No significant relationships.

Research has shown that ADHD and sleep disorders are intimately intertwined in the majority of patients in both childhood and adulthood. Circadian rhythm sleep disturbances, esp. the delayed sleep phase syndrome, as well as several other sleep disorders, such as Insomnia, Restless Legs, Periodic Limb Movement Disorder and Sleep apnea are associated with ADHD. With a prevalence rate of 80% of sleep disorders in adults with ADHD, the question not only is what is chicken and egg, but even if both conditions share a joint pathophysiology.

To investigate the consequences of this comorbid sleep disorders on severity of ADHD, mood and health, as well as to find evidence on improvement of ADHD by treatment of the sleep disorder(s).

Recent research will be evaluated to formulate answers to these questions.

Sleep loss resulting from sleep disorders increases ADHD severity due to more impairment of cognition and memory as well as mood instability. Sleep loss in the longer term also leads to obesity, with negative consequences for health in general. First studies showing a decrease of ADHD symptoms by treatment of sleep disorders will be discussed.

ADHD and sleep disorders come together in the majority of patients and need both assessment and treatment. Treatment of ADHD by improving sleep, is an intriguing research question with potential new treatment options.

The scope of this presentation is to investigate the possible relationship between a delayed sleep phase and the timing of other activities, like meals and other disturbances of eating habits.

The literature will be reviewed and preliminary data from own research regarding these associations will be presented.

The delayed sleep phase has been shown to occur in many children and in around 80% of adults with ADHD (Van Veen ea, accepted for publication, 2009). Adult patients with ADHD who get up relatively too early according to their biological clock, tend to skip breakfast. Skipping breakfast is associated with binge eating in the afternoon; both binge eating and skipping breakfast are associated with overweight and obesity. According to the literature, the prevalence of ADHD and sleepproblems is increased in obese patients; the higher the BMI, the higher the chance of ADHD.

ADHD and the very frequently comorbid delayed sleep phase disorder may be associated with a delayed timing of meals that may lead to overweight and obesity.

Children with ADHD may have chronic sleeping problems, associated with circadian rhythm disturbances. Little is known about sleep in adults with ADHD.

We studied the prevalence and type of sleeping problems in 120 adults with ADHD using an interview questionnaire.

78% of the 120 adults with ADHD had difficulty to go to bed in time (between 1 and 3 am). Almost 70% reported sleep onset problems, more than 50% had difficulty sleeping through. Almost 70% had difficulty getting up in the morning and 62% felt sleepy during the day. In more than 60% these sleeping problems had been there all their lives. These results are very similar to earlier data presented by Dodson (Dodson, 1999). Several explanations for these sleeping problems may be considered (Kooij ea, 2001; Oosterloo ea, 2006; Boonstra ea, 2007). However, the frequently occurring sleeping pattern of being a ‘nightowl’, with restless sleep and difficulty getting up in the morning, may be associated with the delayed sleep phase syndrome, as was recently shown in children with ADHD and sleep onset problems (van der Heijden ea, 2006; van der Heijden ea, 2005; Weiss ea, 2006). We currently study the circadian rhytm in adults by measuring the Dim Light Melatonin Onset (DLMO) in saliva in ADHD patients with sleep onset problems (ADHD+SO), compared to ADHD patients without sleep onset problems (ADHD-SO).

About 70% of adults with ADHD have sleep onset problems compatible with a delayed sleep phase pattern. First data of DLMO in adult ADHD patients with and without sleep onset problems will be discussed.

ADHD occurs in 3–5% of children and adults. Yet little is known about ADHD in elderly.

To review the literature and to present first Dutch epidemiological data on ADHD in elderly (VUmc/LASA and PsyQ).

The study aims to estimate the prevalence of ADHD in eldery and to correlate symptoms of ADHD with comorbidity patterns, cognitive decline and somatic disorders. This knowledge may help predict the future of the current group of adults with ADHD.

The Longitudinal Aging Study Amsterdam (LASA) included a selfreport questionnaire for ADHD in 2009 in around 1500 elderly, aged 63–94 years. From those with low, intermediate and high scores, a random sample was interviewed using the DIVA, a structured Diagnostic Interview for ADHD in adults (N = 234).

First data on prevalence of ADHD in elderly in the general Dutch population will be discussed. The long term consequences of the persistence of the disorder in adults and elderly, and the impact for the organisation of treatment of this lifespan disorder will be reviewed.

The continuity of ADHD symptoms and impairment from childhood into to old age, may pose psychiatric services for important questions like the usefulness of separate treatment facilities for different age groups in case of a lifespan disorder like ADHD.

ADHD is a common disorder with a prevalence rate of 3-5% in children, adults and older persons. In psychiatry, addiction centers and forensic psychiatry, the prevalence of ADHD in adults is estimated higher, around 20%. After careful assessment of ADHD and comorbid disorders, ADHD in adulthood can be effectively treated with psycho-education, medication, coaching and cognitive behaviour therapy.

To give an overview of the current state-of-the-art treatment of ADHD and comorbidity in adults.

Pharmacological treatment of ADHD usually comes after treatment of more acute or severe disorders like depressive or bipolar episodes, anxiety disorders and addiction. Because of the inattention problems of ADHD patients, antidepressant medication is usually preferred above cognitive behaviour therapy for anxiety or depression. Light therapy for seasonal affective disorder and melatonin treatment for the frequent delayed sleep phase syndrome are usually effective, though yet little studied. Available, but off-label medications used for ADHD in adults are stimulants (methylphenidate, dexamphetamine), atomoxetine, bupropion XL, modafinil and tricyclic antidepressants.

Based on 17 years of clinical experience and on efficacy and safety data in the literature, first and other choices of medication will be discussed, as well as common dosing schedules in adults, side effects, contra-indications and combined treatment of stimulants with antidepressants, mood stabilisers and melatonin.

All disorders must be addressed and treated in the right order, based on severity. Treatment of ADHD in adults is not just treatment of ADHD, but of a combination of disorders that cluster in our patients.

Neuropsychological deficits are of major importance in ADHD, yet no previous studies have assessed clinically referred samples of older adults. The authors compared older adults with ADHD (60–75 years) with both younger adults with ADHD (18–45 years) and older healthy controls with regard to various neuropsychological deficits.

Well-established tests were used to investigate working memory, inhibition, switching, planning, fluency, and speed of processing. Self-ratings of executive functioning and delay-related behaviors were also included. Both variable-oriented and person-oriented analyses were conducted.

Older adults with ADHD differed from controls with regard to working memory, inhibition, switching, and delay-related behaviors. In comparison to younger adults with ADHD, they performed at a similar level with regard to working memory and planning, but significantly better with regard to inhibition, switching, fluency, speed of processing, and delay aversion. Despite several significant group differences relative to controls, person-oriented analyses demonstrated that a majority of older adults with ADHD performed within the average range on each test and 20% showed no clear deficit within any neuropsychological domain.

The results are in line with models of heterogeneity that have identified different neuropsychological subtypes in ADHD as well as a subgroup of patients without any clear neuropsychological deficits. For older adults with ADHD, it will be important to assess their functioning across time as normal aging is related to memory decline and these patients could therefore end up with severe deficits as they grow older, which in turn could have serious negative effects on daily life functioning.

Abnormal sensory sensitivity is a feature of autism-spectrum disorder (ASD), but is also reported in attention-deficit/hyperactivity disorder (ADHD). In many cases, ADHD and ASD are comorbid. This study investigated the prevalence of sensory hyper- and hyposensitivity among adults with ADHD, controlling for autistic symptoms.

One hundred and sixteen adults diagnosed with ADHD completed the Adolescent/Adult Sensory Profile-NL (AASP-NL) and the Autism-spectrum Quotient (AQ) questionnaires. Prevalences of hyper- and hyposensitivity and autism-spectrum symptoms were compared to norm values. Multivariate binary logistic regressions were used to determine the association of autistic symptoms, age, gender, ADHD subtype, self-reported severity of ADHD symptoms, comorbid disorders, and use of medication on the sensory hypo- and hypersensitivity in adults with ADHD.

Adults with ADHD had more autistic symptoms, and they had both more hyper- and hyposensitivity compared to norm groups. This was especially apparent in the Activity level and Auditory sensory modalities. Sensory hypo- and hypersensitivity were both related to an increased ADHD score, even showing a dose-response relationship, but not to any autistic symptom or comorbid disorder. As much as 43% of the females with ADHD reported sensory hypo- and/or hypersensitivity, compared to 22% of the men.

Sensory hypo- and hypersensitivity may be viewed as key features of adult ADHD, especially in females, regardless of any autistic symptoms. Future research should be directed at the implications of this sensory dysregulation for the understanding of the pathophysiology of (female) ADHD, and on the usefulness of assessment of atypical sensory profiles in the diagnostic procedure of ADHD in adults.

Attention Deficit Hyperactivity Disorder (ADHD) prevalence in the general adult population is estimated to be between 2–4%. Despite the high prevalence, until recently there was only one validated semi-structured interview available for the accurate diagnostic assessment of ADHD within the adult population: the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID).

To examine the concurrent validity of the DIVA 2.0 interview comparing the diagnostic rate with the CAADID interview. To analyse the criterion validity of the DIVA 2.0 in the Spanish language in an adult sample.

The aim of this is to study was to evaluate criterion validity of the DIVA 2.0 in an adult sample comparing with the CAADID and other ADHD severity scales.

A transversal study was performed to check the criteria and concurrent validity of the DIVA 2.0 compared to the CAADID.

Forty patients were recruited in an adult ADHD program at a university hospital. The DIVA 2.0 interview showed a diagnostic accuracy of 100% when compared with the diagnoses obtained with the CAADID interview and goods correlations with three self-reported rating scales: the WURS, the ADHD Rating Scale and Sheehan's’ Dysfunction Inventory.

The DIVA 2.0 has good psychometric properties and is a reliable tool for the assessment of ADHD in adults.

The authors have not supplied their declaration of competing interest.

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.

Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.

Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?

Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.