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Event Related Potentials ERPs and other EEG Based Methods for Extracting Biomarkers of Brain Dysfunction: Examples from Pediatric Attention Deficit/Hyperactivity Disorder ADHD
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Diagnosing ADHD during active substance use: Feasible or flawed?

Katelijne van Emmerik-van Oortmerssen1, Ellen Vedel2, Floor J Kramer2

  • 1University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands; Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health and Addiction Treatment Center, Amsterdam, The Netherlands; Jellinek Substance Abuse Treatment Center, Amsterdam, The Netherlands.

Drug and Alcohol Dependence
|September 29, 2017
PubMed
Summary

Diagnosing Attention Deficit Hyperactivity Disorder (ADHD) in patients with substance use disorder (SUD) is feasible during active use. Most patients maintained their ADHD diagnosis after a period of reduced substance use, supporting early assessment.

Keywords:
ADHD subtypesAttention deficit hyperactivity disorderComorbidityDiagnosisReliabilitySubstance use disorder

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Area of Science:

  • Psychiatry
  • Addiction Medicine
  • Neurodevelopmental Disorders

Background:

  • Attention Deficit Hyperactivity Disorder (ADHD) frequently co-occurs with Substance Use Disorder (SUD).
  • Delayed ADHD diagnosis in SUD patients until abstinence may impede timely and effective treatment.
  • Current diagnostic practices for ADHD in active SUD populations require further investigation.

Purpose of the Study:

  • To compare ADHD diagnostic assessments in actively using SUD patients versus those with reduced substance use.
  • To evaluate the validity of ADHD diagnosis during active substance use.
  • To inform pragmatic approaches for ADHD assessment in SUD treatment.

Main Methods:

  • Prospective test-retest study involving 127 adult SUD patients with comorbid ADHD.
  • Administered Conners' Adult ADHD Diagnostic Interview for DSM-IV at intake and after SUD treatment.
  • Follow-up assessment occurred after a mean interval of 78 days, with reduced substance use.

Main Results:

  • 95.3% of patients retained their ADHD diagnosis at re-assessment.
  • Good agreement was found for childhood and adult ADHD symptoms between assessments.
  • ADHD subtyping showed lower stability (Cohen's Kappa=0.53).
  • Sensitivity analyses confirmed results in fully abstinent subgroups.

Conclusions:

  • ADHD assessment in actively using SUD patients is feasible and justifiable.
  • A pragmatic approach to ADHD diagnosis in this population is supported.
  • Early ADHD diagnosis can be considered even before complete abstinence.