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Systematic Review and Meta-Analysis of Attention Deficit Hyperactivity Disorder: First Estimates of the Prevalence by
Catherine Comiskey1, David McDonagh1, Sonam Prakashini Banka-Cullen1
1School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
Insights
Attention deficit hyperactivity disorder (ADHD) affects 22% of adults in substance use services. Prevalence varies significantly by sex and substance, with cannabis and benzodiazepine users showing the highest rates.
Area of Science:
- Neuroscience
- Psychiatry
- Public Health
Background:
- Neurodevelopmental disorders, including autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), impact development during infancy.
- Substance use disorders often co-occur with neurodevelopmental conditions, complicating diagnosis and treatment.
- Understanding the prevalence of ADHD and ASD in individuals seeking drug and alcohol services is crucial for tailored interventions.
Purpose of the Study:
- To estimate the prevalence of ADHD and ASD among individuals attending drug and alcohol treatment services.
- To analyze ADHD and ASD prevalence based on sex and specific substances used.
- To identify specific populations within substance use services at higher risk for ADHD.
Main Methods:
- A systematic review and meta-analysis were conducted across hospital, community, and prison healthcare settings.
- Included studies involved adults (18+) diagnosed with ADHD or ASD using validated childhood and adult assessment tools.
- Data from 84 studies comprising 34,036 individuals were analyzed.
Main Results:
- The overall prevalence of ADHD in the studied population was 22% (95% CI [19, 25]).
- Significant heterogeneity was observed across studies; ASD prevalence could not be meta-analyzed due to limited data.
- Highest ADHD prevalence was found in cannabis users (33%) and women using benzodiazepines (33%), and men using benzodiazepines (31%).
- Lowest prevalence was observed in women using cocaine (5%).
- Opioid users showed prevalence rates of 27% for women and 24% for men.
Conclusions:
- ADHD prevalence rates are highly variable among individuals with substance use disorders, influenced by sex and the type of substance used.
- Implementing international consensus guidelines for ADHD management and training is essential for evidence-based service delivery.
- Further research is needed to explore ASD prevalence in this population and refine treatment strategies.
Abstract:
Objective: The World Health Organization describes neurodevelopmental disorders as behavioral and cognitive disorders that occur during a baby's developmental period: these include autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) amongst others. The original aim of this study was to provide estimates of the prevalence of ADHD and ASD by sex and by substance used amongst people who engage with services for drug and alcohol use. This study ultimately focused on people who use substances, are attending treatment and support services and have ADHD symptoms. Methods: A systematic review and meta-analysis were conducted within acute hospitals, community and prison healthcare settings. All participants were adults over the age of 18. Measurements included a diagnosis of ADHD or ASD, defined as having used a suitable tool to diagnose in childhood including a current adult assessment or diagnosis. Results: A total of 84 studies and 99 estimates were included forming a combined sample of 34,036 individuals. A prevalence rate of 22%, 95% CI [19, 25] was found. A significant heterogeneity in studies was detected. Only one paper reported on ASD and a meta-analysis of the prevalence of ASD was not feasible. The highest ADHD prevalence rates were found amongst people using cannabis 33%, 95% CI [28, 39]. This was significantly higher than the overall prevalence rate. The same rate of 33%, 95% CI [23, 44%] was found among women using benzodiazepines. The highest rate amongst males was also found amongst those using benzodiazepines 31%, 95% CI [23, 44%]. The lowest prevalence rate at 5%, 95% CI [1, 11] was found among women using cocaine and this was also significant. Rates amongst those using opioids was 27%, 95% CI [20, 36] for women and 24%, 95% CI [19, 30] for men. These estimates had low or moderate heterogeneity. Conclusions: Rates of ADHD can vary greatly between sex and choice of substance used. It is essential that the international consensus documents on treatment for, and training in ADHD symptom management are implemented to ensure an evidence informed approach to service delivery.
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