Neuroscience Applied

Volume 1, 2022, 101012

Research Articles

Microdosing with psychedelics to self-medicate for ADHD

symptoms in adults: A prospective naturalistic study
Eline C.H.M. Haijen , Petra P.M. Hurks, Kim P.C. Kuypers

Show more

Outline Share Cite

https://doi.org/10.1016/j.nsa.2022.101012
Get rights and content

Under a Creative Commons license open access

Abstract
ADHD in adulthood is often overlooked, which negatively affects the individual’s well-being. First-line pharmacological
interventions are effective in many ADHD patients, relieving symptoms rapidly. However, there seems to be a
proportion of individuals who discontinue, or fail to respond to these treatments. For these individuals, alternative
treatment options should be explored. A retrospective survey study reported that using classic psychedelics in low,
repeated doses, so called microdosing (MD), was rated as being more effective than conventional treatments for ADHD.
The current prospective study aimed to measure the effect of MD on ADHD symptoms, well-being and time perception.
Adults with ADHD who had the intention to start MD on their own initiative to self-treat their symptoms were
measured before MD and two- and four weeks later. It was expected that ADHD symptoms would decrease, well-being
would increase, and performance on a time perception task would improve after MD. It was investigated if
conventional medication use alongside MD and comorbidities alongside ADHD influenced the effect of MD. Sample
sizes included N=233, N=66, and N=47, respectively. The results showed decreases and increases in ADHD symptoms
and well-being, respectively. No improved performance on a time perception task was found. Conventional medication
use and having comorbidities did not change the effect of MD on ADHD symptomatology and well-being after four
weeks of MD. Placebo-controlled experimental studies are needed to explore further whether there is a beneficial
effect of MD for ADHD, beyond the placebo-effect.

Previous Next

Keywords
ADHD; Microdosing; Psychedelics; Self-medication; Well-being; Time perception

1. Introduction
Attention deficit hyperactivity disorder (ADHD) is one of the most common developmental disorders worldwide, with
a prevalence rate of 5% in youths (Sayal et al., 2018). Increasing attention is paid to ADHD in adults, both in research and
health care. Prevalence research indicates that 2.6% of the adult population has persistent ADHD, meaning that the
symptoms had a childhood onset, and about 6.7% of adults diagnosed with ADHD have symptoms that started later
than childhood (Song et al., 2021). ADHD in adults is often associated with financial distress, a higher risk of criminality
and suicidality, resulting in serious detrimental consequences for an individual's quality of life and well-being
(Beauchaine et al., 2020; Di Lorenzo et al., 2021). ADHD in adulthood has a high lifetime comorbidity rate of 60–80%
(Kooij et al., 2019). Mood, anxiety, substance use, and behavioural disorders often co-occur with ADHD (Di Lorenzo
et al., 2021; Ginsberg et al., 2014; Fayyad et al., 2017). ADHD in adults is often overlooked because of the high
comorbidity rate and lack of knowledge about how ADHD is expressed in adulthood (Kooij et al., 2019). Examples of
age-appropriate ADHD symptoms include forgetfulness, chaotic presentation, difficulty in planning and time
management, failing to meet deadlines, problems with finishing tasks in the workplace, inner restlessness, fidgeting,
and emotional impulsivity (Butzbach et al., 2019; Hong et al., 2022; Marx et al., 2021; Ptacek et al., 2019). In addition,
ADHD is associated with deficits in various domains of cognitive functioning. According to the triple pathway model,
three dissociated domains may underlie ADHD symptomatology, including deficits in delay aversion, inhibition, and
temporal processing. Twenty-five percent of ADHD cases suffered from ADHD symptoms purely because of deficiencies
in temporal processing (Sonuga-Barke et al., 2010).

First-line ADHD treatments in adults mainly include pharmacological interventions to enhance dopaminergic and
noradrenergic neurotransmission with stimulants, such as methylphenidate and amphetamine, and non-stimulant
agents, such as atomoxetine (Cortese et al., 2018). Overall, they have been proven to work effectively in adults with
ADHD (Asherson et al., 2016; Castells et al., 2011; Koesters et al., 2009), inducing fast symptom relief and thereby
enhancing the person's quality of life. In the longer term, as shown by prospective studies, approximately twenty
percent of ADHD patients discontinue their prescribed medication after six to nine months (Bejerot et al., 2010), thirty
percent after one year (Fredriksen et al., 2014), and half of them after two years (Bejerot et al., 2010). Treatment
discontinuation has been suggested to result from side effects that outweigh the therapeutic effects, such as insomnia,
headaches, low appetite, weight loss, increased heart rate, and blood pressure (Khan and Aslani, 2021). Further,
previous research has shown that many adults with ADHD fail to respond to prescribed medication. For instance,
approximately half of the adult ADHD patients were considered non-responders (i.e., less than 30% reduction of ADHD
symptoms) after ten weeks of treatment with atomoxetine, and 65% did not show a clinical response after 24 weeks
(Bushe et al., 2016). Failing to respond to ADHD medication has been associated with a lower quality of life (Coghill
et al., 2017; Mick et al., 2008). Alternative options need to be explored for the subset of adults with ADHD who do not
benefit from or do not adhere to first-line pharmacological treatments.

The use of classical psychedelics like lysergic acid diethylamide (LSD) and psilocybin in small repeated doses, which is
better known as microdosing (MD), has been suggested as a potential alternative in treating ADHD symptomatology.
Previously, it was shown that one of the motives of people who microdose was to self-treat their ADHD, a practice they
deemed more effective than taking conventional (first-line) pharmacological treatments (Hutten et al., 2019a). General
claimed effects of MD include increased concentration, productivity, and enhanced positive mood (Hutten et al.,
2019b). Placebo-controlled research in neurotypical volunteers has shown that a single small dose of LSD improved
attention performance (20 ​μg LSD base, equivalent to 26 μ
​ g LSD tartrate) (Hutten et al., 2020) and increased positive
mood (20 μ
​ g LSD base) (Hutten et al., 2020; Bershad et al., 2019). After repeated dosing in elder participants, changes in
time perception were observed after the fourth dose (10 ​μg LSD base, equivalent to 13 μ
​ g LSD tartrate) (Yanakieva et al.,
2019). While the effect profile of a small dose of a psychedelic in healthy volunteers and the user claims about
symptom relief in ADHD seem to point in the direction that MD can help in the treatment of ADHD, research is needed
to show behavioural changes before and after MD in adults with ADHD. This approach will address the shortcomings of
studies asking users retrospectively about their experience with MD.

The aim of this naturalistic, prospective study was to investigate the effectiveness of MD with psychedelics to self-
medicate for ADHD symptoms in adults who had the intention to start MD on their own initiative. Additional measures
focused on well-being and time perception, as the latter might be a key cognitive domain underlying ADHD symptoms
(Sonuga-Barke et al., 2010). This approach provided the opportunity to collect data about this practice of self-
medicating with psychedelics that is prevalent in this patient population (Hutten et al., 2019a) and to inform future
controlled lab-based studies investigating this population. Based on previous findings, it was hypothesized that ADHD
symptoms would decrease and self-rated well-being would increase after four weeks of MD compared to baseline. It
was expected that changes in ADHD symptoms would be associated with changes in well-being. Further, it was
hypothesized that performance on a time perception task would be enhanced. It was investigated if current first-line
pharmacological treatment use alongside MD, and comorbid diagnoses alongside ADHD, influenced the change in
ADHD symptoms, well-being, and time perception after MD. Lastly, it was investigated what type of individuals did not
show an improvement in ADHD symptoms after four weeks of MD, to test whether this was related to using
conventional medication alongside MD or having comorbid diagnoses alongside ADHD.

2. Material and methods

2.1. Study design and participants

The current study employed a prospective naturalistic design, assessing the performance and experiences of
participants at baseline, before they start MD on their own initiative, and at two and four weeks after MD initiation.
The target population included adults diagnosed with ADHD and individuals who experienced ADHD symptoms to the
extent that these interfered with their daily lives and who had not been diagnosed with ADHD before. To be included
in the analyses, participants needed to score above a cut-off point on at least one of the subscales of the Conner's Adult
ADHD Rating Scale (CAARS-S:SV). According to the technical manual, this cut-off was indicative of clinically elevated
symptoms (Conners et al., 1999) (see section 2.3). Furthermore, to be enrolled, participants needed to have the
intention to start MD with psychedelics on their own initiative to relieve these symptoms.

2.2. Study procedure

An online advertisement was used to recruit participants. The online advertisement, including a link to the study, was
placed on a website providing information about MD with psychedelics (www.microdosing.nl ). Interested
participants clicking the link were redirected to the study information explaining the study rationale and procedure.
After reading the information and being provided with the opportunity to contact the researchers regarding questions
about the study, individuals could proceed to the informed consent sheet. Participants were asked to sign the informed
consent sheet one to three days before they would start MD because after providing written consent participants were
redirected to the first survey, which served as the baseline assessment. The baseline survey took about 20 ​min to
complete. Once the baseline survey was completed, participants were enrolled in the emailing system, which
generated links to the measurements two and four weeks after enrolment. If the survey had not been completed after
24 ​h, a reminder was sent, asking the participant to complete the survey as soon as possible. Each of the surveys at the
two- and four-week time points took about 15 ​min to complete. Additionally, participants were asked to keep a diary of
the substances and doses they administered during the study period. Participants were able to pause the surveys and
complete them at another moment. Data collection occurred between November 2020 and July 2021. The study was
approved by the Ethics Review Committee of Psychology and Neuroscience at Maastricht University (ERCPN-
215_05_11_2019_A1).

2.3. Measures

2.3.1. Demographic information and history of substance use

At baseline, demographic information and information about the history of substance use were collected.
Demographics included the variables gender, continent of residence, educational level, and daily occupation. History of
substance use assessed experience with psychedelics (i.e., ayahuasca, DMT, 5-MeO-DMT, LSD, novel lysergamides (e.g.,
1P-LSD, ALD-52), psilocybin, salvia divinorum, ibogaine, and mescaline) in both full (psychedelic) doses and
microdoses.

2.3.2. Psychiatric and physiological diagnoses

At baseline, participants were asked whether they had a current diagnosis of a psychiatric, neurological, or
physiological disorder. If the answer was yes, they were asked what diagnosis this was. Multiple answer options could
be chosen: ADHD, depression, anxiety disorder, substance use disorder, dyslexia, autism/Asperger syndrome,
obsessive-compulsive disorder, bipolar disorder, chronic pain, cluster headaches, epilepsy, migraines, post-traumatic
stress disorder (PTSD), schizophrenia, “I do not want to mention”, or the option to provide another answer in a textbox.
These answer options were chosen because most of the listed diagnoses are often reported to co-occur with ADHD
(Kooij et al., 2019), or because these diagnoses were reported to be common in people who microdose (Fadiman and
Korb, 2019). Specific questions regarding ADHD diagnosis asked at what age the participant received this diagnosis, in
case they were diagnosed, and a question about potential prescribed first-line pharmacological treatment: “Are you
using, or have you ever used, any prescribed medication for ADHD?” If it was indicated that individuals were using
prescribed ADHD medication, it was asked what medication this was. Answer options consisted of six pre-set options:
Adderall (amphetamine), Concerta (methylphenidate), Dexedrine (amphetamine), Focalin (dexmethylphenidate),
Ritalin (methylphenidate), Strattera (atomoxetine hydrochloride), “I do not want to mention” or the option to enter text
in a text box when the medication was not listed.

We constructed a variable Comorbidity alongside ADHD, differentiating respondents with and without a comorbid
diagnosis alongside ADHD (0 ​= ​only ADHD or no ADHD diagnosis; 1 ​= ​ADHD and at least one other diagnosis). We
constructed a variable Medication use alongside MD, differentiating respondents who were and were not using
conventional ADHD medication alongside MD (0 ​= ​only MD; 1 ​= ​conventional medication use alongside MD).

2.3.3. ADHD symptoms

The self-report, short screening version of the Conner's Adult ADHD Rating Scale (CAARS-S:SV) (Conners et al., 1999)
was used to assess ADHD symptoms at baseline, and the two and four-week time points. This questionnaire consists of
30 items assessing the core ADHD symptoms (i.e., inattention and hyperactivity/impulsivity) as well as related problem
areas. Participants were instructed to indicate to what extent the items described them on a four-point Likert scale (0 ​= ​
Not at all, never; 1 ​= ​Just a little, once in a while; 2 ​= ​Pretty much, often; 3 ​= ​Very much, very frequently). All 30 items of
the CAARS-S:SV can be ascribed to one of three subscales: inattention, hyperactivity/impulsivity, and ADHD index. The
inattention subscale captures problems experienced with attention and contains items such as ‘I lose things necessary
for tasks or activities (e.g., to-do lists, pencils, books, or tools)’. The hyperactivity/impulsivity subscale captures
symptoms related to both hyperactivity and impulsivity and contains items such as ‘I have trouble waiting in line or
taking turns with others’. The technical manual states that the ADHD index subscale was created to identify adults who
were likely to be diagnosed with ADHD. Items in this subscale were able to discriminate between individuals with
ADHD and non-clinical individuals and capture features of ADHD that are not included in the DSM-IV diagnostic
criteria, such as ‘Sometimes my attention narrows so much that I am oblivious to everything else; other times it's so
broad that everything distracts me’. A DSM-IV ADHD total symptom score can be calculated by summing the scores of
the inattention and hyperactivity/impulsivity subscales. The CAARS-S:SV is known to have good internal consistency
and inter-rater reliability and is sensitive to treatment outcomes (Adler et al., 2008).

For each subscale, T-scores were calculated to compare participants’ scores to scores of the standardization sample
mentioned in the technical manual consisting of non-clinical adults of the same age range and sex. The technical
manual states as a guideline that if no subscale T-score is above 65, the CAARS-S:SV is not indicative of clinically
elevated symptoms (Conners et al., 1999). Therefore, a cut-off T-score of 65 was used in this study to differentiate
between individuals with and without elevated ADHD complaints. Only participants who scored above this cut-off
point on at least one of the CAARS-S:SV subscales were included in the analyses.

2.3.4. Well-being
The World Health Organisation-Five Well-Being Index (WHO-5) was included to measure the participants’ well-being
(World-Health-Organization, 1998). This scale consists of five statements that have to be rated on a six-point Likert
scale (0 ​= ​At no time; 1 ​= ​Some of the time; 2 ​= ​Less than half of the time; 3 ​= ​More than half of the time; 4 ​= ​Most of the
time; 5 ​= ​All the time). Participants had to indicate to what extent they have felt a certain way over the last two weeks.
Scores of the five items were summed and multiplied by four to achieve a total well-being score ranging from 0 to 100.
It was demonstrated that the WHO-5 has a high construct validity and that it can be used as an outcome measure
capturing changes in well-being resulting from pharmacological and non-pharmacological interventions and is
applicable across study fields (Topp et al., 2015). The WHO-5 was included at baseline, and the two and four-week time
points.
2.3.5. Time perception
An auditory time reproduction task (TRT) was used to assess time perception (Wittmann et al., 2007)
(www.millisecond.com ). Participants were presented with a tone (tone 1: 300 ​Hz) with a duration of a certain time
interval (i.e., 1000 ​ms, 1500 ​ms, 3200 ​ms, 3700 ​ms, 5500 ​ms, 6000 ​ms). Next, they were presented with a second tone
(tone 2: 440 ​Hz). Participants were instructed to reproduce the time interval of tone 1, by pressing the spacebar at the
moment when they felt the same time interval had passed for tone 2. As a measure of performance, the relative
difference score was calculated by subtracting the estimated interval in ms (i.e., the interval between the start of tone 2
and the pressing of the spacebar) from the actual interval in ms (i.e., the duration of tone 1), divided by the actual
interval in ms. A relative difference score of 0 indicated an exact reproduction of the time interval. A negative and
positive relative difference score indicated an underestimation and overestimation of the time interval, respectively.

Before starting the task, instructions were provided and a small training took place. Participants were instructed to
estimate the time interval based on when they felt the same duration of tone 1 had elapsed, explaining it was not the
purpose of the task to count the seconds of the presented time interval of tone 1. Further, they were asked to sit in an
environment without any distractions and use earphones to hear the tones more clearly if preferred. The task consisted
of two practice trials and twelve test trials, each of the six time intervals was presented twice. It took 3 to 4 ​min to
complete the task. The TRT was assessed at baseline, and the two and four-week time points.

2.4. Statistical analyses

All data was entered into the statistical program IBM SPSS Statistics version 26. Descriptive statistics were used to
describe the demographic variables, information regarding psychiatric and physiological diagnoses, and drug types and
doses that were used for MD during the study. Linear mixed model (LMM) analyses were used to assess changes in
ADHD symptoms, well-being, and time perception after two and four weeks of MD compared to baseline. LMM
analysis was chosen because of its ability to handle missing data in a repeated measures design and, as such, to use all
existing data. The first LMMs contained the within-subject factor Time (three levels: baseline (0W), two (2W), and
four-week (4W) time point). The fixed part of the models consisted of Time and the interaction terms between Time
and Medication use (yes/no) and Time and Comorbidity alongside the ADHD diagnosis (yes/no).

To test whether MD decreased ADHD symptoms, the CAARS-S:SV DSM-IV total symptoms T-score was included as
dependent variable. Additionally, T-scores of the CAARS-S:SV remaining subscales (i.e., ADHD index, inattention, and
hyperactivity/impulsivity) were included as dependent variables in separate LMMs. Frequencies of non-responders
(i.e., change in CAARS-S:SV DSM-IV total symptoms T-score (4W–0W and 2W–0W) ​≥ ​0) were calculated. To test
whether MD increased well-being, the WHO-5 total score was included as dependent variable. To test the association
between changes in ADHD symptoms and well-being, Pearson correlations were calculated between the difference
scores (2W–0W and 4W–0W) of the CAARS-S:SV DSM-IV total symptoms T-score and the WHO-5 total score.

To test the effect of MD on time perception, an additional LMM was conducted containing Time (three levels: baseline
(0W), two (2W), and four-week (4W) time point) and Interval (six levels: 1000 ​ms, 1500 ​ms, 3200 ​ms, 3700 ​ms, 5500 ​ms,
6000 ​ms) as within-subject factors. The fixed part of the model consisted of Time, Interval, and the interaction term
between Time and Interval, and the three-way interaction terms between Time, Interval, and Medication use (yes/no)
and Time, Interval, and Comorbidity alongside the ADHD diagnosis (yes/no). Medication use (yes/no) and Time and
Comorbidity alongside the ADHD diagnosis (yes/no) were included as covariates in all LMMs.

Akaike's information criterion (AIC) was used to find the best fitting covariance structure for each LMM. Missing data
were estimated using restricted maximum-likelihood estimation. Significant main effects were followed by pairwise
comparisons between time points and were corrected for multiple comparisons using Bonferroni correction. An alpha
of 0.05 was used. Partial eta squared (ηp2) was used to describe effect sizes, where 0.01, 0.09, and 0.25 were considered
small, medium, and large, respectively (Richardson, 2011). Pearson correlation coefficients of 0.10, 0.30, and 0.50 were
considered small, medium, and large, respectively (Cohen, 2013).

3. Results
3.1. Sample characteristics
Of the 356 participants who consented and started the survey, 247 individuals (69.4%) completed the baseline survey
and received follow-up measurements (Fig. 1). The median completion time of the baseline survey was 26 ​min. When
the total response time of the survey was less than 50% of the median response time, responses were visually checked
to prevent non-serious responses (e.g., responses where only one answer option was chosen repeatedly throughout the
survey leading to inconsistent responses) from being included in the analyses. This led to the exclusion of two
respondents. Furthermore, we excluded 12 participants without an ADHD diagnosis who had T-scores below 65 on all
CAARS-S:SV subscales, as these individuals were not among the target population. See Table 1 for demographic
information of the remaining 233 respondents collected in the baseline survey.

Download : Download full-size image

Fig. 1. Flowchart of included participants for each time point.

Table 1. Demographic information from respondents at baseline and the two and four-week time points.

Time point Baseline Two week Four week

N 233 66 47

Age (mean ​± ​standard deviation) 35.3 ​± ​10.7 35.2 ​± ​10.0 36.9 ​± ​9.5

N (%) N (%) N (%)

Gender Male 112 (48.1) 28 (42.4) 19 (40.4)

Female 117 (50.2) 36 (54.5) 26 (55.3)

Other 4 (1.7) 2 (3.0) 2 (4.3)

Continent of current residence Europe 193 (82.8) 62 (93.9) 46 (97.9)

America (North) 33 (14.2) 3 (4.5) 1 (2.1)

America (South) 5 (2.1) 1 (1.5) –

Asia 2 (0.9) – –

Africa – – –

Australia/Oceania – – –

Highest level of education Tertiary (university, trade school, college) 107 (73.0) 50 (75.8) 34 (72.3)
Time point Baseline Two week Four week

Secondary (high school, academies, gymnasium, etc.) 54 (23.2) 15 (22.7) 13 (27.7)

Primary (elementary) 9 (3.9) 1 (1.5) –

Daily occupation Computer/office work 57 (24.5) 17 (25.8) 13 (27.7)

Working with people 39 (16.7) 15 (22.7) 10 (21.3)

Studying 43 (18.5) 11 (16.7) 6 (12.8)

Creative work 31 (13.3) 10 (15.2) 8 (17.0)

Physical work 13 (5.6) 4 (6.1) 4 (8.5)

Other 50 (21.5) 9 (13.6) 6 (12.8)

Currently diagnosed a Yes 166 (71.2) 51 (77.3) 36 (78.3)

No 67 (28.8) 15 (22.7) 10 (21.7)

Type of disorder b ADHD 159 (68.2) 47 (71.2) 34 (72.3)

Depression 44 (18.9) 8 (12.1) 5 (10.6)

Anxiety disorder 39 (16.7) 9 (13.6) 6 (12.8)

PTSD 17 (7.3) 4 (6.1) 2 (4.3)

Personality Disorder 11 (4.7) 3 (4.5) –

Dyslexia 12 (5.2) 2 (3.0) 2 (4.3)

Migraines 8 (3.4) 4 (6.1) 3 (6.4)

Chronic pain 7 (3.0) 2 (3.0) 2 (4.3)

Cluster headaches 6 (2.6) 3 (4.5) 3 (6.4)

Substance use disorder 4 (1.7) 2 (3.0) –

Autism/Asperger syndrome 4 (1.7) 1 (1.5) –

OCD 3 (1.3) 1 (1.5) –

Bipolar disorder 3 (1.3) – –

Other 23 (9.9) 7 (10.6) 4 (8.5)

Experience with psychedelic drug c Yes 191 (82.0) 51 (77.3) 37 (78.7)

No 42 (18.0) 15 (22.7) 10 (21.3)

Absolute and relative frequencies are shown. Numbers in parentheses indicate the percentage corresponding to the absolute
frequencies.

a
“
Are you currently diagnosed by a medical doctor or therapist with a psychiatric, neurological, or physical disorder?“.

b
Numbers do not add up to the sample size, because multiple answers were possible.

c
“Do you have experience with at least one of the following psychedelics? Ayahuasca, DMT, 5-MeO-DMT, LSD, novel lysergamides
(e.g., 1P-LSD, ALD-52), psilocybin/psilocin (magic mushrooms, truffles), salvia divinorum, ibogaine, mescaline (e.g., san pedro,
peyote).”
Seventy-one percent of the sample had at least one current diagnosis of a psychiatric, neurological, and/or physical
disorder. ADHD was the most prevalent diagnosis in the current sample, indicated by 159 participants of the complete
sample (68%). More than half of the participants diagnosed with ADHD had a comorbid diagnosis (54%). Depression,
anxiety disorder, PTSD, and dyslexia were the most common comorbid diagnoses alongside ADHD. Seven of the
respondents without an ADHD diagnosis (9.5%) reported having a current diagnosis of a psychiatric, neurological,
and/or physical disorder other than ADHD. Most participants diagnosed with ADHD received this diagnosis aged
between 20 and 29 (45%), and about one-quarter were aged between 30 and 39 years old (24%) when diagnosed. More
than half of the 159 participants who had been diagnosed with ADHD indicated to have used conventional ADHD
medication but had stopped using it (53%), one-third were currently using conventional medication, and 14 percent
had never used it. The two most common reasons for stopping conventional ADHD medication were because of
physical and psychological side effects. Other reasons that were mentioned included “Feeling little emotions” and
“Wanting to try microdosing”. The participants who reported using conventional medication most often used
amphetamines (Dextroamphetamine, Lisdexamfetamine, Adderall, Dexedrine) (50%) and methylphenidate (Mylan,
Medikinet, Concerta) (40%). Eighty percent of the sample had at least one previous experience with a psychedelic.

Half of the participants at baseline (50%) reported through a diary what substance they used to microdose during the
study. Of those, the majority indicated that they used psilocybin/psilocin (magic mushrooms, truffles) (78%), followed
by novel lysergamides (e.g., 1P-LSD, ALD-52) (12%), LSD (9.5%), and one respondent used ayahuasca. Three respondents
indicated that they had switched to another substance during the study: one participant used psilocybin/psilocin
(magic mushrooms, truffles) after using novel lysergamides (e.g., 1P-LSD, ALD-52), one participant used
psilocybin/psilocin (magic mushrooms, truffles) after using LSD and one participant used LSD after using
psilocybin/psilocin (magic mushrooms, truffles). Averages of the self-reported doses were: 722 ​mg (SD: 485.5) of
psilocybin/psilocin (magic mushrooms, truffles), 17.5 ​μg (SD: 31.1) of novel lysergamides, 12 μ
​ g (SD: 6.4) of LSD, and 5 ​
mg of ayahuasca (1 person).

3.2. ADHD symptoms

3.2.1. CAARS-S:SV DSM-IV total symptoms score

AR1 covariance structure was found to be the best fit for the model. The LMM showed a significant main effect of Time
on the CAARS-S:SV DSM-IV total symptoms T-score (F(2, 154.2) ​= ​30.63, p ​< ​.001, ηp2 ​= ​0.284), indicating a change in ADHD
symptoms after MD. Bonferroni-corrected pairwise comparisons showed that CAARS-S:SV DSM-IV total symptoms T-
scores were significantly lower at two weeks (Δ2W–0W ​= ​−10.17, p ​< ​.001) and four weeks (Δ4W–0W ​= ​−15.43, p ​< ​.001)
after MD compared to baseline, as expected (see Fig. 2A). CAARS-S:SV DSM-IV total symptoms T-scores were also
significantly lower at the four-week time point compared to the two-week time point (Δ4W–2W ​= ​−5.26, p ​= ​.007).
Further, a significant interaction effect between Time and Medication use was found (F(3, 241.4) ​= ​2.86, p ​= ​.038, ηp2 ​= ​
0.034). The evaluation of the estimates of fixed effects revealed a significant effect of Medication use on the CAARS-
S:SV DSM-IV total symptoms T-score at 2W (β ​= ​8.70, p ​= ​.006), meaning that individuals who were using conventional
ADHD medication alongside MD scored higher on the CAARS-S:SV at 2W, compared to individuals who were not using
conventional medication. No effect of Medication use was found on the remaining two time points (0W and 4W). All
respondents decreased in CAARS-S:SV scores from baseline to 2W and to 4W. Only respondents using conventional
ADHD medication alongside MD showed less decrease in CAARS-S:SV DSM-IV total symptoms T-scores from baseline
to 2W compared to those not using conventional medication alongside MD, leading to a significant difference between
those respondents at 2W (see Fig. 2B). Lastly, the effect of the covariate consisting of the interaction term between Time
and Comorbidity was not statistically significant (F(3, 223.4) ​= ​1.13, p ​= ​.338).
Download : Download full-size image

Fig. 2. Mean scores of the CAARS-S:SV DSM-IV total symptoms T-scores at baseline (0W) and two (2W) and four weeks
(4W) after MD (A) of the whole sample, and (B) per conventional ADHD medication use. Error bars represent mean ​± ​
SEM. ∗p ​< ​.05; ∗∗p ​< ​.001.

3.2.2. CAARS-S:SV subscales

The effect of MD showed a similar pattern on the subscales of the CAARS-S:SV. A main effect of Time was found on all
T-scores of the three subscales (see Table 2). A significant interaction between Time and Medication use was found on
the ADHD index T-scores (F(3, 247.6) ​= ​3.65, p ​= ​.013, ηp2 ​= ​0.042) and on the Inattention T-scores (F(3, 250.6) ​= ​3.45, p ​= ​.017, ηp2 ​
= ​0.040). Evaluation of the estimates of fixed effects showed a similar effect of Medication use alongside MD at 2W on
the ADHD index (β ​= ​8.04, p ​= ​.001) and Inattention (β ​= ​10.92, p ​= ​.002) subscales, as was found on the DSM-IV total
symptoms T-score. Namely, those using conventional medication alongside MD showed a smaller decrease in scores
from baseline to 2W compared to those not using conventional medication alongside MD. No effect of Medication use
alongside MD was found on the ADHD index and Inattention subscale at the remaining time points 0W and 4W.
Further, a significant interaction between Time and Comorbidity was found on the ADHD index subscale (F(3, 232.7) ​= ​
2.73, p ​= ​.045, ηp2 ​= ​0.034). Evaluation of the estimates of fixed effects showed a difference at 0W between those having
a comorbid diagnosis alongside ADHD compared to those without comorbid diagnoses (β ​= ​3.30, p ​= ​.011), meaning that
respondents with comorbid diagnoses alongside ADHD scored higher on the ADHD index subscale at baseline
compared to those without comorbid diagnoses. No effects were found on the ADHD index at 2W and 4W. Lastly, no
interaction effects between Time and Medication use (F(3, 225.4) ​= ​1.63, p ​= ​.184) and Time and Comorbidity (F(3, 217.7) ​= ​
0.54, p ​= ​.653) were found on the Hyperactivity/impulsivity subscale.

Table 2. Mean raw- and T-scores (SEM) for each CAARS-S:SV subscale at baseline (0W), two-week (2W) and the four-
week time points (4W). F-values, p-values and partial eta-squared values are presented describing the main effect of
Time on the corresponding subscale scores.

Mean (SEM) T-score (SEM) F- p- ηp2

value value
0W 2W 4W 0W 2W 4W

ADHD index 22.70 18.02 15.32 70.69 63.02 58.53 30.87 .000 .281
(0.32) (0.78) (0.86) (0.57) (1.40) (1.58)

Inattention 19.12 14.51 12.55 82.61 71.15 65.66 33.32 .000 .288
(0.27) (0.68) (0.73) (0.73) (1.89) (1.86)

Hyperactivity/impulsivity 14.47 11.95 10.60 65.55 59.38 56.08 15.41 .000 .200
(0.32) (0.56) (0.64) (0.78) (1.32) (1.50)
 Mean (SEM) T-score (SEM) F- p- ηp2
value value
0W 2W 4W 0W 2W 4W

DSM-IV ADHD total symptom 33.58 26.47 23.15 77.62 67.34 62.31 30.63 .000 .284
score (0.49) (1.10) (1.26) (0.73) (1.60) (1.75)

3.2.3. MD non-responders on CAARS-S:SV

Nine out of 47 respondents at 4W (19.1%) showed no change or an increase in the CAARS-S:SV DSM-IV total symptoms
T-score. Three out of 9 non-responders at 4W (33.3%) used conventional medication alongside MD; none of these
respondents had a comorbid diagnosis alongside ADHD.

Five of the 9 non-responders at 4W (55.6%) were already non-responders at 2W, of which one individual was using
conventional medication. The remaining 4 non-responders at 4W (44.4%) had shown improvements in CAARS-S:SV
DSM-IV total symptoms scores at 2W compared to baseline, but worsened over time; 2 of these respondents (50%)
were using conventional medication alongside MD.

3.3. Well-being
AR1 covariance structure was the best fit for this model. The LMM showed a significant main effect of Time on the
WHO-5 score (F(2, 119.4) ​= ​31.50, p ​< ​.001, ηp2 ​= ​0.345), indicating a change in well-being scores after MD (see Fig. 3A).
Bonferroni-corrected pairwise comparisons showed that well-being scores were significantly higher two weeks (Δ2W–
0W ​= ​16.47, p ​< ​.001) and four weeks after MD (Δ4W–0W ​= ​17.80, p ​< ​.001) compared to baseline, confirming the second
hypothesis. Well-being scores did not significantly differ between the two- and four-week time points (Δ4W–2W ​= ​1.06,
p ​> ​.999). Further, a significant interaction was found for Time and Comorbidity (F(3, 205.2) ​= ​2.85, p ​= ​.038, ηp2 ​= ​0.040).
Evaluation of the estimates of fixed effects indicated lower well-being scores at baseline for those having a comorbid
diagnosis alongside ADHD compared to those without comorbid diagnoses (β ​= ​−6.61, p ​= ​.009). No interaction effect of
Time and Comorbidity was present at the remaining two time points (2W and 4W). No significant interaction was
found for Time and Medication use on the WHO-5 score (F(3, 210.4) ​= ​1.74, p ​= ​.160) (see Fig. 3B).

Download : Download full-size image

Fig. 3. Mean total scores of the WHO-5 at baseline (0W) and two (2W) and four weeks (4W) after MD (A) of the whole
sample, and (B) per conventional ADHD medication use. Error bars represent mean ​± ​SEM. ∗p ​< ​.05; ∗∗p ​< ​.001.

3.4. Correlations between change in ADHD symptoms and well-being

A moderate negative correlation was found between the change scores of the CAARS-S:SV DSM-IV total symptoms T-
scores and the WHO-5 total scores at the two-week time point (r ​= ​−0.367, p ​= ​.003). Furthermore, a moderate negative
correlation was found between the change scores of the CAARS-S:SV DSM-IV total symptoms T-scores and the WHO-5
total scores at the four-week time point (r ​= ​−0.471, p ​= ​.001) (see Fig. 4).

Download : Download full-size image

Fig. 4. Correlations between changes in ADHD symptoms and well-being. Decreases in CAARS-S:SV DSM-IV total
symptom T-scores were negatively related to increases in WHO-5 total scores at (A) two weeks and (B) four weeks after
MD compared to baseline. The best-fit line is shown including the 95% confidence bands (dotted lines).

3.5. Time perception

The first-order ante-dependence covariance structure was the best fit for the model. No main effect of Time was found
(F(2, 59.2) ​= ​0.63, p ​= ​.534) (see Fig. 5A). A significant main effect of Interval was found on the relative difference score (F(5,
182.2) ​= ​24.66, p ​= ​.000, ηp2 ​= ​0.403), indicating differences in relative difference scores per time interval. Bonferroni-
corrected pairwise comparisons showed that the relative difference scores of all pairs differed significantly from each
other, apart from two pairs (1000 ​ms vs 1500 ​ms and 5500 ​ms vs 6000 ​ms). In general, the longer the time interval, the
more likely it was that the interval was underestimated (see Fig. 5B). No significant interaction was found between
Time and Interval (F(10, 176.7) ​= ​1.01, p ​= ​.441) (see Fig. 5B). The LMM showed a significant three-way interaction between
Time, Interval, and Medication use (F(18, 97.8) ​= ​2.52, p ​= ​.002, ηp2 ​= ​0.317). Evaluation of the estimates of fixed effects
showed a significant effect of Medication use at 2W (β ​= ​0.19, p ​= ​.038) and 4W (β ​= ​0.35, p ​= ​.004) for the 1000 ​ms interval.
This finding indicated that individuals who were using conventional ADHD medication alongside MD had higher
relative difference scores when estimating the 1000 ​ms interval at time points 2W and 4W, compared to individuals not
using conventional medication alongside MD (see Fig. 5C). There was no effect of Medication use on any of the other
intervals. No significant interaction effect between Time, Tone and Comorbidity was found (F(18, 100.2) ​= ​1.31, p ​= ​.201).
Download : Download full-size image

Fig. 5. Means of the relative difference scores of the time reproduction task (TRT) (A) for each time point, (B) for each
interval per time point, and (C) for the 1000 ​ms interval for each time point per Medication use. Error bars represent
mean ​± ​SEM. ∗p ​< ​.05; ∗∗p ​< ​.001.

4. Discussion
This online prospective naturalistic survey study aimed to assess changes in ADHD symptoms, well-being, and time
perception using validated questionnaires and a time reproduction task in individuals with an ADHD diagnosis or
severe ADHD complaints, who started MD on their own initiative. The primary hypothesis that MD would reduce
ADHD symptoms was confirmed, as findings showed decreased (self-report) ADHD symptoms after two weeks of MD,
with additional decrements two weeks later. Using conventional ADHD medication seemed to delay the decrease in
ADHD symptoms after MD. In line with expectations, increased well-being was reported at two and four weeks after
MD. Additionally, MD-related changes in well-being and ADHD symptoms were negatively associated. Using
conventional medication alongside MD, or having comorbidities alongside ADHD, did not change the effect of MD on
ADHD symptoms and well-being after four weeks of MD in the current study. Lastly, time perception seemed to be
altered after MD for individuals using conventional medication, illustrated by an over-reproduction of the shortest
(1000 ​ms) time interval used in a time reproduction task. The results do not find support for the hypothesis that
performance on a time perception task would be improved after MD in individuals with an ADHD diagnosis or severe
ADHD complaints.

The decrease in ADHD symptoms after MD was in line with earlier findings showing that MD as self-medication used
by people diagnosed with ADHD was rated as being more effective than conventional treatments and increasing their
quality of life (Hutten et al., 2019a). Also, the findings were in line with anecdotes of individuals who microdosed to
self-treat their ADHD (Andersson and Kjellgren, 2019). The strength of the present study over retrospective reports is
that the current design allows causal inferences to be made about MD and the observed and self-rated effects. Based on
this, it can be said with more certainty that MD could be beneficial and of therapeutic value for individuals diagnosed
with ADHD or having severe ADHD complaints, even in addition to first-line pharmacological interventions. After four
weeks of MD, mean CAARS-S:SV T-scores were below the used cut-off of 65 for three out of four subscales. The current
study sample showed similar changes in the CAARS-S:SV DSM-IV total symptoms scores compared to studies
investigating the effects of several weeks of mindfulness-based cognitive therapy (Hepark et al., 2019; Janssen et al.,
2019) and treatment with methylphenidate (Takahashi et al., 2014) in adults diagnosed with ADHD. Almost twenty
percent of the sample at the four-week time point did not show improvements in ADHD symptoms. This lack of
improvement did not seem related to using conventional medication alongside MD or having comorbidities alongside
ADHD. Other aspects most likely underlay the lack of improvement in the non-responding participants. A potential
explanation might be that individuals had difficulties determining the right dose, a question that future controlled
dose-titration studies could investigate.

Well-being was increased after two weeks of MD compared to baseline and remained elevated two weeks later. These
scores were put into context by comparing them to normative data collected during the COVID-19 pandemic because
the current data was collected within the same period. Compared to the normative dataset collected from almost 15
thousand respondents from 14 countries, the current study sample reported low well-being scores at baseline (mean
WHO-5: 42.7) (Wilke et al., 2021). After two and four weeks of MD, the current sample showed well-being scores
(mean WHO-5 (2W): 59, mean WHO-5 (4W): 60) that were more in line with the average well-being scores of West-
European countries during the COVID-19 pandemic. This shows that, during MD, the sample evolved from below-
average to average well-being scores.

No support was found for improved performance on a time perception task after MD. However, a decrease in
performance was found after MD compared to baseline in individuals using conventional medication. The hypothesis
was based on previous research showing that individuals diagnosed with ADHD tended to underestimate presented
time intervals (Marx et al., 2021) and a study showing that microdoses of LSD led to an over-reproduction of 2000–
4000 ​ms time intervals (Yanakieva et al., 2019). The only effect of MD on time perception found here included an
overestimation of the 1000 ​ms interval for individuals using conventional ADHD medication next to MD, after two- and
four weeks of MD. This finding should be interpreted with caution, given the small number of respondents using
conventional ADHD medication at the two- (n ​= ​16; 25% of respondents at 2W) and four-week time points (n ​= ​9; 20% of
respondents at 4W). Furthermore, the large variability in the accuracy of time estimations suggests that two trials per
time interval were potentially not enough to capture a potential main effect of MD. The effect found in some of the
respondents in the current study provides enough reason to further investigate the possible impact of MD on time
perception in this population in a controlled environment and using more trials in the time perception task.

Strengths of the current study included using a naturalistic, prospective design. This allowed drawing causal inferences
with less uncertainty compared to asking retrospectively about individuals’ MD experiences. Widely used, validated
questionnaires were used to assess ADHD symptoms and well-being, which allowed comparison across studies
investigating conventional treatments and comparison to normative non-clinical data. In addition, the inclusion of a
cognitive task combined with the subjective self-report questionnaires provided the opportunity to assess the effects
of MD in adults diagnosed with ADHD or having serious ADHD complaints on a clinical, psychological, and cognitive
level.

Although the current study design provided an easy way to collect data and observe the effects of MD in an ADHD
population without manipulating MD practices, it comes, of course, with its limitations. Due to lacking a placebo-
control group, the design could not test whether the MD group behaved differently than a group receiving a placebo. In
the current study, participants were recruited via a MD website and respondents had the intention to microdose to
self-treat their ADHD symptoms. It can only be expected that individuals who choose MD as self-treatment are
positively oriented towards the practice of MD, which might enhance a potential placebo effect (Geers and Rose, 2011;
Rose et al., 2014). Future research could instruct participants on how to blind themselves, including a placebo-control
group, as has been done recently by Szigeti and colleagues (Szigeti et al., 2021). When comparing the effectiveness of
MD for ADHD to other interventions for ADHD, it should be noted that the participants of the current study chose MD
to self-treat their ADHD complaints on their own initiative, while in controlled, experimental studies participants are
assigned to a treatment. In both cases, participants choose to be enrolled in research, however, it can be suggested that
choosing a treatment may increase the positivity about the treatment and the treatment's efficacy (Rose et al., 2012,
2014). Furthermore, participants enrolling themselves in the study might have led to self-selection bias. Perhaps only
individuals who were willing to adhere to completing several questionnaires participated in the study, resulting in a
study sample that may not be representative of the general ADHD population. Further, the study suffered from a large
dropout rate, with only 20% of the sample at baseline completing the four-week time point, which is common in
prospective survey studies (Hübner et al., 2021). Perhaps only those with a positive MD experience continued in the
study, biasing the findings. Future studies could follow up and ask participants about their reason to drop out.
Furthermore, participants were requested to report in a diary what substance they had used to microdose. About half
of the respondents at baseline did not fill in the diary, leading to a large amount of missing data about the substances
and doses that were used during the study. No additional information about the substances was collected, such as the
formulation, storage conditions, and route of administration, which may be important factors influencing experienced
effects. Lastly, the CAARS-S:SV originates from 1999, therefore the change from DSM-IV to DSM-5 has not been taken
into account by using this scale. The DSM-5 devotes more attention to ADHD in adulthood, by including more examples
of how ADHD is expressed in adults and by raising the age of symptom onset. Also, the normative data of the CAARS-
S:SV could be considered outdated. Future research should include a more up-to-date ADHD scale taking into account
the changes from DSM-IV to DSM-5 and more recent norm scores.

Future placebo-controlled studies are needed to assess the possible therapeutic value of MD in adults diagnosed with
ADHD. In this context, it would be interesting to compare another type of practice/therapy as self-treatment to MD, to
assess if MD potentially has effects superior to the effect of treatment choice and placebo in adults self-treating their
ADHD symptoms. Further, a more standardized test administration should be used to assess the effects of MD on time
perception in adults with ADHD. Other cognitive domains that are impaired in ADHD, such as working memory,
attention, and executive functioning, should also be investigated in future studies investigating the effects of MD in
adults with ADHD, to assess in what domain MD might exert beneficial effects. Lastly, since inattention, hyperactivity,
and impulsivity symptoms may occur in other disorders (Grant et al., 2005), such as substance use disorder (Karlsson
et al., 2021), bipolar (Strakowski et al., 2010) and borderline personality disorder (Paris, 2005; Eskander et al., 2020),
future studies should investigate the effects of MD in these populations.

To conclude, the present study provides the first evidence that MD may have therapeutic value in adults diagnosed
with ADHD or experiencing severe ADHD complaints. Given the limitations of the current study design, studies
including placebo-treated and/or other control groups could confirm the magnitude of the therapeutic effect of MD in
ADHD.

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit
sectors.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential
competing interests: KPC Kuypers reports a relationship with Mind Medicine Inc. that includes: funding grants. KPC
Kuypers reports a relationship with The Beckley Foundation that includes: funding grants.

Recommended articles

References
Adler et al., 2008 L.A. Adler, et al.
The reliability and validity of self-and investigator ratings of ADHD in adults
J. Atten. Disord., 11 (6) (2008), pp. 711-719
CrossRef View in Scopus Google Scholar

Andersson and Kjellgren, 2019 M. Andersson, A. Kjellgren

Twenty percent better with 20 micrograms? A qualitative study of psychedelic microdosing self-
rapports and discussions on YouTube
Harm Reduct. J., 16 (1) (2019), pp. 1-12
CrossRef View in Scopus Google Scholar

Asherson et al., 2016 P. Asherson, et al.

Adult attention-deficit hyperactivity disorder: key conceptual issues
Lancet Psychiatr., 3 (6) (2016), pp. 568-578
 View PDF View article View in Scopus Google Scholar
Beauchaine et al., 2020 T.P. Beauchaine, I. Ben-David, M. Bos
ADHD, financial distress, and suicide in adulthood: a population study
Sci. Adv., 6 (40) (2020)
eaba1551
Google Scholar

Bejerot et al., 2010 S. Bejerot, E.M. Rydén, C.M. Arlinde

Two-year outcome of treatment with central stimulant medication in adult attention-
deficit/hyperactivity disorder: a prospective study
J. Clin. Psychiatr., 71 (12) (2010), pp. 1590-1597
View in Scopus Google Scholar

Bershad et al., 2019 A.K. Bershad, et al.

Acute subjective and behavioral effects of microdoses of lysergic acid diethylamide in healthy
human volunteers
Biol. Psychiatr., 86 (10) (2019), pp. 792-800
View PDF View article View in Scopus Google Scholar

Bushe et al., 2016 C. Bushe, et al.

Post Hoc analysis of potential predictors of response to atomoxetine for the treatment of adults with
attention-deficit/hyperactivity disorder using an integrated database
CNS Drugs, 30 (4) (2016), pp. 317-334
CrossRef View in Scopus Google Scholar

Butzbach et al., 2019 M. Butzbach, et al.

Basic processes as foundations of cognitive impairment in adult ADHD
J. Neural. Transm., 126 (10) (2019), pp. 1347-1362
CrossRef View in Scopus Google Scholar

Castells et al., 2011 X. Castells, et al.

Efficacy of methylphenidate for adults with attention-deficit hyperactivity disorder
CNS Drugs, 25 (2) (2011), pp. 157-169
CrossRef View in Scopus Google Scholar

Coghill et al., 2017 D.R. Coghill, et al.

Systematic review of quality of life and functional outcomes in randomized placebo-controlled
studies of medications for attention-deficit/hyperactivity disorder
Eur. Child Adolesc. Psychiatr., 26 (11) (2017), pp. 1283-1307
CrossRef View in Scopus Google Scholar

Cohen, 2013 J. Cohen

Statistical Power Analysis for the Behavioral Sciences
Academic press (2013)
Google Scholar

Conners et al., 1999 C.K. Conners, D. Erhardt, E.P. Sparrow

Conners' Adult ADHD Rating Scales (CAARS): Technical Manual
Multi-Health Systems North Tonawanda, NY (1999)
Google Scholar

Cortese et al., 2018 S. Cortese, et al.

 Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in
children, adolescents, and adults: a systematic review and network meta-analysis
Lancet Psychiatr., 5 (9) (2018), pp. 727-738
View PDF View article View in Scopus Google Scholar
Di Lorenzo et al., 2021 R. Di Lorenzo, et al.
Children and adolescents with ADHD followed up to adulthood: a systematic review of long-term
outcomes
Acta Neuropsychiatr. (2021), pp. 1-42
CrossRef Google Scholar

Eskander et al., 2020 N. Eskander, et al.

The impact of impulsivity and emotional dysregulation on comorbid bipolar disorder and borderline
personality disorder
Cureus, 12 (8) (2020)
Google Scholar

Fadiman and Korb, 2019 J. Fadiman, S. Korb

Might microdosing psychedelics be safe and beneficial? An initial exploration
J. Psychoact. Drugs, 51 (2) (2019), pp. 118-122
CrossRef View in Scopus Google Scholar

Fayyad et al., 2017 J. Fayyad, et al.

The descriptive epidemiology of DSM-IV adult ADHD in the world health organization world mental
health surveys
ADHD Atten. Deficit. Hyperactivity Disord., 9 (1) (2017), pp. 47-65
CrossRef View in Scopus Google Scholar

Fredriksen et al., 2014 M. Fredriksen, et al.

Effectiveness of one-year pharmacological treatment of adult attention-deficit/hyperactivity
disorder (ADHD): an open-label prospective study of time in treatment, dose, side-effects and
comorbidity
Eur. Neuropsychopharmacol, 24 (12) (2014), pp. 1873-1884
View PDF View article View in Scopus Google Scholar

Geers and Rose, 2011 A. Geers, J. Rose

Treatment choice and placebo expectation effects
Soc. Pers. Psychol. Compass, 5 (10) (2011), pp. 734-750
CrossRef View in Scopus Google Scholar

Ginsberg et al., 2014 Y. Ginsberg, et al.

Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the
literature
Prim. Care Companion. CNS Disord., 16 (3) (2014)
Google Scholar

Grant et al., 2005 J.E. Grant, et al.

Impulse control disorders in adult psychiatric inpatients
Am. J. Psychiatr., 162 (11) (2005), pp. 2184-2188
CrossRef View in Scopus Google Scholar

Hepark et al., 2019 S. Hepark, et al.

 The efficacy of adapted MBCT on core symptoms and executive functioning in adults with ADHD: a
preliminary randomized controlled trial
J. Atten. Disord., 23 (4) (2019), pp. 351-362
CrossRef View in Scopus Google Scholar
Hong et al., 2022 J.S. Hong, et al.
Cognitive developmental trajectories in adult ADHD patients and controls: a comparative study
J. Atten. Disord., 26 (3) (2022), pp. 391-407
CrossRef View in Scopus Google Scholar

Hübner et al., 2021 S. Hübner, et al.

Turn on, tune in, and drop out: predictors of attrition in a prospective observational cohort study on
psychedelic use
J. Med. Internet Res., 23 (7) (2021), Article e25973
CrossRef View in Scopus Google Scholar

Hutten et al., 2019a N.R. Hutten, et al.

Self-rated effectiveness of microdosing with psychedelics for mental and physical health problems
amongst microdosers
Front. Psychiatr., 10 (2019), p. 672
View in Scopus Google Scholar

Hutten et al., 2019b N.R. Hutten, et al.

Motives and side-effects of microdosing with psychedelics among users
Int. J. Neuropsychopharmacol., 22 (7) (2019), pp. 426-434
CrossRef View in Scopus Google Scholar

Hutten et al., 2020 N.R. Hutten, et al.

Mood and cognition after administration of low LSD doses in healthy volunteers: a placebo
controlled dose-effect finding study
Eur. Neuropsychopharmacol, 41 (2020), pp. 81-91
View PDF View article View in Scopus Google Scholar

Janssen et al., 2019 L. Janssen, et al.

Mindfulness-based cognitive therapy v. treatment as usual in adults with ADHD: a multicentre,
single-blind, randomised controlled trial
Psychol. Med., 49 (1) (2019), pp. 55-65
CrossRef View in Scopus Google Scholar

Karlsson et al., 2021 A.T. Karlsson, et al.

Levels of impulsivity, hyperactivity, and inattention and the association with mental health and
substance use severity in opioid-dependent patients seeking treatment with extended-release
naltrexone
J. Clin. Med., 10 (19) (2021), p. 4558
CrossRef View in Scopus Google Scholar

Khan and Aslani, 2021 M.U. Khan, P. Aslani

Exploring factors influencing initiation, implementation and discontinuation of medications in
adults with ADHD
Health Expect., 24 (2021), pp. 82-94
CrossRef View in Scopus Google Scholar

Koesters et al., 2009 M. Koesters, et al.

 Limits of meta-analysis: methylphenidate in the treatment of adult attention-deficit hyperactivity
disorder
J. Psychopharmacol., 23 (7) (2009), pp. 733-744
CrossRef View in Scopus Google Scholar
Kooij et al., 2019 J. Kooij, et al.
Updated European Consensus Statement on diagnosis and treatment of adult ADHD
Eur. Psychiatr., 56 (1) (2019), pp. 14-34
View PDF View article CrossRef View in Scopus Google Scholar

Marx et al., 2021 I. Marx, et al.

Meta-analysis: altered perceptual timing abilities in attention-deficit/hyperactivity disorder
J. Am. Acad. Child Adolesc. Psychiatr., 61 (7) (2021), pp. 866-880
Google Scholar

Mick et al., 2008 E. Mick, et al.

Assessing the validity of the quality of life enjoyment and satisfaction questionnaire—short form in
adults with ADHD
J. Atten. Disord., 11 (4) (2008), pp. 504-509
CrossRef View in Scopus Google Scholar

Paris, 2005 J. Paris

The development of impulsivity and suicidality in borderline personality disorder
Dev. Psychopathol., 17 (4) (2005), pp. 1091-1104
View in Scopus Google Scholar

Ptacek et al., 2019 R. Ptacek, et al.

Clinical implications of the perception of time in attention deficit hyperactivity disorder (ADHD): a
review
Med. Sci. Mon. Int. Med. J. Exp. Clin. Res.: Int. Med. J. Exp. Clin. Res., 25 (2019), p. 3918
CrossRef View in Scopus Google Scholar

Richardson, 2011 J.T. Richardson

Eta squared and partial eta squared as measures of effect size in educational research
Educ. Res. Rev., 6 (2) (2011), pp. 135-147
View PDF View article View in Scopus Google Scholar

Rose et al., 2012 J.P. Rose, et al.

Choice and placebo expectation effects in the context of pain analgesia
J. Behav. Med., 35 (4) (2012), pp. 462-470
CrossRef View in Scopus Google Scholar

Rose et al., 2014 J.P. Rose, et al.

Choice-making, expectations, and treatment positivity: how and when choosing shapes aversive
experiences
J. Behav. Decis. Making, 27 (1) (2014), pp. 1-10
CrossRef View in Scopus Google Scholar

Sayal et al., 2018 K. Sayal, et al.

ADHD in children and young people: prevalence, care pathways, and service provision
Lancet Psychiatr., 5 (2) (2018), pp. 175-186
View PDF View article View in Scopus Google Scholar

Song et al., 2021 P. Song, et al.

 The prevalence of adult attention-deficit hyperactivity disorder: a global systematic review and
meta-analysis
J. Global Health, 11 (2021)
Google Scholar
Sonuga-Barke et al., 2010 E. Sonuga-Barke, P. Bitsakou, M. Thompson
Beyond the dual pathway model: evidence for the dissociation of timing, inhibitory, and delay-
related impairments in attention-deficit/hyperactivity disorder
J. Am. Acad. Child Adolesc. Psychiatr., 49 (4) (2010), pp. 345-355
View PDF View article CrossRef View in Scopus Google Scholar

Strakowski et al., 2010 S.M. Strakowski, et al.

Impulsivity across the course of bipolar disorder
Bipolar Disord., 12 (3) (2010), pp. 285-297
CrossRef View in Scopus Google Scholar

Szigeti et al., 2021 B. Szigeti, et al.

Self-blinding citizen science to explore psychedelic microdosing
Elife, 10 (2021), Article e62878
View in Scopus Google Scholar

Takahashi et al., 2014 N. Takahashi, et al.

A randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and
safety of osmotic-controlled release oral delivery system methylphenidate HCl in adults with
attention-deficit/hyperactivity disorder in Japan
World J. Biol. Psychiatr., 15 (6) (2014), pp. 488-498
View PDF View article CrossRef Google Scholar

Topp et al., 2015 C.W. Topp, et al.

The WHO-5 Well-Being Index: a systematic review of the literature
Psychother. Psychosom., 84 (3) (2015), pp. 167-176
CrossRef View in Scopus Google Scholar

Wilke et al., 2021 J. Wilke, et al.

Drastic reductions in mental well-being observed globally during the COVID-19 pandemic: results
from the ASAP survey
Front. Med., 8 (2021), p. 246
Google Scholar

Wittmann et al., 2007 M. Wittmann, et al.

Impaired time perception and motor timing in stimulant-dependent subjects
Drug Alcohol Depend., 90 (2–3) (2007), pp. 183-192
View PDF View article View in Scopus Google Scholar

World-Health-Organization, 1998 World-Health-Organization

Wellbeing measures in primary health care/the DEPCARE project: report on a WHO meeting,
Stockholm, Sweden 12-13 February 1998
Wellbeing Measures in Primary Health Care/the DEPCARE Project: Report on a WHO Meeting (1998)
Stockholm, Sweden 12-13 February 1998
Google Scholar

Yanakieva et al., 2019 S. Yanakieva, et al.

 The effects of microdose LSD on time perception: a randomised, double-blind, placebo-controlled
trial
Psychopharmacology, 236 (4) (2019), pp. 1159-1170
CrossRef View in Scopus Google Scholar

Cited by (0)

© 2022 The Authors. Published by Elsevier B.V. on behalf of European College of Neuropsychopharmacology.

All content on this site: Copyright © 2024 Elsevier B.V., its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies. For all open
access content, the Creative Commons licensing terms apply.