A transdiagnostic view on MDD and ADHD: shared cognitive characteristics?
Rianne van Hal1, Dirk Geurts2, Philip van Eijndhoven2
1Radboud University Medical Center, Department of Psychiatry, Nijmegen, the Netherlands.
Background:
Major Depressive disorder (MDD) and Attention Deficit Hyperactivity Disorder (ADHD) are prevalent mental disorders that often co-occur. There is overlap in symptomatology between MDD and ADHD that complicates diagnostics and treatment selection. Hence, to aid diagnostics of single and comorbid disorders, we aimed to examine the discriminative power of common symptom measures and cognitive dysfunction to differentiate between participants diagnosed with MDD, ADHD, ADHD and comorbid MDD and without a mental disorder.
Methods:
Four diagnosed groups were compared: MDD (n = 103), ADHD (n = 78), comorbid MDD + ADHD (n = 29), healthy controls (HC; n = 123). We examined between-group differences and discriminative functions of clinically validated self-report symptom questionnaires, as well as task-based and self-report measures of cognitive dysfunction.
Results:
Based on the between group comparisons, all patient groups were characterized by clinically relevant levels of ADHD-symptomatology, executive dysfunction, and diminished cognitive performances in the domain of attention; even the MDD-only group. In addition, based on self-reported symptoms of MDD, ADHD, and executive dysfunction, discriminant function analysis classified all HC correctly (100%) and patients diagnosed with ADHD or MDD relatively well (resp. 85% and 82%). Comorbid MDD + ADHD was poorly differentiated from single MDD or ADHD by the commonly used self-report symptom questionnaires for MDD and ADHD (0% correct predictions), which substantially improved by incorporating the questionnaire on executive functioning (42% correct predictions).
Conclusions:
In both MDD and ADHD, clinical levels of attentional and executive dysfunction were found, while these clinical groups differed in cognitive flexibility, initiating, inhibition and meta-cognition. Comorbid MDD + ADHD was poorly distinguishable from non-comorbid MDD and ADHD based on self-reported symptoms of depression and ADHD. Addition of subjective executive function in the discrimination models resulted in increased discriminative power. Our findings indicate that executive functioning measure can improve the diagnostic process of ADHD and MDD.
Insights
Major Depressive Disorder (MDD) and Attention Deficit Hyperactivity Disorder (ADHD) often co-occur, complicating diagnosis. Executive functioning measures significantly improve differentiating comorbid MDD+ADHD from single diagnoses, aiding accurate mental health diagnostics.
Area of Science:
- Neuroscience
- Psychiatry
- Clinical Psychology
Background:
- Major Depressive Disorder (MDD) and Attention Deficit Hyperactivity Disorder (ADHD) are common and frequently co-occur.
- Symptom overlap between MDD and ADHD complicates accurate diagnosis and treatment.
- Differentiating single and comorbid conditions is crucial for effective patient care.
Purpose of the Study:
- To evaluate the diagnostic power of symptom measures and cognitive dysfunction in distinguishing MDD, ADHD, comorbid MDD+ADHD, and healthy controls.
- To identify which cognitive domains are most effective in differentiating these groups.
- To enhance diagnostic accuracy for complex mental health presentations.
Main Methods:
- Comparison of four groups: MDD (n=103), ADHD (n=78), comorbid MDD+ADHD (n=29), and healthy controls (HC; n=123).
- Utilized clinically validated self-report symptom questionnaires for MDD and ADHD.
- Assessed cognitive dysfunction using task-based and self-report measures, focusing on attention and executive functions.
Main Results:
- All patient groups exhibited clinically relevant ADHD symptomatology, executive dysfunction, and attention deficits.
- Self-report measures correctly classified HC (100%), ADHD (85%), and MDD (82%) patients.
- Comorbid MDD+ADHD was poorly differentiated (0%) using only MDD/ADHD symptom questionnaires, but improved to 42% with executive functioning measures.
Conclusions:
- Both MDD and ADHD present with significant attentional and executive dysfunction.
- Cognitive flexibility, initiation, inhibition, and meta-cognition varied across clinical groups.
- Executive functioning measures are vital for improving the diagnostic accuracy of MDD and ADHD, especially in comorbid cases.
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