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Co-occurring Symptoms of Attention Deficit Hyperactivity Disorder and Depression: Sex, Aetiology, Help-Seeking and Assessment
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Centrum för klinisk forskning, Västerås.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of the thesis was to contribute to the knowledge about co-occurring symptoms of ADHD and depression in adolescence, focusing on sex differences, as well as aetiology, help-seeking and assessment.

Studies I–III used epidemiological samples of self-reports from all students in Västmanland aged 15–16 and 17–18 years. Study I investigated the prevalence of co-occurring symptoms of ADHD and depression, as well as associations between co-occurring symptoms of ADHD and depression and one environmental stress factor; experience of sexual abuse. Study II examined associations between one biological factor—a polymorphism in TFAP-2βand co-occurring symptoms of ADHD with andco-occurringsymptoms of depression. Study III investigated the association between the parent–adolescent relationship and seeking help from specialized mental health services in relation to symptoms of ADHD and/or depression. Study IV was a clinical study among adolescent psychiatric patients that compared self-reported ADHD symptoms via the Adult ADHD Self-Report Scale–Adolescent version (ASRS-A) and the Adult ADHD Self-Report Scale–Adolescent–Screening version (ASRS-A-S) with an ADHD diagnosis determined by the gold-standard method; the Kiddie Schedule of Affective Disorders and Schizophrenia diagnostic interview.

Studies I–III showed that the phenotype of co-occurring symptoms of ADHD and depression is frequent, with a distinct preponderance among girls. Approximately 50% of both boys and girls with co-occurring symptoms of ADHD and depression had also experienced sexual abuse, indicating that this is a group with multiple risk factors for long-term impaired mental health.

Results also support biological sex differences because girls with symptoms of ADHD and a common polymorphism of TFAP-2β (absence of a 9 repeat) reported more symptoms of depression, but boys did not.

Further, only 5% of the adolescents with symptoms of ADHD and/or depression sought help from specialized mental health services. The co-occurrence of symptoms of ADHD and depression was a stronger predictor of help-seeking than all other psychosocial factors investigated, including secure attachment cognitions styles to parents. Among help-seeking girls, co-occurring symptoms of ADHD and depression were more common than symptoms of ADHD without co-occurring symptoms of depression.

The ASRS-A/ASRS-A-S showed promising psychometric properties for further validation in adolescentsresults as a screening tool for use in adolescents.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. , 90 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 976
Keyword [en]
Attention deficit hyperactivity disorder, depression, adolescent, sex, sexual abuse, transcription factor AP-2β, help-seeking, attachment object, validation study
National Category
Medical and Health Sciences
Research subject
Child and Youth Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-219389ISBN: 978-91-554-8892-5 (print)OAI: oai:DiVA.org:uu-219389DiVA: diva2:699638
Public defence
2014-04-11, Aros Congress Center, Munkgatan 7, Västerås, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2014-03-21 Created: 2014-02-28 Last updated: 2014-04-29
List of papers
1. Symptoms of ADHD and depression in a large adolescent population: Co-occurring symptoms and associations to experiences of sexual abuse
Open this publication in new window or tab >>Symptoms of ADHD and depression in a large adolescent population: Co-occurring symptoms and associations to experiences of sexual abuse
2011 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 65, no 5, 315-322 p.Article in journal (Refereed) Published
Abstract [en]

Background: Symptoms of either attention-deficit hyperactivity disorder (ADHD) or depression constitute the most common reasons for contact with child and adolescent psychiatry. The development of psychiatric symptoms can be explained by a combination of environmental stress events and genetic vulnerability. One common form of environmental stress with high impact on health is sexual abuse.

Aims: To investigate the prevalence and co-occurrence of symptoms of ADHD and depression in relation to experiences of sexual abuse in a large adolescent general population.

Method: All 15- and 18-year-old students (n = 4910) in the Swedish county of Vestmanland answered a school-based screening instrument including the six-question ADHD self-rating scale (ASRS), the Depression Self-Rating Scale (DSRS) and questions relating to experiences of sexual abuse.

Results: The prevalence of co-occurring symptoms of ADHD and depression was 2.4% (boys 1.0%, girls 3.9%). The prevalence of experience of any sexual abuse was 20.9% (boys 13.3%, girls 28.7%). Of those with co-occurring symptoms, 48% of the boys and 47% of the girls reported a history of sexual abuse.

Conclusions: School-based screening for co-occurring symptoms of ADHD and depression might be a method that identifies students at psychiatric and psychosocial risk.

Keyword
ADHD, adolescents, depression, sex differences, sexual abuse
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-153363 (URN)10.3109/08039488.2010.545894 (DOI)000295001900006 ()21189056 (PubMedID)
Available from: 2011-05-12 Created: 2011-05-12 Last updated: 2017-12-11Bibliographically approved
2. Transcription Factor Activating Protein-2β (TFAP-2β) genotype and symptoms of attention deficit hyperactivity disorder in relation to symptoms of depression in two independent samples
Open this publication in new window or tab >>Transcription Factor Activating Protein-2β (TFAP-2β) genotype and symptoms of attention deficit hyperactivity disorder in relation to symptoms of depression in two independent samples
Show others...
2014 (Norwegian)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 23, no 4, 207-217 p.Article in journal (Refereed) Published
Abstract [en]

The Transcription Factor Activating Protein-2β (TFAP-2β) gene has been shown to influence monoaminergic neurotransmission, and several genes important for monoaminergic function have binding sites for TFAP-2β. Familial studies of attention deficit hyperactivity disorder (ADHD) suggest a hereditary-determined subtype of ADHD with comorbid depression. We examined a functional variation of the TFAP-2β gene in the context of co-occurring symptoms of ADHD and depression in two independent population-based samples of adolescents (Group A, n = 175 and Group B, n = 1,506) from Sweden. Results indicated 6.1 to 7.8 % of adolescents screened positively for ADHD and depression symptoms. Symptoms of depression were more common among girls who screened positively for ADHD and did not carry the nine-repeat allele of the TFAP-2β intron 1 Variable Number Tandem Repeat (VNTR) polymorphism. The presence of the nine-repeat variant of the TFAP-2β intron 1 VNTR appears to protect girls with ADHD symptoms from the co-expression of symptoms of depression.

Keyword
attention deficit hyperactivity disorder, depression, adolescents, comorbitidy, transcription factor AP-2β, 
National Category
Psychiatry
Research subject
Child and Youth Psychiatry
Identifiers
urn:nbn:se:uu:diva-219063 (URN)10.1007/s00787-013-0450-6 (DOI)000334175700004 ()23824473 (PubMedID)
Available from: 2014-02-28 Created: 2014-02-20 Last updated: 2017-12-05Bibliographically approved
3. Influence of the parent–adolescent relationship on mental health help-seeking
Open this publication in new window or tab >>Influence of the parent–adolescent relationship on mental health help-seeking
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: To investigate help-seeking from specialized mental health services, especially in relation to the parent–adolescent relationship, as measured by attachment, and symptoms of attention deficit hyperactivity disorder (ADHD) and/or depression and sex.

Methods: The study was epidemiological and cross-sectional, and used the Experiences in Close Relationships-Revised-Children (ECR-RC9), the Adult ADHD Self-Report Scale Screener and the Depression Self-Rating Scale-Adolescents. Adolescents, 15 to 18 years old, from the Swedish county of Västmanland participated (N = 4,506, 74% participation rate).

Results: Help-seeking was predicted by co-occurring symptoms of ADHD and depression (OR = 5.4), symptoms of depression (OR = 4.8) and symptoms of ADHD (OR = 2.6), as well as any experience of sexual abuse (OR = 1.7) and being female (OR = 1.6). Secure attachment to parents, assessed with the ECR-RC9, did not increase help-seeking. Furthermore, in interaction analyses secure attachment to parents in combination with experiences of sexual abuse and/or conduct problems, or to be female and have symptoms of ADHD, decreased the probability of help-seeking.

Conclusion: Secure attachment, as a measure of the adolescent’s willingness to communicate with their parents about their problems, did not increase help-seeking. Symptoms of ADHD and/or depression predicted help-seeking more than any psychosocial factor.

Keyword
help-seeking, attachment, ADHD, depression, sex
National Category
Medical and Health Sciences
Research subject
Child and Youth Psychiatry
Identifiers
urn:nbn:se:uu:diva-219109 (URN)
Available from: 2014-02-21 Created: 2014-02-21 Last updated: 2014-04-29Bibliographically approved
4. Validation of the World Health Organization Adult ADHD Self-Report Scale for adolescents
Open this publication in new window or tab >>Validation of the World Health Organization Adult ADHD Self-Report Scale for adolescents
Show others...
2015 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 3, 216-223 p.Article in journal (Refereed) Published
Abstract [en]

Background: The World Health Organization Adult ADHD Self Report Scale (ASRS) is a widely used diagnostic tool for assessment of attention-deficit hyperactivity disorder (ADHD) symptoms in clinical psychiatry in Sweden. The ASRS consists of 18 questions, the first six of which can be used as a short screening version (ASRS-S). There is a version for adolescents—ASRS-Adolescent (ASRS-A)—and the corresponding screening version (ASRS-A-S), which has not been validated to date.

Aim: The aim was to validate the ASRS-A and the ASRS-A-S for use in adolescent clinical populations.

Methods: Adolescent psychiatric outpatients (n = 134, mean age 15 years, 40% boys) reported on the ASRS-A, and were interviewed with the Kiddie Schedule of Affective Disorders and Schizophrenia (K-SADS), a semi-structured interview, together with a parent.

Results: Internal consistency was 0.79 for the ASRS-A-S and 0.92 for the ASRS-A (Cronbach's alpha). Internal consistency values were 0.79 and 0.87 for the inattention subscale, and 0.68 and 0.89 for the hyperactivity subscale, respectively. Concurrent validity values, measured with Spearman's correlation coefficient, between the total K-SADS ADHD symptom severity score and the sum of ASRS-A-S and ASRS-A total scores were 0.51 and 0.60, respectively. Psychometric properties of the ASRS-A-S and the ASRS-A were: sensitivity 74% and 79%; negative predictive value 81% and 84%; specificity 59% and 60%; and positive predictive value 49% and 51%, respectively. Both versions showed better properties for girls than for boys.

Conclusion: Both the ASRS-A-S and the ASRS-A showed promising psychometric properties for use in adolescent clinical populations.

Keyword
Validation Study, Attention Deficit Disorder with Hyperactivity, Adolescent
National Category
Psychiatry
Research subject
Child and Youth Psychiatry
Identifiers
urn:nbn:se:uu:diva-219112 (URN)10.3109/08039488.2014.968203 (DOI)000351231500009 ()25348323 (PubMedID)
Available from: 2014-02-21 Created: 2014-02-21 Last updated: 2017-12-05Bibliographically approved

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