy, self-reported measures by various sleep questionnaires and a sleep diary. Melatonin with or without BLT did not advance sleep times, improve sleep in general, or strengthen wake-activity rhythms. So even though the DLMO had advanced, sleep timing did not follow. Adding extensive behavioral coaching to chronotherapy is necessary for advancing sleep times along with DLMO and to further alleviate ADHD symptoms.

OBJECTIVE: Sleep disturbances are highly frequent features in a range of child and adolescent psychiatric conditions. However, it is commonly not clear if such sleep problems represent symptomatic features, co-morbidities or risk factors for these conditions. It is believed that underlying dysfunction in the daily biological (circadian) clock may play important roles in the etiology of many sleep disorders, and circadian rhythm changes are also reported in a number of neuropsychiatric conditions. Here we explore the key identifying features of circadian rhythm disorders in child and adolescent psychiatry, and address how such disorders may be managed in the clinic. METHOD: A narrative review of the extant literature of circadian rhythm disorders in children and adolescents with psychiatric conditions. RESULTS: We identify key biological and social factors that contribute to circadian rhythm disorders in children and adolescents, as well as outlining the cognitive and neurobehavioral consequences resulting from insufficient sleep. We outline the roles of melatonin and other chronotherapeutic and behavioral interventions for the management of circadian rhythm disorders. Further, we highlight the importance of careful investigation of circadian rhythm abnormalities in shaping the most effective treatment plan according to chronobiological principles. CONCLUSION: Circadian rhythm disorders are common in children and adolescents with psychiatric conditions, and arise out of complex interactions between biological and social factors. Careful clinical attention to, and management of, circadian rhythm disorders in child and adolescent psychiatry has the potential for significant benefit not only in the domain of sleep but also in a range of cognitive, affective and behavioral outcomes.

BackgroundSeveral underlying mechanisms potentially account for the link between sleep and attention deficit and hyperactivity disorder (ADHD), including inflammation. However, studies so far have been cross-sectional. We investigate (i) the association between early childhood sleep and probable ADHD diagnosis in childhood; and (ii) whether childhood circulating inflammatory markers mediate any associations.Methods and FindingsData from the Avon Longitudinal Study of Parents and Children (ALSPAC) were available for 7658 10-years-old children. Parent-reported sleep duration, night awakening frequency, and regular sleep routines were collected at 3.5 years. The Development and Wellbeing Assessment (DAWBA) was administered to capture children with clinically relevant ADHD symptoms, or probable ADHD diagnosis. Further, blood samples were collected at 9 years, from which two inflammatory markers were obtained [i.e. interleukin-6 (IL-6) and C-reactive protein (CRP)]. Logistic regressions were applied to investigate the associations between sleep variables at 3.5 years and probable ADHD diagnosis at 10 years. Further, path analysis was applied to examine the mediating role of inflammation at 9 years (i.e. as measured by CRP and IL-6) in the associations between early sleep and ADHD at 10 years. We found that less regular sleep routines (OR=0.51, 95%CI=0.28-0.93, p=0.029), shorter nighttime sleep (OR=0.70, 95%CI=0.56-0.89, p=0.004), and higher night awakening (OR=1.27, 95I%CI=1.06-1.52, p=0.009) at 3.5 years were associated with higher odds of probable ADHD at 10 years. Further, IL-6 at 9 years mediated the association between irregular sleep routines and ADHD (bias-corrected estimate, -0.002; p=0.005); and between night awakening and ADHD (bias-corrected estimate, 0.002; p=0.003).ConclusionsSeveral sleep problems in early childhood constitute a risk factor for probable ADHD diagnosis at 10 years. These associations may be mediated by inflammation, as measured by IL-6. These results open a new research vista to the pathophysiology of ADHD and highlight sleep and inflammation as potential preventative targets for ADHD.

This is the first study to assess the prevalence of symptoms of premenstrual dysphoric disorder (PMDD), episodes of postpartum depression symptoms (PPD) after first childbirth, and climacteric mood symptoms in Attention-Deficit/Hyperactivity Disorder (ADHD). 209 consecutive women (18–71 years) with ADHD completed the PMDD chapter of the Neuropsychiatric Interview Plus version 5.0.0 to assess PMDD, the Edinburgh Postnatal Depression Scale to assess PPD, and the Greene Climacteric Scale to assess climacteric symptoms. Comorbid psychiatric disorders, medication use, and chronobiological sleep characteristics were also assessed. The prevalence of PMDD and PPD were high in ADHD, compared to the general population. PMDD symptoms were associated with less use of contraceptives. Antidepressants were associated with more PMDD symptoms. The following GCS scores were significant increased: anxiety, depression, and sexual dysfunction, vasomotor and somatic complaints. No significant differences were found in sleep characteristics or current comorbidity between the groups with and without PPD or PMDD, or increased climacteric scores. The prevalences of PMDD, PPD and climacteric scores were high in women with ADHD. This is the first study in women with ADHD that suggests that female ADHD patients suffer from significant PMDD symptoms, experience PPD during the first child birth, and experience more severe climacteric symptoms.

Background This study was to assess the validity of the Korean version of the semi-structured Diagnostic Interview for Adult ADHD, third edition (DIVA-5). The secondary aim was to compare sociodemographic and psychiatric comorbidities in adult patients with and without a diagnosis of ADHD. Methods A total of 279 participants were recruited from nine psychiatric outpatient clinics in Korea. All participants were administered the Mini-International Neuropsychiatric Interview (MINI) Plus v.5.0.0, the Adult ADHD Self-Report Scale v1.1 (ASRS-v1.1) Symptom Checklist, and DIVA-5. Diagnosis concordance between two board-certified psychiatrists and DIVA-5 were analysed. Results The DIVA-5 showed a diagnostic accuracy of 92%, a sensitivity of 91.30%, and a specificity of 93.62%. Significant clinical and demographic differences between ADHD and control groups were found. Conclusion The Korean version of DIVA-5 is a reliable tool for assessing and diagnosing ADHD in adult Korean populations.

Objective: To examine the naturalistic response to and cardiovascular side effects of stimulant medication in older adults with ADHD. Methods: Electronic Health Record (EHR) data of adult patients with ADHD (≥55 years) at the specialized PsyQ outpatient clinic for adult ADHD ( n = 113, 55-79 years) were collected. Response, cardiovascular status, side effects, and provided medical care before and after the first ADHD medication dose have been recorded. Results: A total of 65% of the patients reported positive response to the medication, and 42% of the patients quit their medication due to side effects or nonresponse. There was a small but significant decrease in weight and increase in heart rate before and after methylphenidate use. Conclusion: Our results indicate that the use of stimulants may be a relatively safe and effective treatment for older adults with ADHD, under the condition that the cardiovascular parameters are monitored before and during pharmacological treatment. Randomized controlled trials (RCTs) are needed to confirm these findings.

BackgroundMisconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base.MethodsWe reviewed studies with more than 2,000 participants or meta-analyses from five or more studies or 2,000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder.ResultsWe generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 79 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 362 people who have read this document and agree with its contents.ConclusionsMany findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.

Attention-deficit/hyperactivity disorder (ADHD) is highly associated with the delayed sleep phase disorder, a circadian rhythm sleep–wake disorder, which is prevalent in 73–78% of children and adults with ADHD. Besides the delayed sleep phase disorder, various other sleep disorders accompany ADHD, both in children and in adults. ADHD is either the cause or the consequence of sleep disturbances, or they may have a shared etiological and genetic background. In this review, we present an overview of the current knowledge on the relationship between the circadian rhythm, sleep disorders, and ADHD. We also discuss the various pathways explaining the connection between ADHD symptoms and delayed sleep, ranging from genetics, behavioral aspects, daylight exposure, to the functioning of the eye. The treatment options discussed are focused on improvement of sleep quality, quantity, and phase-resetting, by means of improving sleep hygiene, chronotherapy, treatment of specific sleep disorders, and by strengthening certain neuronal networks involved in sleep, e.g., by sensorimotor rhythm neurofeedback. Ultimately, the main question is addressed: whether ADHD needs to be redefined. We propose a novel view on ADHD, where a part of the ADHD symptoms are the result of chronic sleep disorders, with most evidence for the delayed circadian rhythm as the underlying mechanism. This substantial subgroup should receive treatment of the sleep disorder in addition to ADHD symptom treatment.

The majority of adults with Attention-Deficit/Hyperactivity Disorder (ADHD) have a delayed circadian rhythm that is a characteristic of Delayed Sleep Phase Syndrome (DSPS). Treatment of DSPS may improve both the circadian rhythm and ADHD symptoms. In this three-armed randomized clinical trial, 51 adults (18–55 y) with ADHD and DSPS received sleep education and 3 weeks of (1) 0.5 mg/d placebo, (2) 0.5 mg/d melatonin, or (3) 0.5 mg/d melatonin plus 30 minutes of 10,000 lux bright light therapy (BLT) between 07:00 and 08:00 h. Placebo/melatonin conditions were double-blind. Treatment took place in the participants’ naturalistic home settings. Dim-light melatonin onset (DLMO) was measured in saliva as marker of internal circadian rhythm. Melatonin or placebo administration followed individual schedules, starting 3 hours before the individual DLMO and weekly advancing by 1 h. DLMO and ADHD Rating Scale score were assessed at baseline, directly after 3-week treatment, and two weeks after the end of treatment. Results show that at baseline 77% had a DLMO after 21:00 h with an average DLMO at 23:43 h ± 1h46. Directly after treatment, melatonin had advanced DLMO by 1h28 (p = .001), and melatonin plus BLT by 1h58 (p

Slaapproblemen en slaapstoornissen komen in sterk verhoogde mate voor bij kinderen, adolescenten en volwassenen met ADHD. Slaapstoornissen en ADHD zijn gedurende de levensloop zo nauw met elkaar verweven dat ze elkaar in stand lijken te houden en te versterken. De delayed sleep-wake phase disorder (DSPD), ofwel de vertraagd slaap-waakritmestoornis, komt het meeste voor, bij 73–78 % van de kinderen en volwassenen met ADHD. In dit hoofdstuk wordt ingegaan op de relatie tussen de biologische klok en het voorkomen van slaapstoornissen en symptomen van ADHD gedurende de levensloop. Verder zullen de diagnostiek en behandeling van ADHD en de bijkomende slaapstoornissen, en de invloed van ADHD-medicatie op de slaap aan bod komen.

Objectives: This study evaluated the psychometrics of the Farsi translation of diagnostic interview for attention-deficit hyperactivity disorder (ADHD) in adults (DIVA-5) based on DSM-5 criteria. Methods: Referrals to a psychiatric outpatient clinic ( N = 120, 61.7% males, mean age 34.35 ± 9.84 years) presenting for an adult ADHD (AADHD) diagnosis, were evaluated using the structured clinical interviews for DSM-5 (SCID-5 & SCID-5-PD) and the DIVA-5. The participants completed Conner’s Adult ADHD Rating Scale-Self Report-Screening Version (CAARS-S-SV). Results: According to the SCID-5 and DIVA-5 diagnoses, 55% and 38% of the participants had ADHD, respectively. Diagnostic agreement was 81.66% between DIVA-5/SCID-5 diagnoses, 80% between SCID-5/CAARS-S-SV, and 71.66% between DIVA-5/CAARS-S-SV. Test–retest and inter-rater reliability results for the DIVA-5 were good to excellent. Conclusion: Findings support the validity and reliability of the Farsi translation of DIVA-5 among the Farsi-speaking adult outpatient population.

Objective: ADHD may predispose to obesity, a metabolic syndrome component. Affective disorders are also associated with MetSyn and ADHD. This study examined whether ADHD confers any added risk of MetSyn and obesity-related associations in a large sample with varying stages of affective disorders. Method: Participants included 2,303 adults from the Netherlands Study of Depression and Anxiety. Three groups were compared (controls, those with depressive/anxiety disorders without ADHD; and those with depressive/anxiety disorders and ADHD) for presence of MetSyn risk factors, body mass index, and waist–hip ratio. ADHD symptoms were identified by using a T-score > 65 (Conners Adult ADHD Rating Scale). Results: Multivariable analyses were additionally adjusted for sociodemographic, lifestyle, health factors, and affective disorders. Analyses showed no significant association between MetSyn, obesity-related variables, and comorbid ADHD. High Inattention and Hyperactivity/Impulsivity symptoms were not associated with MetSyn. Conclusion: This study did not confirm that MetSyn and obesity-related parameters are increased in comorbid ADHD.

Objective: We evaluated whether the association between Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Seasonal Affective Disorder (SAD) was mediated by the circadian rhythm.Method: Data of 2239 persons from the Netherlands Study of Depression and Anxiety (NESDA) were used. Two groups were compared: with clinically significant ADHD symptoms (N = 175) and with No ADHD symptoms (N = 2064). Sleep parameters were sleep-onset and offset times, mid sleep and sleep duration from the Munich Chronotype Questionnaire. We identified the prevalence of probable SAD and subsyndromal SAD using the Seasonal Pattern Assessment Questionnaire (SPAQ). Clinically significant ADHD symptoms were identified by using a T score>65 on the Conners Adult ADHD Rating Scale.Results: The prevalence of probable SAD was estimated at 9.9% in the ADHD group (vs. 3.3% in the No ADHD group) and of probable s-SAD at 12.5% in the ADHD group (vs 4.6% in the No ADHD group). Regression analyses showed consistently significant associations between ADHD symptoms and probable SAD, even after adjustment for current depression and anxiety, age, sex, education, use of antidepressants and benzodiazepines (B = 1.81, p Conclusion: Both seasonal and circadian rhythm disturbances are significantly associated with ADHD symptoms. Delayed sleep onset time in ADHD may explain the increase in SAD symptoms. Treating patients with SAD for possible ADHD and delayed sleep onset time may reduce symptom severity in these complex patients. (C) 2016 Elsevier Ltd. All rights reserved.

Objective: This is the first study to examine self-reported seasonal differences in the severity of ADHD symptoms in adults from the general population. Method: Data were analyzed from N = 5,303 respondents participating in the second wave of the Netherlands Mental Health Survey and Incidence Study–2, a population-based study on mental health. ADHD symptoms were assessed using the Adult ADHD Self-Report Scale Screener. As indicators of the severity of ADHD symptoms, the total ADHD symptom score and inattention and hyperactivity subscale scores were examined. Results: Compared with participants who were assessed in autumn, total ADHD and inattention subscale scores were significantly higher among participants who were assessed in spring or summer; the hyperactivity subscale score was significantly higher in spring. Conclusion: We found seasonal variations in the severity of ADHD symptoms, which was highest in those assessed in spring and summer. Researchers should be aware of this in the diagnostic process.

The aim of this study was to examine whether ADHD is a dimensional trait in the adult general population. We studied whether an increased number of ADHD symptoms was associated with higher comorbidity, exposure to risk factors (childhood abuse and parental psychopathology), and disability. We ascertained whether even low numbers of ADHD symptoms were associated with an increased burden of disease. Data were used from the second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2, N = 5303). NEMESIS-2 is a nationally representative face-to-face survey on mental health of the Dutch general population. ADHD symptoms, mental comorbidity, and disability were assessed using the Adult ADHD Self-Report Scale Screener, the Composite International Diagnostic Interview version 3.0, and the Medical Outcomes Study Short Form Health Survey, respectively. Dose-response relationships were found between the number of ADHD symptoms and Axis I and II mental disorders; exposure to risk factors; and mental and physical disability. Our study supports the notion that ADHD is a dimensional trait in the adult general population. Even low numbers of symptoms were associated with an increased burden of disease, and therefore these should be identified and treated.

In this chapter, the diagnostic assessment of ADHD in adults is described, starting with the clinical picture, such as the symptoms and the areas of impairment. To start the diagnostic process, screening instruments may be used. During diagnostic assessment, collateral information and neuropsychological tests have their role. The assessment of frequently occurring comorbidity with other psychiatric disorders, such as mood, anxiety, sleep, personality, and autism spectrum disorders, as well as addiction, is necessary to complete the clinical picture. Also, differential diagnosis is part of the diagnostic process. Finally, the Diagnostic Interview for ADHD in adults (DIVA 2.0), and the Conners Adult ADHD Diagnostic Interview (CAADID) are described and discussed. Instructions for use of the DIVA are given. The adjustments in the DSM-5 criteria for ADHD, and the next edition of DIVA based on the DSM-5 criteria, DIVA-5, are described.

Insomnia and short or long sleep duration are important comorbid conditions in adults with attention-deficit hyperactivity disorder (ADHD), but reports of the association vary. In a general population study, we evaluated the relationship between ADHD symptom severity, insomnia symptoms, and sleep duration in adults.Data were from the third wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2; n = 4,618). ADHD symptom severity and symptom dimensions (hyperactivity and inattention) were assessed using the Adult ADHD Self-Report Scale screener. Self-reported insomnia symptoms (Insomnia Rating Scale; IRS) were defined as clinically relevant if IRS ≥ 9. Self-reported short sleep duration was defined as ≤ 6 hours, and long sleep duration as ≥ 10 hours.Within the group with clinically relevant ADHD symptoms, 43% reported significant insomnia symptoms (odds ratio [OR] = 2.66, 95% confidence interval [CI] 1.74-4.07); 41% short sleep duration (relative risk ratio [RRR] = 1.94, 95% CI 1.31-2.85) and 6% long sleep (RRR = 5.87, 95% CI 1.97-17.45). Increased inattention symptoms were associated with IRS ≥ 9, short and long sleep duration in fully adjusted models (OR = 1.10, 95% CI 1.06-1.14; RRR = 1.06, 95% CI 1.02-1.09; RRR = 1.16, 95% CI 1.05-1.28, respectively). Increased hyperactivity symptoms were associated with IRS ≥ 9 (OR = 1.17, 95% CI 1.11-1.23) and short sleep duration (RRR = 1.12, 95% CI 1.05-1.19).Both clinically significant ADHD symptoms and inattention and hyperactivity symptom dimensions were consistently associated with insomnia symptoms and altered sleep duration. These associations confirm that sleep disturbances should be assessed and given appropriate clinical attention in adults with ADHD.

Insomnia and short or long sleep duration are important comorbid conditions in adults with attention-deficit hyperactivity disorder (ADHD), but reports of the association vary. In a general population study, we evaluated the relationship between ADHD symptom severity, insomnia symptoms, and sleep duration in adults. Methods: Data were from the third wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2; n = 4,618). ADHD symptom severity and symptom dimensions (hyperactivity and inattention) were assessed using the Adult ADHD Self-Report Scale screener. Self-reported insomnia symptoms (Insomnia Rating Scale; IRS) were defined as clinically relevant if IRS ≥9. Self-reported short sleep duration was defined as ≤6 hours, and long sleep duration as ≥10 hours. Results: Within the group with clinically relevant ADHD symptoms, 43% reported significant insomnia symptoms (odds ratio [OR] = 2.66, 95% confidence interval [CI] 1.74-4.07); 41% short sleep duration (relative risk ratio [RRR] = 1.94, 95% CI 1.31-2.85) and 6% long sleep (RRR = 5.87, 95% CI 1.97-17.45). Increased inattention symptoms were associated with IRS ≥9, short and long sleep duration in fully adjusted models (OR = 1.10, 95% CI 1.06-1.14; RRR = 1.06, 95% CI 1.02-1.09; RRR = 1.16, 95% CI 1.05-1.28, respectively). Increased hyperactivity symptoms were associated with IRS ≥9 (OR = 1.17, 95% CI 1.11-1.23) and short sleep duration (RRR = 1.12, 95% CI 1.05-1.19). Conclusions: Both clinically significant ADHD symptoms and inattention and hyperactivity symptom dimensions were consistently associated with insomnia symptoms and altered sleep duration. These associations confirm that sleep disturbances should be assessed and given appropriate clinical attention in adults with ADHD.

Study Objectives We evaluated the relationship between leukocyte telomere length (LTL) and sleep duration, insomnia symptoms, and circadian rhythm, to test whether sleep and chronobiological dysregulations are associated with cellular aging. Methods Data from the Netherlands Study of Depression and Anxiety (N = 2,936) were used at two waves 6 years apart, to measure LTL. Telomeres shorten during the life span and are important biomarkers for cellular aging. LTL was assessed by qualitative polymerase chain reaction and converted into base pair number. Sleep parameters were: sleep duration and insomnia symptoms from the Insomnia Rating Scale. Circadian rhythm variables were: indication of Delayed Sleep Phase Syndrome (DSPS), mid-sleep corrected for sleep debt on free days (MSFsc), sleep-onset time, and self-reported chronotype, from the Munich Chronotype Questionnaire. Generalized estimating equations analyzed the associations between LTL, sleep, and chronobiological factors, adjusted for baseline age, sex, North European ancestry, and additionally for current smoking, depression severity, obesity, and childhood trauma. Results Indicators of delayed circadian rhythm showed a strong and consistent effect on LTL, after adjustment for sociodemographic and health indicators. Late MSFsc (B = −49.9, p = .004), late sleep-onset time (B = −32.4, p = .001), indication of DSPS (B = −73.8, p = .036), and moderately late chronotype in adulthood (B = −71.6, p = .003) were associated with significantly shorter LTL across both waves; whereas sleep duration and insomnia symptoms were not. Extremely early chronotype showed significantly less LTL shortening than intermediate chronotype (B = 161.40, p = .037). No predictors showed accelerated LTL attrition over 6 years. Conclusions Individuals with delayed circadian rhythm have significantly shorter LTL, but not faster LTL attrition rates.

ADHD bij volwassenen is inmiddels een erkende psychiatrische diagnose in Nederland en Europa. Onlangs is de ‘Richtlijn ADHD bij volwassenen, deel I, Diagnostiek en Medicamenteuze behandeling’ uitgebracht door de Nederlandse Vereniging voor Psychiatrie. ADHD gaat gepaard met veel comorbiditeit, en is vanwege de chroniciteit een complexe stoornis, die in de specialistische GGZ behandeld dient te worden.

Melanopsin-containing retinal ganglion cells have recently been shown highly relevant to the non-image forming effects of light, through their direct projections on brain circuits that regulate alertness, mood and circadian rhythms. A quantitative assessment of functionality of the melanopsin-signaling pathway could be highly relevant in order to mechanistically understand individual differences in the effects of light on these regulatory systems. We here propose and validate a reliable quantification of the melanopsin-dependent Post-Illumination Pupil Response (PIPR) after blue light, and evaluated its sensitivity to dark adaptation, time of day, body posture, and light exposure history. Pupil diameter of the left eye was continuously measured during a series of light exposures to the right eye, of which the pupil was dilated using tropicamide 0.5%. The light exposure paradigm consisted of the following five consecutive blocks of five minutes: baseline dark; monochromatic red light (peak wavelength: 630 nm, luminance: 375 cd/m2) to maximize the effect of subsequent blue light; dark; monochromatic blue light (peak wavelength: 470 nm, luminance: 375 cd/m2); and post-blue dark. PIPR was quantified as the difference between baseline dark pupil diameter and post-blue dark pupil diameter (PIPR-mm). In addition, a relative PIPR was calculated by dividing PIPR by baseline pupil diameter (PIPR-%). In total 54 PIPR assessments were obtained in 25 healthy young adults (10 males, mean age ± SD: 26.9 ± 4.0 yr). From repeated measurements on two consecutive days in 15 of the 25 participants (6 males, mean age ± SD: 27.8 ± 4.3 yrs) test-retest reliability of both PIPR outcome parameters was calculated. In the presence of considerable between-subject differences, both outcome parameters had very high test-retest reliability: Cronbach's α > 0.90 and Intraclass Correlation Coefficient > 0.85. In 12 of the 25 participants (6 males, mean age ± SD: 26.5 ± 3.6 yr) we examined the potential confounding effects of dark adaptation, time of the day (morning vs. afternoon), body posture (upright vs. supine position), and 24-h environmental light history on the PIPR assessment. Mixed effect regression models were used to analyze these possible confounders. A supine position caused larger PIPR-mm (β = 0.29 mm, SE = 0.10, p = 0.01) and PIPR-% (β = 4.34%, SE = 1.69, p = 0.02), which was due to an increase in baseline dark pupil diameter; this finding is of relevance for studies requiring a supine posture, as in functional Magnetic Resonance Imaging, constant routine protocols, and bed-ridden patients. There were no effects of dark adaptation, time of day, and light history. In conclusion, the presented method provides a reliable and robust assessment of the PIPR to allow for studies on individual differences in melanopsin-based phototransduction and effects of interventions.

Objective To identify risk factors for adverse driving outcomes and unsafe driving among adults with and without ADHD in a Dutch sample. Methods In this cross-sectional study, validated self-report questionnaires were used to compare driving history and current driving behavior between 330 adults diagnosed with ADHD and 330 controls. Results Adults with ADHD had significantly more adverse driving outcomes when compared to controls. Having an ADHD diagnosis significantly increased the odds for having had 3 or more vehicular crashes (OR = 2.72; p = .001). Driving frequency, male gender, age, high anxiety levels, high hostility levels, and alcohol use all significantly influenced the odds for unsafe driving behavior, for having had 12 or more traffic citations, and/or for having had 3 or more vehicular crashes. Conclusions Alcohol use, and high levels of anxiety and hostility are highly prevalent among adults with ADHD, and they mediate the risk for negative driving outcomes in this group.

Purpose of Review: Insomnia is diagnosed when there is dissatisfaction with sleep quantity or quality. It has a prevalence in the general population ranging from 31 to 56%. Insomnia has previously been associated with adult attention-deficit/hyperactivity disorder (ADHD). In this review, we address three topics: (1) the cross-sectional relationship between ADHD and insomnia in adulthood, (2) the longitudinal relationship between ADHD and insomnia, and (3) insomnia as a side effect of pharmacological treatments for adult ADHD. Recent Findings: Three cross-sectional, clinical, and population studies report a prevalence of insomnia in ADHD adults ranging from 43 to 80%. Longitudinal evidence for a link between childhood-onset ADHD and insomnia at later age is mixed, with one study confirming and another study not supporting such a longitudinal association. In randomized, placebo-controlled trials, insomnia is reported significantly more often in the treatment arm than in the placebo arm. In varying percentages of trial participants, insomnia is a treatment-emergent adverse effect in triple-bead mixed amphetamine salts (40–45%), dasotraline (35–45%), lisdexamfetamine (10–19%), and extended-release methylphenidate (11%). Ten to seventeen percent of subjects in placebo-controlled trials of atomoxetine report insomnia, possibly related to poor metabolizer status. The mechanisms explaining the relationship between ADHD and sleep problems are incompletely understood, but both genetic and non-shared environmental influences may be involved. Summary: Adults with ADHD should be assessed for insomnia, which is frequently comorbid, and both conditions should be treated.

Background Little is known about the long-term persistence and adherence of psychostimulant use in adults with attention-deficit/hyperactivity disorder (ADHD) and its relationship to their psychological well-being. Methods The persistence and adherence to psychostimulants and psychological well-being were examined in adults with ADHD in a naturalistic follow-up, starting directly after discharge from their specialized treatment of ADHD at an outpatient ADHD clinic. Ninety-six patients were included at the time of discharge, who were interviewed by telephone at 6 months, 1 year, and 3 years after discharge. Results At the time of discharge, 78% used a psychostimulant prescribed by a psychiatrist. Of those on psychostimulants at the time of discharge, approximately half still used any of these psychostimulants 3 years after discharge. However, adherence rates were good for those who persisted to use psychostimulants. The female sex and middle educational level (relative to a higher educational level) were near-significantly related to nonpersistence, and having a higher educational level and the combined ADHD subtype were related to nonadherence. In turn, nonadherence was related to worse general functioning, lower mood, and poorer sleep quality. Conclusions The importance of adherence should be discussed at the time of discharge, especially with female ADHD patients, those with a higher educational level, and those with a combined ADHD subtype, because nonadherence is associated with poorer outcomes.

In the present study, we investigate whether methylphenidate (MPH) affects emotional processing and whether this effect is modulated by age. We measured amygdala reactivity with functional Magnetic Resonance Imaging (fMRI) during processing of angry and fearful facial expressions in male stimulant treatment-naive patients with ADHD (N = 35 boys; N = 46 men) and 23 healthy control subjects (N = 11 boys; N = 12 men). In ADHD patients, we also measured amygdala reactivity 90 min after an acute oral challenge with MPH (0.5 mg/kg). Mean amygdala reactivity was analyzed for all subjects using a repeated measures analysis of variance (ANOVA). Whole-brain maps were analyzed for the patients only. At baseline, we found a age*diagnosis effect approaching significance (p = 0.05) in the right amygdala due to lower reactivity in children with Attention Deficit/Hyperactivity Disorder (ADHD) vs. controls (−31%), but higher reactivity in adults with ADHD vs. controls (+31%). MPH significantly reduced right amygdala reactivity in all patients, resulting in further reductions in children. In the left amygdala, reduction of amygdala reactivity was confined to adult ADHD patients whereas there was no change in children with ADHD. MPH-induced decrease of amygdala reactivity in adults might be a promising avenue for managing emotional dysregulation when replicated for chronic MPH treatment.

Background Diagnostic guidelines recommend using a variety of methods to assess and diagnose ADHD. Applying subjective measures always incorporates risks such as informant biases or large differences between ratings obtained from diverse sources. Furthermore, it has been demonstrated that ratings and tests seem to assess somewhat different constructs. The use of objective measures might thus yield valuable information for diagnosing ADHD. This study aims at evaluating the role of objective measures when trying to distinguish between individuals with ADHD and controls. Our sample consisted of children (n = 60) and adults (n = 76) diagnosed with ADHD and matched controls who completed self- and observer ratings as well as objective tasks. Diagnosis was primarily based on clinical interviews. A popular pattern recognition approach, support vector machines, was used to predict the diagnosis. Results We observed relatively high accuracy of 79% (adults) and 78% (children) applying solely objective measures. Predicting an ADHD diagnosis using both subjective and objective measures exceeded the accuracy of objective measures for both adults (89.5%) and children (86.7%), with the subjective variables proving to be the most relevant. Conclusions We argue that objective measures are more robust against rater bias and errors inherent in subjective measures and may be more replicable. Considering the high accuracy of objective measures only, we found in our study, we think that they should be incorporated in diagnostic procedures for assessing ADHD.

Objective: To examine the associations between ADHD and social functioning and participation among older adults. Method: Data were used from the Longitudinal Aging Study Amsterdam (LASA). In 2008/2009, respondents were asked about social functioning and participation. A diagnostic interview to diagnose ADHD was administered among a subsample ( N = 231, age 60-94 years). ADHD diagnosis and level of ADHD symptoms were assessed. Results: ADHD diagnosis was associated with being divorced/never married, having less family members in their network, and emotional loneliness. Level of ADHD symptoms was associated with more emotional support given, emotional and social loneliness, greater recreational social participation, and lower income level. Conclusion: ADHD in old age is related to being divorced/never married and loneliness but not to work participation. Psycho geriatric practices should direct their attention to loneliness when treating ADHD.