Supplementary Material for: Frequency of and factors associated with the presence of a history of probable ADHD in a population of patients with sex addiction

Introduction: Since the first description of sex addiction (SA) by Carnes, research on this problematic behaviour has continued to grow, and the association with attention-deficit hyperactivity disorder (ADHD) appears to be frequent. This study aimed to estimate the frequency of a history of probable ADHD in a population of patients with SA and to explore the factors associated with it. Methods: One hundred eighty-five patients referred to the Nantes University Hospital for SA between 2011 and 2020 were included. Patients completed the Sexual Addiction Screening Test (SAST) or its revised version (SAST-R) to establish the presence of SA. As the SAST-R was not validated in French, we conducted a validation study for the French version. ADHD was screened using the Wender-Utah Rating Scale in childhood and the Adult-ADHD Self-Report Scale in adulthood. A multivariate logistic regression model was used to identify factors associated with the presence of a history of probable ADHD. Results: Childhood ADHD was identified in 36% of patients with SA. Factors associated with the presence of a history of probable ADHD were a low education level, an earlier age of onset of problematic sexual behaviour, another addictive disorder, an anxiety disorder, impulsivity (high negative urgency score) and high scores on harm avoidance and novelty-seeking temperament scales. Furthermore, the French version of the SAST-R displayed good psychometric properties, especially excellent sensitivity. Discussion/Conclusion: The frequency of a history of probable ADHD among patients with SA is consistent with the literature and close to the highest range. Specific personality traits in patients with both SA and a history of probable ADHD could induce lasting problems of adaptation, which may precipitate the development of SA or maintain it.

引言：自卡恩斯首次对性成瘾（Sex Addiction, SA）进行阐述以来，针对此类问题性行为的研究持续发展，其与注意缺陷多动障碍（Attention-Deficit Hyperactivity Disorder, ADHD）的关联亦颇为常见。本研究旨在评估性成瘾患者群体中可能的ADHD既往史患病率，并探索与之相关的影响因素。

方法：本研究纳入了2011至2020年间前往南特大学医院就诊的185名性成瘾患者。受试者通过填写性成瘾筛查量表（Sexual Addiction Screening Test, SAST）或其修订版（SAST-R）来确认是否罹患性成瘾。鉴于SAST-R尚未在法语人群中完成效度验证，我们开展了其法语版的效度研究。采用儿童期温德-犹他评定量表（Wender-Utah Rating Scale）与成人期成人ADHD自评量表（Adult-ADHD Self-Report Scale）分别对儿童期与成人期的ADHD进行筛查。本研究采用多因素logistic回归模型，以识别与可能的ADHD既往史相关的影响因素。

结果：本研究中，36%的性成瘾患者存在儿童期ADHD病史。与可能的ADHD既往史相关的因素包括：较低的受教育水平、问题性行为起病年龄更早、共患其他成瘾障碍、共患焦虑障碍、冲动性（高负性紧迫性得分）以及在伤害回避与新奇寻求气质量表上的高分。此外，SAST-R法语版展现出良好的心理测量学特性，尤其具备优异的敏感性。

讨论与结论：性成瘾患者中可能的ADHD既往史患病率与现有文献结果一致，且接近最高区间。同时罹患性成瘾与可能的ADHD既往史的患者所具备的特定人格特质，可能引发持久的适应问题，进而促发性成瘾的发生或维持其病程。