Predictors of antisocial behaviour in children with attention deficit hyperactivity disorder

The impacts associated with having ADHD: an umbrella review

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) affects up to 5% of the population and is characterised by symptoms of impulsivity, hyperactivity and inattention. These symptoms are significantly impairing and carry additional risks for children and adults with ADHD, including negative mental health (e.g. depression), physical health (e.g. obesity) and societal outcomes (e.g. imprisonment, divorce). Very few studies have attempted to synthesise these risks in one publication due to the breadth of evidence published on the adverse outcomes of ADHD.

Methods

An umbrella review was performed to identify reviews (systematic, meta-analysis and narrative) that investigate the risks arising from having ADHD. We conducted a narrative synthesis of the findings and conducted a quality review of the included publications.

Results

Upon searching five databases, 16,675 records were identified. Of these, 125 reviews met the criteria for inclusion. A narrative synthesis of these findings highlighted three key domains of risks associated with ADHD: mental health, physical health, social and lifestyle. Most reviews were of good and moderate quality.

Discussion

This review highlights the many risks associated with having ADHD, beyond its three key symptom domains and the impact of the condition on daily functioning.

Registration

International Prospective Register of Systematic Reviews (PROSPERO CRD42023404073).

Oroxylin A: A Promising Flavonoid for Prevention and Treatment of Chronic Diseases

There have been magnificent advancements in the understanding of molecular mechanisms of chronic diseases over the past several years, but these diseases continue to be a considerable cause of death worldwide. Most of the approved medications available for the prevention and treatment of these diseases target only a single gene/protein/pathway and are known to cause severe side effects and are less effective than they are anticipated. Consequently, the development of finer therapeutics that outshine the existing ones is far-reaching. Natural compounds have enormous applications in curbing several disastrous and fatal diseases. Oroxylin A (OA) is a flavonoid obtained from the plants Oroxylum indicum, Scutellaria baicalensis, and S. lateriflora, which have distinctive pharmacological properties. OA modulates the important signaling pathways, including NF-κB, MAPK, ERK1/2, Wnt/β-catenin, PTEN/PI3K/Akt, and signaling molecules, such as TNF-α, TGF-ꞵ, MMPs, VEGF, interleukins, Bcl-2, caspases, HIF-1α, EMT proteins, Nrf-2, etc., which play a pivotal role in the molecular mechanism of chronic diseases. Overwhelming pieces of evidence expound on the anti-inflammatory, anti-bacterial, anti-viral, and anti-cancer potentials of this flavonoid, which makes it an engrossing compound for research. Numerous preclinical and clinical studies also displayed the promising potential of OA against cancer, cardiovascular diseases, inflammation, neurological disorders, rheumatoid arthritis, osteoarthritis, etc. Therefore, the current review focuses on delineating the role of OA in combating different chronic diseases and highlighting the intrinsic molecular mechanisms of its action.

Attachment Anxiety Moderates the Association Between ADHD and Psychological Distress

This study aims at examining the possible moderating role of attachment style in the association between ADHD and psychological distress, namely, anxiety and depression symptoms. Study included ninty nine participants: Sixty adults with ADHD diagnosis and thirty nine adults without ADHD or other neurological and/or psychiatric disorders. All participants completed the Patient Health Questionnaire (PHQ-9), State-Trait Anxiety (STAI) questionnaires, Emotion in Close Relationships (ECR-R) questionnaire and Adult ADHD Self-Report Scale-Version 1.1 (ASRS-v1.1). Adults with ADHD had greater symptoms of depression (p < .001) and anxiety (p < .001) than adults without ADHD. Process analysis yielded that attachment anxiety moderated the association between ADHD, anxiety and depression, therefore only adults with ADHD that had moderate to high attachment anxiety exhibited higher levels of depression (p < .01) and anxiety (p < .001). No moderating effect was observed for attachment avoidance. Moreover, we did not find correlations between ADHD, anxiety and depression when secure attachment was the moderator; indicating that secure attachment could serve as a "protective factor" against psychological distress among ADHD individuals. Among anxiously attached adults, ADHD was associated with higher levels psychological distress. These findings highlight the important role of attachment style in mental health of adults with ADHD.

Risk and resource factors of antisocial behaviour in children and adolescents: results of the longitudinal BELLA study

BACKGROUND

Antisocial behaviour is a common phenomenon in childhood and adolescence. Information on psychosocial risk and resource factors for antisocial behaviour are important for planning targeted prevention and early intervention programs. The current study explores risk and resource factors of antisocial behaviour in children and adolescents based on population-based longitudinal data.

METHODS

We analysed longitudinal data from the German BELLA study (n = 1145; 11 to 17 year-olds) measured at three measurement points covering two years. Latent growth analysis, linear regression models and structural equation modelling were used to explore cross-sectional and longitudinal data.

RESULTS

Based on baseline data, we found that stronger self-efficacy and worse family climate were each related to stronger antisocial behaviour. Longitudinal data revealed that more severe parental mental health problems, worse family climate at baseline, deteriorating family climate over time, and more social support were each associated with increasing antisocial behaviour over time. We further found a moderating effect for family climate.

CONCLUSIONS

Our study provides important exploratory results on psychosocial risk, resource and protective factors in the context of antisocial behaviour in children and adolescents, which need confirmation by future research. Our exploratory results point in the direction that family-based interventions for antisocial behavior in children and adolescents may benefit from considering the family climate.

Attention-Deficit/Hyperactivity Disorder (ADHD), antisociality and delinquent behavior over the lifespan

Attention-Deficit/Hyperactivity Disorder (ADHD) is closely linked to the development of conduct problems during socialization in early life and to an increased risk for antisocial activities and delinquency over the lifespan. The interaction between ADHD and common comorbid disorders like substance use disorders as well as changing environmental conditions could mediate the course of antisocial and delinquent behavior with increasing age. However, this complex interaction is only partially understood so far. This review presents current knowledge about the association of ADHD with antisociality and the development of delinquent behavior. Thereby, the relationships between ADHD, conduct disorder and antisocial personality disorder in offenders are discussed, as well as the impact of comorbid psychiatric disorders and psychosocial conditions on offending behavior. Also, treatment studies in offender populations with ADHD are presented. Although our understanding of the role of ADHD in the development of criminal behavior has substantially improved during the last two decades, more research is needed to further elucidate the mechanisms generating unfavorable outcomes and to engender adequate treatment strategies for this population at risk. Moreover, more attention is needed on children with conduct problems in order to avoid antisocial or delinquent behaviors over the lifespan.

Inattention in boys from low-income backgrounds predicts welfare receipt: a 30-year prospective study

BACKGROUND

Childhood disruptive behaviors are highly prevalent and associated with adverse long-term social and economic outcomes. Trajectories of welfare receipt in early adulthood and the association of childhood behaviors with high welfare receipt trajectories have not been examined.

METHODS

Boys (n = 1000) from low socioeconomic backgrounds were assessed by kindergarten teachers for inattention, hyperactivity, aggression, opposition, and prosociality, and prospectively followed up for 30 years. We used group-base trajectory modeling to estimate trajectories of welfare receipt from age 19-36 years using government tax return records, then examined the association between teacher-rated behaviors and trajectory group membership using mixed effects multinomial regression models.

RESULTS

Three trajectories of welfare receipt were identified: low (70.8%), declining (19.9%), and chronic (9.3%). The mean annual personal employment earnings (US$) for the three groups at age 35/36 years was $36 500 (s.d. = $24 000), $15 600 (s.d. = $16 275), and $1700 (s.d. = $4800), respectively. Relative to the low welfare receipt group, a unit increase in inattention (mean = 2.64; s.d. = 2.32, range = 0-8) at age 6 was associated with an increased risk of being in the chronic group (relative risk ratio; RRR = 1.16, 95% CI 1.03-1.31) and in the declining group (RRR = 1.13, 95% CI 1.03-1.23), after adjustment for child IQ and family adversity, and independent of other behaviors. Family adversity was more strongly associated with trajectories of welfare receipt than any behavior.

CONCLUSIONS

Boys from disadvantaged backgrounds exhibiting high inattention in kindergarten are at elevated risk of chronic welfare receipt during adulthood. Screening and support for inattentive behaviors beginning in kindergarten could have long-term social and economic benefits for individuals and society.

Association Between Childhood Behaviors and Adult Employment Earnings in Canada

Importance

Specifying the association between childhood behaviors and adult earnings can inform the development of screening tools and preventive interventions to enhance social integration and economic participation.

Objective

To test the association between behaviors at age 6 years and employment earnings at age 33 to 35 years.

Design, Setting, and Participants

This study obtained data from the Quebec Longitudinal Study of Kindergarten Children, a population-based sample of boys and girls (n = 3020) born in 1980 or 1981 in Quebec, Canada, and followed up from January 1, 1985, to December 31, 2015. The data included behavioral ratings by kindergarten teachers when the children were aged 5 or 6 years and 2013 to 2015 government tax returns of those same participants at age 33 to 35 years. Data were analyzed from September 2017 to December 2018.

Main Outcomes and Measures

Mixed-effects linear regression models were used to test the associations between teacher-rated inattention, hyperactivity, aggression, opposition, anxiety, and prosociality at age 6 years and reported annual earnings on income tax returns at age 33 to 35 years. Participant IQ and family adversity were adjusted for in the analysis.

Results

The study included 2850 participants, with a mean (SD) age of 35.9 (0.29) years, of whom 1470 (51.6%) were male and 2740 (96.2%) were white. The mean (SD) personal earnings at follow-up were US $33 300 ($27 500) for men and $19 400 ($15 200) for women. A 1-unit increase in inattention score at age 6 years (males mean [SD], 2.47 [2.42] vs females mean [SD], 1.67 [2.07]) was associated with a decrease in annual earnings of $1271.49 (95% CI, -1908.67 to -634.30) for male participants and $924.25 (95% CI, -1424.44 to -425.46) for female participants. A combined aggression-opposition score (males mean [SD] 2.22 [2.52] vs females mean [SD], 1.05 [1.73]) was associated with a reduction in earnings of $699.83 (95% CI, -1262.49 to -137.17) for males only, albeit with an effect size roughly half that of inattention. A 1-unit increase in prosociality score (males mean [SD], 6.12 [4.30] vs females mean [SD], 7.90 [4.56]) was associated with an increase in earnings of $476.75 (95% CI, 181.53-771.96) for male participants only. A 1-SD reduction in inattention score at age 6 years would theoretically restore $3077 in annual earnings for male participants and $1915 for female participants.

Conclusions and Relevance

In this large population-based sample of kindergarten children, behavioral ratings at 5-6 years were associated with employment earnings 3 decades later, independent of a person's IQ and family background. Inattention and aggression-opposition were associated with lower annual employment earnings, and prosociality with higher earnings but only among male participants; inattention was the only behavioral predictor of income among girls. Early monitoring and support for children demonstrating high inattention and for boys exhibiting high aggression-opposition and low prosocial behaviors could have long-term advantages for those individuals and society.

Does Anxiety Modify the Risk for, or Severity of, Conduct Problems Among Children With Co-Occurring ADHD: Categorical and Dimensional and Analyses

OBJECTIVE

The goal was to examine whether anxiety modifies the risk for, or severity of, conduct problems in children with ADHD.

METHOD

Assessment included both categorical and dimensional measures of ADHD, anxiety, and conduct problems. Analyses compared conduct problems between children with ADHD features alone versus children with co-occurring ADHD and anxiety features.

RESULTS

When assessed by dimensional rating scales, results showed that compared with children with ADHD alone, those children with ADHD co-occurring with anxiety are at risk for more intense conduct problems. When assessment included a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnosis via the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic Version (K-SADS), results showed that compared with children with ADHD alone, those children with ADHD co-occurring with anxiety neither had more intense conduct problems nor were they more likely to be diagnosed with oppositional defiant disorder or conduct disorder.

CONCLUSION

Different methodological measures of ADHD, anxiety, and conduct problem features influenced the outcome of the analyses.

Self- and Parent-Rated Quality of Life of a Treatment Naïve Sample of Children With ADHD: The Impact of Age, Gender, Type of ADHD, and Comorbid Psychiatric Conditions According to Both a Categorical and a Dimensional Approach

OBJECTIVE

Our aim was to evaluate the Quality of Life (QoL) of treatment naïve children with ADHD.

METHOD

Data from 178 parent-child dyads were analyzed using multiple regression to assess the relationships between QoL, and characteristics of ADHD and comorbid psychopathology.

RESULTS

Lower self-reported QoL was associated with female gender, higher age, more symptoms of anxiety and trauma-related disorders in dimensional approach, and with the comorbid diagnoses of trauma-related disorders and oppositional defiant disorder (ODD)/conduct disorder (CD) in categorical approach. Lower parent-reported QoL was related to older age and increasing number of symptoms of mood and anxiety disorders on one hand, and any diagnosis of mood and anxiety disorders and ODD/CD on the other.

CONCLUSION

Our results draw the attention to the importance of taking into account age, gender, and both self- and parent reports when measuring QoL of children with ADHD and both dimensional and categorical approaches should be used.

Neurodevelopmental disorders

Neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder, although most commonly considered in childhood, can be lifelong conditions. In this Personal View that is shaped by clinical experience and research, we adopt a conceptual approach. First, we discuss what disorders are neurodevelopmental and why such a grouping is useful. We conclude that both distinction and grouping are helpful and that it is important to take into account the strong overlap across neurodevelopmental disorders. Then we highlight some challenges in bridging research and clinical practice. We discuss the complexity of clinical phenotypes and the importance of the social context. We also argue the importance of viewing neurodevelopmental disorders as traits but highlight that this is not the only approach to use. Finally, we consider developmental change across the life-span. Overall, we argue strongly for a flexible approach in clinical practice that takes into consideration the high level of heterogeneity and overlap in neurodevelopmental disorders and for research to link more closely to what is observed in real-life practice.

A Multi-method Examination of the Links Between ADHD and Personality Disorder

An existing relationship between attention-deficit/hyperactivity disorder (ADHD) and personality disorder (PD) has been well documented, yet research has been limited by possible selection and self-report biases as well as PD models of questionable validity. This study examined the relationship of ADHD with adult personality traits and disorders in a sample that included individuals prescreened for elevated childhood ADHD symptoms. Four hundred thirty-nine undergraduates completed retrospective reports of childhood ADHD symptoms as well as current ratings of ADHD symptoms, traditional PD categories, and the DSM-5 alternative PD trait model. To overcome potential biases in self-report, 161 parents of the participants provided ratings of childhood and current functioning. Results suggest that while self-report of ADHD was significantly correlated with several PDs, parent reports obtained somewhat more specific links with adult dependent, borderline, and paranoid PDs. Most importantly, the DSM-5 Section III dimensional trait model provided greater specificity, as the trait of distractibility consistently emerged as a unique predictor, and thus appeared more useful for understanding the developmental pathways of ADHD.

Insecure maternal attachment is associated with depression in ADHD children

The objective of this study was to analyze the possible association between maternal attachment style and comorbidity associated with childhood ADHD. We evaluated a total of 103 children with ADHD treated at a Child and Adolescent Mental Health Centre and their mothers. Comorbidity was evaluated using the MINI-KID interview. Maternal attachment was evaluated using the Adult Attachment Questionnaire. We considered child variables that could be associated with the clinical course of ADHD, such as symptom severity, age, gender, evolution time, academic level, and current pharmacological treatment; parental variables, such as the mother's psychiatric history, current psychopathology, marital status, academic level, income, and employment, were also considered. We found an association between maternal insecure attachment and comorbid depressive disorder in childhood ADHD. An insecure maternal attachment style must be considered in the assessment and treatment of childhood ADHD with comorbid depression.

The Association Between ADHD and Antisocial Personality Disorder (ASPD): A Review

OBJECTIVE

Children with ADHD have an increased risk of later developing personality disorders and criminal behavior. The object of the present review is to analyze the associations between ADHD and antisocial personality disorder (ASPD).

METHOD

A review of literature was done using EMBASE, PsycINFO, and Medline databases.

RESULTS

Eighteen prospective studies (n = 5,501) showed that ADHD with and without comorbid conduct disorder (CD) is a strong predictor for the risk of later development of antisocial personality disorder (ASPD). Some of the 13 cross-sectional/retrospective studies (n = 2,451) suggested that ADHD and CD might be a separate subtype of ADHD, that especially impulsivity in ADHD is a predictor for later development of ASPD, or that callous-unemotional traits in the ADHD children are called for a risk factor for later ASPD.

CONCLUSION

There is an increased risk for children with ADHD with or without comorbid CD to develop later onset of antisocial personality disorder.

The Role of the Catechol-o-Methyltransferase (COMT) GeneVal158Met in Aggressive Behavior, a Review of Genetic Studies

Aggressive behaviors have become a major public health problem, and early-onset aggression can lead to outcomes such as substance abuse, antisocial personality disorder among other issues. In recent years, there has been an increase in research in the molecular and genetic underpinnings of aggressive behavior, and one of the candidate genes codes for the catechol-O-methyltransferase (COMT). COMT is involved in catabolizing catecholamines such as dopamine. These neurotransmitters appear to be involved in regulating mood which can contribute to aggression. The most common gene variant studied in the COMT gene is the Valine (Val) to Methionine (Met) substitution at codon 158. We will be reviewing the current literature on this gene variant in aggressive behavior.

School mobility during childhood predicts psychotic symptoms in late adolescence

BACKGROUND

Recently, school mobility was identified as a risk factor for psychotic symptoms in early adolescence. The extent to which this risk continues into late adolescence and the trajectories via which this risk manifests remain unexplored.

METHODS

Psychotic symptoms in 4,720 adolescents aged 18 were ascertained by trained psychologists using the Psychosis-Like Symptoms Interview. Mothers reported on sociodemographic factors (i.e., family adversity, ethnicity and urbanicity) from pregnancy to 4 years; child's involvement in bullying at age 6-7 years; residential mobility at 11 years and school mobility at 11-12 years. Young people reported on their friendships at 8 years, and antisocial behaviour and cannabis use at 15 years.

RESULTS

School mobility across childhood significantly predicted psychotic symptoms at 18 years (adjusted odds ratio = 2.15; 95% confidence intervals = 1.06, 4.40). Within path analysis, school mobility (β = .183, p = .035), involvement in bullying (β = .133, p = .013), antisocial behaviour (β = .052, p = .004), cannabis use (β = .254, p = .020) and female sex (β = .420, p < .001) significantly predicted psychotic symptoms. Residential mobility (β = .375, p < .001), involvement in bullying (β = .120, p = .022) and poor friendships (β = .038, p = .014) significantly predicted school mobility. Residential mobility indirectly increased the risk of psychotic symptoms via school mobility (β = .069, p = .041).

CONCLUSIONS

Children who move schools often are more likely to have experienced peer problems. School mobility, in turn, appears to be a robust marker for psychotic symptoms in late adolescence. Clinicians and teachers should consider school mobility as an important risk indicator for both peer problems and psychopathology.

Gene expression profiling of midbrain dopamine neurons upon gestational nicotine exposure

Maternal smoking during pregnancy is associated with low birth weight, increased risk of stillbirth, conduct disorder, attention-deficit/hyperactivity disorder and neurocognitive deficits. Ventral tegmental area dopamine (DA) neurons in the mesocorticolimbic pathway were suggested to play a critical role in these pathological mechanisms induced by nicotine. Nicotine-mediated changes in genetic expression during pregnancy are of great interest for current researchers. We used patch clamp methods to identify and harvest DA and non-DA neurons separately and assayed them using oligonucleotide arrays to elucidate the alterations in gene expressions in these cells upon gestational nicotine exposure. Microarray analysis identified a set of 135 genes as significantly differentially expressed between DA and non-DA neurons. Some of the genes were found to be related to neurological disease pathways, such as Alzheimer's disease, Parkinson's disease and Huntington's disease. Significantly up-/down-regulated genes found in DA neurons were mostly related to G-protein-coupled protein receptor signaling and developmental processes. These alterations in gene expressions may explain, partially at least, the possible pathological mechanisms for the diseases induced by maternal smoking.

A Flow Chart of Behavior Management Strategies for Families of Children with Co-Occurring Attention-Deficit Hyperactivity Disorder and Conduct Problem Behavior

Behavioral parent training is an evidence-based treatment for problem behavior described as attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder. However, adherence to treatment fidelity and parent performance of the management skills remains an obstacle to optimum outcome. One variable that may limit the effectiveness of the parent training is that demanding behavior management procedures can be deceptively complicated and difficult to perform. Based on outcome research for families of children with co-occurring ADHD and conduct problem behavior, an example of a visual behavior management flow chart is presented. The flow chart may be used to help teach specific behavior management skills to parents. The flow chart depicts a chain of behavior management strategies taught with explanation, modeling, and role-play with parents. The chained steps in the flow chart are elements common to well-known evidence-based behavior management strategies, and perhaps, this depiction well serve as a setting event for other behavior analysts to create flow charts for their own parent training, Details of the flow chart steps, as well as examples of specific applications and program modifications conclude.

The Development of Comorbid Conduct Problems in Children With ADHD: An Example of an Integrative Developmental Psychopathology Perspective

OBJECTIVE

We describe interactions among factors that contribute to the development of conduct problems among children with ADHD.

METHOD

An integrative developmental psychopathology analysis combines various approaches and posits one model of how diverse risk factors operate together to contribute to the development of conduct problems among children with ADHD.

RESULTS

Substantial genetic risk increases covariation between ADHD and conduct problems. Candidate genes are associated with CNS monoaminergic neurotransmission. Subsequent neurodevelopmental impairment interferes with executive function, with impaired verbal working memory playing an important role. Parent/child bi-directional influences exacerbate the risk for conduct problems when ADHD symptoms increase the likelihood of a coercive parenting style. Parent stress in reaction to child comorbid ADHD and conduct problems, and parent attribution for the child's conduct problem behavior, add to the potential for coercion and reduce constructive parent-child interaction that might otherwise enhance the development of verbal working memory.

CONCLUSION

In an integrated manner, these variables increase the risk that a child with ADHD will subsequently develop conduct problems.

Anxiety, Decision Conflict, and Health in Caregivers of Children with ADHD: A Survey

The purpose of this study was to test a theoretical model to determine the effect of caregiver anxiety and decision conflict on the health of caregivers of children with ADHD. Cross-sectional analyses were conducted on data derived from caregivers (aged 24-70). Participants completed the Decision Conflict Scale, the Zung Anxiety Scale, the Duke Health Profile, and a demographic form. A path model that fit well indicated that anxiety and decision conflict had direct and indirect effects on the caregivers' health. Future study is needed to clarify factors contributing to uncertainty and to decrease emotional symptoms for caregivers, thus promoting their mental health.

Maternal psychiatric history is associated with the symptom severity of ADHD in offspring

Controversy exists about the role of parent psychopathology in persistence and severity of attention deficit hyperactivity disorder (ADHD) symptoms in their children. Here we aimed to analyse the potential association between the severity of ADHD symptoms in children and the presence of psychiatric and ADHD symptoms in their biological parents. Seventy-three triads of children and their parents who were in active treatment for their diagnosed ADHD were evaluated in our Child and Adolescent Mental Health Centers. The mental health of the parents was also assessed. The general psychopathology of the parents was evaluated using the Symptom Checklist-90-R (SCL-90-R), and symptoms of hyperactivity were examined using the Adult ADHD Self-Report Scale (ASRS v.1.1). The severity of symptoms in children was assessed using the ADHD Rating Scale-IV (ADHD-RS-IV). Variables that could have affected the clinical development of ADHD such as sex, evolution time, age, academic level and the presence of comorbidities were controlled. The severity of the symptoms in children with ADHD was significantly related to the psychiatric history of their mother, the younger age of the child and the presence of a comorbid conduct disorder in the child. We discussed the importance of screening for parental psychopathology in clinical practice.

Perceived social acceptance and peer status differentially predict adjustment in youth with and without ADHD

OBJECTIVE

This study extends previous research and examined if the longitudinal relation between self-perceived social acceptance and changes in adjustment was moderated by peer status and ADHD diagnosis.

METHOD

A sample of children with ADHD and a normative comparison group (age 8-13 years) were assessed at baseline and one-year follow-up. Self-perceived social acceptance, peer status, and three areas of adjustment (depression symptoms, aggression/conduct problems, and social skills) were measured.

RESULTS

Moderation was found when predicting depression symptoms and aggression/conduct problems. Specifically, in children with ADHD only, higher perceived social acceptance protected against increases in depression symptoms for those with lower peer preference, but predicted greater aggression/conduct problems for those with higher peer preference. There was not evidence of significant moderation for predicting social skills; instead non-ADHD status, greater peer preference, and greater self-perceived social acceptance were each predictive of greater social skills.

CONCLUSION

Results highlight the complex association between positive social self-perceptions and adjustment for children with ADHD and caution against a universal assumption that high self-perceptions are adaptive.

Does low birth weight share common genetic or environmental risk with childhood disruptive disorders?

Although advances in neonatal care over the past century have resulted in increased rates of survival among at-risk births, including infants with low birth weight, we have much to learn about psychological outcomes in this population. In particular, despite growing evidence that low birth weight may be associated with an increased risk for Attention-Deficit/Hyperactive Disorder (ADHD) symptoms in childhood, few studies have examined birth weight as a risk factor for disruptive disorders that commonly co-occur with ADHD. In addition, the etiology of the relation between birth weight and these disorders is unknown. The current investigation aimed to better understand these associations in the context of potentially confounding genetic and environmental influences by examining phenotypic associations between birth weight and disruptive disorder symptoms both between families and within families in two independent twin samples (Sample 1: N = 1,676 individuals; Sample 2: N = 4,038 individuals). We found negative associations between birth weight and inattentive, hyperactive-impulsive, and broad externalizing symptoms in both samples. Nonetheless, the overall magnitude of these associations was very small, contributing to less than 1% of the variance in these symptom dimensions. Within-family associations between birth weight and disruptive disorder symptoms did not differ for monozygotic and dizygotic twin pairs, suggesting that nonshared environmental influences rather than common genetic influences are responsible for these associations. Overall, the consistent albeit weak associations between birth weight and disruptive disorder symptoms suggest that low birth weight may not represent a major risk factor in the development of these symptoms.

Adolescent ADHD and adult physical and mental health, work performance, and financial stress

OBJECTIVE

There is a scarcity of longitudinal studies of adolescents with attention-deficit/hyperactivity disorder (ADHD) followed until adulthood. We studied the relationship between ADHD in adolescence and impaired general physical health, impaired general mental health, antisocial personality disorder, impaired work performance, and high financial stress in adulthood.

METHODS

A prospective design incorporated 6 assessments of participants spanning mean ages from 14 to 37 years. Two baseline assessments were taken between ages 14 and 16 years, and 5 outcome assessments were taken at mean age 37 years. Participants were assessed with structured interviews and questionnaires. The participants were from a community sample of individuals initially drawn in 1975 and followed to a mean age of 37 years in 2009.

RESULTS

The adjusted odds ratios and 95% confidence intervals (CIs) for ADHD in adolescence as related to internal stress in adulthood were 1.82 (95% CI = 1.01-3.25; P < .05) for impaired general physical health, 2.36 (95% CI = 1.23-4.51; P < .01) for impaired general mental health, and 3.28 (95% CI = 1.51-7.13; P < .01) for antisocial personality disorder. The adjusted odds ratios and 95% CIs for ADHD in adolescence as related to external stress were 2.46 (95% CI = 1.37-4.43; P < .01) for impaired work performance and 3.33 (95% CI = 1.70-6.55; P < .001) for high financial stress.

CONCLUSIONS

Clinicians should focus on early diagnosis and treatment of adolescent ADHD because it is a major predictor of an array of physical, mental, work, and financial problems in adulthood.

Association study of GIT1 gene with attention-deficit hyperactivity disorder in Brazilian children and adolescents

Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children with a worldwide prevalence of 5.3%. Recently, a Korean group assessed the G-protein-coupled receptor kinase-interacting protein 1 (GIT1) gene that had previously been associated with ADHD. In their work, 27 single nucleotide polymorphisms SNPs in the GIT1 gene were tested; however, only the rs550818 SNP was associated with ADHD susceptibility. Moreover, the presence of the risk-associated allele determined reduced GIT1 expression, and Git1-deficient mice exhibit ADHD-like phenotypes. The aim of this study was to determine if this association also occurs in a sample of Brazilian children with ADHD. No effect of GIT1 genotypes on ADHD susceptibility was observed in the case-control analysis. The odds ratios (ORs) were 0.75 (P = 0.184) for the CT genotype and 1.09 (P = 0.862) for the TT genotype. In addition, the adjusted OR of the CT+TT genotypes vs. the CC genotype was also estimated (P = 0.245). There were no dimensional associations between the GIT1 genotypes and both hyperactivity and /impulsivity, and only hyperactivity Swanson, Nolan and Pelham Scale-Version IV (SNAP-IV) scores (P = 0.609 and P = 0.247, respectively). The transmission/disequilibrium test indicated that there was no over-transmission of rs550818 alleles from parents to ADHD children (z = 0.305; P = 0.761). We conclude that rs550818 is not associated with ADHD in this Brazilian sample. More studies are required before concluding that this polymorphism plays a role in ADHD susceptibility.

Parenting in adults with attention-deficit/hyperactivity disorder (ADHD)

Although the validity of adult ADHD is well established and research has identified a variety of impairments associated with the condition in adults, study of how ADHD impacts an adult's ability to parent has been relatively neglected. Parenting is a particularly important domain of functioning given the familial nature of the disorder and emerging evidence that parenting behaviors play a role in the development or maintenance of child ADHD symptoms, comorbid psychopathologies, and other associated difficulties. In this paper, we focus on three broad categories of cognitive dysfunction proposed across models of ADHD - cognitive processes (e.g., working memory, planning, and inhibitory control), self-regulation deficits (e.g., self-monitoring of performance to detect errors or the need for regulation of behavior and/or emotions), and motivational or arousal difficulties (e.g., response to incentives, delay aversion). We consider how these deficits may lead to impairments in the parenting behaviors of effective behavioral control and emotional responsiveness, and review the available evidence regarding parenting in adults with ADHD symptoms. We conclude by noting the limitations in existing studies, and argue for further research that is theoretically grounded in how core deficits of ADHD may be related to dimensions of parenting. The implications of an improved understanding of how ADHD impacts parenting for the development of early intervention or prevention programs are outlined.

Attention deficit hyperactivity disorder does not predict criminal recidivism in young adult offenders: Results from a prospective study

As the state of research on the relationship between attention deficit hyperactivity disorder (ADHD) and recidivism can be considered controversial, our prospective study investigated whether ADHD predicts recidivism in a sample of 283 male, German, young adult prisoners. Currently existing ADHD symptoms and symptoms that were present in childhood were screened according to the DSM-IV checklist criteria. Information on general and violent recidivism was gathered using government records with a follow-up period of up to five years. The prevalence of adult ADHD was six times greater than in the general population, and the number of participants who retrospectively met the criteria for a diagnosis with ADHD in childhood was ten times greater than found in community samples. Survival analyses did not identify ADHD as a predictor of recidivism. Controlling for conduct disorder, substance dependence, and other relevant variables did not alter results. However, among individuals who were released from prison and then reconvicted for a new crime, offenders diagnosed with ADHD were found to reoffend sooner after release. These findings stress the necessity of differentiating between risk factors for delinquency and risk factors for recidivism.

Catechol-O-methyltransferase valine158methionine polymorphism moderates methylphenidate effects on oppositional symptoms in boys with attention-deficit/hyperactivity disorder

BACKGROUND

The catechol-O-methyltransferase enzyme plays a key role in the function of prefrontal cortex, accounting for most of the degradation of dopamine. Previous studies have documented the improvement of oppositional symptoms in attention-deficit/hyperactivity disorder (ADHD) patients with methylphenidate (MPH) treatment. However, the effect of the COMT gene in the response to MPH on oppositional symptoms has not been investigated.

METHODS

A total of 251 children with ADHD fulfilled inclusion criteria to participate in the study. Dosages of short-acting MPH were augmented until no further clinical improvement was detected or until there were significant adverse events (MPH dose always > .3 mg/kg/day). The outcome measure was the parent-rated oppositional subscale of the Swanson, Nolan and Pelham Scale-Version IV (SNAP-IV). The scale was applied by child psychiatrists blinded to genotype at baseline and in the first and third months. The COMT valine158methionine polymorphism was genotyped by polymerase chain reaction based methods.

RESULTS

We detected significant improvement in SNAP-IV oppositional scores from baseline to the first and three months of treatment [n = 112; F(2,231) = 5.35, p = .005]. A significant effect of the presence of methionine allele in oppositional defiant disorder scores during treatment [F(1,148) = 5.02, p = .027] and a significant interaction between the methionine allele and treatment over time for the SNAP-IV oppositional scores during this period of treatment [F(2,229) = 6.40, p = .002] were both observed.

CONCLUSIONS

These results suggest an effect of the COMT genotype on the trajectory of oppositional defiant disorder symptoms improvement with MPH treatment in boys with ADHD.

How effective are severe disciplinary policies? School policies and offending from adolescence into young adulthood

Based on the stage environment and the person environment fit perspectives, the current study examined the relation between school disciplinary policies and offending from adolescence into young adulthood. Using Waves I and III of the National Longitudinal Study of Adolescent Health (a.k.a., Add Health), hierarchical multinomial logistic regression models were utilized to test whether school disciplinary policies were related to offending patterns during adolescence and young adulthood. Descriptive results suggest that, overall, severe school policies were not associated with the course of offending. However, relations between individual characteristics (i.e., inattention and impulsivity) and offending patterns did appear to differ depending on the severity of disciplinary policies. Within schools with more severe policies, adolescents scoring higher on inattention were more likely to be in the adolescent-limited offender group over the persistent offender group. On the other hand, adolescents with high levels of impulsivity were more likely to be in the persistent group over the non-offender group within schools with more severe policies. The results suggest that severe policies may not be effective for all students and the policies, alone, may not be promising avenues for the prevention of offending during adolescence and young adulthood.

Changes in self-perceptions in children with ADHD: a longitudinal study of depressive symptoms and attributional style

This study examined positive self-perceptions in relation to depressive symptoms and attributional style in a sample of 88 boys with attention-deficit/hyperactivity disorder (ADHD) assessed at baseline and at a 2- to 3-year follow-up. Change in boys' self-perceptions of competency in the scholastic, social, and behavioral domains was examined as a predictor of changes in depressive symptoms and depressive attributional style. Additionally, teacher-rated perceptions of competency at baseline and follow-up were considered as unique predictors. Results indicated that across all three domains, a reduction in children's self-perceptions of competency over time predicted greater depressive symptoms at follow-up, even when controlling for teacher-rated competency. Analyses also suggested that a reduction in self-perceptions in the social domain was the strongest relative predictor of later depressive symptoms and also predicted greater depressive attributional style at follow-up. In contrast, teacher-rated competency was not a significant predictor of depressive symptoms or attributional style at follow-up. Results support a protective function of positive self-perceptions in regards to depressive cognitions over a 2- to 3-year period for children with ADHD. However, literature suggesting risks for other negative outcomes also is discussed.

[Military service with adult attention deficit hyperactivity disorder: adaptability of affected soldiers on active service in the German Armed Forces]

BACKGROUND

Due to various stressors, soldiers need a high level of social functioning. In those with ADHS, psychological problems and thus a disability for duty can result.

MATERIAL AND METHODS

Thirty-six German Armed Forces members with ADHS who presented themselves as outpatients or inpatients in the Army Hospitals of Hamburg and Berlin between 2005 and 2007 were evaluated retrospectively and compared with a control group. The adaptability during duty was defined based on five criteria and statistical correlations with psychological status and psychosocial risk factors of the soldiers were evaluated.

RESULTS

Of the soldiers with ADHS, 55.6% were able to continue their duty. Cumulative adaptability problems in the Army were significantly correlated with aggressive and dissocial symptoms and with partnership problems. The control group showed no correlations.

CONCLUSIONS

The results show that adult ADHS does not automatically prevent a soldier from military duty and thus indicate that a differentiated judgement should be preferred.

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.

Correlation of a set of gene variants, life events and personality features on adult ADHD severity

Increasing evidence suggests that symptoms of attention deficit hyperactivity disorder (ADHD) could persist into adult life in a substantial proportion of cases. The aim of the present study was to investigate the impact of (1) adverse events, (2) personality traits and (3) genetic variants chosen on the basis of previous findings and (4) their possible interactions on adult ADHD severity. One hundred and ten individuals diagnosed with adult ADHD were evaluated for occurrence of adverse events in childhood and adulthood, and personality traits by the Temperament and Character Inventory (TCI). Common polymorphisms within a set of nine important candidate genes (SLC6A3, DBH, DRD4, DRD5, HTR2A, CHRNA7, BDNF, PRKG1 and TAAR9) were genotyped for each subject. Life events, personality traits and genetic variations were analyzed in relationship to severity of current symptoms, according to the Brown Attention Deficit Disorder Scale (BADDS). Genetic variations were not significantly associated with severity of ADHD symptoms. Life stressors displayed only a minor effect as compared to personality traits. Indeed, symptoms' severity was significantly correlated with the temperamental trait of Harm avoidance and the character trait of Self directedness. The results of the present work are in line with previous evidence of a significant correlation between some personality traits and adult ADHD. However, several limitations such as the small sample size and the exclusion of patients with other severe comorbid psychiatric disorders could have influenced the significance of present findings.

Predictive familial risk factors and pharmacological responses in ADHD with comorbid disruptive behavior disorders

BACKGROUND

The aim of the present study was to examine the putative familial risk factors and evaluate the pharmacological effects in children and adolescents of attention-deficit-hyperactivity disorder (ADHD) with comorbid disruptive behavior disorders (DBD) and normal IQ.

METHODS

The retrospective study included 144 Japanese subjects (age, 5-18 years) with ADHD, of whom 35 subjects (24%) met the diagnostic criteria for DBD. Using multiple regression analysis, the familial background risk factors that might increase any comorbid antisocial behaviors were assessed. Furthermore, the 20 methylphenidate (MPH)-resistant DBD subjects were divided into three treatment groups: MPH plus risperidone (n= 8); MPH plus carbamazepine (n= 5); and MPH plus lithium carbonate (n= 4). The effectiveness of the treatment was evaluated both before and after the add-on therapy using the Clinical Global Impressions-Improvement (CGI-I) and CGI-Severity (CGI-S) scale.

RESULTS

The putative familial risk factors were child abuse (odds ratio [OR], 19.48; P= 0.013) and maternal psychiatric disorders (OR, 15.59; P= 0.027). The addition of risperidone had the strongest tendency to improve the CGI-S score (P= 0.063) and the highest rate of responses (50%) among the three treatment groups, albeit with no significant differences. Very few remarkable adverse clinical symptoms were observed.

CONCLUSIONS

Child abuse and maternal psychiatric disorders are suggested to be significant risk factors in influencing the development of comorbid DBD in offspring. The use of risperidone appears to be well tolerated and is moderately effective in MPH-resistant aggression in ADHD children and adolescents with comorbid DBD.

Attention-deficit/hyperactivity disorder phenotype is influenced by a functional catechol-O-methyltransferase variant

The catechol-O-methyltransferase gene (COMT) plays a crucial role in the metabolism of catecholamines in the frontal cortex. A single nucleotide polymorphism (Val(158)Met SNP, rs4680) leads to either methionine (Met) or valine (Val) at codon 158, resulting in a three- to fourfold reduction in COMT activity. The aim of the present study was to assess the COMT Val(158)Met SNP as a risk factor for attention-deficit/hyperactivity disorder (ADHD), ADHD symptom severity and co-morbid conduct disorder (CD) in 166 children with ADHD. The main finding of the present study is that the Met allele of the COMT Val(158)Met SNP was associated with ADHD and increased ADHD symptom severity. No association with co-morbid CD was observed. In addition, ADHD symptom severity and early adverse familial environment were positive predictors of lifetime CD. These findings support previous results implicating COMT in ADHD symptom severity and early adverse familial environment as risk factors for co-morbid CD, emphasizing the need for early intervention to prevent aggressive and maladaptive behavior progressing into CD, reducing the overall severity of the disease burden in children with ADHD.

Childhood ADHD and conduct disorder as independent predictors of male alcohol dependence at age 40

OBJECTIVE

The Danish Longitudinal Study on Alcoholism was designed to identify antecedent predictors of adult male alcoholism. The influence of premorbid behaviors consistent with childhood conduct disorder (CD) and attention-deficit/hyperactivity disorder (ADHD) on the development of alcohol misuse was examined.

METHOD

Subjects were selected from a Danish birth cohort (9,125), which included 223 sons of alcoholic fathers (high risk) and 106 matched sons of nonalcoholic fathers (low risk). These subjects have been studied systematically over the past 40 years. They were evaluated in their teens (n=238), later as adults at age 30 (n=241), and more recently at age 40 (n=202). At 19-year/20-year follow-ups, an ADHD scale was derived from teacher ratings and a CD scale was derived from a social worker interview. At 30-year and 40-year follow-ups, a psychiatrist used structured interviews and criteria from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, to quantify lifetime alcoholism severity and to diagnose alcohol-use disorder. Of the original subjects, 110 had complete data for the two childhood measures and the adult alcoholism outcomes.

RESULTS

In this smaller subsample, paternal risk did not predict adult alcohol dependence. Subjects who were above a median split on both the ADHD and the CD scales were more than six times more likely to develop alcohol dependence than subjects who scored below the median on both. Although the two childhood measures were correlated, a multiple regression showed that each independently predicted a measure of lifetime alcoholism severity.

CONCLUSIONS

ADHD comorbid with CD was the strongest predictor of later alcohol dependence.

Psychopathy traits in adolescents with childhood attention-deficit hyperactivity disorder

BACKGROUND

Children with attention-deficit hyperactivity disorder (ADHD) are thought to be at higher risk of psychopathy. Early biological and social adversity may contribute to this risk.

AIMS

To examine psychopathy traits in ADHD.

METHOD

In a sample of children with ADHD who had reached adolescence, total psychopathy and 'emotional-dysfunction' scores (e.g. callousness, lack of affect) were assessed using the Hare Psychopathy Checklist-Youth Version.

RESULTS

A total of 156 (79%) eligible families participated. Total psychopathy and emotional-dysfunction scores were elevated in comparison to published UK norms but none scored in the clinical range for psychopathy. Adjusting for associated conduct problems, total psychopathy scores were associated with maternal smoking during pregnancy, emotional-dysfunction scores were associated with birth complications, and neither was associated with family adversity.

CONCLUSIONS

Children with ADHD show psychopathy traits but are not 'psychopaths'. Early adversity, indexed by pre- or perinatal adversity but not family factors, appears to be associated.

Serotonin transporter gene and adverse life events in adult ADHD

Childhood attention deficit hyperactivity disorder (ADHD) symptomatology persists in a substantial proportion of cases into adult life. ADHD is highly heritable but the etiology of ADHD is complex and heterogeneous, involving both genetic and non-genetic factors. In the present article we analyzed the influence of both genetics and adverse life events on severity of ADHD symptoms in 110 adult ADHD patients. Subjects were genotyped for the norepinephrine transporter (NET), the catechol-O-methyltransferase (COMT), the serotonin transporter promoter polymorphism (SERTPR) and the more rare A/G variant within SERTPR. Three main outcomes were obtained: (1) adverse events showed a small but positive correlation with current ADHD severity; (2) NET, COMT and the A/G variant within SERTPR were not associated with ADHD severity; (3) taking into account stressors, the long (L) SERTPR variant showed a mild effect on ADHD, being associated with an increased severity, particularly as regard affective dysregulations; on the other hand, in subjects exposed to early stressors, it showed a protective effect, as compared to the short (S) variant. In conclusion, our data support the role of environmental factors in adult ADHD symptomatology. SERTPR may be involved in some features of the illness and act as a moderator of environmental influences in ADHD.

An orbitofrontostriatopallidal pathway for morality: evidence from postlesion antisocial and obsessive-compulsive disorder

INTRODUCTION

A detailed proposal is made to the effect that nonlesional antisocial personality disorder (APD) is, among other things, a dysfunctional hypomoralism and that nonlesional obsessive-compulsive disorder (OCD) is, among other things, a dysfunctional hypermoralism.

METHOD

To provide an empirical test of this proposal, 25 previously published cases of acquired (post lesion) APD and 39 cases of acquired OCD are reviewed and compared with multivariate inference tests.

RESULTS

The acquired APD patients most often present putamenal or pallidal lesions.

CONCLUSION

The ensemble of neurobiological, endocrine, and behavioural traits in APD and OCD, as well as the distinct lesion sites in the acquired variants, support the notion of an orbitofrontostriatopallidal brain system underlying morality.

Effects of diagnostic comorbidity and dimensional symptoms of attention-deficit–hyperactivity disorder in men with antisocial personality disorder

OBJECTIVE

Although children with attention deficit hyperactivity disorder (ADHD) are at increased risk for later onset of antisocial personality disorder (APD) as adults, the utility of ADHD as either a comorbid diagnosis (ADHD(c)) or dimensional symptoms (ADHD(d)) in predicting behaviour and substance use problems in APD subjects has not been examined.

METHOD

A total of 105 adult male offenders with Structured Clinical Interview for Axis II Disorders (SCID-II)-based DSM-III-R APD were studied in terms of: (i) psychopathy scores on the Hare Psychopathy Checklist-Revised (PCL-R); (ii) ADHD(c) diagnostic comorbidity on clinically administered DSM-IV questionnaire; and (iii) ADHD(d) dimensional symptoms by means of Wender Utah Rating Scale (WURS) and Conners Adult ADHD Rating Scale (CAARS) during a 12 month study period (May 2005-May 2006).

RESULTS

Sixty five per cent of APD subjects met criteria for ADHD(c) diagnostic comorbidity with significantly increased rates of childhood neglect, parental divorce and suicide attempt, but not of psychopathy. APD subjects with ADHD(d) symptoms were noted to have earlier onset and increased rate of self-injurious behaviour (SIB), suicide attempt, and psychopathy. The psychopathy scores, in turn, were predictive of earlier onset of SIB and behavioural problems.

CONCLUSION

Both ADHD(c) diagnostic comorbidity and ADHD(d) symptoms need to be assessed in APD subjects and the dimensional measures may be better in detecting earlier onset SIB, suicide attempt and other behavioural problems.

Is NICE infallible? A qualitative study of its assessment of treatments for attention-deficit/hyperactivity disorder (ADHD)

BACKGROUND

Conclusions of the recent NICE technology appraisal of treatments for attention-deficit/hyperactivity disorder (ADHD) differ from recommendations by other Health Technology Assessment (HTA) agencies, such as the Scottish Medicines Consortium (CMS) and the Australian Pharmaceutical Benefits Advisory Committee (PBAC). NICE did not identify differences on grounds of clinical effectiveness between treatment options studied and issued technology guidance based on clinical profiles of compounds and on drug acquisition costs. The aim of the present study was to explore the robustness of NICE assessment methods when addressing a complex clinical problem such as the evaluation of ADHD treatment strategies. This robustness will be of interest to international policy-makers, given the widespread perception of NICE as a role model for the implementation of HTAs including economic evaluation.

METHODS

A qualitative case study was performed to critically appraise the technology assessment report (AR) underlying NICE conclusions, including a systematic search for and analysis of relevant literature.

RESULTS

The AR produced on behalf of NICE was found to exhibit a range of anomalies. Search criteria were not applied consistently, and the available clinical evidence was not used optimally; selection of clinical endpoints and clinical trials for analysis were idiosyncratic. The primary cost-effectiveness model relied on six short-term studies only, and secondary extensions combined heterogeneous study designs and different clinical endpoints. Neither the distinction between efficacy and effectiveness nor the role of treatment compliance in ADHD was addressed adequately. Long-term extensions of the model were impaired by use of inappropriate discount rates and absence of consideration of long-term sequelae associated with ADHD.

CONCLUSION

A review of the literature strongly suggests that the NICE assessment of ADHD treatment strategies was incomplete and likely prone to bias. It is concluded that NICE did not adequately accommodate a complex clinical decision problem. Although the present qualitative case study of one assessment cannot, and was not designed to, invalidate the NICE approach to economic evaluation of healthcare programs, this observation may have potentially far-reaching implications for the generalizability of NICE-like approaches.

Structural brain abnormalities in psychopaths-a review

The biological basis of psychopathy has not yet been fully elucidated. Few studies deal with structural neuroimaging in psychopaths. The aim of this article is to review these studies in order to contribute to our understanding of the biological basis of psychopathy. Data in the literature report a reduction in prefrontal gray matter volume, gray matter loss in the right superior temporal gyrus, amygdala volume loss, a decrease in posterior hippocampal volume, an exaggerated structural hippocampal asymmetry, and an increase in callosal white matter volume in psychopathic individuals. These findings suggest that psychopathy is associated with brain abnormalities in a prefrontal-temporo-limbic circuit-i.e. regions that are involved, among others, in emotional and learning processes. Additionally, data indicate that psychopathic individuals cannot be seen as a homogeneous group. The associations between structural changes and psychopathic characteristics do not enable causal conclusions to be drawn, but point rather to the important role of biological brain abnormalities in psychopathy. To gain a comprehensive understanding of this, psychopathy must be viewed as a multifactorial process involving neurobiological, genetic, epidemiological and sociobiographical factors.

Inattention/overactivity following early severe institutional deprivation: presentation and associations in early adolescence

The current study examined the persistence and phenotypic presentation of inattention/overactivity (I/O) into early adolescence, in a sample of institution reared (IR) children adopted from Romania before the age of 43 months. Total sample comprised 144 IR and 21 non-IR Romanian adoptees, and a comparison group of 52 within-UK adoptees, assessed at ages 6 and 11 years. I/O was rated using Rutter Scales completed by parents and teachers. I/O continued to be strongly associated with institutional deprivation, with continuities between ages 6 and 11 outcomes. There were higher rates of deprivation-related I/O in boys than girls, and I/O was strongly associated with conduct problems, disinhibited attachment and executive function but not IQ more generally, independently of gender. Deprivation-related I/O shares many common features with ADHD, despite its different etiology and putative developmental mechanisms. I/O is a persistent domain of impairment following early institutional deprivation of 6 months or more, suggesting there may be a possible pathway to impairment through some form of neuro-developmental programming during critical periods of early development.

Parent-child relationships and ADHD symptoms: a longitudinal analysis

Evidence both from psychological research and clinical intervention studies suggests that there are bidirectional influences between overt child behavior problems and parent-child relations. Very little research however, has considered the pattern of relations that exists between Attention Deficit Hyperactivity Disorder (ADHD) and the parent-child relationship within a longitudinal context. Using a longitudinal community sample from the United Kingdom which included 194 school aged children (46% male and 54% female) and both parents, this study examined the relationship between child ADHD symptoms and displays of rejection in the parent-child relationship. These relationships were investigated separately for mothers and fathers using cross-lagged panel correlation and reciprocal effects analysis. Mothers and fathers reported on ADHD symptoms and children reported on their feelings of rejection in the mother-child and father-child relationships. Results suggested differences in the direction of effects linking mother- and father-child rejection and child ADHD symptoms; with ADHD symptoms affecting the mother-child relationship and the converse pattern of effects noted for fathers. Implications for future research focusing on the link between ADHD symptoms and parent-child relationships are discussed.

[Experience of parent-related negative life events, mental health, and delinquent behavior among Korean adolescents]

OBJECTIVES

This study examined the relationship of parent-related negative life events with mental health and delinquent behaviors among Korean adolescents.

METHODS

A total of 2,976 high school first-grade pupils (1,498 boys & 1,478 girls) taking part in the third wave of Korean Youth Panel Survey completed a self-administered questionnaire regarding parent-related life events, depressive feelings, suicidal ideation, delinquent behaviors, demographic characteristics, parental socioeconomic status, social support, and social capital. Data analyses were conducted using multivariate logistic regression.

RESULTS

After adjusting for all covariates, the more parent-related negative life events adolescents experienced throughout their whole life, the more likely adolescent were to have mental and behavioral problems. A significant dose-response relationship between them was more clearly observed in girls than in boys. The experience of parent-related negative events during childhood was significantly associated with suicidal ideation and delinquent behaviors for boys, and with depressive feelings for girls during adolescence. Indeed, parental social support, social capital, and having a close friend with delinquent behaviors, especially for girls, partially mediated the relationship between parent-related negative life events and both outcomes.

CONCLUSIONS

The study showed a clear dose-response relationship of frequency of parent-related negative life events with poor mental and behavioral health for both genders. The residual effect of being exposed to parent-related events during childhood on mental health and delinquent behaviors during adolescence still remained.

Prenatal smoking exposure and dopaminergic genotypes interact to cause a severe ADHD subtype

BACKGROUND

In utero exposure to smoking and alcohol are common risk factors that have been associated with attention-deficit/hyperactivity disorder (ADHD) in human beings and animal models. Furthermore, molecular studies have focused on the association between ADHD and DNA polymorphisms in dopamine pathway-related genes. We examined the joint effects of genetic and prenatal substance exposures on DSM-IV and population-defined subtypes of ADHD.

METHODS

Logistic regression was used to assess the relationship between ADHD subtypes, DAT1 and DRD4 polymorphisms, and prenatal substance exposures in a birth-record sample of male and female twin pairs, aged 7-19 years.

RESULTS

Interactions between prenatal exposure to smoking and variations in the DAT1 and DRD4 loci were observed in children with either the DSM-IV or population-defined ADHD combined subtypes. The odds of a diagnosis of DSM-IV combined subtype was 2.9 times greater in twins who had inherited the DAT1 440 allele and who were exposed, than in unexposed twins without the risk allele. The OR was 2.6 in the population-defined subtype. Odds ratios for the DRD4 seven-repeat allele were 3.0 (2.8) in the population-defined (DSM-IV) combined ADHD subtypes. The OR for exposed children with both alleles was 9.0 (95% confidence interval=2.0-41.5) for the population-defined combined subtypes.

CONCLUSIONS

Results indicate that smoking during pregnancy is associated with specific subtypes of ADHD in genetically susceptible children.