ADHD Exacts Higher Mental Health Toll vs Autism in Adults

Attention-deficit hyperactivity disorder (ADHD) is more predictive of poor mental health in adults than autism spectrum disorder (ASD), new research suggests.

In a trait-based analysis of more than 500 adults, researchers found that ADHD traits trumped ASD traits in predicting internalizing problems.

“Further research is now needed to delve deeper into understanding exactly why ADHD is linked to poor mental health, particularly in terms of the mental processes that might drive people with ADHD traits to engage in anxious and depressive thinking,” senior author Punit Shah, PhD. , said in a news release.

“As the evidence becomes clear that ADHD isn’t just a childhood condition but persists throughout life, we must adjust our research agendas to better understand ADHD in adulthood,” added Shah, associate professor of psychology and deputy director, Center for Applied Autism Research at University of Bath, Bath, United Kingdom.

The study was published online January 16 in Scientific Reports.

Overlooked, Neglected

It’s long been known that ASD is linked to anxiety and depression, but ADHD has been “somewhat neglected,” lead researcher Luca Hargitai, a PhD researcher at the University of Bath, noted in the release.

Researchers have also struggled to separate the importance of ADHD and autism for mental health outcomes because they are frequently comorbid.

“Our aim was to precisely measure how strongly ADHD personality traits were linked to poor mental health while statistically accounting for autistic traits,” Hargitai explained.

The researchers had a representative sample of 504 adults (49% male) from the general UK population complete standard questionnaires used for identifying ADHD and autistic traits.

In a series of analyses, the researchers found that both ASD and ADHD traits predicted greater anxiety and depression, but ADHD traits were a much stronger predictor of these internalizing problems than ASD traits.

“Our findings suggest that the management of ADHD traits in adults, with or without ASD, has potential to reduce internalizing problems, which could supplement clinical interventions directly targeting anxiety and depression,” such as antidepressant medication and talk therapy, the authors wrote.

“The main clinical implication of our findings, particularly for neurodevelopmental specialist clinics, is that they should be looking more closely at how ADHD characteristics — in people with ADHD, autism, or both ASD and ADHD — could be targeted to improve mental health outcomes, Shah said Medscape Medical News.

“Additionally, thinking about neurodevelopmental conditions and neurodiversity as lifelong phenomena is crucial, which has historically been underappreciated in research and clinical practice,” Shah added.

The researchers cautioned that while the trait-based approach was “an important step” in understanding the unique contributions of ASD and ADHD to internalizing problems, replication of the findings in clinically diagnosed samples of adults with ASD and ADHD is needed.

They also note that internalizing problems were assessed using brief depression and anxiety measures, which may not provide a comprehensive measure of these problems.

ADHD Rarely Travels Alone

Reached for comment, Lidia Zylowska, MD, psychiatrist with the University of Minnesota, Minneapolis, said mental health is an important aspect of care for adults with ADHD.

“ADHD rarely travels alone in adulthood and having other mental comorbidities (internalizing or externalizing conditions) are very common. Anxiety is one of the most common comorbidities,” Zylowska, who wasn’t involved in the study, told Medscape Medical News.

Oftentimes, said Zylowska, “adults with ADHD get mental health treatment for anxiety and depression or other mental health issues, such as substance abuse, which are more familiar and more easy for clinicians to diagnose. The ADHD or ASD may be there, but is often not evaluated for and not treated.

She also said it’s not surprising that ADHD has the potential to harm mental health.

“Having ADHD often predisposes one to increased stress, family conflict, school or professional difficulties, and sleep problems, which can predispose the adult to developing anxiety or depression,” Zylowska said.

In this way, you can think of ADHD as a neurodevelopmental vulnerability factor that leads to [the] development of other mental health conditions,” she said. “There may also be shared genetic contributions to ADHD and anxiety, and research into the overlap of ADHD and other mental health conditions is ongoing.”

The study was supported by an award from the GW4 Neurodevelopmental Neurodiversity Network. Shah is director of the GW4 Neurodevelopmental Neurodiversity Network and serves as editor-in-chief of Neurodiversity and associate editor of Cortex. Zylowska is a coauthor of the book, Mindfulness Prescription for Adult ADHD: An 8-Step Program for Strengthening Attention, Managing Emotions, and Achieving Your Goals.

Science Rep. Published online January 16, 2023. Full Text.

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