Higher Perceived Stress Increases the Subjective Reporting of ADHD: A Sample of Medical Students
Yıl 2023,
Cilt: 33 Sayı: 3, 261 - 267, 30.06.2023
Elif Akçay
,
Gülsüm Akdeniz
,
Pınar Özışık
,
Gulsen Yilmaz
Öz
This study aimed to evaluate the subjective Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms with self-reported ratings and objective neurocognitive tests among medical students. Also, we examined to identify the psychological factors that predict ADHD reporting among medical students. Medical students (N=57) completed self-report questionnaires, and neurocognitive tests were conducted for attention measures. Participants had a mean age of 20.3 years, and 69.0% were female. High levels of perceived stress, state-trait anxiety, and current and childhood ADHD symptoms were possible risk factors; however, only higher perceived stress was a risk factor for the possibility of reporting themselves as ADHD in medical school students [odds ratio [OR] =1.184, 95% confidence interval [CI] = [1.015; 1.381]]. Higher perceived stress levels, the more reported ADHD subjectively in medical students. Objective attention measures had no impact on reporting ADHD subjectively. Screening for perceived stress is necessary for medical students, especially those with subjective ADHD symptoms.
Teşekkür
Thank you to all students who volunteered to participate in the research.
Kaynakça
- 1. Biederman J, Petty CR, Evans M, Small J, Faraone SV. How persistent is ADHD? A controlled 10-year follow-up study of boys with ADHD. Psychiatry Res. 2010;177(3):299-304.
- 2. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716-23.
- 3. Song P, Zha M, Yang Q, Zhang Y, Li X, Rudan I. The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of global health. 2021;11:04009-.
- 4. Association. AP. Diagnostic and statistical manual of mental disorders. 5th ed. ed: American Psychiatric Association Washington, DC; 2013.
- 5. Wilens TE, Spencer TJ. Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgrad Med. 2010;122(5):97-109.
- 6. Hagar KS, Goldstein S. Case study: Diagnosing adult ADHD: Symptoms versus impairment. The ADHD Report. 2001;9(3):11.
- 7. Roy-Byrne P, Scheele L, Brinkley J, Ward N, Wiatrak C, Russo J, et al. Adult attention-deficit hyperactivity disorder: assessment guidelines based on clinical presentation to a specialty clinic. Compr Psychiatry. 1997;38(3):133-40.
- 8. Barr VM. Getting Ready for College: Advising High School Students with Learning Disabilities. 1995.
- 9. Tuttle JP, Scheurich NE, Ranseen J. Prevalence of ADHD diagnosis and nonmedical prescription stimulant use in medical students. Acad Psychiatry. 2010;34(3):220-3.
- 10. Mattos P, Nazar BP, Tannock R. By the book: ADHD prevalence in medical students varies with analogous methods of addressing DSM items. Brazilian Journal of Psychiatry. 2018;40:382-7.
- 11. Conners CK, Erhardt D, Sparrow E. Conner's adult ADHD rating scales: Technical manual: Multi-Health Systems Incorporated (MHS); 1999.
- 12. Tucha L, Fuermaier AB, Koerts J, Groen Y, Thome J. Detection of feigned attention deficit hyperactivity disorder. J Neural Transm (Vienna). 2015;122 Suppl 1:S123-34.
- 13. Towey G, Fabio R, Caprì T. Measurement of Attention. 2019. p. 41-83.
- 14. Goodman DW. ADHD in adults: update for clinicians on diagnosis and assessment. Primary Psychiatry. 2009;16(11):38.
- 15. Barkley RA, Grodzinsky GM. Are tests of frontal lobe functions useful in the diagnosis of attention deficit disorders? The Clinical Neuropsychologist. 1994;8(2):121-39.
- 16. Hervey AS, Epstein JN, Curry JF. Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review. Neuropsychology. 2004;18(3):485.
- 17. Dyrbye LN, Massie FS, Eacker A, Harper W, Power D, Durning SJ, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010;304(11):1173-80.
- 18. Maser B, Danilewitz M, Guérin E, Findlay L, Frank E. Medical Student Psychological Distress and Mental Illness Relative to the General Population: A Canadian Cross-Sectional Survey. Acad Med. 2019;94(11):1781-91.
- 19. Yusoff MSB, Abdul Rahim AF, Baba AA, Ismail SB, Mat Pa MN, Esa AR. The impact of medical education on psychological health of students: A cohort study. Psychol Health Med. 2013;18(4):420-30.
- 20. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354-73.
- 21. Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80(12):1613-22.
- 22. Booth R, Sharma D. Stress reduces attention to irrelevant information: Evidence from the Stroop task. Motivation and Emotion. 2009;33(4):412.
- 23. Hirvikoski T, Lindholm T, Nordenström A, Nordström A-L, Lajic S. High self-perceived stress and many stressors, but normal diurnal cortisol rhythm, in adults with ADHD (attention-deficit/hyperactivity disorder). Horm Behav. 2009;55(3):418-24.
- 24. Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol. 1935;18(6):643-62.
- 25. Scarpina F, Tagini S. The Stroop Color and Word Test. Front Psychol. 2017;8(557).
- 26. Arbuthnott K, Frank J. Trail making test, part B as a measure of executive control: validation using a set-switching paradigm. J Clin Exp Neuropsychol. 2000;22(4):518-28.
- 27. Kortte KB, Horner MD, Windham WK. The trail making test, part B: cognitive flexibility or ability to maintain set? Appl Neuropsychol. 2002;9(2):106-9.
- 28. Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35(2):245-56.
- 29. Association AP. Diagnostic and statistical manual of mental disorders: American Psychiatric Publishing; 2013.
- 30. Yeh CB, Gau SS, Kessler RC, Wu YY. Psychometric properties of the Chinese version of the adult ADHD Self-report Scale. Int J Methods Psychiatr Res. 2008;17(1):45-54.
- 31. Dogan S, Oncu B, Varol-Saracoglu G, Kucukgoncu S. Validity and reliability of the Turkish version of the Adult ADHD Self-Report Scale (ASRS-v1. 1). Anadolu Psikiyatri Dergisi-Anatolian Journal of Psychiatry. 2009;10(2).
- 32. Ward MF. The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry. 1993;150:885-.
- 33. Oncu B, Olmez S, Senturk V. Validity and reliability of the Turkish version of the Wender Utah Rating Scale for attention-deficit/hyperactivity disorder in adults. Turk Psikiyatri Dergisi. 2005;16(4):252.
- 34. Spielberger CD. Manual for the state-trait anxietry, inventory. Consulting Psychologist. 1970.
- 35. Oner N, Le Compte A. Handbook of state-trait anxiety inventory. Istanbul: Bosphorus University Publications. 1985(333).
- 36. Cohen S, Kamarck T, Mermelstein R. Perceived stress scale. Measuring stress: A guide for health and social scientists. 1994;10(2):1-2.
- 37. Örücü MÇ, Demir A. Psychometric evaluation of perceived stress scale for Turkish university students. Stress and Health. 2009;25(1):103-9.
- 38. Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3:17.
- 39. Suhr J, Hammers D, Dobbins-Buckland K, Zimak E, Hughes C. The relationship of malingering test failure to self-reported symptoms and neuropsychological findings in adults referred for ADHD evaluation. Arch Clin Neuropsychol. 2008;23(5):521-30.
- 40. McCann BS, Roy-Byrne P. Screening and diagnostic utility of self-report attention deficit hyperactivity disorder scales in adults. Compr Psychiatry. 2004;45(3):175-83.
- 41. King JA, Colla M, Brass M, Heuser I, von Cramon D. Inefficient cognitive control in adult ADHD: evidence from
trial-by-trial Stroop test and cued task switching performance. Behav Brain Funct. 2007;3:42.
- 42. Lansbergen MM, Kenemans JL, van Engeland H. Stroop interference and attention-deficit/hyperactivity disorder: a review and meta-analysis. Neuropsychology. 2007;21(2):251-62.
- 43. Schwartz K, Verhaeghen P. ADHD and Stroop interference from age 9 to age 41 years: a meta-analysis of developmental effects. Psychol Med. 2008;38(11):1607-16.
- 44. Martel M, Nikolas M, Nigg JT. Executive function in adolescents with ADHD. J Am Acad Child Adolesc Psychiatry. 2007;46(11):1437-44.
- 45. Halleland HB, Haavik J, Lundervold AJ. Set-Shifting in Adults with ADHD. J Int Neuropsychol Soc. 2012;18(4):728-37.
- 46. Johnson DE, Epstein JN, Waid LR, Latham PK, Voronin KE, Anton RF. Neuropsychological performance deficits in adults with attention deficit/hyperactivity disorder. Arch Clin Neuropsychol. 2001;16(6):587-604.
- 47. Marchetta NDJ, Hurks PPM, Krabbendam L, Jolles J. Interference control, working memory, concept shifting, and verbal fluency in adults with attention-deficit/hyperactivity disorder (ADHD). Neuropsychology. 2008;22(1):74-84.
- 48. Müller BW, Gimbel K, Keller-Pließnig A, Sartory G, Gastpar M, Davids E. Neuropsychological assessment of adult patients with attention-deficit/hyperactivity disorder. Eur Arch Psychiatry Clin Neurosci. 2007;257(2):112-9.
- 49. Stavro GM, Ettenhofer ML, Nigg JT. Executive functions and adaptive functioning in young adult attention-deficit/hyperactivity disorder. J Int Neuropsychol Soc. 2007;13(2):324-34.
- 50. Walker AJ, Shores EA, Trollor JN, Lee T, Sachdev PS. Neuropsychological functioning of adults with attention deficit hyperactivity disorder. J Clin Exp Neuropsychol. 2000;22(1):115-24.
- 51. Rapport LJ, Van Voorhis A, Tzelepis A, Friedman SR. Executive functioning in adult attention-deficit hyperactivity disorder. Clin Neuropsychol. 2001;15(4):479-91.
- 52. van Mourik R, Oosterlaan J, Sergeant JA. The Stroop revisited: a meta-analysis of interference control in AD/HD. J Child Psychol Psychiatry. 2005;46(2):150-65.
- 53. Kooij JS. Adult ADHD: Diagnostic assessment and treatment: Springer Science & Business Media; 2012.
- 54. Pettersson R, Söderström S, Nilsson KW. Diagnosing ADHD in Adults: An Examination of the Discriminative Validity of Neuropsychological Tests and Diagnostic Assessment Instruments. J Atten Disord. 2018;22(11):1019-31.
- 55. James BO, Thomas IF, Omoaregba JO, Okogbenin EO, Okonoda KM, Ibrahim AW, et al. Psychosocial correlates of perceived stress among undergraduate medical students in Nigeria. Int J Med Educ. 2017;8:382-8.
- 56. Rahimi B, Baetz M, Bowen R, Balbuena L. Resilience, stress, and coping among Canadian medical students. Can Med Educ J. 2014;5(1):e5-e12.
- 57. Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132-49.
- 58. Salla J, Galéra C, Guichard E, Tzourio C, Michel G. ADHD Symptomatology and Perceived Stress Among French College Students. J Atten Disord. 2019;23(14):1711-8.
- 59. Harrison AG, Alexander SJ, Armstrong IT. Higher Reported Levels of Depression, Stress, and Anxiety Are Associated With Increased Endorsement of ADHD Symptoms by Postsecondary Students. Canadian Journal of School Psychology. 2013;28(3):243-60.
- 60. Overbey GA, Snell WE, Jr., Callis KE. Subclinical ADHD, stress, and coping in romantic relationships of university students. J Atten Disord. 2011;15(1):67-78.
- 61. Miklósi M, Máté O, Somogyi K, Szabó M. Adult Attention Deficit Hyperactivity Disorder Symptoms, Perceived Stress, and Well-Being: The Role of Early Maladaptive Schemata. The Journal of Nervous and Mental Disease. 2016;204(5).
- 62. Faraone SV, Antshel KM. Diagnosing and treating attention-deficit/hyperactivity disorder in adults. World Psychiatry. 2008;7(3):131-6.
Daha Yüksek Algılanan Stres, DEHB’nin Öznel Bildirimini Artırır: Tıp Fakültesi Öğrencileri Örneklemi
Yıl 2023,
Cilt: 33 Sayı: 3, 261 - 267, 30.06.2023
Elif Akçay
,
Gülsüm Akdeniz
,
Pınar Özışık
,
Gulsen Yilmaz
Öz
Bu çalışmada, tıp öğrencilerinde Dikkat eksikliği/hiperaktivite bozukluğuna (DEHB) ait subjektif semptomların objektif nörobilişsel testler ile birlikte değerlendirilmesi amaçlanmıştır. Ayrıca, tıp öğrencileri arasında subjektif DEHB bildirimini öngören olası psikolojik faktörler incelenmiştir. Tıp öğrencileri (N=57) öz bildirim anketlerini doldurmuştur ve dikkat ölçümleri için nörobilişsel testler yapılmıştır. Katılımcıların yaş ortalaması 20.3 yıl olup, %69.0'ı kadındır. Yüksek düzeyde algılanan stres, durumluk ve sürekli kaygı düzeyi ve şimdiki ve çocukluktaki DEHB belirtileri olası risk faktörleri bulunmuştur. Ancak, tıp fakültesi öğrencilerinde kendilerini DEHB olarak bildirme olasılığı için yalnızca yüksek algılanan stres bir risk faktörü olarak saptanmıştır [olasılık oranı [OR] =1.184, %95 güven aralığı [CI] = [1.015; 1.381]]. Algılanan stres seviyeleri ne kadar yüksekse, tıp öğrencilerinde subjektif olarak daha fazla DEHB rapor edilmiştir. Objektif dikkat ölçümlerinin DEHB'yi subjektif olarak bildirmede hiçbir etkisi olmamıştır. Algılanan stres düzeyinin taranması, özellikle subjektif DEHB semptom bildirimleri olan tıp öğrencileri için önemli görünmektedir.
Kaynakça
- 1. Biederman J, Petty CR, Evans M, Small J, Faraone SV. How persistent is ADHD? A controlled 10-year follow-up study of boys with ADHD. Psychiatry Res. 2010;177(3):299-304.
- 2. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716-23.
- 3. Song P, Zha M, Yang Q, Zhang Y, Li X, Rudan I. The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of global health. 2021;11:04009-.
- 4. Association. AP. Diagnostic and statistical manual of mental disorders. 5th ed. ed: American Psychiatric Association Washington, DC; 2013.
- 5. Wilens TE, Spencer TJ. Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgrad Med. 2010;122(5):97-109.
- 6. Hagar KS, Goldstein S. Case study: Diagnosing adult ADHD: Symptoms versus impairment. The ADHD Report. 2001;9(3):11.
- 7. Roy-Byrne P, Scheele L, Brinkley J, Ward N, Wiatrak C, Russo J, et al. Adult attention-deficit hyperactivity disorder: assessment guidelines based on clinical presentation to a specialty clinic. Compr Psychiatry. 1997;38(3):133-40.
- 8. Barr VM. Getting Ready for College: Advising High School Students with Learning Disabilities. 1995.
- 9. Tuttle JP, Scheurich NE, Ranseen J. Prevalence of ADHD diagnosis and nonmedical prescription stimulant use in medical students. Acad Psychiatry. 2010;34(3):220-3.
- 10. Mattos P, Nazar BP, Tannock R. By the book: ADHD prevalence in medical students varies with analogous methods of addressing DSM items. Brazilian Journal of Psychiatry. 2018;40:382-7.
- 11. Conners CK, Erhardt D, Sparrow E. Conner's adult ADHD rating scales: Technical manual: Multi-Health Systems Incorporated (MHS); 1999.
- 12. Tucha L, Fuermaier AB, Koerts J, Groen Y, Thome J. Detection of feigned attention deficit hyperactivity disorder. J Neural Transm (Vienna). 2015;122 Suppl 1:S123-34.
- 13. Towey G, Fabio R, Caprì T. Measurement of Attention. 2019. p. 41-83.
- 14. Goodman DW. ADHD in adults: update for clinicians on diagnosis and assessment. Primary Psychiatry. 2009;16(11):38.
- 15. Barkley RA, Grodzinsky GM. Are tests of frontal lobe functions useful in the diagnosis of attention deficit disorders? The Clinical Neuropsychologist. 1994;8(2):121-39.
- 16. Hervey AS, Epstein JN, Curry JF. Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review. Neuropsychology. 2004;18(3):485.
- 17. Dyrbye LN, Massie FS, Eacker A, Harper W, Power D, Durning SJ, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010;304(11):1173-80.
- 18. Maser B, Danilewitz M, Guérin E, Findlay L, Frank E. Medical Student Psychological Distress and Mental Illness Relative to the General Population: A Canadian Cross-Sectional Survey. Acad Med. 2019;94(11):1781-91.
- 19. Yusoff MSB, Abdul Rahim AF, Baba AA, Ismail SB, Mat Pa MN, Esa AR. The impact of medical education on psychological health of students: A cohort study. Psychol Health Med. 2013;18(4):420-30.
- 20. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354-73.
- 21. Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80(12):1613-22.
- 22. Booth R, Sharma D. Stress reduces attention to irrelevant information: Evidence from the Stroop task. Motivation and Emotion. 2009;33(4):412.
- 23. Hirvikoski T, Lindholm T, Nordenström A, Nordström A-L, Lajic S. High self-perceived stress and many stressors, but normal diurnal cortisol rhythm, in adults with ADHD (attention-deficit/hyperactivity disorder). Horm Behav. 2009;55(3):418-24.
- 24. Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol. 1935;18(6):643-62.
- 25. Scarpina F, Tagini S. The Stroop Color and Word Test. Front Psychol. 2017;8(557).
- 26. Arbuthnott K, Frank J. Trail making test, part B as a measure of executive control: validation using a set-switching paradigm. J Clin Exp Neuropsychol. 2000;22(4):518-28.
- 27. Kortte KB, Horner MD, Windham WK. The trail making test, part B: cognitive flexibility or ability to maintain set? Appl Neuropsychol. 2002;9(2):106-9.
- 28. Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35(2):245-56.
- 29. Association AP. Diagnostic and statistical manual of mental disorders: American Psychiatric Publishing; 2013.
- 30. Yeh CB, Gau SS, Kessler RC, Wu YY. Psychometric properties of the Chinese version of the adult ADHD Self-report Scale. Int J Methods Psychiatr Res. 2008;17(1):45-54.
- 31. Dogan S, Oncu B, Varol-Saracoglu G, Kucukgoncu S. Validity and reliability of the Turkish version of the Adult ADHD Self-Report Scale (ASRS-v1. 1). Anadolu Psikiyatri Dergisi-Anatolian Journal of Psychiatry. 2009;10(2).
- 32. Ward MF. The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry. 1993;150:885-.
- 33. Oncu B, Olmez S, Senturk V. Validity and reliability of the Turkish version of the Wender Utah Rating Scale for attention-deficit/hyperactivity disorder in adults. Turk Psikiyatri Dergisi. 2005;16(4):252.
- 34. Spielberger CD. Manual for the state-trait anxietry, inventory. Consulting Psychologist. 1970.
- 35. Oner N, Le Compte A. Handbook of state-trait anxiety inventory. Istanbul: Bosphorus University Publications. 1985(333).
- 36. Cohen S, Kamarck T, Mermelstein R. Perceived stress scale. Measuring stress: A guide for health and social scientists. 1994;10(2):1-2.
- 37. Örücü MÇ, Demir A. Psychometric evaluation of perceived stress scale for Turkish university students. Stress and Health. 2009;25(1):103-9.
- 38. Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3:17.
- 39. Suhr J, Hammers D, Dobbins-Buckland K, Zimak E, Hughes C. The relationship of malingering test failure to self-reported symptoms and neuropsychological findings in adults referred for ADHD evaluation. Arch Clin Neuropsychol. 2008;23(5):521-30.
- 40. McCann BS, Roy-Byrne P. Screening and diagnostic utility of self-report attention deficit hyperactivity disorder scales in adults. Compr Psychiatry. 2004;45(3):175-83.
- 41. King JA, Colla M, Brass M, Heuser I, von Cramon D. Inefficient cognitive control in adult ADHD: evidence from
trial-by-trial Stroop test and cued task switching performance. Behav Brain Funct. 2007;3:42.
- 42. Lansbergen MM, Kenemans JL, van Engeland H. Stroop interference and attention-deficit/hyperactivity disorder: a review and meta-analysis. Neuropsychology. 2007;21(2):251-62.
- 43. Schwartz K, Verhaeghen P. ADHD and Stroop interference from age 9 to age 41 years: a meta-analysis of developmental effects. Psychol Med. 2008;38(11):1607-16.
- 44. Martel M, Nikolas M, Nigg JT. Executive function in adolescents with ADHD. J Am Acad Child Adolesc Psychiatry. 2007;46(11):1437-44.
- 45. Halleland HB, Haavik J, Lundervold AJ. Set-Shifting in Adults with ADHD. J Int Neuropsychol Soc. 2012;18(4):728-37.
- 46. Johnson DE, Epstein JN, Waid LR, Latham PK, Voronin KE, Anton RF. Neuropsychological performance deficits in adults with attention deficit/hyperactivity disorder. Arch Clin Neuropsychol. 2001;16(6):587-604.
- 47. Marchetta NDJ, Hurks PPM, Krabbendam L, Jolles J. Interference control, working memory, concept shifting, and verbal fluency in adults with attention-deficit/hyperactivity disorder (ADHD). Neuropsychology. 2008;22(1):74-84.
- 48. Müller BW, Gimbel K, Keller-Pließnig A, Sartory G, Gastpar M, Davids E. Neuropsychological assessment of adult patients with attention-deficit/hyperactivity disorder. Eur Arch Psychiatry Clin Neurosci. 2007;257(2):112-9.
- 49. Stavro GM, Ettenhofer ML, Nigg JT. Executive functions and adaptive functioning in young adult attention-deficit/hyperactivity disorder. J Int Neuropsychol Soc. 2007;13(2):324-34.
- 50. Walker AJ, Shores EA, Trollor JN, Lee T, Sachdev PS. Neuropsychological functioning of adults with attention deficit hyperactivity disorder. J Clin Exp Neuropsychol. 2000;22(1):115-24.
- 51. Rapport LJ, Van Voorhis A, Tzelepis A, Friedman SR. Executive functioning in adult attention-deficit hyperactivity disorder. Clin Neuropsychol. 2001;15(4):479-91.
- 52. van Mourik R, Oosterlaan J, Sergeant JA. The Stroop revisited: a meta-analysis of interference control in AD/HD. J Child Psychol Psychiatry. 2005;46(2):150-65.
- 53. Kooij JS. Adult ADHD: Diagnostic assessment and treatment: Springer Science & Business Media; 2012.
- 54. Pettersson R, Söderström S, Nilsson KW. Diagnosing ADHD in Adults: An Examination of the Discriminative Validity of Neuropsychological Tests and Diagnostic Assessment Instruments. J Atten Disord. 2018;22(11):1019-31.
- 55. James BO, Thomas IF, Omoaregba JO, Okogbenin EO, Okonoda KM, Ibrahim AW, et al. Psychosocial correlates of perceived stress among undergraduate medical students in Nigeria. Int J Med Educ. 2017;8:382-8.
- 56. Rahimi B, Baetz M, Bowen R, Balbuena L. Resilience, stress, and coping among Canadian medical students. Can Med Educ J. 2014;5(1):e5-e12.
- 57. Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132-49.
- 58. Salla J, Galéra C, Guichard E, Tzourio C, Michel G. ADHD Symptomatology and Perceived Stress Among French College Students. J Atten Disord. 2019;23(14):1711-8.
- 59. Harrison AG, Alexander SJ, Armstrong IT. Higher Reported Levels of Depression, Stress, and Anxiety Are Associated With Increased Endorsement of ADHD Symptoms by Postsecondary Students. Canadian Journal of School Psychology. 2013;28(3):243-60.
- 60. Overbey GA, Snell WE, Jr., Callis KE. Subclinical ADHD, stress, and coping in romantic relationships of university students. J Atten Disord. 2011;15(1):67-78.
- 61. Miklósi M, Máté O, Somogyi K, Szabó M. Adult Attention Deficit Hyperactivity Disorder Symptoms, Perceived Stress, and Well-Being: The Role of Early Maladaptive Schemata. The Journal of Nervous and Mental Disease. 2016;204(5).
- 62. Faraone SV, Antshel KM. Diagnosing and treating attention-deficit/hyperactivity disorder in adults. World Psychiatry. 2008;7(3):131-6.