Exploring Adult Attention-Deficit/Hyperactivity Disorder and Comorbid Disorders Utilizing an Intraindividual Network Analysis Approach



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Due to underreporting and diagnostic challenges, it is difficult to estimate the prevalence rates of adult ADHD; however, a recent estimate is that approximately 5% of the adult population meets criteria for the disorder (NIH, 2017). Further, adults with ADHD have poor emotion regulation, reduced social support, and fewer coping mechanisms, and because of this, psychiatric comorbidity is often higher in this population than in non-ADHD adults (Fischer et al., 2002). It has been estimated that as many as 80% of adults diagnosed with ADHD have at least one comorbid disorder, with some of the most common being mood and anxiety (Katzman et al., 2017). Despite the prevalence of comorbid ADHD and emotional disorders in adults, to date, very few studies have investigated the interrelation of core ADHD symptoms and distress associated with the comorbidities and no studies have utilized a network analysis (NA) approach to psychopathology to understand how symptoms mutually interact and influence each other for complex cases of adult ADHD. The purpose of this study was to conduct an intraindividual, dynamic (over time) network analysis of ADHD and comorbid symptoms in individuals diagnosed with ADHD and a mood and/or anxiety disorder. Specifically, this study analyzed pre-collected EMA data that was collected two times daily utilizing an Individualized Questionnaire (IndQ) that assessed ADHD-related symptoms, distress, depression, anxiety, etc. This study assessed the concurrent and lead-lag relations of the individual’s symptoms, examined nomothetic networks across individuals, and compared pre- and post-treatment networks to understand how networks changed after receiving an intervention targeting adult ADHD. Disparities in the relationships between relevant variables for each participant across the three types of networks indicated that to best capture a comprehensive understanding of the relationship between the comorbidities, all three networks (i.e., concurrent bivariate, lead-lag bivariate, and lead-lag partial) should be examined. Additionally, differences amongst participant nomothetic networks supported the heterogeneity of ADHD symptom expression and utility of intraindividual network analysis. Finally, inattention was generally correlated with higher levels of comorbid distress across the four participants, suggesting it may be an important treatment target for individuals presenting with complex, comorbid cases of adult ADHD.



Attention-Deficit/Hyperactivity Disorder (ADHD), Network Analysis, Idiographic Assessment, Comorbidity