PSY2004 S2 W10 Adulthood & Neurodevelopmental COnditions 2

Question 1

How does ADHD prevalence change in adulthood?

Answer 1

Similar to autism, prevalence decrease with age.

Question 2

What is meant by symptomatic adult ADHD? What’s the prevalence of those adults?

Meta-Analysis Song et al. 2021

Answer 2

“presence of above-the-diagnostic-threshold ADHD symptoms in adulthood”. [6.8%]

Question 3

What is meant by Persistent adult ADHD? And what is their prevalence?

Meta-Analysis Song et al. 2021

Answer 3

“presence of above-the-diagnostic-threshold ADHD symptoms in adulthood with the additional requirement of a confirmed onset in childhood”. [2.6%]

Question 4

Are levels of depression or anxiety higher in those with neurodevelopmental conditions?

Answer 4

Estimate of current prevalence
Depression: 23%
Anxiety: 27%
Estimate of Lifelond prevalence
Depression: 37%
Anxiety: 42%

Estimate in neurotypical population
Depression: 5.5% (current), 14.6% (lifelong)
Anxiety: 18% (current), 28.8% (lifelong)

Estimate in ADHD (Kessler et al. 2008)
Depression: 18.6% (current)
Anxiety: 47% (current)

Question 5

Critical evaluate the data for prevalence of anxiety and depression in ADHD?

Answer 5

The data on ADHD has come from a single study using national records in the US published in 2006. The data from neurotypical population has come from an AI overview.

Estiamtes are not directly comparable, they are sources from different data sets.

Nevertheless, it is appropriate to conclude that experience of anxiety and / or depression are higher in adults with neurodevelopmental conditions than in those without.

Question 6

What are some reason behing increased prevalence of anxiety and depression in neurodevelopment conditions?

Answer 6

Shared genetic risk
Challeges associated with conditions
Adverse environmental experiences
Co-ocuring difficulties

Question 7

What is meants by shared genetic risk when explaing why there is an increase in prevalence of anxiety and depression in neurodevelopmental conditions?

Answer 7

Genes that are related to autism or ADHD are also associated with anxiety and/or depression

Question 8

What is meants by challenges associated with the condition when explaing why there is an increase in prevalence of anxiety and depression in neurodevelopmental conditions?

Answer 8

(e.g. emotional regulation, social interaction) can lead to feelings of frustration and isolation which can contribute to depression and anxiety.

Question 9

What is meants by adverse environmental experiences when explaing why there is an increase in prevalence of anxiety and depression in neurodevelopmental conditions?

Answer 9

e.g. bulling more likely in ADHD / autism, which in turn can increase risk of depression and / or anxiety.

Question 10

What is meants by co-occuring difficulties when explaing why there is an increase in prevalence of anxiety and depression in neurodevelopmental conditions?

Answer 10

e.g. sensory issues, sleep problems can increase stress and increase risk of depression / anxiety.

Question 11

Is there a shared genetic association between autism and mental health conditions?

Ghirardi et al. 2021

Answer 11

Sweden sample

Prevalence of other conditions (other neruodevelopmental conditions, anxiety, OCD, eating disorders & depression) were calculated in differente relatives to estimate familial and genetic association between autim and other conditions.

Results:
Anxiety and depression were linked to autism with odds ratios > 1 for all familial relationships, with greatest relationship found in monozygotic twins, suggesting a genetic component to the link between autism and anxiety and depression.

Question 12

What do odds ratio provide?

Answer 12

Odds ratio provides a statistical method for understanding the association between exposure and an outcome.

Question 13

How to interpret odds ratios?

Answer 13

OR = 1 - exposure to the cause (cigarettes) does not lead to an effect (cigarette smoking isn’t linked to lung cancer).

OR < 1- Greater exposure to the cause (cigarettes) is associated with less of an effect (less chance of lung cancer)

OR > 1- Greater exposure to the cause (cigarettes) is associated with a larger effect (greater chance of lung cancer).

Question 14

What are autism and ADHD associated with?

Answer 14

increased experience of anxiety and depression

Question 15

What are the potential explanation for the increase in anxiety and depression in Autism and ADHD?

Answer 15

potential genetic overlap and, separately, the link with adverse environmental experiences and how these may explain increased anxiety and depression in autism and ADHD.

Question 16

What might be a mediator for mental health in ADHD?

Answer 16

Self-compassion

Lower levels of self compassion in adults with ADHD partially explain why adults with ADHD lower levels of psychological social and emotional well-being and higher levels of depression, anxiety and stress have compared to adults without ADHD.

Current finding demonstrates that self-compassion may be an important factor in many different aspect of mental for people with ADHD. It, therefore, provides preliminary support for the use of self-compassion interventions in adults with ADHD in conjunction with existing empirically supported interventions

Question 17

What extra research is needed to better understand self-compassion and mental health in ADHD?

Answer 17

Longitudinal research is needed to verify if increased self-compasion can improve mental health outcomes associated with ADHD

Question 18

How does different aspects of mental health differ between No-ADHD and ADHD?

(Beaton et al. 2022)

Answer 18

ADHD means are higher for depression, anxiety and perceived stress.

ADHD means are lower for Social wellbeing, Emotional wellbeing, psychological well being and self-cmpassion

Question 19

What did Beaton et al. 2022 Find?

Reading

Answer 19

Suggests that lower levels of Self-compassion in adults with ADHD partially explain why adults with ADHD lower levels of psychological, social, emotional wellbeing and higher levels of depression, anxiety and stress have compared to adults without ADHD.

Question 20

What are the differences in mental health between autistic and non-autistic people?

Cai et al. 2023

Answer 20

Autistic peopel’s mean is lower than non-autistic in self-compassion and positive well-being.

Autistic mean is higher in depression and anxiety scores.

Question 21

How is self-compassion usually measured?

Answer 21

Using a scale: 1-5
Almost never, occasionally, about half of the time, fairly often, almost always

Question 22

What are the three elements of self-compassion?

Answer 22

Self-kindness vs Self-judgment
Common humanity vs isolation
Mindfulness vs over-identification

Question 23

What is meant by self-kindness vs self-judgement?

Self-compassion

Answer 23

the tendency to be understanding and warm towards the self rather than take a judgmental and hostile attitude towards one’s difficult experience.

Question 24

What is meant by common humanity vs isolation?

Self-compassion

Answer 24

the recognition that failure and suffering are all part of the human experience, and not something unique to the individual.

Question 25

What is meant by mindfulness vs over-identification? | Self-compassion

Answer 25

- the ability to have an awareness of the experience as is, without over identifying and applying it globally.

Question 26

What do self-compassionate people recognise?

Answer 26

recognise that all people have negative experiences, fail and make mistakes and are able to acknowledge these experiences and approach them with acceptance and kindness, without becoming over-identified with their negative feelings

Question 27

What might be a risk factor for anxiety and depression in ADHD?

Answer 27

the association of ADHD and criticism (failure)

Question 28

What evidence is there for the experience of ADHD and criticism?

Answer 28

Guntuku et al. 2019 Analysis of text from social media Found that individuals with ADHD used language associated with criticism and failure more than individuals without ADHD. Beaton et al. 2020 and 2022 Perceived criticism - measured via a single question (scored 1 – 10) – higher in adults with ADHD Qualitative study of criticism experienced by adults with ADHD (2022).

Question 29

What did Beaton et al. work find?

Answer 29

Data collection carried out online. Series of questions about: ADHD diagnosis status and traits, co-occuring conditions, mental health, experience of criticism and self-compassion. Mix of questinnaire-based and open-ended questions 2020: Self-compassion and perceived criticism in aduts with ADHD 2022: experiences of criticism in adults with ADHD (qualitative) 2022: role of self-compassion in the mental health of ADHD

Question 29

How did Beaton et al. try to minimise the cons of online research?

Answer 29

requreid multiple criteria to be met for participants to be included in ADHD groups. Included an attention-check question and excluded participants who did not pass the attention check. Study did not incentivise people who had specific experiences.

Question 30

What are the cons of online data collection?

Answer 30

Limited oversight of participants, leading to concern about the integrity of the data (e.g. are all participants truthful? Does the study encourage participants to be dishonest about their experiences?) No control over the environment where participants complete the study or how participants complete the study (e.g. while watching TV, with help from others, etc). Reduced opportunity for participants to ask for clarification if needed. Reduced opportunity for debrief at the end of the study.

Question 31

What are the pros of online data collection?

Answer 31

Increased access to large and representative samples Data usually collected very quickly Cheaper to administer than face-to-face research More resilient to external factors (e.g. covid lockdowns) Access to participants across the world

Question 32

What is HEARTS?

Answer 32

It is a social disability framework (neurodiveristy not deficit model) Doesn't view autistic communication as inherently needing to be changed. Believes that differences in social communication, executive function, sensory processing should be accepted without judgement. HEART provides support

Question 33

What does HEART encourage autistic people to do?

Answer 33

Instead of teaching autistic people to conform to non-autistic social norms (e.g., eye contact, small talk), HEARTS encourages them to: Identify their preferred communication styles. Express their needs, boundaries, and desires in a way that promotes mutually pleasurable relationships.

Question 34

What is Psychoeducational group-based intervention (Holmes et al. 2023)?

Answer 34

intervention to reduce depression and anxiety in autism Premise ==> HEART interventions ==> Intermediate outcomes ==> Clinical endpoint outcomes Contextual factors ==> Intermediate outcomes & Clinical endpoint outcomes HEART interventions & Intermediate outcomes ==> Contextual factors

Question 35

What is the premise? | Psychoeducational group-based intervention (Holmes et al. 2023)

Answer 35

Premise: social isolation, nullying, victimization, dating nad sexual violence, peer rejection and other negative social experiences can lead to depression and anxiety

Question 36

What is the HEART intervention? | Psychoeducational group-based intervention (Holmes et al. 2023)

Answer 36

6 sessions of psychoeducation About: Healthy vs unhealthy relationships Launching new relationships Neurohealth fro relationship health Meeting new people Setting and respecting boundaries Ending relationships

Question 37

What is the intermediate outcomes? | Psychoeducational group-based intervention (Holmes et al. 2023)

Answer 37

decrease hostile automatic thought decraese fight, flight or freeze response to stress decrease relationship anxiety decreased rejection sensitivity decreased dating violence decreased loneliness increased positive thinking increased self-compassion increased coping with rejection and jealousy increased motivation to engage

Question 38

What are the clinical endpoint outcomes? | Psychoeducational group-based intervention (Holmes et al. 2023)

Answer 38

decreased depression and anxiety

Question 39

What are the contextual factors? | Psychoeducational group-based intervention (Holmes et al. 2023)

Answer 39

mental health diagnoses receipt fo other sercive socioexonomic status, gender, age, race/ethnicity, sexual oritnetatino

Question 40

What is social prescribing?

Answer 40

Describes a healthcare model where health professionals connect people to wellbeing-enhancing activity in communities, such as exercise groups, nature referrals and advice services Addressing people’s needs in a holistic way. GPs and other health care professionals can refer people to a range of local, non-clinical service, supported by a link worker or connector.

Question 41

How does social prescribing change with autistic patients?

Answer 41

Most autistic adults do not get enough support, especially if they also have an intellectual disability. However, some areas have better support.

Question 42

What's the medical model of disability?

Answer 42

The problem is in the disable person: a person is: housebound, confied to a wellchair, needs help and careers, has fits, is sick, looking for a cure, can't see or hear, can't get up steps, can't walk.

Question 43

What is the social model of disability?

Answer 43

the problem is the disabling world: Badly designed building, poor jobs prospects, isolated families, inaccessible transport, no parking places, discrimination, few sign language interpreters, special schools, stairs not ramps, no lifts.

Question 44

What aer the two models of disability?

Answer 44

social model of disability and the medical model of disability

Question 45

What is a cohort study?

Answer 45

Track a large cohorts experience over time

Question 46

Where is there a gap in literature?

Answer 46

To date, although it has been shown that childhood bullying predicts psychological distress in adulthood, there is no clear data testing this hypothesis in neurodevelopmental conditions.

Question 47

Is bullying associated with poorer mental health ? | bullying in childhood & mental health in adulthood (general population)

Answer 47

Takizawa et al. 2014 Data: British National Child Development Study: Results: In the general population, childhood bullying is associated with increased depression and anxiety in adulthood. The odds-ratios are higher when bullying experience was frequent.

Question 48

What is the temporal relationship between bullying and mental health ?

Answer 48

Studies show that there is increased experience of bullying in autistic children and those with ADHD. ADHD/ASC > Increased bullying > increased risk of depression and/or anxiety Cross-sectional data Impact that childhood bullying might have in adulthood? ADHD/ASC >Increased bullying in childhood > increased risk of depression and or anxiety in adulthood

Question 49

What increased levels of anxiety and depression?

Answer 49

experience of being bullied

Question 50

What is the association between bullying and autism/ADHD? | Accardo et al. 2024

Answer 50

autistic PTT had increased experience of bullying ADHD had increased experience of bullying compared to neurotypical but less than autism.

Question 51

Adverse environmental experiences: Do children with neurodevelopmental conditions experience increased bullying?

Answer 51

Maïano et al. 2016 – systematic review and meta-analysis. “Bullying victimization was significantly more common among school-aged youth with ASD than among their TD peers, the former being three times more at risk of general victimization and nearly twice as likely to be verbally victimized at school.”

Question 52

What are adverse environmental experience that correlate to anxiety and depression in autism?

Answer 52

loneliness Strong relationship (r = .48) between depression and loneliness. Weaker, but still significant relationship, between anxiety and loneliness (r = .29).

Question 53

Does loneliness increase in autism? | adverse environmental experience

Answer 53

Recently published meta-analysis (Hymas et al. 2024) Results shows a pooled effect size of 0.891 (large effect) Supporting the hypothesis that autistic adults report higher levels of loneliness than neurotypical adults.

Question 54

What did Hollocks et al. 2019 find? | Reading

Answer 54

In conclusion, adults with a diagnosis of autism spectrum disorder experience high rates of comorbid anxiety and depression. It is possible that depression is underestimated, especially in the context of ASD with intellectual disability (ID), both anxiety and depression are prominent and common in adults with a diagnosis of ASD.