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Trial Lecture on a chosen topic – time and place
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Trial Lecture on a given topic – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Terje Torgersen, NTNU - Norwegian University of Science and Technology
- Second opponent: Professor Per Hove Thomsen, Aarhus University, Denmark
- Third member and chair of the evaluation committee: Associate Professor Kjersti Narud, University of Oslo
Chair of the Defence
Professor Emeritus Ulrik Fredrik Malt, University of Oslo
Summary
This dissertation focuses on adults diagnosed with attention deficit hyperactivity disorder (ADHD). The study was conducted in a private psychiatric outpatient clinic in Oslo, where 922 participants were assessed and diagnosed with ADHD between 2005 and 2018.
Adults with ADHD are a diverse group with individual expressions of problems associated with attention difficulties, with or without hyperactivity-impulsivity. The requirements for diagnosis include impairments in social, work, or educational settings. The focus on psychosocial functioning is important for diagnosis and planning appropriate interventions.
The subjective severity of ADHD may be measured with different self-reported instruments. In this dissertation used the ADHD Adult Self-Report Scale (ASRS), an often- used severity rating scale for adult ADHD. Many adults with ADHD also have excessive anger episodes, described as ‘emotional dysregulation’. The severity of these symptoms was measured with the Deficient Emotional Self-Regulation (DESR) questionnaire.
The results of this study presented in this dissertation have been published internationally in five scientific articles. The main findings are as follows:
- As many as 50% of participants had one current comorbid psychiatric disorder, and 25% had two or more comorbid psychiatric disorders, most commonly major depression, social anxiety, and drug use disorders.
- Nearly 60% of our participants reported work as their main source of income. The prevalence of work participation was associated with positive social factors, such as living with someone and having children, and with not previously having severe depression.
- A total of 22% of women and 32% of men in our sample reported a lifetime history of drug use disorder (mainly amphetamine and cannabis), and this was associated with both higher hyperactivity-impulsivity and emotional dysregulation severity scores.
- A total of 12% of women and 25% of men in our sample reported a lifetime history of criminal conviction, and this was associated with both higher hyperactivity-impulsivity and emotional dysregulation severity scores.
- The severity of ADHD is emphasized in the DSM-5. We sought to investigate whether psychometric WAIS test scores have utility as an indicator of severity. The psychometric index scores of verbal working memory (as WMI) and processing speed (as PSI) appear to have limited utility as an indicator of the severity of attention deficit and emotional dysregulation in adult ADHD.
ADHD research is often performed in state-funded, public clinics. In this dissertation, I show that patients in private clinics also show higher rates of psychiatric comorbidity, drug-abuse, and criminality, and lower rates of work participation, than the general population. This finding underscores the personal cost of having undiagnosed, untreated ADHD, and should alert authorities to recognise the struggle of this patient group.
Emotional dysregulation is an important feature in many people with ADHD and measuring emotional dysregulation may contribute to understanding ADHD comorbidity, particularly substance abuse and criminality.
Because ADHD is a dimensional diagnosis, I show that the severity of ADHD and the presence of additional emotional control problems, are both associated with drug use disorder and criminal conviction. I also show that neuropsychological measures of verbal working memory and processing speed are not suitable indicators of the objective severity of ADHD and emotional dysregulation.
Additional information
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