A Comparative Study of Phenomenology, Psychiatric Co-Morbidities and Global Functioning of People with ADHD from Childhood to Adulthood.

Introduction: Although previously thought to remit largely in adolescence, a growing literature supports the persistence of the disorder and/or associated impairment into adulthood. Studies in India are lacking on ADMD. Aims and Objectives: To compare the phenomenology of ADHD in childhood, adolescence and adulthood, to compare the psychiatric co-morbidities with ADHD in childhood, adolescence and adulthood, to compare the global functioning of subjects with ADHD in childhood, adolescence and adulthood. Methods: A statistical comparison was made between studies done in dept. of psychiatry, CSMMU UP, Lucknow on childhood, adolescent and adult ADHD for its various aspects. Conclusions: Hyperactivity-impulsivity decreases as subjects with ADHD grow up and inattention symptoms become more impairing, ADHD is highly co-morbid across all age groups but the nature of co-morbidities change, functioning of subjects with ADHD improve as they grow older.

A Comparative Study of Social, Adaptive, Relational and Global Functioning of Adolescents with OCD and ADHD.

Aim – Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD) are one of the most common childhood and adolescent neuropsychiatric disorders. Adolescents with these disorders experience difficulties and impairments in various domains of life. However studies on functional impairments in adolescents with these disorders are lacking in India. This study was conducted with the aim to study and compare the functional impairments of Indian adolescents suffering with these disorders. Methods – 57 adolescents (36 having ADHD and 21 having OCD) between the age group 13 years to less than 18 years were recruited during the study period. HONOSCA, VABSII and C-GAS were applied to study the social, relational, emotional, adaptive and global functioning of these adolescents. The two groups were compared with each other using appropriate statistical methods. Result – Adolescents with ADHD had significantly greater impairments in the areas of ‘disruptive, antisocial and aggressive behavior’, ‘peer relationships’ and ‘self care and independence’ whereas adolescents with OCD had significantly greater impairments in the areas of ‘emotional and related problems’ and ‘poor school attendance’. Significantly greater number of adolescents with ADHD were below average in their functioning in the ‘receptive’ (77.8%) and ‘written’ (75%) subdomain and overall in the ‘communication’ domain (63.9%) as compared to the adolescents having OCD. Adolescents with ADHD were more impaired in their global functioning as compared to adolescents with OCD. Conclusion - There are important differences in the various correlates of functioning between the two groups of adolescents. The present findings have implications in the planning for treatment intervention in these adolescents to make them more cost effective and efficient.

Adult attention deficit/hyperactivity disorder: One year follow up.

Background & objective: This study aimed to find out phenomenology, stability of diagnosis, comorbidities, impairments and treatment status of the adults with ADHD one year follow up as there are no such data. Methods: 20 subjects (all males, mean age 25.1±6.2 yr) with adult ADHD (DSM-IV-TR) were followed up at mean 1.3±0.2 yr after their diagnosis. Phenomenological assessments were done using ASRS v1.1, WMH-CIDI, ADHD-RS and clinical assessment where required. Diagnoses of ADHD and comorbidities were made using DSM-IV-TR. Global functioning was also assessed using GAF. Results: 19 (95%) of the 20 subjects could be followed up. All (100%) of them could again be diagnosed having ADHD according to DSM-IV-TR criteria. However, the symptoms declined in severity over a period of one year. Diagnosis of 2 (10.5%) subjects of ADHD-CT was changed to ADHD-IA. 1 (5.3%) subject each of ADHD-IA and ADHD-NOS types went into partial remission. Substance abuse was increased at the follow up from 26.3 to 47.4 per cent. Rates of the other comorbidities did not change during the follow up. Only 3 (15.8%) subjects adhered to the prescribed treatment at the follow up. Global functioning of the adherent group improved significantly at the follow up (t = 6.000, P = 0.027). Interpretation & conclusion: Adult ADHD has diagnostic stability at the one year follow up. The adult ADHD subjects remained highly comorbid with other psychiatric disorders including increased substance abuse at the follow up. Only 10.5 per cent subjects remained in the regular follow up. The above findings suggest that the patients with adult ADHD should be properly psycho-educated and regularly followed up.

A Clinical Psychiatric Study of Non-Psychotic Young Adolescents.

Background : Only a few clinical psychiatric studies have been done on adolescents in India. Non-psychotic psychiatric disorders in Indian adolescents require greater clinical attention. Aim: To clinically evaluate, diagnose and classify non-psychotic adolescents, aged 13 to 16 years, attending the child and adolescent psychiatry OPD. Methods and Material : 40 subjects were assessed on Kiddie Schedule for Affective Disorder and Schizophrenia, Present and Lifetime version (K-SADS-PL) or clinically for non-psychotic clinical psychiatric disorders. ‘Parent Interview Schedule’ and ‘Interview Schedule for Children’ were used to assess abnormal psychosocial situations, and Children’s Global Assessment Scale for psychosocial disability. Subjects were diagnosed using ICD-10 DCR and ICD-10 multi-axial classification. Results: Common adolescent non-psychotic psychiatric disorders found were mood disorders (27.5%), conduct disorder (17.5%) and dissociative disorder (12.5%). 7.5% adolescents had a specific disorder of psychological development. Abnormal psychosocial situations were present in 40% of the adolescents. Nearly half the adolescents (47.5%) had moderate social disability. Comorbidity was present in 17.5% adolescents. Conclusion :Common imparing psychiatric disorders among young clinic adolescents were mood disorders, conduct disorders, and dissociative disorders. More and larger studies in Indian general population and clinic settings are needed in this age group.

An exploratory clinical study of adult attention deficit/hyperactivity disorder from India.

BACKGROUND & OBJECTIVE: Although adult attention-deficit/hyperactivity disorder (ADHD) is well recognized in western countries, there are no reports of adult ADHD from India. Therefore, this study was planned to identify ADHD in adults in an Indian psychiatry outpatient setting and elicit its phenomenology and co-morbidities. METHODS: A total of 283 adults were screened using Adult ADHD Self-Report Scale-v1.1 (ASRSV1.1) screener. Screen positives were evaluated on ASRSv1.1 symptom checklist, World Mental Health Survey Initiative Version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) and by clinical assessments. DSM-IV-TR and Wender-Utah criteria were used for diagnosis. RESULTS: Twenty five men (mean age +/- SD, 23.4 +/- 5.6 yr) were diagnosed as having adult ADHD. The subjects' most common presentations were of losing temper and poor academic performance. The most common ADHD symptoms were difficulty in sustaining attention, easy distractibility, often losing things, and blurting out answers. A majority (80%) of the subjects had one or more psychiatric co-morbidity like oppositional defiant disorder, major depressive disorder and substance abuse/dependence. INTERPRETATION & CONCLUSION: Adult ADHD can be diagnosed in an Indian psychiatry outpatient setting. ADHD adults infrequently presented with the core symptoms of the disorder and had high psychiatric co-morbidity rates.

Adult Manifestation of Childhood Autism.

Pervasive developmental disorders (PDD) are a group of neuro-developmental syndromes characterized by disturbances of social interaction, language and communication, presence of stereotyped behaviour and interests. Nowadays more and more cases of pervasive developmental disorder are being diagnosed due to availability of more refined diagnostic criteria. There are wide variations in final outcome. Follow-up studies predict a poor or very poor long-term outcome. With best of my knowledge adult manifestations of child hood autism are still not reported from India. We will discuss the clinical manifestations and outcome of a previously diagnosed case of childhood autism in a 21-year-old adult.