The results of this study suggest that adults who are diagnosed with ADHD and taking medication often experience side effects and symptoms that substantially reduce their quality of life. For example, the researchers found evidence of reduced well-being, increased unemployment, mood issues, and insomnia.

It appears that the study was produced by employees and consultants for the pharmaceutical company Otsuka, which is currently developing and promoting its own drug for ADHD, Centanafadine. As such, the company may benefit from research that shines a light on the failures and adverse effects of current treatments for ADHD.

The authors from Otsuka frame the study this way:

While pharmacological treatments, especially stimulants, are the primary treatment for adults with ADHD in the United States, the side effects of these treatments have also been documented in the scientific literature. The most common side effects are sleeping problems or insomnia, restlessness, loss of appetite, weight loss, dry mouth, depressed mood, and emotional dysregulation.

Due to the similarities between ADHD symptoms and the side effects of the medication used to treat it, researchers often have difficulties identifying whether the patients’ experiences are caused by ADHD, by the treatment, or by a combination of both. For this reason, the researchers of this study focused on studying ADHD/treatment-related adverse events rather than identifying them as different phenomena.

Most research on ADHD has focused on the effects symptoms and treatments might have on children and adolescents. Many studies have identified how pharmacological treatments for ADHD lead to symptom reduction but often miss how these treatments might influence other areas of the child’s life and well-being. For example, a recent study found children diagnosed with ADHD had poorer quality of life and were more likely to engage in self-harm than kids who shared the same symptoms but were not diagnosed.

Other studies also suggest that these treatments influence children’s growth and brain development. One research study published this year found that kids diagnosed with ADHD who were under pharmacological treatment were more likely to finish in-class activities and experience behavioral changes in the classroom but did not see an improvement in learning when compared to kids with ADHD that were not on medication. Despite these complicated findings, ADHD continues to be overdiagnosed in children.

Because of the limited research on ADHD in the adult population and the limited research on the effects of pharmacological treatments on quality of life, the researchers developed a survey study to identify ADHD/treatment-related adverse effects in this group. Participants in this online survey were adults living with ADHD in the United States.

The survey was composed of four parts. First, they were screened for eligibility and signed their consent to participate. Second, the researchers asked participants about individual characteristics and general outcomes of treatment. Third, they asked about sleep disturbances, including but not limited to insomnia. Finally, they asked about their emotional impulsivity.

Among the 585 adults living with ADHD who participated in the survey, 58.5% identified as female, 40.5% identified as male, and 1% identified as non-binary. Regarding race, 74.4% identified as White, 14.2% identified as African American or Black, 11.1% identified as Hispanic or Latino, 4.4% identified as Asian or Pacific Islander, 3.6% identified as Native American or Alaskan Native, 0.7% identified as Other, and 0.2% preferred not to answer. In addition, 60.9% had been diagnosed with ADHD before 18, many experienced comorbidities, and all were under pharmacological treatment.

The results show that 95.2% of the participants experienced at least 1 symptom of ADHD/treatment-related adverse effect during the last month, with the average being about 6 symptoms per participant. The most common adverse effects were insomnia and other sleep disturbances, anxiety and panic attacks, depressed mood, and emotional impulsivity or mood liability. These were experienced by slightly less than half of the participants.

People who experienced sleep disturbances and emotional impulsivity often presented more symptoms than those who did not, reporting about eight symptoms of ADHD/treatment-related adverse effects.

Other reported ill effects were feeling jittery and restless, headaches and migraines, fatigue and drowsiness, excess energy, dry mouth, decreased appetite, weight loss, sweats or hot flashes, constipation, painful menstrual cramps, involuntary movements or tremors, diarrhea, abdominal pain, nausea or vomiting, substance abuse, skin rash, problems with urination, problems with erection, and being in an accident.

Upon further analysis, the researchers found a negative relationship between adverse side effects and quality of life, meaning the quality of life worsened with every adverse effect. They also found a significant relationship between these effects and their employment probability. The more reported symptoms of ADHD, the higher the odds of unemployment. Those who experienced sleep disturbances and emotional impulsivity were also less likely to be employed than those who did not.

As expected, they also found that the more adverse effects experienced, the worse their activity impairment. This was also significantly worse among those who had trouble sleeping and emotional impulsivity than those who did not experience these symptoms.

The authors name some of the main limitations of their study. Among them were the sampling method, the comorbidities present in the sample, their need to recollect past events to provide accurate information, and the difficulty in distinguishing between ADHD symptoms and the adverse effects of pharmacotherapy.

This research also assumes symptoms of ADHD are the result of either a mental illness, the effects of medication, or a combination, while there is a large body of research that suggests there is a relationship between ADHD symptoms and exposure to environmental problems and socioeconomic deprivation.

This research adds to the growing literature on the negative impact of ADHD diagnoses and treatments on well-being and quality of life. It is novel in its focus on the adult population. While there is significant research on the ill effects of diagnosis and psychopharmacological treatments of ADHD in children, this study might serve in the development of future research questions that could provide more accurate information about the possible side effects of these treatments, beyond simple treatment reduction (or not), in adults.

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Declaration of funding
Financial support for this research was provided by Otsuka Pharmaceutical Development & Commercialization, Inc. The study sponsor was involved in several aspects of the research, including the study design, the interpretation of data, the writing of the manuscript, and the decision to submit the manuscript for publication.

Declaration of financial/other relationships
JS is an employee of Otsuka Pharmaceutical Development & Commercialization, Inc. AC received research support from Allergan, Takeda/Shire, Emalex, Akili, Ironshore, Arbor, Aevi Genomic Medicine, Neos Therapeutics, Otsuka, Pfizer, Purdue, Rhodes, Sunovion, Tris, KemPharm, Supernus, and the U.S. Food and Drug Administration; was on the advisory board of Takeda/Shire, Akili, Arbor, Cingulate, Ironshore, Neos Therapeutics, Otsuka, Pfizer, Purdue, Adlon, Rhodes, Sunovion, Tris, Supernus, and Corium; received consulting fees from Arbor, Ironshore, Neos Therapeutics, Purdue, Rhodes, Sunovion, Tris, KemPharm, Supernus, Corium, Jazz, Tulex Pharma, and Lumos Pharma; received speaker fees from Takeda/Shire, Arbor, Ironshore, Neos Therapeutics, Pfizer, Tris, and Supernus; and received writing support from Takeda/Shire, Arbor, Ironshore, Neos Therapeutics, Pfizer, Purdue, Rhodes, Sunovion, and Tris. MC, MGL, RB, and AG are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Otsuka Pharmaceutical Development & Commercialization, Inc. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Schein, J., Cloutier, M., Gauthier-Loiselle, M., Bungay, R., Guerin A. & Childress, A. (2022). Symptoms associated with ADHD/treatment-related adverse side effects and their impact on quality of life and work productivity in adults with ADHD. Current Medical Research and Opinion, DOI: 10.1080/03007995.2022.2122228 (Link)

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“A daily influx of social messages suggests to young people that those who reach traditional forms of success in society earned their status through their ability and efforts,” the author, Mesmin Destin at Northwestern University, writes. “At some point in development, though, people from lower socioeconomic status (SES) contexts recognize unique barriers that they are much more likely to face on the path to reaching their goals than people from higher SES backgrounds. Over time, these socioeconomic barriers can weaken a young person’s tendency to effectively pursue their goals, even if they still express a vaguely optimistic outlook.”

In the United States, socioeconomic disparities are related to people’s academic performance. Research demonstrates that higher SES and financial means are associated with better academic achievement. Children’s motivation to do well at school depends on feeling they have access to the resources they need to achieve their goals. Through experiments, psychologists have found that children from low SES are more likely to be academically-driven, spend additional time studying, or see themselves in education-dependent careers when (1) exposed to information about possible financial resources that would allow them to achieve those goals, (2) when led to visualize themselves in roles related to that academic trajectory, and (3) when they believe that economic mobility is possible. 

“The idea that the motivation of students from lower SES backgrounds can be influenced by information about opportunities for their future socioeconomic advancement suggests the role of key underlying beliefs about the nature of society in general,” Destin writes. 

Another area of research has focused on how social context influences how children and adolescents identify and imagine their future. These students examine students’ reactions when they are exposed to messages about their future from parents, teachers, friends, peers, and institutions. It has been found that students who have been mentored about their future by older peers are more likely to become motivated at school. 

Parents who are exposed to success stories of older children, information about financial support, and possible challenges their kids might encounter were more likely to share that information with their children. When parents discussed these opportunities with their children, it positively affected their grades throughout the school year. Additionally, undergraduate students from low SES who perceived “warm” messages about socioeconomic diversity could more readily identify with academic achievement. 

People’s identities and lived experiences are influenced by other systemic factors other than socioeconomic status. For this reason, some psychological research on socioeconomic status has taken into consideration the intersections between SES, race, and racism. Destin reminds us how “…some of the most significant experiences of opportunity can come from unique combinations of socioeconomic and racial privileges such as the historically rooted concentration of intergenerational wealth within White families and communities in the United States.” 

This research highlights the racial-economic disparities in the US. Studies have found that Black and White people from the same SES are judged as being in different socioeconomic categories, that people tend to relate “poverty and public assistance with Blacks while associating desirable job opportunities with Whites,” and that people make decisions to shoot armed or unarmed individuals according to both SES and race. Research on intersectionality also suggests that Black people’s social challenges have a negative impact on achievement, physical health, wellbeing, and being at higher risk of “downward social mobility,” even when they are middle or upper-class. 

Although strides have been made within the field of psychology and socioeconomic status, researchers provide recommendations for developing this line of study. They suggest (1) systematically studying the intersections between SES, race, and racism to the academic achievement and trajectory of young people; (2) a stronger and more explicit focus on the strengths and assets of low SES youth; and (3) taking a more holistic approach to understanding both health and academic achievement. 

Current theories and conceptualizations about how the opportunities that are present (or lacking) in particular SES affect identity and motivation could be expanded by using ecological frameworks that consider a variety of factors that shape self-perception. For example, taking into account the monetary cost of higher education, the barriers such as racial prejudice and discrimination in academic contexts, and how systematic inequality, resource distribution, and school segregation profoundly impact minoritized students.

While identity-focused research and practice have focused on the values and goals of their participants and communities, this field of study could additionally benefit from taking a “community strength and assets” perspective in relation to youth who experience difficulties due to SES. Often interventionist research had focused on this population’s deficits, which can reinforce a history of racist and classist ideology.

Research should also focus on understanding the lives of the individuals that make up these groups from a more holistic perspective. This implies studying a variety of issues that come along with academic achievement. For example, research shows that those who move up from lower SES could be at health risks such as epigenetic aging and inflammation. 

As new knowledge has made the understanding of this issue more complex, it is also essential to increase the complexity of approaches used to tackle the effects of socioeconomic disparities. Destin proposes that “as people interact with multiple systems of power, opportunity, privilege, and oppression through the lens of multiple identities, interventions can also address multiple levels of an individual’s context. For young people, this means that in addition to direct-to-student interventions, coordinated approaches can work to address psychological contributors to achievement disparities at the teacher, school, and neighborhood levels simultaneously.” 

He also proposes reducing inequality through policy-level interventions that might address broader structural level issues such as intergenerational wealth and residential segregation. Finally, the author suggests using new research methods that could allow us to understand the complexity of these lived experiences further.

The implications of these articles are essential to address. Psychological research and interventions have historically focused on individual-level processes and personal change while ignoring the political implications of this work. By addressing historical, systemic, and environmental factors associated with decreased academic achievement, new approaches can be developed to address the psychological barriers to motivation and negative self-perception related to economic class. 

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Mesmin, D. (2019). A Path to Advance Research on Identity and Socioeconomic Opportunity. American Psychologist, 74(9), p.1071-1079 (Link)

The post Building an Intersectional Psychology of Economic Class appeared first on Mad In America.

“Although socioeconomic status is an important social determinant of health, these racial health disparities also persist across socioeconomic levels), indicating that a fundamental cause of racial health disparities may be racism itself rather than socioeconomic status,” the authors write. “Therefore, we focus on the ways in which psychological science can be employed to illuminate and combat racism for the reduction of racial health disparities.”

Research has made racial health disparities evident as morbidity & mortality rates, cardiovascular disease, obesity, and diabetes are higher in racial minority groups. Also, research finds that living in an environment with high levels of structural racism is associated with a variety of adverse health outcomes. Yet, while psychological science on health disparities has had a stronger focus on socioeconomic status as a social determinant of health, structural racism is fundamental to the perpetuation of these racial health disparities. For this reason, psychological science should focus on structural racism if psychologists are committed to reducing and eliminating these health disparities.

Psychological research has historically focused on the individual experience of racism. For example, there is ample literature on how discrimination is lived, and how different coping styles and the ability to cope with discrimination affect health and well-being. Moreover, to maintain supposed neutrality and objectivity, and to describe the subjective nature of self-reported data, social psychologists have focused on their participants’ individual perceptions of racism and discrimination. The authors highlight how “in the context of discussions of race and racism, the word perceived is accompanied by a history of invalidation of Black Americans’ ’perceptions‘ of experiences with White supremacist structures and agents.”

“The use of ‘perceived’ comes with an added danger of inappropriate emphasis on psychological interventions that seek to alter individuals’ perceptions as the solution to racial health disparities, focusing solely on an individual approach rather than a systemic one.”

Individual interventions that aim to change perception may have positive effects, but, as they alter the perception of those being affected by racism, they do not offer solutions to changing systemic racism, or the diminishing or elimination of racial health disparities.

As psychologists’ are becoming increasingly interested in reducing racial health disparities, the authors of this article recommend addressing the sociopolitical and historical context of racial oppression. To do so, they suggest: (1) changing psychological science’s language, (2) changing psychological science’s framework, and (3) changing psychological science’s black health narrative.

By changing psychological science’s language, the authors propose changing the way terms and constructs are defined, conceptualized, and operationalized. First, psychologists must depart from the historical tendency to reduce race to biology, as “it is important that psychological science does not seek to replicate essentialist notions of race as biological by examining race as a construct removed from its sociopolitical and theoretical context.”

Instead, race should be understood as a sociopolitical construction. For this reason, race should not be utilized as an independent variable in studies of health disparities. Psychologists should instead use variables that highlight how racialization affects the lives of racial minorities.

Second, psychologists should change the way they conceptualize research about lived experience, as the term ‘perception’ reifies colorblind ideologies and hinders steps towards improving structural issues. Finally, psychologists must also acknowledge the problems of focusing on individual change, and place the terms and concepts used, such as race, racism, and health disparities, in their historical and sociopolitical context.

The authors of this article also suggest moving psychological theories toward integration with Critical Race Theory (CRT) to critically examine and address the causal roots of racial health disparities. By using a CRT framework, psychologists can better understand how the “examination and transformation of racism and power is at the center of any meaningful study of psychological phenomena.”To explore the complexity and pervasiveness of racism in determining racial health disparities, psychological research could benefit from five principles of CRT.

First, understanding that racism is a pervasive form of systemic discrimination, and thus it does not occur in isolation. Second,  considering how different social perspectives and ideologies such as liberalism, individualism, colorblindness, etc., perpetuate racism as it turns it invisible and detracts attention from the causal factors of discrimination. Thirdly, acknowledging how social change for the “equitable conditions” for racial minorities has only been achieved when it favors White Americans.

Fourth, unpacking how racism thrives as Whiteness provides sociocultural, legal, and economic privilege. And fifth, CRT proposes a voice-of-color thesis, which promotes ‘counterstorytelling’ as a way of challenging cultural racist narratives, as the particular experiences lived by people of color concerning marginalization and systemic oppression are made visible.

Finally, the authors suggest changing psychological science’s black health narrative as “[t]he majority of psychological applications to reduce racial health disparities still consider Black health in the context of risk, often framing Black individuals’ health as implicitly lacking rather than framing racism itself as problematic.”

Research and interventions that focus on reducing individual risk by providing skills and psychoeducation create health narratives that position Black individuals and groups as powerless, uneducated, and unhealthy. Furthermore, they go without examining or intervening at the structural level. Thus, psychological research must change narratives about black health by also acknowledging community and individual strengths, as well as developing community-led narratives.

Psychology’s focus on individual factors, and its lack of appreciation for the historical and cultural context in psychological research, has obscured knowledge creation and interventions that address the cause of health disparities. These guidelines provide ample suggestions on how psychologists can ethically and critically address these disparities by researching and intervening at a structural level.

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Volpe, V. V., Dawson, D. N., Rahal, D., Wiley, K. C., & Vesslee, S. (2019). Bringing psychological science to bear on racial health disparities: The promise of centering Black health through a critical race framework. Translational Issues in Psychological Science, 5(4), 302–314. https://doi.org/10.1037/tps0000205 (Link)

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