Attention-Deficit Hyperactivity Disorder (ADHD) and narrative discourse in older adults / Déficit de Atenção e Hiperatividade (TDAH) e discurso narrativo em idosos

ABSTRACT Attention-Deficit Hyperactivity Disorder (ADHD) encompasses other symptoms besides inattention, hyperactivity, and impulsivity, such as language problems. ADHD can have a non-remitting course and is also found in older individuals, although there are no studies on language problems in elderly individuals with the disorder. Objective: To investigate the presence of language impairment in older adults with ADHD. Methods: Language impairment was investigated in three older ADHD adults, and compared with two matched control subjects using a narrative discourse task. The transcript discourses were evaluated based on the Trabasso Model for discourse analysis, and then processed by the Speech Graph Analysis software. Results: Compared to control subjects, ADHD patient discourse had more Plot components and their networks exhibited more Edges. The patients had higher scores on the Narrative Inefficiency, Density and Diameter Indexes as well as on the Average Clustering Coefficient. The networks of control subjects were sequential, with little or no recursiveness, whereas those of ADHD subjects were convoluted. Conclusion: Our results suggest that language deficits described in children, adolescents and young adults with ADHD may persist in older adults with the disorder.

RESUMO O Transtorno do Déficit de Atenção/Hiperatividade (TDAH) compreende diversos outros sintomas além de desatenção, hiperatividade e impulsividade, tais como problemas de linguagem. O TDAH pode cursar sem remissão, tendo sido demonstrado em indivíduos mais velhos, porém não há estudos investigando a linguagem em idosos com o transtorno. Objetivo: Investigar a presença de déficits de linguagem em adultos mais velhos portadores de TDAH. Métodos: Avaliou-se a presença de comprometimento de linguagem em três adultos mais velhos com TDAH, que foram comparados a dois indivíduos controles pareados, através de tarefa de discurso narrativo. A transcrição das narrativas foi avaliada com base no modelo de análise de narrativa de Trabasso, e então analisada com uso do programa Speech Graph Analysis. Resultados: Comparados aos indivíduos controles, adultos mais velhos com TDAH utilizaram mais componentes (Núcleos) da história em suas narrativas e suas redes mais Arestas. Eles apresentaram escores mais altos no Índice de Ineficiência, Diâmetro e Densidade e também no Coeficiente Médio de Grupamento. As redes dos indivíduos controles foram lineares e sequenciais, com pouca ou nenhuma recursividade, ao contrário das redes de adultos com TDAH. Conclusão: Estes resultados sugerem que problemas de linguagem já descritos em crianças, adolescentes e adultos com TDAH, podem persistir em adultos mais velhos com o transtorno.

By the book: ADHD prevalence in medical students varies with analogous methods of addressing DSM items

Objective: The marked increase in the prevalence of attention-deficit/hyperactivity disorder (ADHD) among university students gives rise to questions about how best to diagnose in this setting. The aim of the present study was to calculate ADHD prevalence in a large non-clinical sample of medical students using a stepwise design and to determine whether ADHD diagnosis varies if interviewees use additional probing procedures to obtain examples of positive DSM items. Methods: A total of 726 students were screened with the Adult Self-Report Scale (ASRS) and invited for an interview with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) adapted for adults. Results: The ASRS was positive for 247 students (37%), although only 83 (7.9%) received an ADHD diagnosis. ASRS sensitivity and specificity rates were 0.97 and 0.40, respectively. Probing procedures were used with a subgroup of 226 students, which decreased the number of ADHD diagnoses to 12 (4.5%). Conclusion: Probing for an individual's real-life examples during the K-SADS interview almost halved ADHD prevalence rate based on the ASRS and K-SADS, which rendered the rate consistent with that typically reported for young adults. In reclassified cases, although examples of inattention did not match the corresponding DSM item, they often referred to another DSM inattention item.