ADHD and subthreshold symptoms in childhood and life outcomes at 40 years in a prospective birth-risk cohort

Childhood ADHD and subthreshold symptoms are associated with cognitive functioning at age 40-a cohort study on perinatal birth risks

Introduction

In this prospective cohort study over 40 years we investigated the effect of childhood attention-deficit/hyperactivity disorder (ADHD) and subthreshold ADHD on cognitive performance in adulthood.

Methods

The cohort comprised individuals with mild perinatal risks. Childhood ADHD group (cADHD, n = 39) was compared to a group with subthreshold childhood attention or hyperactivity symptoms (cAP; n = 79), a group with similar perinatal risks but no ADHD symptoms (n = 255), and to controls without ADHD symptoms or perinatal risks (n = 69). The groups were assessed with multiple neuropsychological measures in domains of verbal reasoning, perceptual skills, memory, working memory, attention, executive functions, and speed. Group-level differences and frequencies of deficient functioning were analyzed.

Results

Overall, the groups' performance differed in all cognitive domains at age 40. Verbal reasoning, perceptual skills, memory, and speed had the largest effect sizes (0.51-0.62). The cADHD group's performance was lower than the other groups' on 13 out of 21 measures. The cAP group performed poorer than controls on five measures. In the cADHD group, 23% had three or more deficient cognitive domains, compared to 4-6% in the other groups.

Discussion

Childhood ADHD is associated with impaired cognitive functioning in adulthood on several cognitive domains whereas childhood subthreshold ADHD is linked to fewer cognitive deficits. Task complexity was linked to poorer performance within the ADHD group. Our results add to the scarce longitudinal evidence of cognitive outcomes related to childhood ADHD and subthreshold symptoms.

Children's emotional reactivity and negative affect predict future ADHD symptom severity beyond initial ADHD symptom severity

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience significant emotion dysregulation. However, there is limited longitudinal data on associations between multiple aspects of emotion dysregulation and ADHD symptoms. Additionally, given substantial evidence that increased levels and variability of negative affect (NA) are identified in children with ADHD, it is important to examine the role of NA in this relationship. The present study used momentary and longitudinal data to examine the relation between two aspects of emotion dysregulation (emotional lability and emotional reactivity), the two ADHD symptom clusters separately (inattentive and hyperactive/impulsive), total ADHD symptom severity, and NA variability over a period of six months. Participants (N = 68) were parents of children aged 7-12 years old (M = 9.80, SD = 1.34) who completed baseline and 6-month follow-up reports of children's ADHD symptoms and emotion dysregulation as well as ecological momentary assessments (EMA) of their children's NA for one week. Results were threefold: (1) children's emotional reactivity predicted inattentive, hyperactive/impulsive, and total ADHD symptom severity above and beyond initial ADHD symptom severity, but emotional lability did not significantly predict severity of any ADHD symptom cluster; (2) NA variability predicted hyperactive/impulsive and total ADHD symptom severity, but not inattentive severity; and (3) initial ADHD symptom severity did not predict emotion dysregulation at follow-up. The current study provides novel insight regarding the longitudinal influence of specific aspects of emotion dysregulation and NA on ADHD symptom severity in children and suggests that targeting emotional reactivity could minimize ADHD symptom severity.

Facial emotion recognition in children and youth with attention-deficit/hyperactivity disorder and irritability

The ability to recognize emotions evident in people's faces contributes to social functioning and might be affected by ADHD and irritability. Given their high co-occurrence, we examined the relative contribution of ADHD and irritability to facial emotion recognition (FER). We hypothesized that irritability but not ADHD traits would predict increased likelihood of misrecognizing emotions as negative, and that FER performance would explain the association of ADHD and irritability traits with social skills. FER was measured using the Reading the Mind in the Eyes Test (RMET) in children (6-14 years old) referred for ADHD assessment (n = 304) and healthy controls (n = 128). ADHD, irritability and social skills were measured using parent ratings. We used repeated measure logistics regression, comparing the effects across emotion valence of images (i.e., neutral/positive/negative). High irritability but not ADHD diagnosis predicted lower RMET accuracy. ADHD traits predicted lower RMET accuracy in younger but not older participants, whereas irritability predicted poorer accuracy at all ages. ADHD traits predicted lower RMET accuracy across all emotion valences, whereas irritability predicted increased probability of misrecognizing neutral and positive but not negative emotions. Irritability did not increase the probability for erroneously recognizing emotions as negative. ADHD and irritability traits fully explained the association between RMET and social skills. ADHD and irritability traits might impact the ability to identify emotions portrayed in faces. However, irritability traits appear to selectively impair recognition of neutral and positive but not negative emotions. ADHD and irritability are important when examining the link between FER and social difficulties.

Executive Functions Contribute to the Differences Between ADHD and Sluggish Cognitive Tempo (SCT) in Adults

OBJECTIVES

This paper analyses the relationship between sociodemographic variables, executive dysfunctions, Sluggish Cognitive Tempo (SCT) and the mainly dimensions of ADHD: hyperactivity-impulsivity (ADHD-H/I) and inattention (ADHD-IN) in Brazilian adults.

METHOD

A cross-sectional, exploratory, and comparative design was used. A total of 446 participants (295 women) aging from 18 to 63 years old (M = 3,499 years, SD = 10.7) were recruited on the internet. Correlations, t independent tests and regressions were conducted.

RESULTS

Higher scores in ADHD dimensions were associated to more executive functioning problems and time perception distortions in comparison to those participants without significant ADHD symptoms. However, ADHD-IN dimension as well as SCT were higher associated with these dysfunctions than ADHD-H/I. The regression results showed that ADHD-IN was more related to Self-Management to time while ADHD-H/I to Self-Restraint and SCT to Self-Organization/Problem Solving.

CONCLUSION

This paper contributed to the distinction between SCT and ADHD in adults in important psychological dimensions.

Cannabis use in Attention - Deficit/Hyperactivity Disorder (ADHD): A scoping review

INTRODUCTION

Treatments for Adult ADHD include stimulants, two non-stimulant medications, as well as cognitive-behavioral therapy (CBT). These pharmacological agents are often associated with side effects, contributing to poor treatment adherence. Patients with ADHD have regularly stated that cannabis has helped improve their ADHD symptoms; however, scientific literature describing the effects of cannabis on symptoms of ADHD is scarce.

METHODS

We systematically searched MEDLINE, EMBASE, EMCARE, PsycINFO, Web of Science, Cochrane Library, and Clinicaltrials.gov. The searches included all publications in English up to June 27, 2022. We included both experimental and observational studies that assessed the effect of cannabis on ADHD symptomatology and neuropsychiatric outcomes. To synthesize our current understanding of the potential effects of cannabis use on ADHD symptoms and pathophysiology, and the effects of ADHD on cannabis use, data was extracted from each study regarding the characteristics of its population, methods used to assess both cannabis consumption and ADHD symptoms, and key findings.

RESULTS

Our scoping review included a total of 39 studies. Only one study employed a randomized and placebo-controlled design to directly measure the effect of cannabis on ADHD, and no significant effect was observed for the study's primary outcome, the QbTest (Est = -0.17, 95% CI -0.40 to 0.07, p = 0.16). Most of the literature consists of cross-sectional studies that evaluate the association between ADHD severity and cannabis use. 15 studies addressed the neuropsychiatric effects of cannabis on ADHD by employing either a battery of neuropsychiatric tests or neuroimaging. The concentration and amount of THC and CBD used were not well measured in most of the studies. Although some studies indicated that cannabis improved ADHD symptoms, most studies indicated it worsened or had no effect on ADHD symptoms.

CONCLUSIONS

Given the current evidence, cannabis is not recommended for people with ADHD. Limitations of the literature include the absence of objective measurements for cannabis exposure and ADHD symptoms, heterogenous definitions, oversampling, and small sample sizes.

Mortality in individuals with childhood ADHD or subthreshold symptoms - a prospective perinatal risk cohort study over 40 years

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is associated with negative life outcomes and recent studies have linked it to increased mortality. These studies have examined nationwide registers or clinic-referred samples and mostly included participants up until the age of 30. No studies have investigated mortality associated with subthreshold levels of ADHD symptoms. Our aim was to analyze mortality in a perinatal risk cohort of 46-year-old adults with childhood ADHD (cADHD) and milder childhood attention problems (including hyperactivity and inattention; cAP) compared with a group with similar birth risks but no or low levels of childhood ADHD symptoms (Non-cAP). Causes of death obtained from a national register were examined.

METHODS

Mortality was analyzed with Cox proportional hazard models for all-cause mortality, cause-specific mortality (natural and unnatural causes), and age-specific mortality (under and over age 30). All models were adjusted with gender. The total n in the study was 839 (cADHD n = 115; cAP n = 216; Non-cAP n = 508).

RESULTS

By the age of 46, 11 (9.6%) deaths occurred in the cADHD group, 7 (3.2%) in the cAP group, and 20 (3.9%) in the Non-cAP group. The cADHD group had the highest mortality risk (adjusted hazard ratio = 2.15; 95% CI 1.02, 4.54). Mortality was not elevated in the cAP group (adjusted hazard ratio = 0.72; 95% CI .30, 1.72). Mortality in the cADHD group was mainly attributed to unnatural causes of death (adjusted hazard ratio = 2.82; 95% CI 1.12, 7.12). The mortality risk in the cADHD group was sixfold before age 30 (adjusted hazard ratio = 6.20; 95% CI 1.78, 21.57).

CONCLUSIONS

Childhood ADHD was associated with a twofold risk of premature death by the age of 46 in this prospective longitudinal cohort study. Our results corroborate previous findings and the morbidity of ADHD. Subthreshold levels of childhood ADHD symptoms were not linked to increased mortality. Our results suggest that mortality risk is higher in young than middle adulthood. Future studies should examine mortality associated with ADHD in different ages in adulthood to identify those in greatest risk of premature death.

Children With ADHD Are at Risk for a Broad Array of Adverse Adult Outcomes That Cross Functional Domains: Results From a Population-Based Birth Cohort Study

OBJECTIVE

To identify patterns ("classes") of outcomes for adults with and without childhood ADHD.

METHOD

Subjects were 232 childhood ADHD cases and 335 non-ADHD referents from a 1976 to 1982 birth cohort. We used latent class analyses to identify classes based on a broad array of adult psychosocial outcomes and determined the proportion of subjects with childhood ADHD within each class.

RESULTS

A three class solution provided optimal model fit; classes were termed "good," "intermediate," and "poor" functioning. Subjects with childhood ADHD comprised 62.8% of the "poor," 53.5% of the "intermediate," and 24.9% of the "good" functioning class. The "poor" functioning class was distinguished by increased likelihood of legal trouble and substance use disorders and included more individuals with childhood ADHD and psychiatric disorder than the "intermediate" class (45.5% vs. 30.6%).

CONCLUSION

Children with ADHD are at risk for adverse adult outcomes in multiple domains and co-morbid childhood psychiatric disorders increase risk.

Examination of Pre-pandemic Measures on Youth Well-being During Early Stages of the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has affected our lives in numerous ways. How youth have been impacted by the pandemic and which preexisting factors best relate to COVID-19 responses are of high importance for effective identification and treatment of those most vulnerable. Youth with pre-pandemic mental health difficulties such as attention-deficit/hyperactivity disorder (ADHD) could be at risk for worse well-being during and after the pandemic.

METHODS

The current study tested potential risk factors (i.e., pre-pandemic mental health, age, and parental education) and their relationship to family experiences during early months of the COVID-19 pandemic. Participants were previously enrolled in an ongoing, yearly longitudinal study examining the relationship between mental health and executive functions in youth. Families with 1-4 annual pre-pandemic lab visits filled out an online COVID-19 survey in May-July 2020 to assess how the pandemic impacted their well-being (n = 135 youth).

RESULTS

Youth pre-pandemic mental health difficulties, especially ADHD symptoms, related to worse well-being during the early pandemic. Trajectories of recent ADHD symptoms over time also predicted cognitive difficulties during the pandemic. We found that youth age was a strong predictor of pandemic response, with younger youth showing fewer negative responses. Parental education level buffered family economic impact during early COVID-19. Families showed synchrony in their pandemic responses.

CONCLUSIONS

Pre-pandemic ADHD severity and slope, youth age, and parental education (a proxy for socioeconomic status) were risk factors that influenced youth or family well-being early in the COVID-19 pandemic; this information can help identify those who may need more community and educational support.

Efficacy of Omega-3 and Korean Red Ginseng in Children with Subthreshold ADHD: A Double-Blind, Randomized, Placebo-Controlled Trial

OBJECTIVE

The purpose of the present study was to investigate the efficacy of combined omega-3 and Korean red ginseng supplementation on ADHD symptoms and cognitive function in children with subthreshold ADHD.

METHOD

120 children from 6 to 12 years with subthreshold ADHD were enrolled in this 12-week, double-blind, randomized, placebocontrolled study. The primary outcome was measured by Attention-Deficit Hyperactivity Disorder Rating Scale (ADHD-RS). Children Behavior Check List (CBCL), and neuropsychological tests assessing attention, memory, and executive function were included as secondary primary outcome measures.

RESULTS

Significant effects on the scores of ADHDRS, as well as several subscales of CBCL including ADHD and attention problem subscales were revealed.

CONCLUSION

The combination of omega-3 and Korean red ginseng may have beneficial effects in children with subthreshold ADHD. Increased clinical awareness of ADHD symptoms even at a subthreshold level is needed.

Clinical characteristics of attention-deficit/hyperactivity disorder in children and adolescents: association with quality of life and behavioral aspects

Objective:

To identify associations between clinical characteristics of children with attention-deficit/hyperactivity disorder (ADHD) and their sociodemographic aspects, quality of life, and results from the strengths and difficulties questionnaire.

Methods:

This is an observational analytical cross-sectional study with a non-probabilistic sample consisting of 72 children diagnosed with ADHD, aged 6 to 13 years, treated at 2 neuropediatric outpatient clinics. The instruments used were the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder – Swanson, Nolan, and Pelham, version IV (MTA-SNAP-IV), the Strengths and Difficulties Questionnaire (SDQ), the Brazilian Economic Classification Criteria (CCEB), and the Quality of Life Assessment Scale for Children and Adolescents (AUQEI). We performed descriptive, bivariate, and multivariate analyses, considering a 5% significance level.

Results:

SDQ results were associated with abnormal MTA-SNAP-IV results (inattentive/hyperactive/combined). A 1-point increment in the SDQ score increased by 36.5% the likelihood of the child having an abnormal MTA-SNAP-IV classification. Regarding AUQEI, 30.6% of participants perceived their quality of life as poor and 69.4% as good.

Conclusions:

A higher SDQ score increased the child's chance of having an abnormal MTA-SNAP-IV result.

Executive functions, effortful control, and emotional lability in adults with ADHD. implications for functional outcomes

Adults with diagnosis of childhood attention-deficit hyperactivity disorder (ADHD) experience impairments in self-regulation (SR). This study examined whether subgroups of these impairments can be established based on differentiable patterns. The relationships between these subgroups and a group without ADHD were then analyzed, focusing on functional outcomes. Executive functions, effortful control, and emotional lability, in addition to self-concept, quality of life, and different comorbidities, were evaluated in 61 adults with a childhood diagnosis of ADHD and 54 adults without ADHD. Latent profile analysis (LPA) revealed three ADHD classes based on different self-regulation indicators: "Normalized" (49.18%), "Moderate impairments" (27.86%), and "Severe generalized impairments" (22.96%), who were compared with a Non-ADHD group on different functional measures. The "Normalized" profile showed significantly less dysfunctionality than the other two profiles, and it only exhibited significant differences with respect to the Non-ADHD group on the Hyperactivity index. By contrast, the "Severe generalized impairments" group, with the lowest self-regulatory skills, was impaired on all the functional outcomes. Self-regulatory skills could be a key target in interventions for adults with ADHD.

Insomnia, Alcohol Consumption and ADHD Symptoms in Adults

Introduction

Substance use disorders and insomnia are common in the general population, and particularly among adults with attention-deficit/hyperactivity disorder (ADHD). Here we investigated the relationship between insomnia, alcohol consumption and ADHD symptoms.

Methods

Adults with an ADHD diagnosis (n = 235, 41.3% males) and controls (n = 184, 38% males) completed a questionnaire assessing insomnia (Bergen Insomnia Scale), alcohol consumption (Alcohol Use Disorders Identification Test), and current ADHD symptoms (Adult ADHD Self-report Scale). The majority of the sample (95%) gave additional information about childhood ADHD symptoms (Wender Utah Rating Scale), and information about lifetime occurrence of an internalizing disorder was included as part of background information.

Results

Compared to controls, the ADHD group reported a higher frequency of insomnia, a higher quantity of consumed alcohol and a higher frequency of internalizing disorders. Current and childhood ADHD symptoms were more severe in those with than without insomnia. Scores on ADHD symptom scales were explained by the presence of insomnia and internalizing disorders, while the contribution from alcohol consumption was restricted to the control group.

Discussion

The high functional impact of insomnia, alcohol misuse and internalizing disorders is well known. The present study contributed by focusing on their relations to ADHD symptoms, and by showing that strong relations were not restricted to adults with a clinical ADHD diagnosis. By this, the results put a critical light on a categorical delineation between adults with an ADHD diagnosis and population selected controls, and call for further studies including dimensional metrics of ADHD symptoms and co-occurring problems.