Network analysis of attention deficit hyperactivity disorder traits and mental health indicators in Brazilian adults

Attention-Deficit/Hyperactivity Disorder (ADHD), a neurodevelopmental disorder characterized by behavioral traits such as inattention, hyperactivity, and impulsivity, has been widely associated with mental health impairments. However, the presence of these traits alone does not determine diagnosis, as they must also cause significant functional impairment for the individual to fulfill diagnostic criteria. Therefore, this study aimed at exploring how ADHD traits are associated with mental health indicators in general population adults regardless of whether participants met full diagnostic criteria for the disorder. The Adult ADHD Self-Report Scale (ASRS) was used to screen ADHD traits in an online survey that also addressed mental health indicators such as excessive preoccupation, lack of meaning in life and substance use. Invitations were distributed via social media platforms. The final sample consisted of 2,159 Brazilian adult participants. Data were analyzed using network analysis. An undirected network was modeled using the Gaussian Graphical Model based on partial polychoric correlations, and regularization was applied using EBICglasso. The main network analysis was conducted for individual ADHD traits. Additional analyses were performed for the summed inattention and hyperactivity/impulsivity scores, for the total ASRS summed score, and for subgroups of participants exhibiting extreme levels of trait presentation. Results indicate that, in an adult community sample, association between ADHD traits and mental health impairment is predominantly indirect. This indirect association was commonly interposed by younger age and feelings of insecurity. The results were consistent across all analyses. Overall, our results suggest that the presence of ADHD traits alone is not strongly associated with mental health impairment in the general population. We propose that both research and clinical practice may benefit from further exploring and addressing intervening factors—such as insecurity—that could underlie the association between ADHD traits and mental health impairment observed in previous studies.