The Relevance of Noncore Symptoms in Patients With ADHD

In this video, Psych Congress Steering Committee member Vladimir Maletic, MD, MS, discusses the noncore symptoms of attention/deficit-hyperactivity disorder (ADHD) and how they are relevant to diagnosis and treatment.

Dr. Maletic is Clinical Professor of Psychiatry, University of South Carolina School of Medicine, Greenville. Noncore symptoms of ADHD is one of the topics he will address in "Trees or the Forest? Advances in Neurobiological Understanding of ADHD and Novel Treatments," which he is presenting at the 2021 Psych Congress Regionals meeting series.

Read the transcript:

We will discuss relevance of noncore symptoms of ADHD in its clinical presentation and possibly how they would influence treatment.

Narrowly defined, ADHD is predominately presented as impulsivity, hyperactivity, inattentiveness. More recent research has indicated that we should possibly revise our diagnostic definition of ADHD to include some other very common and important manifestations of this disorder.

Individuals who have ADHD will often manifest varying degrees of emotional dysregulation and especially pronounced negative emotions such as irritability, anxiety, and changes in stress response.

It is not uncommon for patients with ADHD also to have learning disabilities, to have issues with their social functioning but also diurnal disturbances, manifest as altered sleep-wakefulness cycle, manifest as a different meal schedule. These are all very, very important.

If we look at the large clinical studies that have looked at some of these less typical manifestations of ADHD, and I'm talking about meta-analysis that included dozen studies or more, here are some bottom-line findings.

Individuals who have ADHD also are more prone to reactive aggression. This is not an intentional aggression, instrumental aggression in order to have their goals met. We see this sometimes in individuals who have a criminal past, not at all. This is more impulsive reactive aggression in context of ADHD.

Also, ADHD may have an impact on one's ability to properly identify and recognize emotions. Individuals who are afflicted by this condition will have a harder time reading social cues and will sometimes be likely to misinterpret them.

Finally, when it comes to reward processing, ADHD is associated with preference of immediate gratification, accepting smaller rewards, rather than delayed larger rewards.

Again, clinically, there are multiple manifestations of ADHD that do have bearing on its treatment.

When we're talking about comorbidities of ADHD, it's good to understand that these comorbidities are not necessarily present at the same time in children and adults. In children, we tend to see more anxiety tics and disruptive disorders such as oppositional defiant and conduct disorder, while in adults, we see more comorbid depression, anxiety, bipolar disorder, and substance use.

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