An evidenced-based perspective on the validity of attention-deficit/hyperactivity disorder in the context of high intelligence

Prevalence and Correlates of Poor Safety Awareness and Accidental Injury in ASD, ADHD, ASD + ADHD, and Neurotypical Youth Samples

The purpose of the present study is to compare risk and predictors of poor safety awareness and accidental injuries in ASD, ADHD, and neurotypical samples. Neurodivergent groups (ADHD-I n = 309; ADHD-C n = 747; ASD-only n = 328; ASD + ADHD n = 1,108) were 2-17 years old. The neurotypical group (n = 186) was 6-12 years of age. Maternal ratings on the Pediatric Behavior Scale examined safety awareness, accidental injury, and psychological problems. Children with ASD + ADHD had significantly poorer safety awareness and accidental injury ratings than all other groups. Predictors of poor safety awareness in the total ASD and/or ADHD sample were: impulsivity, younger age, lower IQ, and hyperactivity. Predictors of accidental injuries were: incoordination, hyperactivity, and conduct problems. Clinicians working with children who have ASD and ADHD are encouraged to screen for poor safety awareness, discuss child safety measures, and provide evidence-based intervention to improve safety awareness and mitigate the risk of injury.

The Chinese Version of the Compensatory ADHD Behaviors Scale (CABS): A Study on Reliability, Validity, and Clinical Utility

Purpose

With the further development of attention-deficit/hyperactivity disorder (ADHD) research, more and more assessment tools related to ADHD have been used. However, there is still no measurement instrument to evaluate the compensatory behavior of ADHD in China. This study aimed to examine the reliability and validity of the Compensatory ADHD Behaviors Scale (CABS) adapted in Chinese and explore ecological characteristics in adults with ADHD using the CABS.

Patients and Methods

Data were collected from a sample of 306 adults (Mage = 26.43 years, SD = 5.32; 46.08% male). The original version CABS was translated into Chinese using the forward and backward translation procedures. Participants completed the CABS and questionnaires assessing ADHD symptoms and executive function. We utilized content validity, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and criterion validity to test the validity. Internal consistency and test-retest reliability were employed to test the reliability. Analysis of variance (ANOVA) was employed to compare ADHD subgroups based on gender, ADHD subtype, comorbidities, and medication status, while controlling for demographic variables as covariates.

Results

CABS exhibited good construct validity (two factors: present-oriented and future-oriented), content validity (content validity index: 0.98), internal consistency reliability (Cronbach's alpha coefficient: 0.85 to 0.87) and test-retest reliability (intraclass correlation coefficient: 0.59 to 0.88). The results of CFA showed acceptable fitness for each subscale. CABS demonstrated significant associations with inattention symptoms and plan/organizational abilities. Medicated ADHD individuals scored higher on future-oriented effectiveness subscale of CABS than non-medicated (F = 6.106, p = 0.014).

Conclusion

The results indicate that the Chinese CABS exhibited good validity and reliability. It can be considered a valid tool for assessing compensatory behaviors in Chinese adults with ADHD. Further research is needed to explore the connection between medication and compensatory behavior.

ADHD in Adults: Does Age at Diagnosis Matter?

OBJECTIVE

To provide additional information about clinical features associated with adult ADHD in patients diagnosed in childhood compared to those first diagnosed in adulthood.

METHOD

We stratified a sample of adults with ADHD into patients diagnosed in childhood versus adulthood and compared demographic and clinical characteristics.

RESULTS

We found similar clinical features in adults diagnosed in childhood and adults diagnosed in adulthood. Among those diagnosed in adulthood, 95% reported symptom onset in youth. Our results do not support the hypothesis that ADHD diagnosed in adulthood is due to misinterpreting symptoms of other disorders as ADHD. They also suggest incorporating behavioral signs of executive dysfunction into diagnostic criteria for ADHD in adults may increase diagnostic sensitivity.

CONCLUSION

These results support the validity of ADHD diagnoses in adulthood, as these adults show similar clinical profiles to those diagnosed in youth. Our results also suggest that if adult-onset ADHD exists, it is rare.

Attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD; also known as hyperkinetic disorder) is a common neurodevelopmental condition that affects children and adults worldwide. ADHD has a predominantly genetic aetiology that involves common and rare genetic variants. Some environmental correlates of the disorder have been discovered but causation has been difficult to establish. The heterogeneity of the condition is evident in the diverse presentation of symptoms and levels of impairment, the numerous co-occurring mental and physical conditions, the various domains of neurocognitive impairment, and extensive minor structural and functional brain differences. The diagnosis of ADHD is reliable and valid when evaluated with standard diagnostic criteria. Curative treatments for ADHD do not exist but evidence-based treatments substantially reduce symptoms and/or functional impairment. Medications are effective for core symptoms and are usually well tolerated. Some non-pharmacological treatments are valuable, especially for improving adaptive functioning. Clinical and neurobiological research is ongoing and could lead to the creation of personalized diagnostic and therapeutic approaches for this disorder.

Cerebrospinal and Brain Proteins Implicated in Neuropsychiatric and Risk Factor Traits: Evidence from Mendelian Randomization

Neuropsychiatric disorders present a global health challenge, necessitating an understanding of their molecular mechanisms for therapeutic development. Using Mendelian randomization (MR) analysis, this study explored associations between genetically predicted levels of 173 proteins in cerebrospinal fluid (CSF) and 25 in the brain with 14 neuropsychiatric disorders and risk factors. Follow-up analyses assessed consistency across plasma protein levels and gene expression in various brain regions. Proteins were instrumented using tissue-specific genetic variants, and colocalization analysis confirmed unbiased gene variants. Consistent MR and colocalization evidence revealed that lower cortical expression of low-density lipoprotein receptor-related protein 8, coupled higher abundance in the CSF and plasma, associated with lower fluid intelligence scores and decreased bipolar disorder risk. Additionally, elevated apolipoprotein-E2 and hepatocyte growth factor-like protein in the CSF and brain were related to reduced leisure screen time and lower odds of physical activity, respectively. Furthermore, elevated CSF soluble tyrosine-protein kinase receptor 1 level increased liability to attention deficit hyperactivity disorder and schizophrenia alongside lower fluid intelligence scores. This research provides genetic evidence supporting novel tissue-specific proteomic targets for neuropsychiatric disorders and their risk factors. Further exploration is necessary to understand the underlying biological mechanisms and assess their potential for therapeutic intervention.

Masking effect of high IQ on the Rey Auditory Verbal Learning Test in an adult sample with attention deficit/hyperactivity disorder

OBJECTIVE

High intelligence (IQ) adults with attention-deficit/hyperactivity disorder (ADHD) often perform better on neuropsychological tests relative to average IQ adults with ADHD, despite commensurate functional impairment. This study compared adults with ADHD and high versus average IQ on the Rey Auditory Verbal Learning Test (RAVLT) to specifically assess this proposed masking effect of IQ on verbal learning/memory performance among those undergoing neuropsychological evaluation.

METHOD

RAVLT performance between patients with ADHD and average versus high Test of Premorbid Function-estimated IQ were compared. Latent growth curve modeling (LGCM) evaluated learning acquisition across trials.

RESULTS

RAVLT total learning, immediate, and delayed free recall performances were significantly better in the high IQ relative to the average IQ group. LGCM showed similar quadradic growth trajectories for both IQ groups. Both groups reported equivalent symptom severity and functional complaints in childhood and adulthood.

CONCLUSIONS

Adults with ADHD and high IQ performed normally on a verbal learning/memory test compared to adults with average IQ, who scored 0.5-1.0 standard deviations below the mean. These results suggest a masking of performance-based memory deficits in the context of higher IQ in adults with ADHD, supporting growing evidence that higher IQ masks neurocognitive deficits during the assessment of adults with ADHD.

Clinical and Cognitive Features of Attention Deficit Hyperactivity Disorder with Intellectual Giftedness: A Systematic Review

A systematic review was carried out on publications from the last 15 years that have studied the effect of intellectual giftedness, defined as IQ > 115, on the clinical and cognitive features of ADHD. Studies indicate that about 15% of people with high IQ meet ADHD criteria. IQ has shown no effect on the pharmacological treatment, and comorbidity does not differ from that of other children with ADHD. High IQ-ADHD, compared to average IQ-ADHD, tends to show less severity in cognitive and behavioral symptoms, as well as a better prognosis; however high IQ may mask ADHD symptoms delaying diagnosis and treatment.

Neuropsychological Profile of Intellectually Gifted Children: A Systematic Review

OBJECTIVE

The term intellectually gifted (IG) refers to children of high intelligence, which is classically measured by the intelligence quotient (IQ). Some researchers assume that the cognitive profiles of these children are characterized by both strengths and weaknesses, compared with those of their typically developing (TD) peers of average IQ. The aim of the present systematic review was to verify this assumption, by compiling data from empirical studies of cognitive functions (language, motor skills, visuospatial processing, memory, attention and executive functions, social and emotional cognition) and academic performances.

METHOD

The literature search yielded 658 articles, 15 of which met the selection criteria taken from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses model. We undertook a qualitative summary, to highlight any discrepancies between cognitive functions.

RESULTS

IG children exhibited better skills than TD children in a number of domains, including attention, language, mathematics, verbal working memory, shifting, and social problem solving. However, the two groups had comparable skills in visuospatial processing, memory, planning, inhibition, and visual working memory, or facial recognition.

CONCLUSION

Although IG children may have some strengths, many studies have failed to find differences between this population and their TD peers on many other cognitive measures. Just like any other children, they can display learning disabilities, which can be responsible for academic underachievement. Further studies are needed to better understand this heterogeneity. The present review provides pointers for overcoming methodological problems and opens up new avenues for giftedness research.

Educational level, attention problems, and externalizing behaviour in adolescence and early adulthood: the role of social causation and health-related selection-the TRAILS study

Social causation and health-related selection may contribute to educational differences in adolescents' attention problems and externalizing behaviour. The social causation hypothesis posits that the social environment influences adolescents' mental health. Conversely, the health-related selection hypothesis proposes that poor mental health predicts lower educational attainment. From past studies it is unclear which of these mechanisms predominates, as attention problems and externalizing behaviour have the potential to interfere with educational attainment, but may also be affected by differences in the educational context. Furthermore, educational gradients in mental health may reflect the impact of 'third variables' already present in childhood, such as parental socioeconomic status (SES), and IQ. We investigated both hypotheses in relation to educational differences in externalizing behaviour and attention problems throughout adolescence and young adulthood. We used data from a Dutch cohort (TRAILS Study; n = 2229), including five measurements of educational level, externalizing behaviour, and attention problems from around age 14-26 years. First, we evaluated the directionality in longitudinal associations between education, externalizing behaviour, and attention problems with and without adjusting for individual differences using fixed effects. Second, we assessed the role of IQ and parental SES in relation to attention problems, externalizing behaviour, and educational level. Attention problems predicted decreases in education throughout all of adolescence and young adulthood. Differences in parental SES contributed to increases in externalizing behaviour amongst the lower educational tracks in mid-adolescence. Childhood IQ and parental SES strongly predicted education around age 14. Parental SES, but not IQ, also predicted early adolescent attention problems and externalizing behaviour. Our results provide support for the health-related selection hypothesis in relation to attention problems and educational attainment. Further, our results highlight the role of social causation from parental SES in determining adolescent educational level, attention problems, and externalizing behaviour.

Alerting, orienting, and executive control in intellectually gifted children

INTRODUCTION

Intellectually gifted children have higher performance in many domains of attention than intellectually average children. However, these empirical findings are not consistent in the literature. Few studies investigated the characteristics of alerting, orienting, and executive control networks in intellectually gifted children. The aim of our study was to investigate their characteristics of attentional abilities compared to intellectually average children.

METHOD

Fifty-five intellectually gifted children (age range 8-14 years old) were compared to 55 intellectually average children (age range 8-14 years old) using the Attention Network Test (ANT) to assess these three attentional constructs.

RESULTS

Intellectually gifted children made fewer errors than intellectually average children in the processing of the ANT. In terms of attention network scores, they also outperformed intellectually average children in executive control only.

CONCLUSION

Intellectually gifted children do not differ from intellectual average children in terms of the speed of processing in a speeded task such as ANT, but they stand out in terms of accuracy of processing. Intellectually gifted children have better ability to focus volitionally in order to solve a simple perceptual conflict than intellectually average children.

Brain voxel-based morphometry correlates of emotion dysregulation in attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) has a high prevalence of co-occurring with emotion dysregulation (ED). Youths with ADHD and ED are more likely to have increased functional impairment. There is accumulating research on defining the features, behavioral, and physiological manifestations of ED, but there are currently few studies elucidating neuroanatomical correlations of ED in ADHD. Structural magnetic resonance imaging data from 118 children (aged 7-18 years) with ADHD (50 ADHD+high ED, 68 ADHD+low ED), and 104 typically developing controls (TDC) were processed using voxel-based morphometry. We used both dichotomous and continuous indices of ED to examine the possible correspondence between ED and ADHD. Relative to ADHD+high ED, ADHD+low ED had greater gray matter (GM) volumes over the left anterior prefrontal cortex (PFC). ADHD+low ED and ADHD+high ED shared a negative association of ED levels with the left middle temporal pole GM volume. TDC and ADHD+low ED also shared negative relationships of ED levels with the right temporal volume, and positive relationships with the left dorsolateral PFC volume. Besides, ED-by-group interactions were also noted. Specifically, medial PFC GM volumes increased and decreased with ED severity in ADHD+low ED and ADHD+high ED, respectively; and left cerebellum Crus GM volumes decreased and increased with ED severity in ADHD+low ED and ADHD+high ED, respectively. Our findings add to the evidence that some specific neural correlates are underpinning ED across ADHD and TDC. These findings suggest the importance of incorporating ED problems when considering heterogeneity in studies of ADHD.

Lifetime psychiatric hospital diagnoses among 8,412 Danish men registered in an outpatient alcohol clinic

OBJECTIVE

To describe the prevalence of lifetime psychiatric hospital diagnoses among men registered in an outpatient alcohol clinic and compare the prevalence with matched controls. To assess temporality of alcohol use disorder (AUD) diagnoses and another psychiatric hospital diagnosis and examine the prevalence of lifetime psychiatric hospital diagnoses according to this temporal order.

METHODS

The study included 8,412 Danish men registered in an outpatient alcohol clinic, and 8,412 unregistered controls from the Danish Conscription Database matched on birth date, lifespan, intelligence and draft board district. Information on first outpatient AUD treatment was retrieved from the Copenhagen Alcohol Cohort. Information on lifetime psychiatric hospital diagnoses was retrieved from national Danish psychiatric registers and based on the International Classification of Diseases the 8th and 10th Revisions. Prevalence estimates of lifetime psychiatric hospital diagnoses were compared with odds ratios (OR) between men registered in an outpatient alcohol clinic and the control population.

RESULTS

Among men registered in an outpatient alcohol clinic, 66.6% had a lifetime psychiatric hospital diagnosis. In total, 8.6% had neuroses and anxiety disorders, while 25.3% had personality disorders. The OR of a lifetime psychiatric hospital diagnosis was 9.77 (95%CI: 8.87-10.75) when comparing men registered in an outpatient alcohol clinic with the control population. Among men with a lifetime psychiatric hospital diagnosis, 42.8% was registered with another psychiatric hospital diagnosis before registration with an AUD diagnosis.

CONCLUSION

Among men with a lifetime psychiatric hospital diagnosis, AUD is rarely diagnosed without psychiatric comorbidity at first-time admissions to psychiatric hospital departments.

Investigative interviewing of youth with ADHD - recommendations for detective training

Attention deficit hyperactivity disorder (ADHD) in youth can lead to a trajectory of early and repeated contact with the criminal justice system (CJS), where such youth face significant challenges due to the nature of their diagnosis and the lack of specialized detective training in this area. This article reviews Australian detectives' perceptions regarding contact with ADHD-affected youth, ongoing contact of such youth with the CJS, and the impact of ADHD on interviewing time efficiency and quality of information gathered. It explores detectives' perceived impact of ADHD on components of the Cognitive Interview (CI). It overviews detectives' perceptions regarding their own skill/ability, training availability and future training preferences regarding the interviewing of ADHD-affected youth. The authors highlight best practice in specialized detective training, as well as in working with ADHD-affected youth. Recommendations are made regarding the design features of a potential specialized training programme for detectives interviewing ADHD-affected youth.

Cognitive correlates of attention-deficit hyperactivity disorder in children and adolescents with high intellectual ability

BACKGROUND

There is an ongoing debate as to whether attention-deficit hyperactivity disorder (ADHD) in highly intelligent individuals has a similar presentation as in average intelligent individuals. The aim of this study was to examine the cognitive correlates of ADHD in highly intelligent children and adolescents with ADHD.

METHOD

Two independent samples (N = 204 and N = 84) of (1) high intelligence quotient (IQ) (IQ ≥ 120) children and adolescents with ADHD were used, carefully matched on age, gender, ADHD severity, and IQ with (2) control participants with high intelligence, (3) participants with ADHD with an average intelligence (IQ 90-110), and (4) control participants with an average intelligence. These samples were selected from the Dutch node of the International Multicenter ADHD Genetics (NeuroIMAGE) and Tracking Adolescents' Individual Lives Survey (TRAILS) cohorts, respectively, in which a large battery of cognitive tasks was administered. Linear mixed models were used to examine the main effects of ADHD and IQ and their interaction on cognitive performance.

RESULTS

ADHD-control group differences were not moderated by IQ; mostly equally large ADHD-control differences in cognitive performance were found for high versus average intelligent groups. The small moderating effects found mostly indicated somewhat milder cognitive problems in highly intelligent individuals with ADHD. Overall, highly intelligent children and adolescents with ADHD performed at the level of the average intelligent control children.

CONCLUSIONS

Our findings indicate the cognitive profile of ADHD is similar in highly versus average intelligent individuals with ADHD, although ADHD-related cognitive deficits may be easily overlooked in the high intelligence population when compared to the typical (i.e., average intelligent) control group.

Dopaminergic gene analysis indicates influence of inattention but not IQ in executive dysfunction of Indian ADHD probands

Organizational inefficiency and inattention are speculated to be the reason for executive deficit (ED) of ADHD probands. Even with average IQ, probands often perform poorly due to higher inattention. Pharmacotherapy, cognitive behavioural therapy, and counselling provide only symptomatic relief. Several candidate genes showed involvement with ADHD; the most consistent are dopamine receptor 4 (DRD4) and solute carrier family 6 member 3 (SLC6A3). We analyzed association of rarely investigated DRD4 and SLC6A3 variants with ADHD core traits in Indo-Caucasoid probands. ED, inattention, organizational efficiency, and IQ were measured by Barkley Deficit in Executive Functioning-Child & Adolescent scale, DSM-IV-TR, Conners' Parent Rating Scale-revised, and WISC respectively. Target sites were analyzed by PCR, RFLP, and/or Sanger sequencing of genomic DNA. DRD4 variants mostly affected inattention while SLC6A3 variants showed association with IQ. Few DRD4 and SLC6A3 variants showed dichotomous association with IQ and inattention. DRD4 Exon3 VNTR >4R showed negative impact on all traits excepting IQ. Inattention showed correlation with attention span, organizational efficiency, and ED, while IQ failed to do so. We infer that IQ and attention could be differentially regulated by dopaminergic gene variants affecting functional efficiency in ADHD and the two traits should be considered together for providing better rehabilitation.

Brain-behavior patterns define a dimensional biotype in medication-naïve adults with attention-deficit hyperactivity disorder

BACKGROUND

Childhood-onset attention-deficit hyperactivity disorder (ADHD) in adults is clinically heterogeneous and commonly presents with different patterns of cognitive deficits. It is unclear if this clinical heterogeneity expresses a dimensional or categorical difference in ADHD.

METHODS

We first studied differences in functional connectivity in multi-echo resting-state functional magnetic resonance imaging (rs-fMRI) acquired from 80 medication-naïve adults with ADHD and 123 matched healthy controls. We then used canonical correlation analysis (CCA) to identify latent relationships between symptoms and patterns of altered functional connectivity (dimensional biotype) in patients. Clustering methods were implemented to test if the individual associations between resting-state brain connectivity and symptoms reflected a non-overlapping categorical biotype.

RESULTS

Adults with ADHD showed stronger functional connectivity compared to healthy controls, predominantly between the default-mode, cingulo-opercular and subcortical networks. CCA identified a single mode of brain-symptom co-variation, corresponding to an ADHD dimensional biotype. This dimensional biotype is characterized by a unique combination of altered connectivity correlating with symptoms of hyperactivity-impulsivity, inattention, and intelligence. Clustering analyses did not support the existence of distinct categorical biotypes of adult ADHD.

CONCLUSIONS

Overall, our data advance a novel finding that the reduced functional segregation between default-mode and cognitive control networks supports a clinically important dimensional biotype of childhood-onset adult ADHD. Despite the heterogeneity of its presentation, our work suggests that childhood-onset adult ADHD is a single disorder characterized by dimensional brain-symptom mediators.

High intelligence and the risk of ADHD and other psychopathology

BackgroundHigh intelligence may be associated with positive (adaptive, desired) outcomes, but may also come with disadvantages.AimsTo contribute empirically to the debate concerning whether a trade-off in IQ scores exists in relation to attention-deficit hyperactivity disorder (ADHD) and related problems, suggesting that high intelligence - like low intelligence - increases the risk of ADHD.MethodCurves of the relation between IQ score and ADHD problems were fitted to questionnaire data (parent, teacher, self-report} in a population-based study of 2221 children and adolescents aged 10-12 years. Externalising and internalising problems were included for comparison purposes.ResultsHigher IQ score was most strongly related to fewer attention problems, with more rater discrepancy in the high v. average IQ range. Attention problems - but only minimally hyperactivity/impulsivity problems - predicted functional impairment at school, also in the higher IQ range.ConclusionsAttention problems in highly intelligent children are exceptional and affect school performance; they are therefore a reason for clinical concern.