The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study

Long-term school outcomes for children with attention-deficit/hyperactivity disorder: a population-based perspective

OBJECTIVE

The purpose of this study was to compare long-term school outcomes (academic achievement in reading, absenteeism, grade retention, and school dropout) for children with attention-deficit/hyperactivity disorder (AD/HD) versus those without AD/HD.

METHODS

Subjects included 370 children with research-identified AD/HD from a 1976-1982 population-based birth cohort (N = 5718) and 740 non-AD/HD control subjects from the same birth cohort, matched by gender and age. All subjects were retrospectively followed from birth until a median age of 18.4 years (AD/HD cases) or 18.3 years (non-AD/HD controls). The complete school record for each subject was reviewed to obtain information on reading achievement (last available California Achievement Test reading score), absenteeism (number/percentage of school days absent at each grade level), grade retention (having to repeat an entire grade in the subsequent school year), and school dropout (failure to graduate from high school).

RESULTS

Median reading achievement scores at age 12.8 years (expressed as a national percentile) were significantly different for AD/HD cases and non-AD/HD controls (45 vs 73). Results were similar for both boys and girls with AD/HD. Median percentage of days absent was statistically significantly higher for children with AD/HD versus those without AD/HD, although the difference was relatively small in absolute number of days absent. Subjects with AD/HD were three times more likely to be retained a grade. Similarly, subjects with AD/HD were 2.7 times more likely to drop out before high school graduation (22.9%) than non-AD/HD controls (10.0%).

CONCLUSIONS

The results of this population-based study clearly demonstrate the association between AD/HD and poor long-term school outcomes.

Multidisciplinary perspectives on attention and the development of self-regulation

During infancy and early childhood, children develop their ability to regulate their own emotions and behavior. This development of self-regulatory mechanisms has been considered to be the crucial link between genetic predisposition, early experience, and later adult functioning in society. This paper brings together the updated empirical findings related to the role of attention and the maturation of brain frontal areas in self-regulation. It reviews viewpoints and evidence of disciplines such as developmental psychology, cognitive neuroscience, social psychology, and neurobiology. It examines the causes of individual differences in self-regulation and the effects of those differences on the social and academic functioning of the individual. The consequences of failure in self-regulation are illustrated by focusing on the attention deficit/hyperactivity disorder (ADHD), including a detailed review of the animal models related to this disorder. Finally, some initial evidence suggesting the possibility of fostering self-regulation through training of attention is presented.

Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder

This practice parameter describes the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) based on the current scientific evidence and clinical consensus of experts in the field. This parameter discusses the clinical evaluation for ADHD, comorbid conditions associated with ADHD, research on the etiology of the disorder, and psychopharmacological and psychosocial interventions for ADHD.

Attention Deficit Hyperactivity Disorder Symptoms Predict Nicotine Dependence and Progression to Regular Smoking from Adolescence to Young Adulthood

OBJECTIVE

To examine the association between retrospectively reported attention deficit hyperactivity disorder (ADHD) symptoms and progression to smoking and the association with nicotine dependence.

METHODS

Study sample consisted of a nationally representative cohort of U.S. adolescents (n = 13,494). Logistic regression was used to examine ADHD symptoms from both the inattentive (IN) and hyperactive-impulsive (HI) domains and smoking trajectories. Linear regression was used to examine nicotine dependence.

RESULTS

HI symptoms were associated with progression from nonsmoking to regular smoking (OR = 1.14, 95% CI = 1.07-1.21), and with progression from experimentation to regular smoking (OR = 1.16, 95% CI = 1.08-1.26). IN and HI symptoms were associated with nicotine dependence among current smokers (IN: beta = 0.17, SE = 0.03, p < 0.0001; HI: beta = 0.10, SE = 0.04., p < .001).

CONCLUSIONS

These results have important implications for the development of prevention and treatment modalities.

A novel task for examining strategic planning: evidence for impairment in children with ADHD

Children with attention deficit hyperactivity disorder (ADHD) often show poor performance on tasks that require strategic planning. To assess this ability, we developed a paper and pencil task that required consistent use of a simple test-taking strategy to maximize the number of points. The visual discrimination task with minimal cognitive demands required children to maximize their gains by responding only to outlined high-point problems and to skip the low-point problems. The task was administered twice, the second time with explicit instructions on how to implement the strategy. Few of the children in the ADHD or control group, ages 8-13 years, were able to discover the strategy on their own, but after explicit instruction 90% of the children in the control group but only 57.5% of children with ADHD used the strategy to maximize points (p < .005). The ADHD group used the strategy less efficiently, despite the fact that they did not differ on the total number of problems completed. The findings suggest that children with ADHD have impaired ability to implement strategic approaches for tasks similar to school assignments. The task can potentially be developed as a diagnostic aid and as a basis for further research assessing strategic planning in ADHD.

Computerized Progressive Attentional Training (CPAT) Program: Effective Direct Intervention for Children with ADHD

We tested the efficacy of a pioneering intervention program grounded in a contemporary theoretical framework of attention and designed to directly improve the various attentional functions of children with ADHD. The computerized progressive attentional training (CPAT) program is composed of four sets of structured tasks that uniquely activate sustained attention, selective attention, orienting of attention, and executive attention. Performance was driven by tight schedules of feedback and participants automatically advanced in ordered levels of difficulty contingent upon performance. Twenty 6- to 13-year-old children with ADHD were assigned to the experimental group and received the CPAT sessions twice a week over an 8-week period. Sixteen age-matched control children with ADHD were assigned to the control group and participated in sessions of the same frequency, length, and format except that instead of performing the training tasks they played various computer games during the session. The experimental participants showed a significant improvement in nontrained measures of reading comprehension, and passage copying as well as a significant reduction of parents' reports of inattentiveness. No significant improvements were observed in the control group. We thus concluded that the above academic and attentional improvements were primarily due to the CPAT.

Monoamine oxidase A gene polymorphism predicts adolescent outcome of attention-deficit/hyperactivity disorder

ADHD is generally deemed to be a highly heritable disorder with mean heritability of 0.75. The enzyme monoamine oxidase (MAO), which has both A and B types, has long been considered a candidate pathological substrate for ADHD, and more recently, the genes for both MAO enzymes have been examined as mediators of the illness. Previous studies indicated that 30-50% of children with ADHD will experience symptoms that persist into adolescence and will have more significant impairment in social and neuropsychological functioning compared to those whose symptoms have remitted. Genes may also influence these characteristics of the disorder, and in this context MAO genes may also be candidates for moderating the presentation of ADHD. The current study examined the association between adolescent outcome of ADHD and MAO gene polymorphisms, including the 941T > G polymorphism in exon 8 (rs1799835) and 1460C > T polymorphism in exon 14 (rs1137070) of the MAOA gene, and the A > G polymorphism in intron13 (rs1799836), C > T polymorphism in the 3'UTR (rs1040399), and 2327T > C polymorphism in exon15 of the MAOB gene. Significant associations were observed between the MAOA gene polymorphisms and ADHD remission. Due to the small sample size and the possibility of phenotypic and etiologic heterogeneity of ADHD outcomes across ethnic or geographic groups, these results must be replicated before they can be generalized to other populations.

A 30-year prospective follow-up study of hyperactive boys with conduct problems: adult criminality

OBJECTIVE

To compare the official arrest records for a large number of hyperactive boys (N = 179), most with conduct problems, and 75 control boys; to examine childhood IQ, socioeconomic status, and parent reports of childhood hyperactivity and conduct problems for their contribution to criminal behavior in adulthood; and to compare adult outcome for multimodality-treated (MMT) and drug-treated-only (DTO) hyperactives.

METHOD

We report on the official arrest history from early to mid- (18 to 38 years of age) adulthood in these 254 white subjects.

RESULTS

Ninety one percent of subjects were followed up. California official arrest records were obtained on all of these subjects. Hyperactive subjects had significantly higher arrest, conviction, and incarceration rates compared with controls. Childhood antisocial behaviors, socioeconomic status, and IQ predicted adult criminality. Multimodality-treated boys with Hyperactive/ADHD (attention-deficit/hyperactivity disorder) did not fare better than DTO boys with ADHD.

CONCLUSIONS

Hyperactive/ADHD boys with conduct problems are at increased risk for adult criminality. Hyperactive boys without childhood conduct problems are not at increased risk for later criminality. An intensive 3-year MMT treatment of 6- to 12-year-old hyperactive boys is insufficient to prevent later adult criminality.

Bioavailability of triple-bead mixed amphetamine salts compared with a dose-augmentation strategy of mixed amphetamine salts extended release plus mixed amphetamine salts immediate release

OBJECTIVE

To compare the single-dose pharmacokinetics of triple-bead mixed amphetamine salts (MAS), an oral, once-daily, enhanced extended-release amphetamine formulation, with MAS extended release (MAS XR) (Adderall XR) + MAS immediate release (MAS IR) administered 8 h later.

METHODS

This was a phase I, randomized, open-label, single-dose, single-center, two-period, crossover study in healthy adult volunteers designed to evaluate the bioavailability of triple-bead MAS over the course of a full day. Subjects were randomized to triple-bead MAS 37.5 mg or MAS XR 25 mg + MAS IR 12.5 mg administered 8 h later (MAS XR + MAS IR). The reference treatment was designed to mimic the clinical practice of providing extended coverage by supplementing a morning dose of MAS XR with a dose of MAS IR 8 h later in order to increase the duration of action. Plasma was assayed for d-amphetamine and l-amphetamine. Treatment-emergent adverse events (TEAEs), vital signs, electrocardiograms (ECGs), and laboratory data were also collected for safety evaluation.

RESULTS

Exposure to d- and l-amphetamine was equivalent between triple-bead MAS and MAS XR + MAS IR based on maximum plasma concentration (Cmax) and area under the plasma concentration-time curve from time 0 to infinity (AUC(0-infinity)). For Cmax, least-squares mean ratios comparing triple-bead MAS with MAS XR + MAS IR were 101.0% and 90.9% for d-amphetamine and l-amphetamine, respectively, and for AUC(0-infinity) were 104.4% and 95.3% for d-amphetamine and l-amphetamine, respectively. Median time to maximum observed plasma concentration (Tmax) values for d-amphetamine and l-amphetamine were 8.0 h for triple-bead MAS and 10.0 h for MAS XR + MAS IR. There were no clinically meaningful differences between the study formulations for TEAEs or laboratory values. One subject experienced an ECG abnormality (asymptomatic premature ventricular contractions) leading to early termination from the study.

CONCLUSIONS

In healthy adults, the exposure observed with triple-bead MAS 37.5 mg was bioequivalent to MAS XR 25 mg supplemented by MAS IR 12.5 mg administered 8 h later. These data demonstrate that a single morning dose of triple-bead MAS provides equivalent plasma concentrations to those observed with a dose-augmentation strategy of MAS XR in the morning followed by MAS IR in the afternoon, while minimizing peak-to-trough fluctuations. Triple-bead MAS was also generally well-tolerated in this study.

Contexto familiar e problemas de saúde mental infantil no Programa Saúde da Família

OBJETIVO: Analisar a associação entre variáveis do contexto familiar e o risco de problemas emocionais/comportamentais em crianças cadastradas em Programa Saúde da Família. MÉTODOS: Realizou-se estudo de delineamento transversal com 100 crianças entre 6 e 12 anos de idade e seus familiares, principalmente mães biológicas (82%), cadastradas em um núcleo do Programa Saúde da Família, no município de Ribeirão Preto, SP, em 2001. Problemas emocionais/comportamentais da criança, em níveis considerados de risco para o desenvolvimento de transtornos, foram identificados por meio do Questionário de Capacidades e Dificuldades. Avaliaram-se as variáveis do contexto familiar: nível socioeconômico, eventos adversos, estresse materno, depressão materna e organização e estruturação do ambiente familiar. Para análise estatística foram utilizados os modelos de regressão logística univariada e multvariada. RESULTADOS: O estresse materno mostrou-se associado a problemas de saúde mental em geral na criança (OR=2,2). Rotina diária com horários definidos e o maior acesso a atividades para preencher o tempo livre foram associados à ausência desses problemas (1/OR 1,3 e 1,9, respectivamente). O estresse materno foi também um fator de risco para sintomas de ansiedade/depressão (OR=1,6). Para hiperatividade, a instabilidade financeira foi variável de risco (OR=2,1) e todos os indicadores de estabilidade ambiental foram variáveis protetoras (1/OR entre 1,2 e 1,6). CONCLUSÕES: Indicadores do contexto familiar associados aos problemas de saúde mental em escolares podem subsidiar a atuação das equipes do Programa Saúde da Família frente à criança e sua família. Recomenda-se a utilização do Questionário de Capacidades e Dificuldades pelas equipes, a fim de identificar precocemente os problemas de saúde mental infantil.

Early adolescent psychopathology as a predictor of alcohol use disorders by young adulthood

Few prospective studies have examined the relation between early adolescent conduct disorder (CD) symptoms and the development of alcohol use disorders (AUD) by young adulthood. The relative contribution of other forms of adolescent psychopathology (i.e., attention-deficit hyperactivity disorder, depression, anxiety/withdrawal) to the development of AUD also remains poorly understood. There is some suggestion that the co-occurrence of conduct disorder symptoms with other forms of psychopathology may interact synergistically in predicting later alcohol use problems. The current study explores these issues using data on 506 boys from the oldest sample of the Pittsburgh Youth Study (PYS). Consistent with prior research, early conduct disorder symptoms emerged as a consistent predictor of increased AUD symptoms and an alcohol dependence diagnosis by young adulthood. In contrast, adolescent boys with high levels of anxiety/withdrawal had lower levels of AUD symptoms and were less likely to develop alcohol dependence by young adulthood. Increased depression in early adolescence was associated with higher AUD symptoms and alcohol abuse and dependence diagnoses by young adulthood, but only for boys with high levels of conduct disorder symptoms. No evidence was found for a relation between attention-deficit hyperactivity disorder symptoms and AUD symptoms or diagnoses after controlling for co-occurring psychopathology.

Attention-deficit/hyperactivity disorder risk for heavy drinking and alcohol use disorder is age specific

BACKGROUND

This study was designed to assess age specificity in the risk for heavy drinking and alcohol use disorder (AUD) among adolescents and young adults with Attention-Deficit/Hyperactivity Disorder (ADHD) diagnosed in childhood.

METHOD

Children diagnosed with ADHD (n=364 probands) were interviewed an average of 8 years later in the Pittsburgh ADHD Longitudinal Study, either as adolescents (11-17 years old) or as young adults (18-28 years of age). Demographically similar age-matched participants without ADHD were recruited as adolescents (n=120) or as adults (n=120) for comparison with the probands. Alcohol involvement was assessed comprehensively to include measures of heavy drinking that are standard in alcoholism research and prognostic of later alcohol-related problems.

RESULTS

Results revealed age specificity in the association such that episodic heavy drinking (measured as 5+ drinks per occasion), drunkenness, DSM-IV AUD symptoms, and DSM-IV AUD were elevated among 15- to 17-year-old probands, but not among younger adolescents. Among young adults, drinking quantity and AUD were elevated among probands with antisocial personality disorder. Childhood predictors indexing antisocial behavior were also examined.

CONCLUSIONS

The age- specificity of these findings helps to explain prior inconsistencies across previous studies regarding risk for alcohol-related outcomes among children with ADHD.

Conduct and attentional problems in childhood and adolescence and later substance use, abuse and dependence: results of a 25-year longitudinal study

BACKGROUND

This paper examines the linkages between conduct problems and attentional problems in middle childhood and adolescence and later substance use, abuse and dependence in young adulthood.

METHODS

Data were gathered over the course of a 25-year longitudinal study of a birth cohort of 1265 New Zealand born children. These data included: (a) measures of conduct and attentional problems in middle childhood (7-9 years) and adolescence (14-16 years); (b) measures of substance use, abuse and dependence from 18-25 years; and (c) confounding social, family and related factors.

RESULTS

Statistical modelling produced a consistent set of results showing: (i) conduct problems in childhood and adolescence were generally related to later substance use, abuse and dependence even after control for attentional problems and confounders; (ii) attentional problems were largely unrelated to later substance use, abuse and dependence after control for conduct problems and confounders.

CONCLUSIONS

Conduct problems in both middle childhood and adolescence are related to increased risks of longer-term substance use, abuse and dependence. Any association between early attentional problems and later substance use abuse and dependence is largely mediated via the association between conduct and attentional problems.

Phenomenology and diagnosis of bipolar disorder in children, adolescents, and adults: complexities and developmental issues

This review addresses the phenomenology of mania/bipolar disorder from a developmental psychopathology perspective and uses cases with longitudinal information to illustrate major points. Beginning with a summary of the phenomenology of bipolar illness as it occurs in adults, the authors identify diagnostic complexities unique to children and adolescents. These include the challenges of characterizing elation and grandiosity; differentiating mania from comorbid symptoms, rages, sequelae of maltreatment, and typical developmental phenomena; and the unique manifestations of psychosis. We conclude with the observation that a significant difference between early and later onset bipolar disorder is that, in the former, there appears to be a global delay or arrest in the development of appropriate affect regulation; whereas in adult-onset bipolar illness, emotion dysregulation generally presents as an intermittent phenomenon. At this juncture, the study of childhood bipolar illness would benefit from a developmental psychopathology perspective to move beyond the level of cross-sectional symptom description to begin to study individuals over time, focusing on developmental, environmental, genetic, and neurobiological influences on manifest behavior.

Evidence for specificity of transmission of alcohol and nicotine dependence in an offspring of twins design

Alcohol dependence (AD) and nicotine dependence (ND) have been shown to co-occur. Results from twin studies implicate the role of genetics in the etiology of both ND and AD with substantial, yet incomplete, overlap. To test for specificity of transmission of AD and ND in an offspring of twins sample we analyzed data from a study of adolescent and adult offspring of twin fathers ascertained from the Vietnam Era Twin Registry. This sample consists of 1213 twin fathers, 862 biologic or rearing mothers, and 1270 offspring. Offspring were allocated to one of four risk groups for AD based on twin fathers' zygosity and father's and cotwins AD history. Offspring DSM-IV AD and ND were measured by structured diagnostic interview. Paternal AD and ND were significantly associated with offspring AD and ND, respectively. Bivariate probit regression results suggest specificity for transmission of AD and ND. This remained constant after controlling for offspring demographics and psychopathology and maternal AD and ND. Despite the substantial genetic overlap between the two disorders, there is evidence for genetic effects specific for AD and ND.

Consultation-based academic interventions for children with ADHD: effects on reading and mathematics achievement

The purpose of this investigation was to evaluate the relative efficacy of two consultation-based models for designing academic interventions to enhance the educational functioning of children with attention-deficit/hyperactivity disorder (ADHD). Children (N=167) meeting DSM-IV criteria for ADHD were randomly assigned to one of two consultation groups: Individualized Academic Intervention (IAI; interventions designed using a data-based decision-making model that involved ongoing feedback to teachers) and Generic Academic Intervention (GAI; interventions designed based on consultant-teacher collaboration, representing "consultation as usual"). Teachers implemented academic interventions over 15 months. Academic outcomes (e.g., standardized achievement test, and teacher ratings of academic skills) were assessed on four occasions (baseline, 3 months, 12 months, 15 months). Hierarchical linear modeling analyses indicated significant positive growth for 8 of the 14 dependent variables; however, trajectories did not differ significantly across consultation groups. Interventions in the IAI group were delivered with significantly greater integrity; however, groups did not differ with respect to teacher ratings of treatment acceptability. The results of this study provide partial support for the effectiveness of consultation-based academic interventions in enhancing educational functioning in children with ADHD; however, the relative advantages of an individualized model over "consultation as usual" have yet to be established.

Executive functions and adaptive functioning in young adult attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is associated with impairments in occupational, social, and educational functioning in adults. This study examined relations of adaptive impairment to ADHD symptom domains (inattentive-disorganized and hyperactive-impulsive) and to deficits in executive functioning (EF) in 195 well-characterized adults (105 ADHD, 90 non-ADHD, between ages 18 and 37). Participants completed a battery of EF measures as well as assessments of adaptive functioning. Confirmatory factor analyses were used to validate latent factors for adaptive functioning and EF. In a measurement model, weaker EF was associated with poorer adaptive functioning (r = -.30). When multi-informant composite variables for current inattentive-disorganized and hyperactive-impulsive ADHD symptoms were included in the structural model, EF no longer predicted adaptive functioning. While both symptom composites were similarly related to EF (inattentive-disorganized r = .36; hyperactive-impulsive r = .29), inattentive-disorganized symptoms accounted for more variance in adaptive functioning (67.2% vs. 3.6%). Furthermore, for retrospectively reported childhood symptoms of ADHD, only the inattentive-disorganized symptom domain was related to EF or adaptive impairment. These results suggest that, in adults with ADHD, inattentive-disorganized symptoms may be the primary contributor to key aspects of poorer adaptive function and may be the behavioral path through which EF deficits lead to adaptive impairment.

A pilot study of the effects of atomoxetine on driving performance in adults with ADHD

OBJECTIVE

There is a high risk of vehicular crashes, traffic citations, and poorer driving performance in adults with ADHD. This pilot study examines the value of a new nonstimulant (atomoxetine) for improving the driving performance of adults with ADHD.

METHOD

Atomoxetine (1.2 mg/kg daily for 3 weeks) and a placebo are studied on 18 adults with ADHD (M age = 37 years) using ratings of ADHD symptoms, impairment, and safe driving behavior; a virtual reality driving simulator; and ratings of simulator performance.

RESULTS

Atomoxetine improves self-ratings of ADHD symptoms, impairments, safe driving behavior, and simulator driving performance. No effects of atomoxetine are evident on others' ratings of driving behavior or on the simulator. Practice effects on the simulator may have obscured those drug effects.

CONCLUSION

The authors find a mixed pattern of results such that atomoxetine warrants further study for its effects on driving in this high-risk population.

Variations in prevalence of attention deficit hyperactivity disorder worldwide

Attention deficit hyperactivity disorder (ADHD) is among the most common, intensely investigated, and yet diagnostically controversial neurobehavioral conditions of childhood. The prevalence of ADHD has been reported with great variations among different studies, ranging from 2.2% to 17.8%. The aim of this review was to investigate the variables that influence the prevalence of ADHD and to derive a best estimate for the prevalence of the disorder. We reviewed all the 39 studies on ADHD prevalence appearing in the Pubmed and published since 1992. These studies indicate that ADHD is more common in boys than girls, in younger than older children and adolescents, in one-setting rather than two-setting screening studies, in studies based on DSM-IV rather than DSM-III-R criteria. Additional factors that may well influence prevalence rates include source of information and assessment of clinical impairment. In conclusion, our findings suggest that population characteristics, methodology features, ethnic and cultural differences and diagnostic criteria involved in studies affect the prevalence of ADHD. Standardized designs may lead to firm conclusions on the true prevalence of ADHD, the estimation of which seems impossible to be achieved by reviewing the already existing literature.

Clinical precursors of adolescent conduct disorder in children with attention-deficit/hyperactivity disorder

OBJECTIVE

To examine precursors of adolescent conduct disorder (CD) in children with attention-deficit/hyperactivity disorder (ADHD), investigating the significance of childhood oppositional defiant disorder (ODD) and ADHD.

METHOD

A total of 151 children with ADHD recruited from child psychiatric and pediatric clinics were assessed through standardized diagnostic interviews at ages 6 to 13 years and in adolescence 5 years later. Using multiple regression analysis, we assessed baseline ODD diagnosis and ODD, CD, and ADHD symptom scores as clinical predictors of adolescent CD diagnosis and symptom scores.

RESULTS

Childhood ODD (diagnosis and severity) was significantly associated with adolescent CD (diagnosis and severity), independent of childhood ADHD severity and childhood CD. Children with a diagnosis of ODD were almost three times more likely to develop CD in adolescence (odds ratio = 2.79, 95% CI 1.16-6.70, p = .02). Childhood ADHD severity predicted adolescent CD scores but not diagnosis of CD (although there was a trend toward association). The presence of at least one CD symptom in childhood predicted adolescent CD severity.

CONCLUSIONS

ODD is a significant precursor of adolescent CD in children with ADHD independent of ADHD severity. Considering the negative prognosis of ADHD with comorbid CD, it is imperative that clinicians pay specific attention to the presence of childhood ODD behaviors.

Interventions to address the academic impairment of children and adolescents with ADHD

There exists a strong link between ADHD and academic underachievement. Both the core behavioral symptoms of ADHD and associated executive functioning deficits likely contribute to academic impairment. Current evidence-based approaches to the treatment of ADHD (i.e., stimulant medication, clinical behavior therapy and classroom behavioral interventions) have demonstrated a robust impact on behavioral variables such as attention and disruptive behavior within classroom analogue settings; however, their efficacy in improving academic outcomes is much less clear. Although surprisingly few treatment outcome studies of ADHD have attempted to incorporate interventions that specifically target academic outcomes, the studies that are available suggest that these interventions may be beneficial. The state of the treatment literature for addressing academic impairment in children and adolescents with ADHD will be reviewed herein, as well as limitations of current research, and directions for future research.

TDAH: remissão na adolescência e preditores de persistência em adultos

Embora no passado se acreditasse que o TDAH persistia somente até a adolescência, atualmente já há um corpo sólido de conhecimento científico evidenciando que o TDAH freqüentemente persiste em adultos que foram diagnosticados como tendo TDAH na infância. São poucos os relatos na literatura sobre o padrão dessa evolução dos sintomas e, principalmente, sobre os fatores que predizem esse desfecho. O objetivo deste artigo é revisar a literatura científica sobre o TDAH, com foco específico em dados sobre remissão dos sintomas na adolescência e preditores de persistência do transtorno até a vida adulta. São apresentados dados de prevalência na adolescência e idade adulta, fatores relacionados à variabilidade de resultados entre os estudos, potenciais fatores de risco de persistência e o único estudo delineado especificamente com o objetivo de avaliar um conjunto abrangente de preditores do transtorno da infância à idade adulta.

A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance

INTRODUCTION

Attention-Deficit/Hyperactivity Disorder (ADHD) may interfere with driving competence, predisposing those with the disorder to impaired driving performance and greater risk for adverse driving outcomes. Effective treatment may minimize the risk in those with ADHD.

METHOD

We reviewed the scientific literature on driving risks and impairments associated with ADHD and the effects of stimulants on driving performance. Several lines of evidence were considered, including longitudinal studies and community-derived sample studies. The present review is based on a weekly review (by the first author) of all journals in the behavioral and social sciences indexed in the publication Current Contents spanning the past 15 years, as well as a search of the reference section of all studies found that pertained to driving risks associated with ADHD or to the treatment of ADHD as it relates to driving difficulties.

RESULTS

The review of the scientific literature demonstrated well-documented driving risks and impairments associated with ADHD and the positive effects of stimulant medications on driving performance.

CONCLUSIONS

Clinicians should educate patients/caregivers about the increased risk of adverse outcomes among untreated individuals with ADHD and the role of medication in potentially improving driving performance.

IMPACT ON INDUSTRY

Owing to the significantly higher risk of adverse driving outcomes, the use of stimulant medications to treat people with ADHD who drive may reduce such safety risks.

Hyperactive children as young adults: driving abilities, safe driving behavior, and adverse driving outcomes

ADHD has been linked to poorer driving abilities and greater adverse outcomes (crashes, citations) in clinic-referred cases of teens and adults with ADHD. No study, however, has focused systematically on ADHD children followed into adulthood. The present paper does so while measuring driving-related cognitive abilities, driving behavior, and history of adverse driving outcomes. A multi-method, multi-source battery of driving measures was collected at the young adult follow-up on hyperactive (H; N=147; mean age=21.1) and community control children (CC; N=71; mean age=20.5) followed for more than 13 years. More of the H than CC groups had been ticketed for reckless driving, driving without a license, hit-and-run crashes, and had their licenses suspended or revoked. Official driving records found more of the H group having received traffic citations and a greater frequency of license suspensions. The cost of damage in their initial crashes was also significantly greater in the H than CC group. Both self-report and other ratings of actual driving behavior revealed less safe driving practices being used by the H group. Observations by driving instructors during a behind-the-wheel road test indicated significantly more impulsive errors. Performance on a simulator further revealed slower and more variable reaction times, greater errors of impulsiveness (false alarms, poor rule following), more steering variability, and more scrapes and crashes of the simulated vehicle against road boundaries in the H than in the CC group. These findings suggest that children growing up with ADHD may either have fewer driving risks or possibly under-report those risks relative to clinic-referred adults with this disorder. Deficits in simulator performance and safe driving behavior, however, are consistent with clinic-referred adults with ADHD suggesting ongoing risks for such adverse driving outcomes in children growing up with ADHD.

ADHD and achievement: meta-analysis of the child, adolescent, and adult literatures and a concomitant study with college students

This article presents results from two interrelated studies. The first study conducted a meta-analysis of the published literature since 1990 to determine the magnitude of achievement problems associated with attention-deficit/hyperactivity disorder (ADHD). Effect sizes were significantly different between participants with and without ADHD (sample weighted r = .32, sample weighted d = . 71; p = .001). Effects were also examined according to the moderators of age, gender, achievement domain (reading, math, spelling), measurement method (standardized tests vs. grades, parent/teacher ratings, etc.), sample type (clinical vs. nonclinical), and system used to identify ADHD (DSM-III-R vs. DSM-IV). Significant differences emerged from the moderator comparisons. The second study, using averaged effect sizes from the first study as a baseline for comparison, investigated achievement levels for an understudied age group with ADHD, namely, college students. Unlike previous studies at the college level, the sample incorporated both student and parent ratings (N = 380 dyads). The results were comparable to outcomes from the meta-analysis for college students and adults. Analyses demonstrated modest (R = .21) but meaningful predictive validity across 1 year to end-of-first-year grades. However, unlike earlier studies with children and adolescents, student ratings were as predictive as parent ratings. Findings are discussed in terms of the impact of moderator variables on ADHD and achievement.

Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology

Attention-deficit/hyperactivity disorder (ADHD) is an established diagnosis in children, associated with a large body of evidence on the benefits of treatment. Adolescents with ADHD are now leaving children's services often with no readily identifiable adult service to support them, which presents problems as local pharmacy regulations often preclude the prescription of stimulant drugs by general practitioners (GPs). In addition, adults with ADHD symptoms are now starting to present to primary care and psychiatry services requesting assessment and treatment. For these reasons, the British Association for Psychopharmacology (BAP) thought it timely to hold a consensus conference to review the body of evidence on childhood ADHD and the growing literature on ADHD in older age groups. Much of this initial guidance on managing ADHD in adolescents in transition and in adults is based on expert opinion derived from childhood evidence. We hope that, by the time these guidelines are updated, much evidence will be available to address the many directions for future research that are detailed here.

A Family-Centered Approach to Planning and Measuring the Outcome of Interventions for Children with Attention-Deficit/Hyperactivity Disorder

This paper discusses a set of closely related parenting and family factors that should be considered when planning and measuring the outcome of interventions for children with attention-deficit/hyperactivity disorder (ADHD). These include parenting and parent-child relationships, parental cognitions, parental adjustment, marital interactions, general family relationships, and adaptive child functioning within the family. The measurement of each construct is discussed, and comparative, longitudinal, and treatment outcome studies using these measures are reviewed. It is concluded that measures of treatment outcome for children with ADHD could be improved by utilizing multiple informants, developing tools with greater content and contextual validity, relying more on observational methods, and identifying those measures which are of greatest importance to families. Given the multiple pathways via which both psychosocial and pharmacological interventions exert their influence, composite measures combining multi-informant, multimethod constructs may represent more useful measures of treatment outcome than measures of primary ADHD symptoms.

The stability of axis I diagnoses in youth across multiple psychiatric hospitalizations

The literature has yet to reach a consensus as to the stability of severe psychiatric diagnoses in youth. Previous studies among youngsters tracked over set follow-up periods have reported diagnostic stability estimates that are similar to or slightly lower than those of adults. Less is known, however, about the stability of youth psychiatric diagnoses across multiple episodes of psychopathology, such as recurrent inpatient hospitalizations. The present study investigated diagnostic stability among inpatient youth with multiple hospitalizations through longitudinal and cross-sequential designs. Results indicate that diagnostic stability, as measured by positive concordance rates and the kappa coefficient, is highest for mood disorders, especially bipolar disorder. Externalizing disorders and schizophrenia displayed moderate to low stability, with oppositional-defiant disorder displaying the lowest stability. Substance use disorders were found to have moderate stability. Overall, across-episode diagnostic stability among hospitalized youngsters appears to be lower than that of adults. This finding appears to be due to lower stability among certain externalizing disorders and substance use disorders, whereas mood disorders display stability rates resembling those of adults. Potential explanations for and implications of these findings are discussed.

Methylphenidate and its isomers: their role in the treatment of attention-deficit hyperactivity disorder using a transdermal delivery system

dl-threo-Methylphenidate is a highly efficacious drug for treating attention-deficit hyperactivity disorder (ADHD) that is currently administered as immediate- or controlled-release and osmotically controlled-released formulations. The drug exists as two enantiomers, d-threo-methylphenidate and l-threo-methylphenidate, with the former having been developed as a medication to treat ADHD in its own right. dl-threo-Methylphenidate undergoes enantioselective metabolism in the liver, which results in marked differences in the plasma concentrations of its isomers, depending on the route of administration and formulation. When dl-threo-methylphenidate is orally administered, the plasma concentrations of d-threo-methylphenidate are higher than those of l-threo-methylphenidate. However, with the recently developed methylphenidate transdermal system (MTS), 'first-pass' metabolism is circumvented and, as a consequence, plasma concentrations of d-threo-methylphenidate are consistent with those produced by oral formulations, but the relative concentrations of l-threo-methylphenidate are much higher, i.e. 50-60% of those of d-threo-methylphenidate. In this article, we review the pharmacokinetics and pharmacology of dl-threo-methylphenidate and its isomers to assess the extent to which their mechanism of action as noradrenaline (norepinephrine) and dopamine reuptake inhibitors is responsible for their efficacy and commonly occurring adverse effects. The major findings are that d-threo-methylphenidate and l-threo-methylphenidate share the same pharmacological profile as the parent racemate, i.e. catecholamine-selective reuptake inhibition with higher potency against dopamine versus noradrenaline reuptake in vivo. However, d-threo-methylphenidate is approximately 10-fold more potent than the l-isomer in this regard. For these drugs, their abilities not only to ameliorate the behavioural and cognitive dysfunctions in ADHD, but also to induce the common adverse effects of reduced appetite, nausea/vomiting and stomach ache, are almost certainly due to their ability to potentiate noradrenergic and/or dopaminergic function in the central and peripheral nervous systems. The sympathomimetic actions of ADHD drugs on cardiovascular function are currently an issue of concern. Since noradrenaline reuptake inhibition is the likely mediator for the effects of dl-threo-methylphenidate on blood pressure and heart rate, the more potent d-isomer will therefore be predominantly responsible. Motor and vocal tics are the other important adverse event to be considered in the treatment of ADHD. It is now accepted that tics are a frequently occurring behavioural manifestation of ADHD itself and the evidence for or against their exacerbation by treatment with dl-threo-methylphenidate or other stimulants remains highly contradictory. Focusing on the enantiomers of dl-threo-methylphenidate, it can be concluded that d-threo-methylphenidate, which is the more potent and abundant of the two isomers, is the major contributor of both efficacy and adverse effects, irrespective of the formulation or route of administration of the racemate. Moreover, for the oral, extended-release formulations of dl-threo-methylphenidate, the d-isomer represents the only pharmacologically active moiety when these medications are used in the clinic. With the MTS, plasma concentrations of l-threo-methylphenidate are higher than are achieved using oral formulations, but even in this case, it is likely that the contribution of this enantiomer to the efficacy and adverse effects of the racemate is no greater than 5-10% of the total.

Attention-deficit hyperactivity disorder symptoms in a clinic sample of children and adolescents with pervasive developmental disorders

OBJECTIVES

The aims of this systematic chart review were to determine the frequency of attention-deficit/hyperactivity disorder (ADHD) in a clinic sample of children and adolescents with autism spectrum disorders (ASD), to compare ADHD symptoms in children with Autistic Disorder, Asperger's Disorder, and pervasive developmental disorders-not otherwise specified (PDD-NOS), to compare ADHD symptoms in individuals with and without ADHD-related chief complaints, and to determine the correlation between ADHD Rating Scale (ADHD RS) scores and age.

METHOD

This systematic chart review examined data from children and adolescents who were consecutively referred to a university-based autism psychopharmacology program. All individuals were diagnosed by semistructured interview for ASD and ADHD, and ADHD symptoms were assessed using ADHD RS scores.

RESULTS

Of 83 children, 78% fulfilled Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for ADHD and exceeded the 93rd percentile norm for the ADHD RS. Hyperactivity-impulsivity scores were significantly greater in individuals with autism than those with other ASDs. DSM-IV ADHD diagnosis was represented equally in individuals with and without ADHD as their chief complaints. ADHD RS hyperactivity-impulsivity and total scores were negatively correlated with age.

CONCLUSION

ADHD symptoms are pervasive in clinically referred children and adolescents with ASD.

Remission versus response as the goal of therapy in ADHD: A new standard for the field?

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) has a substantial negative impact; however, within long-term follow-up studies, a proportion of patients do very well, both symptomatically and functionally, suggesting that the lower the symptom burden, the greater the functional improvements. Studies in major depressive disorder have identified a relationship between symptomatic remission and restoration of normal functioning.

OBJECTIVE

The purpose of this article was to propose a definition of remission in ADHD, review remission rates in clinical trials for commonly used medications, and explore the relationship between symptomatic remission and optimal functioning.

METHODS

Remission and response rates for medications were obtained through MEDLINE searches of English-language citations (1999-2005) and meeting abstracts (2003-2005) using the terms amphetamine, atomoxetine, methylphenidate, ADHD, efficacy, effectiveness, and controlled trial, as well as hand searches of efficacy studies. Evidence from randomized controlled trials, as well as effectiveness studies, where the proportions of patients achieving predefined cutoff points for remission or response are reported, was reviewed. Because higher remission rates were identified with the oral, osmotic, controlled-release system (OROS) of methylphenidate, a relationship between symptomatic response/remission and optimal functioning was explored further.

RESULTS

Remission in ADHD should be defined as a loss of diagnostic status, minimal or no symptoms, and optimal functioning when individuals are being treated with or without medication. Symptomatic remission can be operationalized as a mean total score of S1 on most standardized questionnaires. For the medications examined (OROS methylphenidate, immediate-release methylphenidate, atomoxetine, and mixed amphetamine salts), response rates were comparable at approximately 70% to 75%; however, remission rates were higher with OROS methylphenidate compared with either immediate-release methylphenidate or atomoxetine (remission rates with amphetamines were not found). Benefits, including decreased illness burden as well as improved psychosocial and academic functioning, were associated with treatment versus no treatment and were greater with medication that offered higher remission rates.

CONCLUSIONS

The literature provided evidence that greater symptom improvements are associated with greater functional improvements, emphasizing that remission of ADHD as defined should be the goal of therapy. Treatment ought to include the early use of strategies with the greatest chance of achieving remission. Future clinical research should use remission as the primary outcome.

Adults' versus children's perceptions of a child with autism or attention deficit hyperactivity disorder

The present study examined public perceptions toward children with autism or with attention deficit hyperactivity disorder (ADHD). A convenience sample was used consisting of 30 children (7-12-year-olds) and 30 adults. Participants read a stereotyped scenario featuring either a child with autism, a child with ADHD, or a normal child. Child participants were significantly more likely than adults to (a) express dislike/avoidance toward a child described with either stereotypic autistic or ADHD behaviors, and (b) perceive the child with ADHD as unlike themselves. However, child participants and adults were equally likely to see the autistic child as unlike themselves. Reasons for the different perceptions of children and adults may include differences in perceived threat and in categorization.

Attention-deficit/hyperactivity disorder (ADHD) and driving risk: a review of the literature and a methodological critique

This article examines the literature on attention-deficit/hyperactivity disorder (ADHD) and unintentional driving injury. This literature has emerged over the last decade as part of the burgeoning epidemic of road traffic death and injury, which is the number-one cause of death among young adults in North America. The available literature on observational outcome studies and experimental pharmacologic interventions is critically reviewed. A meta-analysis of behavioral outcomes and a review of effect size of pharmacologic studies are presented. Current data support the utility of stimulant medication in improving driving performance in younger ADHD drivers. A conceptual model of risk factors in young ADHD drivers is offered. The current state of screening instruments for identifying high-risk subjects within this clinical group is summarized along with a final section on emerging trends and future prospects for intervention.

Reducing hyperactivity with a feedback actigraph: initial findings

Schulman and colleagues demonstrated that classroom activity level can be reduced in hyperactive boys using activity-level feedback and positive reinforcement. This article reports preliminary results using a device that combines modern beeper and actigraphy technology for the purpose of measuring, monitoring, and modifying motor excess in children with confirmed diagnoses of Attention Deficit Hyperactivity Disorder (ADHD). Nine boys ranging in age from 8 to 9 years with the ADHD Combined Type wore prototype BuzzBee feedback actigraphs during school periods and were reinforced for activity-level reductions in the context of a simple pre/post research design. The findings indicated that 7 of the 9 boys reduced their activity level from 20 to 47% of baseline levels while the activity levels of the two remaining boys increased from 2 to 7% of baseline levels. These changes were statistically significant and constitute a large effect.

Long-term treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD)

Only 7% to 50% of children with attention-deficit/hyperactivity disorder actually are treated. Of those who begin treatment, only 18% to 50% persist in the treatment for any length of time (eg, 2 to 3 years). Thus, available data on effects of long-term medication and psychosocial treatment are sparse and problematic. This article reviews available data on long-term effects of medication (stimulant and nonstimulant) and psychosocial treatment.

Mixed amphetamine salts extended release: a clinical review of its use in the treatment of attention-deficit hyperactivity disorder

Mixed amphetamine salts extended release (MAS-XR) has been demonstrated in pediatric, adolescent and adult studies to be a well tolerated and effective treatment for attention-deficit hyperactivity disorder (ADHD). MAS-XR utilizes a double-pulse delivery system to replicate the pharmacokinetic properties of equal doses of immediate-release MAS administered 4 h apart. Doses of 20 mg MAS-XR produce significant reductions of core symptoms of ADHD over a 12-h period. Adverse effects observed in controlled studies include anorexia, weight loss, dry mouth, insomnia and abdominal pain, and rates of adverse effects are comparable to other stimulant agents approved for ADHD. At this time, there are no data to suggest that sudden death due to cardiovascular complications occurs more frequently in patients treated with MAS-XR than in the general population, but careful consideration of the risks and benefits of MAS-XR is warranted in patients with pre-existing structural heart disease and adult patients with a history of hypertension.

Relative benefits of stimulant therapy with OROS methylphenidate versus mixed amphetamine salts extended release in improving the driving performance of adolescent drivers with attention-deficit/hyperactivity disorder

OBJECTIVE

Automobile accidents are the leading cause of death among adolescents, and collisions are 2 to 4 times more likely to occur among adolescents with attention-deficit/hyperactivity disorder. Studies have demonstrated that stimulants improve driving performance. This study compared 2 long-acting stimulant medications during daytime and evening driving evaluations.

METHODS

Adolescent drivers with attention-deficit/hyperactivity disorder were compared on a driving simulator after taking 72 mg of OROS methylphenidate, 30 mg of mixed amphetamine salts extended release, or placebo in a randomized, double-blind, placebo-controlled, crossover study design. During laboratory testing, adolescents drove a driving simulator at 5:00 pm, 8:00 pm, and 11:00 pm. Driving performance was rated by adolescents and investigators.

RESULTS

The study included 35 adolescent drivers with attention-deficit/hyperactivity disorder (19 boys/16 girls). The mean age was 17.8 years. The overall Impaired Driving Score demonstrated that OROS methylphenidate led to better driving performance compared with placebo and mixed amphetamine salts extended release, whereas mixed amphetamine salts extended release demonstrated no statistical improvement over placebo. Specifically, relative to placebo, OROS methylphenidate resulted in less time driving off the road, fewer instances of speeding, less erratic speed control, more time executing left turns, and less inappropriate use of brakes. OROS methylphenidate and mixed amphetamine salts extended release worked equally well for male and female adolescents and equally as well with teenagers who have combined and inattentive subtypes of attention-deficit/hyperactivity disorder.

CONCLUSIONS

This study validates the use of stimulants to improve driving performance in adolescents with attention-deficit/hyperactivity disorder. In the study, OROS methylphenidate promoted significantly improved driving performance compared with placebo and mixed amphetamine salts extended release.

Revisiting the role of the prefrontal cortex in the pathophysiology of attention-deficit/hyperactivity disorder

Most neural models for the pathophysiology of attention-deficit/hyperactivity disorder (ADHD) have centered on the prefrontal cortex and its interconnections with the striatum and other subcortical structures. However, research only partially supports these models, and they do not correspond with the development of the prefrontal cortex and its interrelated neurocircuitry. The neural and functional development of the prefrontal cortex more closely parallels recovery from ADHD as indicated by the developmental remission of symptomatology. The authors hypothesize that ADHD is due to noncortical dysfunction that manifests early in ontogeny, remains static throughout the lifetime, and is not associated with the remission of symptomatology. Data supporting this neurodevelopmental model of prefrontal cortex function in ADHD are reviewed. Research and treatment implications are discussed.

Hyperactivity and attention problems in a Swiss sample of school-aged children: effects of school achievement, child gender, and informants

OBJECTIVE

The sensitivity and tolerance regarding ADHD symptoms obviously differ from one culture to another and according to the informants (parents, teachers, or children). This stimulates the comparison of data across informants and countries.

METHOD

Parents and teachers of more than 1,000 school-aged Swiss children (5 to 17 years old) fill in Conners's questionnaires on ADHD. Children who are older than 10 years old also fill in a self-report questionnaire. Results are compared to data from a North American sample.

RESULTS

Swiss parents and teachers tend to report more ADHD symptoms than American parents and teachers as far as the oldest groups of children are concerned. Interactions are evidenced between school achievement, child gender, and informants. A relatively low rate of agreement between informants is found.

CONCLUSION

These results strengthen the importance to take into account all informants in the pediatric and the child psychiatry clinic, as well as in the epidemiological studies.

Genetic contributions to the development of ADHD subtypes from childhood to adolescence

OBJECTIVES

Little is known about how genes influence the development of symptoms included in the DSM-IV subtypes of attention-deficit/hyperactivity disorder (ADHD) from childhood to adolescence. The aim of this study was to examine genetic influences contributing to the development of hyperactive-impulsive symptoms and inattentive symptoms of ADHD from childhood to adolescence.

METHOD

The sample included all 1,480 twin pairs born in Sweden between May 1985 and December 1986. Parents responded to mailed questionnaires on three occasions, when the twins were 8 to 9, 13 to 14, and 16 to 17 years old. The authors used dimensional scales of hyperactivity-impulsivity and inattention derived from a checklist of items based on the DSM symptoms of ADHD.

RESULTS

Symptoms of hyperactivity-impulsivity declined with increasing age, whereas there was no decline in symptoms of inattention. Persistent genetic influences explain between 45% and 90% of the total genetic variance in hyperactivity-impulsivity and inattention across age. Persistent genetic variance was primarily operating across subtypes, even though persistent subtype-specific influences were also significant.

CONCLUSIONS

The finding of persistent cross-subtype (i.e., combined) and persistent subtype-specific genetic influences (i.e., primarily hyperactive-impulsive and primarily inattentive) are in line with a genetic basis for the DSM-IV classification of ADHD subtypes.

Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder

Despite the vast literature supporting the efficacy of stimulant medication in the treatment of attention-deficit/hyperactivity disorder (ADHD), several limitations of pharmacological treatments highlight the clear need for effective psychosocial treatments to be identified. A large evidence base exists for behavioral interventions, including parent training and school interventions, which has resulted in their classification as "empirically validated treatments." Additionally, social skills training with generalization components, intensive summer treatment programs, and educational interventions appear promising in the treatment of ADHD. Given the chronic impairment children with ADHD experience across multiple domains of functioning, multimodal treatments are typically necessary to normalize the behavior of these children. The state of the ADHD treatment literature is reviewed, important gaps are identified (e.g., treatment for adolescents), and directions for future research are outlined within a developmental psychopathology framework.

Driving anger and driving behavior in adults with ADHD

OBJECTIVE

This study assesses whether anger in the context of driving is associated with the negative driving outcomes experienced by individuals with ADHD.

METHOD

ADHD adults (n = 56) complete measures of driving anger, driving anger expression, angry thoughts behind the wheel, and aggressive, risky, and crash-related behavior. Results are compared to two non-ADHD control groups: one from the same community as the ADHD sample (n = 106) but that did not complete all instruments and the other from college students (n = 432) who completed all instruments.

RESULTS

ADHD participants report more driving anger and aggressive expression through the use of their vehicle and less adaptive and constructive anger expression than their non-ADHD peers. Adult ADHD drivers rate themselves as more angry, risky, and unsafe drivers and report experiencing more losses of concentration and vehicular control than college students.

CONCLUSION

Results are discussed with regard to drivingrelated problems for drivers with ADHD.

Differential effectiveness of behavioral parent-training and cognitive-behavioral therapy for antisocial youth: a meta-analysis

Extended the findings from previous meta-analytic work by comparing the effectiveness of behavioral parent-training (BPT) and cognitive-behavioral therapy (CBT) for youth with antisocial behavior problems. Youth demographic variables were also examined as potential moderators of the effectiveness of these 2 types of interventions. Thirty BPT studies and 41 CBT studies met inclusion criteria for this meta-analysis. The weighted mean effect size (ES) for all interventions was 0.40. Youth age was found to moderate the outcome of the 2 interventions, with BPT having a stronger effect for preschool and school-aged youth and CBT having a stronger effect for adolescents. The results also indicate that there may be systematic differences in the outcomes associated with BPT and CBT when the setting of the intervention is considered, suggesting the need to carefully consider the effect of setting in future research. This study also highlights the need for outcome research dealing with more diverse populations and the better classification of research participants on different developmental trajectories of antisocial behavior.

An examination of the behavioral and neuropsychological correlates of three ADHD candidate gene polymorphisms (DRD4 7+, DBH TaqI A2, and DAT1 40 bp VNTR) in hyperactive and normal children followed to adulthood

Several candidate gene polymorphisms have been implicated in attention deficit hyperactivity disorder (ADHD), including DAT1 40bp VNTR, DRD4 7+, and DBH TaqI A2 alleles. We used the Milwaukee longitudinal study of hyperactive (n = 122) and normal (n = 67) children to compare participants with and without these respective polymorphisms on ADHD-related behavioral ratings at childhood, 8 years later in adolescence, and 13+ years later into young adulthood. Neuropsychological tests were given at the adolescent and young adulthood follow-up. No differences were found between the DRD4-7+ and 7- repeat polymorphism. The DBH TaqI A2 allele, when homozygous, was associated with being more hyperactive in childhood, having more pervasive behavior problems at adolescence, and earning less money on a card playing task in adulthood. At adolescence, poorer test scores were also found only in the hyperactive group with homozygous for this allele. The DAT1 40bp VNTR heterozygous 9/10 repeat, however, differed from the 10/10 repeat pair in many respects, having greater ADHD and externalizing symptoms at all three follow-ups, more cross-situational behavioral problems at both childhood and adolescence, poorer mother-teen relations at adolescence, and lower class rankings in high school. Participants with the 9/10 pair in the control group also had lower work performance, a lower grade point average in high school, greater teacher rated externalizing symptoms at adolescence, and greater omission errors on a continuous performance test in adulthood. The DAT1 40bp VNTR 9/10 polymorphism pairing appears to be reliably associated with greater symptoms of ADHD and externalizing behavior from childhood to adulthood, and with family, educational, and occupational impairments. We also present a contrary view on the appropriate endophenotypes for use in behavioral genetic research on ADHD.

Contribution of 5-HT2A receptor gene -1438A>G polymorphism to outcome of attention-deficit/hyperactivity disorder in adolescents

Attention-deficit/hyperactivity disorder (ADHD) typically emerges before 7 years of age and may persist into adolescence or adulthood. The adolescent outcome can be classified into four types, including non-remission, syndromatic remission, symptomatic remission, and functional remission. Genetic factors are believed to contribute to symptom stability and change across development, so adolescent outcome may be a sub-phenotype for molecular genetic studies of ADHD. Serotonin system genes are prime candidates for this sub-phenotype, since the development of this neurotransmitter system parallels the course of ADHD. The current study examined the association between adolescent outcome in ADHD and serotonin system genes, including the -1438A>G polymorphism of the serotonin 2A receptor gene (HTR2A) and the -759C>T polymorphism of the serotonin 2C receptor gene (HTR2C). The -1438A>G polymorphism was found to be related to remission in ADHD, especially functional remission (P = 0.029). Due to potential phenotypic and etiologic heterogeneity in ADHD, the results of this study must be replicated in additional samples before they can be generalized to other populations.