ASSESSING SOCIAL AND ROLE FUNCTIONING IN HELP-SEEKING YOUTH AT CLINICAL HIGH-RISK FOR PSYCHOSIS WITH COMORBID ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AND HISTORY OF STIMULANT EXPOSURE: A SIX-MONTH LONGITUDINAL FOLLOW-UP STUDY
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Date
2019-01-01
Type of Work
Department
Psychology
Program
Psychology
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Access limited to the UMBC community. Item may possibly be obtained via Interlibrary Loan thorugh a local library, pending author/copyright holder's permission.
This item is likely protected under Title 17 of the U.S. Copyright Law. Unless on a Creative Commons license, for uses protected by Copyright Law, contact the copyright holder or the author.
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Abstract
Compared to the general population, the prevalence of ADHD is estimated to be two to five times higher in those with psychosis. Individuals with both a history of ADHD and psychosis show a pattern of greater deficits in functioning and poorer prognoses over time compared to psychosis and ADHD alone. Further, research indicates that premorbid psychostimulant intervention may be associated with significantly younger age of psychosis onset (e.g., approximately 2-4 years earlier than individuals without stimulant exposure). Importantly, earlier onset is associated with worse clinical and functional outcomes compared to individuals with later onset. Less is known about these relations among individuals with and without a history of ADHD/psychostimulant exposure at an earlier point in the psychosis continuum, specifically at clinical high-risk (CHR) for psychosis. This study prospectively evaluated, over a six-month period, factors that might differentiate individuals categorized according to CHR, ADHD, and history of stimulant exposure. In particular, it assessed clinician-rated multi-dimensional social and role functioning measures sensitive to CHR samples, clinical symptomatology, age of symptom onset, and ADHD subtype. Analyses were used to compare various control groups in a sample of help-seeking youth, ages 12 to 25. Participants were categorized into four nominal groups: (1) help-seeking control, (2) individuals with ADHD/stimulant treatment without psychosis-risk, (3) individuals with clinical high-risk for psychosis without a history of ADHD/psychostimulant exposure, and (4) individuals with psychosis-risk, ADHD, and history of psychostimulant exposure. Results showed the prevalence of ADHD was 45% within the current psychosis risk sample, similar to the elevated rate in psychosis. Additionally, comparable to individuals with early onset first episode psychosis, individuals in the current sample with CHR showed an over two and a half year earlier age of attenuated positive symptom onset in the context of stimulant exposure. Correlations further showed that the earlier the age of attenuated symptom onset, the poorer the participants' functioning in the home and interactions with others. Hypothesized differences did not quite reach significance, however, CHR groups with and without ADHD trended toward the pattern of varying functioning over time in these same functioning domains (i.e., in the home and behavior towards others). CHR groups as a whole, surprisingly, showed improvement in some clinical and functioning domains, but also showed salient deficits across various functional measures and symptomatology compared to other control groups, even when controlling for variance associated with age, gender, and key clinical symptoms. Regardless of ADHD status or conversion, these findings, as a whole, provide new information about the clinical high-risk construct. These results inform earlier points of illness identification and possible areas for early intervention that could be tailored to address the unique needs of these individuals, with the effect of influencing the course of symptoms and functioning.