Anthony L. Rostain, MD MA - ADHD in Adults

This article reviews existing evidence for the use of locomotor activity measures in diagnosing ADHD. The authors conducted a meta-analysis of published studies on ADHD using motion measures to compare patients with ADHD with controls and then conducted a case control study using the McLean motion activity test (MMAT) on a sample of child, adolescent and adult ADHD patients (N=81) and matched controls (N=91).

Methods
The meta-analysis procedure involved searching several electronic medical databases and selecting only articles which used validated methods for diagnosing ADHD, which compared ADHD subjects to healthy controls and which reported data in ways that enabled the authors to calculate the effect sizes as measured by standardized mean differences (SMD) between study groups. A total of 18 studies were chosen, 13 of which involved actigraphy measures and 5 which used motion tracking systems. The combined sample sizes were 570 ADHD patients (305 children and adolescents and 265 ADHD adults) and 515 controls (equally divided between youth and adults). The SMD (or effect size) between ADHD subjects and controls was 0.64 using actigraphy measures and 0.92 using the motion tracking systems. The SMD or pooled effect size for youth was 0.75 and for adults was 0.73, indicating that excessive motion is seen as often in adult ADHD patients as in children and adolescents. This contradicts the prevailing view that excessive motor activity is less prominent in adults as compared to youth with ADHD.

The authors then conducted a case control study comparing ADHD patients and controls. Patients were diagnosed using a comprehensive assessment procedure consisting of structured psychiatric interviews, Conners’ rating scales and the BRIEF (a measure of executive functioning). Subjects were administered the MMAT, an infrared motion tracking system that measures the micro-movements of participants during a Go/No-Go task (15 minutes for youth and 20 minutes for adults). ADHD groups differed significantly from controls on most motion measures, with an effect size of 0.83 for adults and 0.45 for children and adolescents. Reaction time variability was also significantly greater in the ADHD sample across all ages (p<0.05). Interestingly, there were no differences in excessive motion seen among the different ADHD subtypes (combined vs inattentive vs hyperactive vs NOS).

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Conclusions
The authors conclude that locomotor hyperactivity is a core constituent feature of ADHD even in adults and across all diagnostic subtypes. They further suggest that objective locomotion measures may be useful in improving the process of diagnosing difficult cases of ADHD. While it is still premature to suggest that movement measurement devices like the MMAT are necessary for ADHD diagnosis in most patients, there is certainly a role for using them in clinical practice along with established ADHD resources. Future research will help delineate additional uses for these tools in diagnosing other neurodevelopmental disorders.

Murillo LG, Cortese S, Anderson D, DiMartino A, Castellanos FX (2015). “Locomotor activity measures in the diagnosis of attention deficit hyperactivity disorder: Meta-analyses and new findings.” Journal of Neuroscience Methods Epub ahead of print March 11, 2015. DOI: 10.1016/j.jneumeth.2015.03.001.

 

Robert Tudisco: I was diagnosed with ADHD after a number of problems that I had in my life. Coming out of law school, I got what I think was probably the perfect job for someone with ADHD. I was a prosecutor in the South Bronx and it was tailor made for someone with ADHD. Everything was an emergency, the motto in the office was “baptism by fire,” and it was just an exciting place to be. When I left the DA’s office and I started a private practice, that’s when I really had some problems. I had to keep track of my time, I had to bill my clients, I had to run an office. It was all of those administrative tasks that were really a problem.

At the same time, I thought I was setting a bad example for my son and I was having some difficulty in my marriage. And so, I sought some help, I found out about ADHD, and I was diagnosed pretty quickly, and that was about 14 years ago and it started this whole journey. My ADHD diagnosis was a major turning point in my life. It really helped me understand a lot about how I grew up and the struggles that I had as a child. I always knew, when I was a child, that there was a lot more going on behind my eyes than I was getting credit for and that was enormously frustrating for me.

Robert Tudisco tremendous benefit of ADHD diagnosis DI00O3
There’s an enormous amount of comfort in knowing that you’re not alone and being involved in the disability community and meeting other people with ADHD, I really found a lot of comfort there, that I was in this with other people that were challenged by the same things that I was. And so I kind of look at the work that I do now as like a second chance to help children and adults cope with their ADHD and really maximize their potential. There have been so many benefits since I’ve been diagnosed with ADHD. I think I’m a better father. I’m certainly a better husband. My relationship with my wife is much more relaxed because we understand each other a lot better. We also understand that ADHD is not an excuse for what happened, and we understand where the behaviors come from so we can kind of work around them in the future.

I really think that a lot of adults would benefit from a diagnosis and it’s just one of the barriers, I think, to a lot of adults getting diagnosed is that there aren’t more clinicians that are diagnosing adults with ADHD. I think it’s important to manage ADHD as an adult or a child in a multimodal way. I take medication for my ADHD. I actually take two types of medication but that’s just a part of a multimodal approach. I run religiously to manage my ADHD. I employ a lot coping mechanisms that I’ve developed over the years that work for me. They may not work for somebody else but that was a process that I went through.

I think the important thing to stress about medication is that it’s not a cure for ADHD. When it works, it can be a very effective tool that helps people make positive changes in their life. I also think it’s important to give myself permission to fail and kind of let myself off the hook. It’s very important for adults to have a sense of humor about their ADHD. And when something doesn’t work, try to look at why it didn’t work and that may help you come up with a better way to solve that problem. And so don’t piece it as a failure-failure, it’s a learning experience.

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