Young adults with attention deficit hyperactivity disorder: subtype differences in comorbidity, educational, and clinical history

Contextual influence of highly valued rewards and penalties on delay decisions in children with ADHD

In this study, we examined the influence of both reward and penalty on delay decisions in subjects with ADHD. Eighteen 6- to 13-year-old boys with ADHD (combined or hyperactive-impulsive subtype) along with age- and IQ-matched control participants performed a memory game. If the children were successful at the game, they could choose between a small immediate reward (one white chip in exchange for 5 s of waiting) or a large delayed reward (two white chips in exchange for 60 s of waiting). If they failed, they could choose between a large immediate penalty (two black chips in exchange for 5 s of waiting) or a small delayed penalty (one black chip in exchange for 60 s of waiting). Subsequent to task completion, white chips were exchanged for video time and black chips were exchanged with completion of a written task. All of the participants, regardless of ADHD diagnosis, were motivated to complete the task and chose the delayed alternative most often. We conclude that under highly motivating conditions, children with ADHD are not more delay averse than children from the control group with respect to anticipation of reward and penalty.

Teacher management practices for first graders with attention problems

OBJECTIVE

To examine whether teacher reports of accommodations and interventions for inattentive first graders are consistent with best practice guidelines.

METHOD

A total of 36 teachers completed the Teacher Management Questionnaire (TMQ) for 92 students in five predominantly low-income, minority schools. The TMQ is a newly developed measure designed to assess the frequency with which teachers implement a variety of accommodations and interventions with individual students. Additional teacher and student background data were collected on the inattentive sample, including behavior ratings and academic testing.

RESULTS

Teachers reported variable implementation of different management strategies, with more frequent use of class-wide structure and organizational interventions, and less frequent assignment modifications and individual behavior plans. Greater use of some strategies was reported for inattentive students and those with additional risk characteristics such as oppositional behavior and school-based referrals.

CONCLUSION

Teachers appear to differentiate some management strategies based on the presence of attention problems, although their self-reported implementation is not well aligned with best practice guidelines.

Not always hyperactive? Elevated apathy scores in adolescents and adults with ADHD

OBJECTIVES

To investigate the presence of apathy symptoms in adolescents and adults with ADHD as a behavioral manifestation of underlying motivational deficits and to determine whether apathy symptoms were associated with a specific neuropsychological profile.

METHOD

A total of 38 ADHD participants (28 of the combined subtype [ADHD/C] and 10 of the inattentive subtype [ADHD/I]) and 30 healthy controls (Ctrl) were assessed on two measures of apathy administered to subjects and informants. As well, ADHD participants completed a comprehensive neuropsychological battery.

RESULTS

ADHD participants presented elevated scores on measures of apathy relative to controls (ADHD/I > ADHD/C > Ctrl). Informant-based ratings of apathy correlated significantly with behavioral measures of inattention. Apathy measures correlated significantly with executive tests, working memory, verbal fluency, and general intellectual abilities, only in the inattentive sample.

CONCLUSIONS

This study stresses the relevance of motivational deficits in adult ADHD as a significant clinical dimension closely linked to inattention and executive difficulties.

Attention-deficit/hyperactivity disorder subtypes in adolescents with comorbid substance-use disorder

BACKGROUND

Little is known about the relationship between attention-deficit/hyperactivity disorder (ADHD) subtypes and substance-use disorder (SUD). As there is literature suggesting different subtype phenotypes, there may be subtype differences in regard to the risk for developing SUD and substance treatment response.

OBJECTIVES

To characterize the sample in a Clinical Trials Network (CTN) study according to ADHD subtypes and baseline psychosocial and substance-use characteristics and to compare subtypes on response to treatment.

METHODS

Secondary analyses on data collected from adolescents (n = 276) diagnosed with ADHD and SUD (non-nicotine) and treated with stimulant medication or placebo and cognitive behavioral therapy (CBT) for substance use. Participants were characterized as inattentive or combined ADHD subtype and compared on baseline characteristics and treatment outcome.

RESULTS

The combined subtype presented with more severe SUDs and higher rates of conduct disorder. There were a greater proportion of boys with inattentive subtype. The inattentive subtype appeared less ready for treatment (greater University of Rhode Island Change Assessment precontemplation scores) with poorer coping skills (poorer problem-solving and abstinence focused coping) at baseline. However, the two subtypes responded equally to treatment even after controlling for baseline differences.

CONCLUSIONS

Findings from this large community sample indicate that there were no subtype differences in treatment response, although there were differences in terms of substance use, antisocial behavior, readiness for treatment, and gender prior to treatment.

SCIENTIFIC SIGNIFICANCE

This study is the first to report on subtype differences for treatment response for non-nicotine SUD in a comorbid ADHD-SUD population. Despite some baseline differences, both subtypes responded equally to treatment, suggesting limited relevance for subtype designation on treatment planning.

Coexisting disorders and academic achievement among children with ADHD

OBJECTIVE

ADHD is a commonly diagnosed neuropsychological disorder among school-aged children with reported high rates of coexisting or comorbid disorders. As ADHD has been associated with academic underachievement, the current study examines this association in view of the presence of coexisting disorders. The purpose of the current study is to examine the relationship between the presence of coexisting disorders and academic achievement among children with ADHD using a large, nationally representative, and community-based sample.

METHOD

To achieve this purpose, the presence of coexisting disorders with ADHD and academic achievement are examined across time utilizing latent growth models.

RESULTS

Our results indicate an inverse relationship between the presence of coexisting disorders and academic achievement across time among children diagnosed with ADHD.

CONCLUSION

The authors conclude that practitioners must be concerned with the presence of coexisting disorders for children with ADHD with respect to academic achievement as well as other behavioral and psychological outcomes.

A research model for investigating the effects of artificial food colorings on children with ADHD

The United Kingdom and European Union recently restricted the use of artificial food colorings (AFCs) to improve the health of children. These decisions provide an interesting case study of the role of scientific evidence in the assessment of food additives and risk to children's health and formulation of food policy. Although there continues to be uncertainty concerning the link between AFCs and attention-deficit/hyperactivity disorder (ADHD), policy decisions have been made that have far-reaching implications. In addition, publicity surrounding the policy changes may shape public perceptions concerning effective management of ADHD. We believe that the balance of existing evidence neither refutes nor supports the link between AFCs and ADHD, which highlights the need for carefully designed studies to further investigate the link between AFCs and ADHD. In this article we describe a model for such studies. In developing our model, we drew from current investigative standards in ADHD research, such as those used in the landmark Multimodal Treatment Study of Children With ADHD. These standards encompass methodologic considerations including sample selection, outcome assessment, and data analyses. It is our hope that this model research methodology may prove valuable in addressing design considerations in future studies of AFCs and ADHD with the goal of producing reliable data that will enable policy-makers to better formulate effective, evidence-based food-policy decisions.

Neuropsychological correlates of written expression in college students with ADHD

OBJECTIVE

To examine written expression and the executive function skills (working memory, verbal fluency, and planning and organization) involved in written expression in college-aged students with ADHD.

METHOD

Two groups of undergraduate students, aged 19 to 28 years, (ADHD, n = 31; control, n = 27) are evaluated on selected measures of executive function and a measure of written expression.

RESULTS

No statistically significant differences are found between groups on measures of executive function and written expression. A standard multiple regression model is significant for predicting writing mechanics, with a measure of behavioral inhibition making a statistically significant contribution.

CONCLUSION

Findings from the study provide important information about the link between specific executive function abilities and written expression, particularly for fundamentals in writing in college students.

Do hyperactive symptoms matter in ADHD-I restricted phenotype?

The objective of the current study was to evaluate a proposed restrictive inattentive type of Attention Deficit Hyperactivity Disorder (ADHD) by comparing clinical correlates among youths with ADHD inattentive type (ADHD-I) as a function of the number of hyperactivity symptoms presented (none vs. 3 or less) and controls (individuals without ADHD). The sample for this community-based study was comprised of youths aged 6 to 18 years from 12 public schools in Porto Alegre, Brazil. ADHD-I groups had lower levels of adaptive functioning (p < .001) and a higher occurrence of familial ADHD (p < .001) when compared with the controls. There was no significant difference between the two ADHD-I groups. Also, both ADHD-I groups had higher rates of oppositional defiant disorder than controls (p < .001) without significant difference between them. For generalized anxiety disorder and social phobia, only the ADHD-I without HI group showed significant differences compared to controls.

Characteristics of ADHD among Omani schoolchildren using DSM-IV: descriptive study

BACKGROUND

There is a dearth of studies describing the characteristics of ADHD among schoolchildren attending child psychiatry clinics in the Arab world. Most of the previous quests have focused on community surveys or themes that hampered international comparison.

AIM

This study screened for the presence of ADHD as well as investigates the psychosocial and educational history relevant for the diagnosis of ADHD among children.

METHOD

Consecutive schoolchildren attending child psychiatric consultations were screened for the presence of ADHD according to the Diagnostic and Statistical Manual for Mental disorders (DSM) criteria.

RESULT

A total of 221 schoolchildren suffering from ADHD were identified according to the DSM. The year incidence was 0.16. Males constituted the majority presenting with ADHD. The contribution of consanguinity and a history of acquired brain injury were common features. The majority were attending mainstream education as pharmacotherapy is the only option available for managing ADHD.

CONCLUSION

This study is one of the few from this part of the world using DSM criteria to diagnose ADHD. The implications of the present findings are discussed in the context of the available literature and the specific situation in Oman.

Severity of childhood attention-deficit hyperactivity disorder--a risk factor for personality disorders in adult life?

Some evidence points to an increased rate of cluster B and C personality disorders (PDs) in adult ADHD patients. In order to assess axis II disorders comprehensively we used the diagnostic instrument of the WHO. In sixty adult out-patients with ADHD according to DSM-IV criteria PDs were assessed with the International PD Examination (IPDE) and severity of childhood ADHD with the Wender-Utah-Rating Scale (WURS). We found at least one PD in 25% of cases. Cluster C PDs were most common (36.6%) followed by Cluster B (23.3%) and A (8.3%). Avoidant (21.7%) and borderline (18.3%) were the most frequent single PD entities. ADHD patients with PD suffered from significantly more severe childhood ADHD compared to those without co-occurring PD. Applying the IPDE we confirmed a high number of PDs among adult ADHD patients. Our findings point to a higher vulnerability for the development of PDs in patients with severe childhood ADHD.

Resilience and well-being in college students with and without a diagnosis of ADHD

OBJECTIVE

The study examines psychological well-being and self-concept in college students diagnosed with ADHD.

METHOD

We surveyed 17 undergraduate college students with ADHD and 19 undergraduate controls concerning academic and emotional support received from family and friends. All students completed the Connor's Continuous Performance Test (CPT-II), Connor's Adult Rating Scale (CAARS), Tennessee Self-Concept Scale (TSCS:2) and Psychological Well-Being Scale (PWB).

RESULTS

Between group differences were significant for the CAARS and CPT-II, but not total self-concept (TSC) or global PWB. The strongest predictors for TSC were environmental mastery (PWB) for the ADHD group and positive relations with others (PWB) for the controls. Students with ADHD reported significantly higher paternal support than controls who reported significantly greater support from friends.

CONCLUSION

College students with a diagnosis of ADHD may represent an especially resilient group. Future studies should investigate competencies of students with ADHD who have achieved success against the odds.

Executive function profile of Chinese boys with attention-deficit hyperactivity disorder: different subtypes and comorbidity

This study examined the executive function (EF) profile of Chinese boys with attention-deficit hyperactivity disorder (ADHD) using a large sample. Executive function performance within the ADHD subtypes and the effects of comorbidity were also investigated. Five hundred Chinese boys (375 with ADHD and 125 controls) aged 6-15 completed a battery of EF tests. Boys with all types of ADHD performed worse in all of the EF tests than age- and intelligence quotient-matched healthy controls. The boys with the inattention ADHD subtype and the combined subtype showed similar impairments across different EF tasks, whereas the boys with the hyperactive-impulsive ADHD subtype primarily displayed deficits in theory of mind and visual memory. Comorbid oppositional defiant disorder/conduct disorder had no additional influence on the EF characteristics of the boys with ADHD only, whereas comorbid learning disorder increased the severity of inhibition and shifting impairments.

Transtorno do déficit de atenção e hiperatividade em crianças: uma revisão interdisciplinar

O presente artigo revisa criticamente o amplo escopo da literatura relacionada aos critérios diagnósticos, bases etiológicas e tratamentos farmacológico e comportamental do transtorno do déficit de atenção e hiperatividade (TDAH) em crianças. Foram consultadas as bases eletrônicas MedLine, Lilacs, PsycINFO e PubMed nas últimas três décadas. Os resultados dessa revisão apontam para uma predominância do critério diagnóstico baseado no Manual Diagnóstico e Estatístico das Doenças Mentais, bem como a necessidade de uma maior interação entre variáveis biológicas e comportamentais na compreensão das bases etiológicas e de tratamento deste transtorno. Sugestões para maximizar a eficácia desta interação são apresentadas e discutidas.

An exploratory study of substance use and misuse among college students with and without ADHD and other disabilities

OBJECTIVE

The present study investigated potential differences between college students with and without disabilities (including ADHD, Asperger's syndrome, executive functioning disorder, and learning, mental health, vision, hearing, and physical/chronic disabilities) regarding self-reported substance use and misuse, perceived stress, and sensation seeking.

METHOD

Students responded to a Stimulant Survey Questionnaire (SSQ), Perceived Stress Scale (PSS), Sensation-Seeking Scale (SSS), and items from the National College Health Assessment (NCHA).

RESULTS

The hypotheses were part supported as MANOVA results revealed that students with disabilities provided significantly lower ratings on the SSS and also reported lower alcohol and marijuana use. Students with ADHD were more likely to use or misuse prescription stimulant medication but were less likely to use alcohol than did students without ADHD.

CONCLUSION

Students with disabilities compared to those without disabilities differed on levels of sensation seeking and alcohol and marijuana use.

Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder

CONTEXT

Major depression and dysthymia in adolescence are associated with substantial disability, need for mental health services, and risk for recurrence. Concrete suicidal ideation and attempts during adolescence are particularly associated with significant distress, morbidity, and risk for completed suicide.

OBJECTIVES

To test the hypothesis that young children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for depression and suicidal ideation and attempts during adolescence and to identify early predictors of which young children with ADHD are at greatest risk.

DESIGN

Prospective follow-up study.

SETTING

Chicago, Illinois, and Pittsburgh, Pennsylvania. Patients  A cohort of 125 children who met DSM-IV criteria for ADHD at 4 to 6 years of age and 123 demographically matched comparison children without ADHD were prospectively followed up in 7 structured diagnostic assessments of depression and suicidal behavior in assessment years 6 through 14, spanning 9 through 18 years of age.

MAIN OUTCOME MEASURES

DSM-IV criteria for depressive disorders and suicidal behavior.

RESULTS

Children with ADHD at 4 to 6 years of age were at greatly increased risk for meeting DSM-IV criteria for major depression or dysthymia (hazard ratio, 4.32) and for attempting suicide (hazard ratio, 3.60) through the age of 18 years relative to comparison children. There were marked variations in risk for these outcomes among children with ADHD, however. Within the ADHD group, children with each subtype of ADHD were at risk but for different adverse outcomes. Girls were at greater risk for depression and suicide attempts. Maternal depression and concurrent child emotional and behavior problems at 4 to 6 years of age predicted depression and suicidal behavior.

CONCLUSIONS

All subtypes of ADHD in young children robustly predict adolescent depression and/or suicide attempts 5 to 13 years later. Furthermore, female sex, maternal depression, and concurrent symptoms at 4 to 6 years of age predict which children with ADHD are at greatest risk for these adverse outcomes. Identifying high-risk young children with ADHD sets the stage for early prevention trials to reduce risk for later depression and suicidal behavior.

European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe.

METHODS

The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated.

RESULTS

Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated?

CONCLUSIONS

ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.

Frequency of attention deficit in first-episode schizophrenia compared to ADHD

Attention deficit in schizophrenia may be underestimated due to limited sensitivity of attention tests. Comparing the frequency of attention deficits in schizophrenia to attention deficit hyperactivity disorder (ADHD) may solve this problem, since all subjects with ADHD should demonstrate impaired attention. Twenty-seven subjects with schizophrenia were compared to 74 clinical controls with ADHD on tests of focused/divided/sustained attention and impulsivity.

RESULTS

The frequency of impaired attention was equal among subjects with schizophrenia and ADHD-combined (ADHD-C), while ADHD-inattentive (ADHD-I) subjects were more impaired. Half the subjects with schizophrenia had a mild impairment in dual processing. Twenty-one percent showed normal performance on all tests. Fewer subjects with schizophrenia were impulsive/hyperactive, and fewer were impaired in sustained attention compared with the ADHD-C and ADHD-I groups, respectively.

CONCLUSION

Attention tests are not sufficiently sensitive to attention deficits in everyday functioning. Taking this into account, the possibility still remains that a substantial portion of subjects with schizophrenia are not impaired in attention.

Psychosocial factors associated with parent and teacher reports of aggression in children and adolescents with attention deficit hyperactivity disorder

OBJECTIVE

The prognosis for individuals diagnosed with attention deficit hyperactivity disorder (ADHD) and comorbid aggression is substantially worse than for those with ADHD alone. This study investigates the contribution of key psychosocial factors to both parent and teacher reports of aggressive behaviour in children and adolescents diagnosed with ADHD. It was hypothesized that greater impairment in each would be associated with higher levels of both parent-rated and teacher-rated aggression.

METHOD

Information collected during semi-structured clinical interviews from 676 boys and girls aged 6 to 16 and diagnosed with ADHD was analysed. Measures of potential psychosocial factors including parental psychopathology, family functioning, marital relationship quality and child interpersonal relationship status were administered. Ratings of aggression were obtained from both parents and teachers, and the association of psychosocial measures for each were separately analysed.

RESULTS

Correlation and multiple regression analyses revealed significant associations between parent-rated aggression and measures of increased parent psychopathology, decreased family function and deficient child interpersonal relationships. Teacher-rated aggression was only associated with deficient child interpersonal relationships.

CONCLUSION

The findings highlight important differences in the psychosocial factors that contribute to parent and teacher ratings of aggression in the context of ADHD. The implications of these findings for both the clinician and researcher are discussed.

The importance of ADHD subtype classification for educational applications of DSM-V

OBJECTIVE

An examination of the academic achievement of children with ADHD by stimulant treatment status must consider this heterogeneity of the disorder. With the dissemination of the final wave of data, the Special Education Elementary Longitudinal Study presents an opportunity to examine the academic achievement of students with ADHD using a large, community-based, and nationally representative sample over 4 years.

METHOD

In Study 1, the association between stimulant treatment and academic achievement is examined over 4 years. In Study 2, the association between stimulant treatment and academic achievement is examined acknowledging the influence of subtype symptoms of ADHD using growth mixture modeling.

RESULTS

Results indicate significant differences in academic achievement according to long-term stimulant treatment status within each subtype symptom class.

CONCLUSION

Research should acknowledge the influence of subtype symptoms when examining outcomes such as academic achievement. The upcoming DSM-V should consider the results as indicating the educational relevance of ADHD subtype classification.

A randomized trial of two promising computer-based interventions for students with attention difficulties

Few studies have examined whether attention can be improved with training, even though attention difficulties adversely affect academic achievement. The present study was a randomized-controlled trial evaluating the impact of Computerized Attention Training (CAT) and Computer Assisted Instruction (CAI) on attention and academic performance in 77 inattentive first graders. Students receiving either intervention were more likely than controls to show a moderate decline in teacher rated attention problems in first grade. Students receiving CAI also showed gains in reading fluency and in teacher ratings of academic performance. Intervention effects for attention were absent by second grade largely because attention problems declined in all groups. However, post hoc analyses indicated potential longer-term benefits for children with 6 or more inattentive symptoms at baseline. Persistent attention problems were associated with poorer academic performance in multiple domains. Results provide initial evidence that CAT and CAI can improve children's attention in the classroom - and support additional studies to determine whether more clinically significant benefits are attainable.

Investigating the relationship between attention and working memory in clinical and community samples

The first aim of the present study was to investigate whether differences in core deficits in ADHD subtypes lead to dissociable working memory profiles. The second aim was to compare the working memory profiles of inattentive students with those identified as having poor working memory, as they exhibit very similar behavioral profiles. Finally, the relationship between working memory and academic attainment in these groups were also of interest. Four groups of 9-year-olds were recruited: a community sample of children with inattentive symptoms, a clinically diagnosed group of children with ADHD-Combined, children with low working memory, and a healthy comparison group. They were assessed on measures of working memory, IQ, academic attainment, and sustained attention. The findings indicated that the combined and inattentive subtypes could not be distinguished on the basis of their working memory profile. In contrast, those with inattentive symptoms did better on the short-term memory tasks than the low working memory group. The majority of all three atypical groups performed very poorly in reading and math. This pattern can be interpreted as reflecting the link between working memory and academic attainment, even in those with attention problems.

The road less traveled: Associations between externalizing behaviors and eating pathology

OBJECTIVE

Few studies have examined associations between externalizing behaviors and eating disorders in either sex. The current study investigated sex differences in associations between internalizing and externalizing symptoms and disordered eating.

METHOD

A sample of 541 men and women completed self-reported measures of disordered eating (e.g., binge eating), internalizing symptoms (e.g., anxiety), and externalizing behaviors (e.g., delinquency). Hierarchical linear modeling was used to examine sex differences in associations between these symptoms and disordered eating.

RESULTS

Internalizing symptoms showed the strongest associations with disordered eating in both sexes. Hyperactivity and aggression were more strongly associated with disordered eating in men, whereas alcohol use was more strongly associated with disordered eating in women.

DISCUSSION

Results indicated several sex similarities in associations between internalizing symptoms and disordered eating, but some important sex differences among externalizing behaviors. Externalizing behaviors may play a significant role in the development of disordered eating uniquely within men and women.

The effects of strain and prenatal nicotine exposure on ethanol consumption by adolescent male and female rats

Two studies of variables affecting voluntary ethanol consumption by adolescent male and female rats are reported. Sprague-Dawley (SD) and spontaneously hypertensive rats (SHRs) were compared in Experiment 1. Starting on postnatal day 30 all had 24-h access to 2%, then 4%, and then 6% ethanol, followed by 1-h access to the 6% until intake stabilized. During the 1-h access SHR females consumed more ethanol than all other groups. In Experiment 2, the same procedure was used to compare SD groups prenatally exposed to nicotine, with controls. Nicotine-exposed females consumed more ethanol during 1-h access than both nicotine-exposed and control males; but after using water intake as a covariate, the differences were not significant. These data show that deprivation conditions need to be considered when generalizing the results of voluntary consumption studies, and that estrogens may be a modulator of addictive behavior.

Pilot feasibility study of binaural auditory beats for reducing symptoms of inattention in children and adolescents with attention-deficit/hyperactivity disorder

INTRODUCTION

The purpose of this pilot study was to explore the potential for the use of binaural auditory beat stimulation to reduce the symptom of inattention in children and adolescents with attention-deficit/hyperactivity disorder.

METHODS

This pilot study had a randomized, double-blind, placebo-controlled design. Twenty participants were randomly assigned to listen to either an audio program on compact disk that contained binaural auditory beats or a sham audio program that did not have binaural beats for 20 minutes, three times a week for 3 weeks. The Children's Color Trails Test, the Color Trails Test, the Test of Variables of Attention (TOVA), and the Homework Problem Checklist were used to measure changes in inattention pre- and postintervention.

RESULTS

Repeated measures analysis of variance was used to analyze pre- and postintervention scores on the Color Trails Tests, Homework Problem Checklist, and the TOVA. The effect of time was significant on the Color Trails Test. However, there were no significant group differences on the Color Trails Test or the TOVA scores postintervention. Parents reported that the study participants had fewer homework problems postintervention.

DISCUSSION

The results from this study indicate that binaural auditory beat stimulation did not significantly reduce the symptom of inattention in the experimental group. However, parents and adolescents stated that homework problems due to inattention improved during the 3-week study. Parents and participants stated that the modality was easy to use and helpful. Therefore, this modality should be studied over a longer time frame in a larger sample to further its effectiveness to reduce the symptom of inattention in those diagnosed with attention-deficit/hyperactivity disorder.

Impulsive aggression in adults with attention-deficit/hyperactivity disorder

OBJECTIVE

DSM-IV criteria for attention-deficit/hyperactivity disorder (ADHD) include examples of 'impulsivity'. This term can refer to various dysfunctional behaviours, including some examples of aggressive behaviour. However, impulsive aggression is not included in the DSM-IV criteria for ADHD. The associations of impulsive aggression with ADHD were investigated.

METHOD

Seventy-three male adults with DSM-IV ADHD, and their informants, completed questionnaires. Impulsive aggression was assessed by ratings of two criteria for borderline personality disorder (BPD), involving hot temper and/or self-harm.

RESULTS

Logistic regression indicated that features of DSM-IV ADHD were predictors of comorbid impulsive aggression. However, compared with ADHD features, verbal IQ and comorbid psychopathology were more strongly associated with impulsive aggression.

CONCLUSION

The findings support the inclusion of features of impulsive aggression, such as hot temper/short fuse, in the ADHD syndrome in adults. These overlap with features of BPD. The findings inform the selection of research samples.

Speed of language comprehension is impaired in ADHD

OBJECTIVE

Children with ADHD have an increased risk of poor academic performance. It is important to identify cognitive processes that may be related to this academic failure. In Western schooling systems, especially language processing skills may be of relevance. The present study, therefore, compares the ability to comprehend complex sentences of individuals with and without ADHD.

METHOD

Fifteen children (aged 8-11) and 15 adolescents (aged 12-16) with ADHD combined subtype are matched for age, gender, and parental level of education to 30 control subjects. Language comprehension is measured using the neuropsychological procedure proposed by Luria and an adapted version of the Token Test.

RESULTS

Compared with the control group, children and adolescents with ADHD perform significantly slower on language comprehension tasks. Differences in accuracy are limited. No interaction between age and ADHD is found.

CONCLUSIONS

Children and adolescents with ADHD are slower and less efficient than matched control subjects with regard to complex sentence comprehension.

ADHD symptomatology and adjustment to college in China and the United States

This study examined ADHD symptomatology and college adjustment in 420 participants--147 from the United States and 273 from China. It was hypothesized that higher levels of ADHD symptoms in general and the inattentive symptom group in particular would be related to decreased academic and social adjustment, career decision-making self-efficacy, and poorer study skills in both countries. Results generally supported the hypotheses, indicating that the difficulties associated with inattention are cross-cultural and not specific to the United States.

College students with ADHD: current status and future directions

Approximately 2 to 8% of the college population reports clinically significant levels of ADHD symptomatology and at least 25% of college students with disabilities are diagnosed with ADHD. A comprehensive review of the literature was conducted with findings consistently indicating academic deficits associated with ADHD in college students. It is less clear whether this disorder significantly impacts social, psychological, and neuropsychological functioning. Although several self- and parent-report measures have been developed for this population, very few studies of assessment methods have been conducted. Similarly, no controlled studies of psychopharmacological, psychosocial, or educational interventions have been completed in samples of college students with ADHD. Non-prescribed use (i.e., diversion) of stimulant medication is a growing problem with approximately 7% of college students reporting this behavior. Studies, to date, are limited by lack of controlled investigations, use of small samples, and lack of confirmation of diagnostic status. Comprehensive and methodologically sound investigations are needed, especially regarding treatment, to promote the success of students with ADHD in higher education settings.

Comorbidity in adults with attention-deficit hyperactivity disorder

OBJECTIVE

To examine the prevalence of comorbid Axis I (current and lifetime) and II disorders in adult men and women with attention-deficit hyperactivity disorder (ADHD).

METHOD

Adult patients (n = 447; 266 men, 181 women) received comprehensive assessments for ADHD and Axis I and II disorders. Adults were aged between 17 and 74 years. Among the patients diagnosed with ADHD (n = 335), there were those with ADHD inattentive subtype (ADHD-I) (n = 199), hyperactive-impulsive subtype (ADHD-H) (n = 24), or combined ADHD subtype (ADHD-C) (n = 112). Chi-square and logistic regression analyses were performed to examine associations between adults with and without ADHD on Axis I and II disorders.

RESULTS

Adults with ADHD, compared with those without ADHD, had higher rates of Axis I (46.9% and 27.31%) and Axis II (50.7% and 38.2%) disorders. Adults with ADHD-C were more likely to have mood disorder, anxiety, conduct disorder, and substance use disorder as well as obsessive-compulsive personality disorder, passive-aggressive personality disorder, depressive personality disorder, narcissistic personality disorder, and borderline personality disorder (BPD). Men with ADHD were more likely to have antisocial personality disorder and had higher rates of current drug abuse than women with ADHD. Women with ADHD had higher rates of past and current panic disorder, and past anorexia and bulimia. Women with ADHD were more likely to have BPD than men with ADHD.

CONCLUSIONS

Adults with ADHD have very high rates of comorbid Axis I and II disorders, with differences found between men and women on certain comorbid disorders.

Occupational outcome in adult ADHD: impact of symptom profile, comorbid psychiatric problems, and treatment: a cross-sectional study of 414 clinically diagnosed adult ADHD patients

OBJECTIVE

To determine the effects of symptom profile, comorbid psychiatric problems, and treatment on occupational outcome in adult ADHD patients.

METHOD

Adult ADHD patients (N = 414) responded to questionnaires rating past and present symptoms of ADHD, comorbid conditions, treatment history, and work status.

RESULTS

Of the patients, 24% reported being in work, compared to 79% in a population-based control group (N = 359). Combined subtype of ADHD, substance abuse, and a reported history of depression or anxiety were correlated with being out of work. Current and past medical treatment of ADHD was correlated with being in work. Logistic regression analyses showed that stimulant therapy during childhood was the strongest predictor for being in work as adults (odds ratio = 3.2, p = .014).

CONCLUSION

Early recognition and treatment of ADHD is a strong predictor of being in work as an adult, independently of comorbidity, substance abuse, and current treatment.

The impact of childhood ADHD on dropping out of high school in urban adolescents/ young adults

OBJECTIVE

To examine cognitive and psychosocial factors associated with high school dropout in urban adolescents with and without childhood ADHD.

METHOD

In a longitudinal study, 49 adolescents/young adults with childhood ADHD and 44 controls who either dropped out or graduated from high school are included. Risk factors examined as potential correlates of dropout were intelligence, reading skills, socioeconomic status, marijuana use, and paternal contact.

RESULTS

Lower IQ, reading ability, socioeconomic status, frequent marijuana use, and limited paternal contact significantly differentiated dropouts from graduates, irrespective of childhood ADHD. Follow-up analyses determined that IQ, marijuana use, and paternal contact independently contribute to the likelihood of dropout.

CONCLUSION

Selected cognitive and psychosocial factors appear independently associated with the likelihood of high school dropout irrespective of ADHD. Notably, childhood ADHD did not increase this risk, suggesting that previous reports of increased dropout because of ADHD may become negated in urban areas when matched with similar community controls.

Possible association between attention deficit hyperactivity disorder and attempted suicide in adolescents - a pilot study

OBJECTIVE

Both adolescent suicide and attention deficit hyperactivity disorder (ADHD) are troubling phenomena with high comorbidity, including impulsivity, depression and personality disorders (PD). Studies on the association between these two phenomena are relatively rare. This pilot study's aim was to estimate the rate of ADHD in adolescents attempting suicide.

METHOD

Subjects constituted consecutive admissions to the psychiatric emergency room (ER) who were admitted as a result of attempting suicide. Assessment included the use of the Kiddie-SADS, Strengths and Difficulties Questionnaire (SDQ) and the Conners' Rating Scale (CRS). Those diagnosed as suffering from ADHD were assessed by a standardized Continuous Performance Test (Test of Variables of Attention [TOVA]) that included methylphenidate (MPH) challenge. Twenty-three (23) adolescents completed the study. M:F ratio was 5:18, respectively.

RESULTS

Of the 23 participants who completed the study, 65% were diagnosed with ADHD, 43.5% with depression and 39% with cluster B PD. ADD/ADHD ratio was 66%:34%. Only five of the patients were formerly diagnosed as ADHD, only three had been medicated and 14 out of 15 adolescents responded well to MPH challenge.

CONCLUSION

These preliminary results suggest a significant association between ADHD and suicidal behavior in adolescents. Further study is needed to establish this association and assess the causality.

School performance and hospital admissions due to self-inflicted injury: a Swedish national cohort study

BACKGROUND

Self-inflicted injury in youth has increased in many Western countries during recent decades. Education is the most influential societal determinant of living conditions in young people after early childhood. This study tested the hypothesis that school performance predicts self-inflicted injury.

METHODS

A national cohort of 447 929 children born during 1973-77 was followed prospectively in the National Patient Discharge Register from the end of their ninth and last year of compulsory school until 2001. Multivariate Cox analyses of proportional hazards were used to test hypotheses regarding grades in ninth grade as predictors of hospital admission due to self-inflicted injury.

RESULTS

The risk of hospital admission because of self-inflicted injury increased steeply in a step-wise manner with decreasing grade point average. Hazard ratios were 6.2 (95% confidence interval 5.5-7.0) in those with the lowest level of grade point average compared with the highest. The risks were similar for women and men. Adjustment for potential socio-economic confounders in a multivariate proportional hazards regression analysis attenuated this strong gradient only marginally.

CONCLUSION

School performance is a strong factor for predicting future mental ill-health as expressed by self-inflicted injury.

Diversidade de resultados no estudo do transtorno de déficit de atenção e hiperatividade

Com este artigo pretende-se abordar a problemática da diversidade de dados na investigação do Transtorno de Déficit de Atenção e Hiperatividade (TDAH). Apresenta-se uma revisão da literatura centrada na heterogeneidade de conclusões relativas à caracterização do transtorno, à distinção dos subtipos, aos contextos de informação, às diferenças de gênero e à comorbidade. Na tentativa de compreender a disparidade de conclusões, salientam-se potenciais fatores explicativos, nomeadamente a heterogeneidade das amostras, a diversidade de metodologias e de procedimentos de investigação, entre outros. A revisão efetuada baseou-se, majoritariamente, em publicações referenciadas pelas bases de dados PsycInfo e ERIC, e, pontualmente, PubMed e Elsevier Direct.

Smoking cessation and inattention or hyperactivity/impulsivity: a post hoc analysis

Tobacco use is more prevalent and smoking cessation less likely among persons with attention deficit hyperactivity disorder (ADHD) than the general population. Evidence that tobacco use and nicotine hold divergent relationships with inattention and hyperactivity/impulsivity, the core symptoms of ADHD, prompted this post hoc investigation of abstinence patterns by type of ADHD symptoms. Subjects were 583 adult smokers treated openly with bupropion and nicotine patch during the initial 8-week phase of a maintenance treatment study. Using the ADHD Current Symptom Scale, clinically significant ADHD symptom subtypes, i.e., predominantly inattention (ADHD-inattention) and predominantly hyperactivity/impulsivity with or without inattention (ADHD-hyperactivity/impulsivity with or without inattention), were identified. The study outcome was abstinence status, verified by expired carbon monoxide </=8 parts per million, at five clinic visits from Week 1 through the end of treatment at Week 8. The distribution by ADHD symptom status was: No ADHD = 540; ADHD-inattention = 20; ADHD-hyperactivity/impulsivity with/without inattention = 23. The study groups did not differ on demographic or smoking variables. The frequency of past major depression was highest with ADHD-inattention and the frequency of past alcohol dependence was highest with ADHD-hyperactivity/impulsivity with/without inattention. Compared to smokers with no ADHD, smokers of both ADHD subtypes combined showed lower abstinence rates throughout the study (OR = 0.54, 95% CI = 0.32-0.99). Disaggregation by symptom subtype and separate comparisons against smokers with no ADHD showed that lower odds of quitting occurred mainly with ADHD-hyperactivity/impulsivity with/without inattention (OR = 0.40, 95% CI = 0.19-0.82), not with ADHD-inattention (OR = 0.74, 95% CI = 0.36-1.51). Combined bupropion and nicotine patch treatment appears to be helpful for smokers with inattention but not smokers with hyperactivity/inattention symptoms. The reasons for this divergent treatment response warrant further investigation.

Somatostatin receptor subtypes 2 and 5 are associated with better survival in well-differentiated endocrine carcinomas

The majority of gastroenteropancreatic well-differentiated endocrine carcinomas (WDEC) express somatostatin receptors (SSTR). To correlate the expression of SSTR subtypes by reverse transcriptase-polymerase chain reaction (RT-PCR) with clinicopathological features and survival in a group of WDEC patients, 42 WDEC tissue specimens from 33 patients were analysed. All patients were treated with somatostatin analogues and had a median follow-up period of 45 months (range 6-196). Neither SSTR2 and SSTR5 expression nor Ki-67 level alone correlated with survival. A significantly better survival rate was observed in patients with tumours expressing SSTR2, SSTR5 and Ki-67 <2%, compared to those with SSTR2- and SSTR5-negative tumours and Ki-67 >or=2% (p < 0.038), with 5-year survival rates of 91 vs. 43%, respectively. Expression of SSTR2 and SSTR5 appears to play a positive prognostic role, possibly correlated with the high affinity that the available somatostatin analogues display for these 2 specific SSTR subtypes.

The association between children's ADHD subtype and parenting stress and parental symptoms

Objective. To investigate the association between two attention deficit/hyperactivity disorder (ADHD) subtypes-combined and inattentive subtypes-and parental stress in a Taiwanese population. Method. One hundred and nine children with ADHD were interviewed using the MINI Kid questionnaire. The children were divided into combined and inattentive subtypes. The level of parenting stress was measured with the self-report Parenting Stress Index and Parental Symptom Scale (Symptom Check List, SCL-90). The data were used to identify child and parental risk factors. Results. Combined subtype was highly associated with parental stress. Parents of children in this group were significantly younger, had a poorer understanding of ADHD, and had significantly higher levels of marital discord, parenting stress, parental symptoms, and life stress (all P<0.05). Multivariate analysis revealed that age of mother, child with comorbidity diagnosis, and parents with poor understanding of ADHD were significantly associated with the combined subtype relative to inattentive subtype (all P<0.05). Conclusion. The combined subtype of ADHD is associated with more parental psychopathology and stress than the inattentive subtype and the presence of combined subtype may indicate that such a child is at greater risk than the inattentive subtype for comorbid conditions such as oppositional defiant disorder and conduct disorder.

Organizational-skills interventions in the treatment of ADHD

Children with attention-deficit/hyperactivity disorder (ADHD) often experience problems with temporal and materials organization. These difficulties remain prominent throughout development. For children, organizational problems are most apparent in the school setting and result in impairments such as lost and forgotten homework assignments and inadequate planning for tests. Temporal aspects of organization tend to be most salient for adults with ADHD and manifest as procrastination and missed appointments and deadlines. Skills and strategy training interventions have been developed to address the organizational problems of children and adults with ADHD. Patients are taught systems for managing their time and materials more effectively. Contingency management is often used in conjunction with organizational skills training to promote the use of organizational skills and their generalization. Organizational skills interventions have been evaluated as standalone interventions and part of multicomponent interventions for children, adolescents and adults with ADHD. These interventions are associated with significant improvements in the organization of materials, homework management, time management and planning. There is also some evidence to suggest that organizational improvements lead to reductions in ADHD symptoms and gains in academic functioning. Additional research using randomized controlled research designs and long-term follow-up evaluation is necessary before organizational interventions may be considered established evidence-based interventions for patients with ADHD.

Review of literature of attention-deficit/hyperactivity disorder with comorbid eating disorders

OBJECTIVE: According to studies of prevalence, up to 70% of adults with attention deficit/hyperactivity disorder have at least one psychiatric comorbidity, which leads to diagnostic and therapeutic difficulties as well as more severe functional impairment. There is a paucity of data on the comorbidity of attention deficit/hyperactivity disorder and eating disorders. The objective of this study was to review the literature regarding the attention deficit/hyperactivity disorder/eating disorders comorbidity, performing a critical analysis of relevant data. METHOD: Articles in Medline, Lilacs, SciELO, ISI and PsycINFO databases from 1980 up to 2008, were searched. The references from the articles were used as additional sources of data. RESULTS: Fourteen articles were found: five prevalence studies, four case reports, three case-control studies, one symptom-assessment study of attention deficit/hyperactivity disorder and eating disorders, and one article regarding possible causes of the association between attention deficit/hyperactivity disorder and eating disorders. These articles suggested that adult women with attention deficit/hyperactivity disorder are at higher risk of developing eating disorders, especially bulimia nervosa. Bulimia Nervosa rates found in attention deficit/hyperactivity disorder groups ranged from 1% to 12%, versus 0% to 2% in control groups. CONCLUSIONS: Although there seems to be a relationship between attention deficit/hyperactivity disorder and eating disorders, the reduced number of studies available, with various methodologies, and small sample sizes limit the generalization of the findings.

Relationship of attention-deficit-hyperactivity disorder symptoms, depressive/anxiety symptoms, and life quality in young men

AIM

Attention-deficit-hyperactivity disorder (ADHD) continues to be among the most frequently missed of psychiatric diagnoses in adults because its presentation in adulthood so often mimics those of better-known disorders. The aim of the present study was to examine the relationship between ADHD symptoms, depression/anxiety symptoms, and life quality in young men.

METHODS

Nine hundred and twenty-nine draftees into the Taiwanese army completed the Adult ADHD Self-Report Scale (ASRS), the World Health Organization (WHO) Quality of Life-Brief Version, the Epworth Sleepiness Scale, the second edition of the Beck Depression Inventory, and the Beck Anxiety Scale. Based on high ASRS scores, a total of 328 adults (35.3%) were identified as having ADHD: 65 (7.0%) with definite ADHD and 263 (28.3%) with probable ADHD.

RESULTS

The 328 subjects in the ADHD group had more severe depressive, anxiety symptoms and daytime sleepiness, and had poorer quality of life than the 601 controls (all P < 0.05).

CONCLUSIONS

ADHD should be included in the differential diagnosis for young men presenting with anxiety, depression, daytime sleepiness, and poor quality of life.

Sexually transmitted infection among adolescents receiving special education services

BACKGROUND

To estimate the relative risk of sexually transmitted infections (STIs) among children identified as having learning disabilities through the special education system.

METHODS

This cross-sectional study used special education data and Medicaid data from Philadelphia, Pennsylvania, for calendar year 2002. The sample comprised 51,234 Medicaid-eligible children, aged 12-17 years, 8015 of whom were receiving special education services. Claims associated with diagnoses of STIs were abstracted, and logistic regression was used to estimate the odds of STI among children in different special education categories.

RESULTS

There were 3% of males and 5% of females who were treated for an STI through the Medicaid system in 2002. Among females, those in the mental retardation (MR) category were at greatest risk (6.9%) and those in the emotionally disturbed or "no special education" category at lowest risk (4.9% each). Among males, STIs were most prevalent among those classified as mentally gifted (6.7%) and lowest among those in the MR category (3.0%). In adjusted analyses, males with specific learning disabilities and females with MR or who were academically gifted were at excess risk for STIs.

CONCLUSIONS

The finding that children with learning disabilities are at similar or greater risk for contracting STIs as other youth suggests the need to further understand their risk behaviors and the potential need to develop prevention programs specific to their learning needs.