Future directions in ADHD etiology research

The Comparison of Psychological Factors and Executive Functions of Children with Attention Deficit Hyperactivity Disorder and Cognitive Disengagement Syndrome to ADHD and ADHD Comorbid with Oppositional Defiant Disorder

OBJECTIVE

The study aims to examine family functionality, emotion regulation difficulties, preference for loneliness, social exclusion, internalizing and externalizing disorders, and executive functions in children with Attention Deficit Hyperactivity Disorder (ADHD) and Cognitive Disengagement Syndrome (CDS) and compare with ADHD, and ADHD+ Oppositional Defiant Disorder (ODD).

METHOD

This study included 842 children aged 8-12 years. The subjects were categorized according to DSM-V as ADHD (n = 246), ADHD + ODD (n = 212), ADHD + CDS (n = 176), and Control group (n = 207). The solitude and social exclusion, difficulties in emotion dysregulation and Barkley SCT scales, Child Behavior Checklist, family assessment device, and Central Vital Signs (CNSVS) test were used.

RESULTS

According to the study, children with ADHD + CDS had higher rates of internalizing disorders. They also preferred being alone and experienced more difficulty communicating with their parents and solving problems within the family. Additionally, these children had difficulty recognizing and understanding the emotional reactions of others. The ADHD + ODD group presented a poorer performance on CNSVS domain tests except for the psychomotor speed test than other groups. Also, ADHD + CDS children had the lowest psychomotor speed scores and lower scores on reaction time and cognitive flexibility than pure ADHD children.

CONCLUSION

This study will contribute to the etiology, treatment, and clinical discrimination of ADHD + CDS.

The Beginnings of Attention Deficit in a Dutch 18th Century Medical Treatise

OBJECTIVE

An early description, possibly the earliest, of attention deficit disorder in a 1753 Dutch medical book by Cornelius Kloekhof is presented.

METHOD

The author of this text is briefly introduced and contextualized. The text is translated from Latin and afterwards, its impact on later scientific literature is discussed.

RESULTS AND CONCLUSIONS

Kloekhofs description of attention deficit was one of the first and thoroughly inspired the subsequent literature, such as Adam Weikard, making this text an important moment in the rich history of ADHD.

Iranian Traditional Medicine for Treatment of Attention Deficit Disorder with Hyperactivity in Children: A Systematic Review of Randomized Controlled Trials

Background

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with a complex etiology. Stimulants as a first-line treatment are not effective in some cases. In this study, we conducted a systematic review to evaluate the efficacy of traditional Persian Iranian medicine (TIM) for children and adolescents with ADHD.

Methods

Data were collected mainly from PubMed, Google Scholar, Web of Science, ProQuest, and Scopus databases until Dec 2022. The keywords related to ADHD, traditional Persian medicine (TPM), and (TIM) were searched. Two reviewers independently screened 714 abstracts and eventually, eight trials were included in the systematic reviews. Changes in the severity of ADHD symptoms were considered based on the validated cutoff on recognized rating scales as the result of the effect of TIM on ADHD.

Results

Interventions included herbal extracts of Passiflora incarnate, whey protein, Ginkgo biloba, Crocus sativus L, sweet almond syrup, and horse milk. In all studies, except G. biloba, there was evidence of a reduction in the severity of ADHD. Low evidence could be found for G. biloba.

Conclusion

Herbal and traditional remedies are an efficient and safe solution to alleviate the symptoms of ADHD. In future studies, TIM as a complementary therapy may be useful to alleviate ADHD symptoms, especially in children who are resistant to stimulant medications.

Psychological Treatments for Hyperactivity and Impulsivity in Children with ADHD: A Narrative Review

Treatment of the ADHD types (hyperactive-impulsive, inattentive, and combined) in children has rarely been studied separately, although their prognostic courses differ widely. In addition, data show that improvements in hyperactivity/impulsivity are hard to achieve. Thus, we focused on treatments tailored to hyperactivity/impulsivity. We examined meta-analyses and systematic reviews within the inter- and intra-individual treatments and found that psychoeducation and training for parents, school-based interventions, reinforcement strategies, and neurofeedback consistently showed small to moderate effect sizes in reducing hyperactivity/impulsivity in children. Conversely, emotional self-regulation, social skills, and cognitive trainings showed unsatisfactory results. In summary, we found that the quality of usual care can be surpassed when the designated interventions are purposefully combined into a multimodal treatment program.

The role of psychosocial adversity in the aetiology and course of attention deficit hyperactivity disorder

INTRODUCTION

Attention deficit/hyperactivity disorder (ADHD) has genetic and environmental aetiological factors. There are few publications on the environmental factors. The objective of this review is to present the role of psychosocial adversity in the aetiology and course of ADHD.

METHODS

A search was carried out in the following databases: PubMed, ScienceDirect, SciELO, ClinicalKey, EMBASE, Lilacs, OVID, APA and PsycNET. English and Spanish were selected without being limited by type of study or year of publication. Finally, a qualitative synthesis was conducted.

RESULTS

ADHD development could be related to exposure to adverse factors in the family, school or social environment. It has been proposed as an explanatory mechanism that adversity interacts with genetic variants and leads to neurobiological changes. There may also be a gene-environment correlation whereby individual hereditary characteristics increase the risk of exposure to adversity, and indirectly increase the probability of developing ADHD. Research on psychosocial adversity represents a big challenge, not only due to the complexity of its construct, but also to the effect of subjective perception of a given event.

CONCLUSIONS

ADHD aetiology is complex and involves the interaction of both genetic and environmental factors, in which these factors correlate and cause the disorder. The study of the role of psychosocial adversity in ADHD is fundamental, but it remains a task that entails great difficulties.

Explaining the Prospective Association of Positive and Negative Parenting Behaviors and Child ADHD Symptoms: Pathways Through Child Executive Function and Reward Responsivity

Objective: Parenting behavior is a well-established correlate of offspring ADHD. However, little is known about how parenting exerts its effects on offspring ADHD symptomatology. We examined whether prospective associations between positive and negative parenting behaviors and child ADHD symptoms are mediated by deficits in child executive function (EF) and reward responsivity (RR). Method: One hundred and thirty-five children with and without ADHD were assessed across two Waves, when children were mean ages 6 and 8 respectively. Children completed tasks on EF, and parents completed questionnaires about their parenting behaviors and their children's RR and ADHD symptoms. Results: Negative parenting behavior at Wave 1 was indirectly associated with offspring ADHD symptoms at Wave 2 via offspring EF. Conclusion: Individual differences in EF, but not RR, during early childhood may constitute a potential pathway by which negative parenting behaviors exerts its effects on subsequent offspring ADHD symptomatology. Treatment implications are discussed.

Best Practices in Structural Neuroimaging of Neurodevelopmental Disorders

Structural magnetic resonance imaging (sMRI) offers immense potential for increasing our understanding of how anatomical brain development relates to clinical symptoms and functioning in neurodevelopmental disorders. Clinical developmental sMRI may help identify neurobiological risk factors or markers that may ultimately assist in diagnosis and treatment. However, researchers and clinicians aiming to conduct sMRI studies of neurodevelopmental disorders face several methodological challenges. This review offers hands-on guidelines for clinical developmental sMRI. First, we present brain morphometry metrics and review evidence on typical developmental trajectories throughout adolescence, together with atypical trajectories in selected neurodevelopmental disorders. Next, we discuss challenges and good scientific practices in study design, image acquisition and analysis, and recent options to implement quality control. Finally, we discuss choices related to statistical analysis and interpretation of results. We call for greater completeness and transparency in the reporting of methods to advance understanding of structural brain alterations in neurodevelopmental disorders.

The Interplay Between Prenatal Adversity, Offspring Dopaminergic Genes, and Early Parenting on Toddler Attentional Function

Background: Few studies have explored the complex gene-by-prenatal environment-by-early postnatal environment interactions that underlie the development of attentional competence. Here, we examined if variation in dopamine-related genes interacts with prenatal adversity to influence toddler attentional competence and whether this influence is buffered by early positive maternal behavior. Methods: From the Maternal Adversity, Vulnerability and Neurodevelopment cohort, 134 participants (197 when imputing missing data) had information on prenatal adversity (prenatal stressful life events, prenatal maternal depressive symptoms, and birth weight), five dopamine-related genes (DAT1, DRD4, DRD2, COMT, BDNF), observed maternal parenting behavior at 6 months and parent-rated toddler attentional competence at 18 and 24 months. The Latent Environmental and Genetic Interaction (LEGIT) approach was used to examine genes-by-prenatal environment-by-postnatal environment interactions while controlling for sociodemographic factors and postnatal depression. Results: Our hypothesis of a three-way interaction between prenatal adversity, dopamine-related genes, and early maternal parenting behavior was not confirmed. However, consistent two-way interactions emerged between prenatal adversity and dopamine-related genes; prenatal adversity and maternal parenting behavior, and dopamine-related genes and maternal parenting behavior in relation to toddler attentional competence. Significant interaction effects were driven by the DAT1, COMT, and BDNF genotypes; prenatal stressful life events; maternal sensitivity, tactile stimulation, vocalization, and infant-related activities. Conclusions: Multiple dopamine-related genes affected toddler attentional competence and they did so in interaction with prenatal adversity and the early rearing environment, separately. Effects were already visible in young children. Several aspects of early maternal parenting have been identified as potential targets for intervention.

The effect of zinc supplementation in children with attention deficit hyperactivity disorder: A systematic review and dose-response meta‑analysis of randomized clinical trials

OBJECTIVE

The present systematic review and dose-response meta-analysis was conducted to quantify the efficacy of zinc supplementation on clinical symptoms of attention-deficit/hyperactivity disorder (ADHD) in children.

METHODS

Electronic databases including PubMed, Scopus, ISI web of science, and Google Scholar were searched until January 2021. Results were reported as standardized mean difference (SMD) with a 95% confidence interval (CI) using Hedges's adjusted g method.

RESULTS

six randomized clinical trials with 489 school-aged children were identified for the meta-analysis. Our findings showed a significant effect of zinc supplementation on ADHD total scores (SMD: -0.62 Hedges' g; 95% CI: -1.24 to -0.002, p = 0.04) but not in hyperactivity scores (SMD: -0.93 Hedges' g; 95% CI: -3.31 to 1.45, p = 0.44) and inattention scores (SMD: 0.21 Hedges' g; 95% CI: -0.09 to 0.51, p = 0.17) compared to the control group. Besides, the dose-response analysis did not find any significant non-linear association between zinc supplementation dosage or duration on ADHD total scores. The certainty of the evidence was rated moderate to very low for all outcomes.

CONCLUSION

Zinc supplementation may have beneficial effects in improving ADHD symptoms in children with ADHD. Future well-designed, large-scale randomized controlled trials are needed to establish the benefit of zinc supplementation for ADHD.

The role of psychosocial adversity in the aetiology and course of attention deficit hyperactivity disorder

INTRODUCTION

Attention deficit/hyperactivity disorder (ADHD) has genetic and environmental aetiological factors. There are few publications on the environmental factors. The objective of this review is to present the role of psychosocial adversity in the aetiology and course of ADHD.

METHODS

A search was carried out in the following databases: PubMed, ScienceDirect, SciELO, ClinicalKey, EMBASE, Lilacs, OVID, APA and PsycNET. English and Spanish were selected without being limited by type of study or year of publication. Finally, a qualitative synthesis was conducted.

RESULTS

ADHD development could be related to exposure to adverse factors in the family, school or social environment. It has been proposed as an explanatory mechanism that adversity interacts with genetic variants and leads to neurobiological changes. There may also be a gene-environment correlation whereby individual hereditary characteristics increase the risk of exposure to adversity, and indirectly increase the probability of developing ADHD. Research on psychosocial adversity represents a big challenge, not only due to the complexity of its construct, but also to the effect of subjective perception of a given event.

CONCLUSIONS

ADHD aetiology is complex and involves the interaction of both genetic and environmental factors, in which these factors correlate and cause the disorder. The study of the role of psychosocial adversity in ADHD is fundamental, but it remains a task that entails great difficulties.

The associations between maternal and child diet quality and child ADHD - findings from a large Norwegian pregnancy cohort study

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder. Effective long-term treatment options are limited, which warrants increased focus on potential modifiable risk factors. The aim of this study was to investigate associations between maternal diet quality during pregnancy and child diet quality and child ADHD symptoms and ADHD diagnosis.

METHODS

This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa). We assessed maternal diet quality with the Prenatal Diet Quality Index (PDQI) and Ultra-Processed Food Index (UPFI) around mid-gestation, and child diet quality using the Diet Quality Index (CDQI) at 3 years. ADHD symptoms were assessed at child age 8 years using the Parent Rating Scale for Disruptive Behaviour Disorders. ADHD diagnoses were retrieved from the Norwegian Patient Registry.

RESULTS

In total, 77,768 mother-child pairs were eligible for studying ADHD diagnoses and 37,787 for ADHD symptoms. Means (SD) for the PDQI, UPFI and CDQI were 83.1 (9.3), 31.8 (9.7) and 60.3 (10.6), respectively. Mean (SD) ADHD symptom score was 8.4 (7.1) and ADHD diagnosis prevalence was 2.9% (male to female ratio 2.6:1). For one SD increase in maternal diet index scores, we saw a change in mean (percent) ADHD symptom score of - 0.28 (- 3.3%) (CI: - 0.41, - 0.14 (- 4.8, - 1.6%)) for PDQI scores and 0.25 (+ 3.0%) (CI: 0.13, 0.38 (1.5, 4.5%)) for UPFI scores. A one SD increase in PDQI score was associated with a relative risk of ADHD diagnosis of 0.87 (CI: 0.79, 0.97). We found no reliable associations with either outcomes for the CDQI, and no reliable change in risk of ADHD diagnosis for the UPFI.

CONCLUSIONS

We provide evidence that overall maternal diet quality during pregnancy is associated with a small decrease in ADHD symptom score at 8 years and lower risk for ADHD diagnosis, with more robust findings for the latter outcome. Consumption of ultra-processed foods was only associated with increased ADHD symptom score of similar magnitude as for overall maternal diet quality, and we found no associations between child diet quality and either outcome. No causal inferences should be made based on these results, due to potential unmeasured confounding.

Moderator Role of Monitoring in the Inhibitory Control of Adolescents With ADHD

Objective: The aim of this research was to analyze the role of monitoring in the causal relationship between inhibitory control and symptoms of combined ADHD. Method: It has been conducted a quantitative investigation of two phases. Results: In the first study, a moderation model was analyzed (N = 144 adolescents with combined ADHD), where monitoring was considered as a moderating variable in the causal relationship between the inhibitory control and the symptomatology of ADHD F(3, 140) = 28.03, p < .001; R² = .37. In the second study, the model through an experimental study was tested (N = 52 adolescents with and without ADHD) where it was found that adolescents with ADHD improve in their inhibitory control when they receive external support to the monitoring F(1, 50) = 21.38, p < .001, η² = .30. Conclusion: Results suggest that monitoring compensates the poor performance of inhibitory control in adolescents with ADHD, which is a contribution to the theoretical construction of ADHD and to the treatments proposed for this condition because it goes beyond the classic conception of a causality chain among the deficit of inhibitory control and ADHD symptomatology to propose a new explanation about this disorder, where neuropsychology intervention of monitoring would diminish ADHD's symptomatology impact on adolescents.

Catechol-O-methyltransferase Val158Met Genotype and Early-Life Family Adversity Interactively Affect Attention-Deficit Hyperactivity Symptoms Across Childhood

Attention-deficit hyperactivity disorder (ADHD) is among the most commonly diagnosed psychiatric disorders of childhood. The dopaminergic system has been shown to have substantial effects on its etiology, with both functional Catechol-O-methyltransferase (COMT) Val158Met genotype and early-life environmental adversity involved in the risk of inattention and hyperactivity/impulsivity symptoms. In this prospective longitudinal study, we examined for the first time the impact of proximal and distal early-life family adversity and COMT Val158Met polymorphism gene - both the direct and the interactive effects, on children's ADHD symptoms across childhood. Data came from the Family Life Project, a prospective longitudinal study of 1,292 children and families in high poverty from birth to 11 years. In infancy, data regarding socioeconomic (SES)-risk-factors, observed-caregiving behaviors, and DNA genotyping were collected. In early and middle childhood teachers rated the occurrence and severity of the child's ADHD symptoms. Multilevel growth curve models revealed independent effects of COMT, early-life SES-risk and negative caregiving on ADHD symptoms in early and middle childhood. Significant gene-environment interactions were found, indicating that overall, carriers of at least one COMT158Met allele were more sensitive to early-life adversity, showing higher inattention and hyperactivity/impulsivity symptoms severity in childhood when exposed to high SES-risk factors in infancy, compared to Val-Val carriers. Findings provide new insights into the complex etiology of ADHD and underline the need for further investigation of the neuronal mechanisms underlying gene-environment interactions. Findings might have implications for prevention and intervention strategies with a focus on early-life family relationships in genetically at-risk children.

The efficacy of zinc augmentation in children with attention deficit hyperactivity disorder under treatment with methylphenidate: A randomized controlled trial

INTRODUCTION

Regarding to the role of the zinc in the metabolism of the central nervous system and the correlation of zinc supplementation in the treatment of any Attention deficit hyperactivity disorder (ADHD) symptoms, this study was conducted to evaluate the complementary effects of this nutrient.

METHOD

This was a double-blind randomized clinical trial study and 60 children with ADHD who were treated with methylphenidate were chosen by random allocation and were divided in the two groups: 30 for the case and 30 for the control group. The treatment in case group was augmented with zinc. Duration of study was six weeks.

RESULT

Forty eight (80%) of participants were boy and 12 (20%) were girl. The mean age of patients was 9.6 ± 1.70 years. There was no significant difference between the two groups after the intervention in terms of total score, hyperactivity and impulsivity subscales during variance analysis, but there was a significant difference between the mean of inattention score.

CONCLUSION

Augmentation with zinc can enhance the improvement of inattention.

The Inter-Relationships of Extremely Low Birth Weight, Asthma, and Behavior: A Study of Common Cause, Mediation, and Moderation

BACKGROUND

Extremely low birth weight (ELBW; <1000 g) infants are at risk for both asthma and problems like inattention, hyperactivity, anxiety, and depression. Asthma predicts behavioral and emotional problems in term-born children. The nature of these associations is poorly understood. We tested 3 models of association: independent risk, mediation, and effect modification to explore interplay among birth weight, asthma, and behavioral and emotional problems.

METHODS

We used data from a prospective cohort of ELBW infants born 1992 to 1995. Exposure was ELBW; primary outcomes were parent-reported diagnosis of asthma and symptoms of inattention, hyperactivity, anxiety, and depression at age 8 years. Covariates included child sex and maternal socioeconomic status.

RESULTS

There were 139 ELBW and 101 normal BW (>2500 g) children followed to 8 years. ELBW children were more likely to have asthma (35.7% vs 14.4%, P < .05). Inattention, hyperactivity, depression, and anxiety scores were higher among ELBW children and children with asthma. ELBW was a common cause of asthma and anxiety. There was no evidence of mediation or effect modification by asthma on the effect of ELBW on behavior and emotion symptoms.

CONCLUSION

Asthma does not underlie or amplify the effect of ELBW on behavioral and emotional problems at school age, suggesting that increased risk for respiratory morbidity and neurodevelopment represent largely independent consequences of developmental vulnerability related to ELBW. Noting the impact of chronic illnesses on neurodevelopment in other populations, data focused on symptom trajectories over time in a larger cohort may be necessary to shed further light onto this question.

Early life predictors of attention deficit/hyperactivity disorder symptomatology profiles from early through middle childhood

This study used repeated measures data to identify developmental profiles of elevated risk for ADHD (i.e., six or more inattentive and/or hyperactive-impulsive symptoms), with an interest in the age at which ADHD risk first emerged. Risk factors that were measured across the first 3 years of life were used to predict profile membership. Participants included 1,173 children who were drawn from the Family Life Project, an ongoing longitudinal study of children's development in low-income, nonmetropolitan communities. Four heuristic profiles of ADHD risk were identified. Approximately two thirds of children never exhibited elevated risk for ADHD. The remaining children were characterized by early childhood onset and persistent risk (5%), early childhood limited risk (10%), and middle childhood onset risk (19%). Pregnancy and delivery complications and harsh-intrusive caregiving behaviors operated as general risk for all ADHD profiles. Parental history of ADHD was uniquely predictive of early onset and persistent ADHD risk, and low primary caregiver education was uniquely predictive of early childhood limited ADHD risk. Results are discussed with respect to how changes to the age of onset criterion for ADHD in DSM5 may affect etiological research and the need for developmental models of ADHD that inform ADHD symptom persistence and desistance.

Review of the Evidence for Motivation Deficits in Youth with ADHD and Their Association with Functional Outcomes

Preeminent theories of attention-deficit/hyperactivity disorder (ADHD) suggest that motivation deficits are core underlying features of the disorder. However, it is currently unclear whether empirical evidence supports the assertion that significant group (ADHD v. comparison) differences in motivation exist or that problems with motivation contribute to the functional impairments that youth with ADHD experience. Accordingly, this review focused on evaluating and summarizing the empirical literature on the presence of motivation deficits and their association with functional outcomes in samples of youth with ADHD. Twenty studies met the review inclusion criteria. Results support the assertion that youth with ADHD have lower academic-related motivation in comparison to their peers and that motivation plays an important role in academic outcomes, with the strongest evidence to date for reading achievement. However, the available evidence is limited, and few existing studies are aligned with the much larger theoretical and empirical motivation literature in typically developing youth. Given preliminary evidence that motivation plays a role in the academic impairments of youth with ADHD, the review concludes with a discussion of whether current ADHD interventions adequately target motivation and highlights important future directions.

Direction dependence analysis: A framework to test the direction of effects in linear models with an implementation in SPSS

In nonexperimental data, at least three possible explanations exist for the association of two variables x and y: (1) x is the cause of y, (2) y is the cause of x, or (3) an unmeasured confounder is present. Statistical tests that identify which of the three explanatory models fits best would be a useful adjunct to the use of theory alone. The present article introduces one such statistical method, direction dependence analysis (DDA), which assesses the relative plausibility of the three explanatory models on the basis of higher-moment information about the variables (i.e., skewness and kurtosis). DDA involves the evaluation of three properties of the data: (1) the observed distributions of the variables, (2) the residual distributions of the competing models, and (3) the independence properties of the predictors and residuals of the competing models. When the observed variables are nonnormally distributed, we show that DDA components can be used to uniquely identify each explanatory model. Statistical inference methods for model selection are presented, and macros to implement DDA in SPSS are provided. An empirical example is given to illustrate the approach. Conceptual and empirical considerations are discussed for best-practice applications in psychological data, and sample size recommendations based on previous simulation studies are provided.

Is the Association of ADHD with Socio-Economic Disadvantage Explained by Child Comorbid Externalizing Problems or Parent ADHD?

It has been unclear whether an associations of child ADHD with socio-economic disadvantage (SES) could be accounted for by (a) parental ADHD explaining both low SES and child ADHD, and/or (b) the joint overlap of ODD or CD with low SES and ADHD. Study 1 used a community-recruited case-control sample with detailed evaluation of SES indicators, child ADHD, child externalizing, and parent ADHD symptoms (n = 931 children, 521 ADHD, 577 boys, 354 girls) in a path modeling analysis with latent variables. Study 2 evaluated ADHD and externalizing behavior in a regression model using a poverty index for SES, in 70,927 children (48.2% female) aged 5-17 years from the US 2011-2012 National Survey of Children's Health (NSCH). In Study 1, lower SES was related to the ADHD latent variable, β = -.18, p < .001; 95%CI [-.25,-.12]. This effect held when parent ADHD and child ODD and CD were in the model, β = -.11, p < .01, 95% CI [-.09,-.03], equivalent to OR = 1.50, 95% CI[1.12-2.04]). In Study 2, these results replicated. Adjusting only for age and sex, children from families who were below 200% of the federal poverty line were more likely to have moderate or severe ADHD than no ADHD, versus children above that line, OR = 2.13, 95% CI[1.79,2.54], p < .001. The effect held after adjusting for disruptive/externalizing problems, OR = 1.61, p < .01, 95%CI [1.32,1.96]. The effect size for comparable models was similar across both studies, lending higher confidence to the results. It is concluded that the SES association with child ADHD is not explained by artifact and requires a mechanistic explanation.

The Burden of ADHD in Older Adults: A Qualitative Study

OBJECTIVE

To explore how ADHD may have affected the lives of older adults who meet the diagnostic criteria of ADHD, but are unaware of their diagnosis. Our second aim was to examine whether the reported symptoms change over the life span.

METHOD

A qualitative study was conducted. Seventeen Dutch older people (>65 years) diagnosed in this study with ADHD participated in in-depth interviews. Data were analyzed according to techniques of thematic approach.

RESULTS

Seven themes emerged from the analyses. Four themes correspond to ADHD symptoms: "being active," "being impulsive," "attention problems," and "mental restlessness." In addition, the themes "low self-esteem," "overstepping boundaries," and "feeling misunderstood" emerged. The impact of ADHD symptoms seems to have declined with age.

CONCLUSION

ADHD has a negative impact on late life, and older adults with the disorder may benefit from treatment. Moreover, this study's findings call for early detection and treatment of ADHD in children and adults.

The Zappel-Philipp a historical example of ADHD Clinics

In his book "Die Geschichte von dem Zappel-Philipp," the German psychiatrist Heinrich Hoffmann (1809-1894) offers a clinical vignette which raises the question of the description of a disobedient child or presenting hyperactivity symptoms. This article describes the historical context and the biographical aspects related to this interesting approach to describing a psychiatric syndrome to children and adults. It also underlines the importance of a global approach of ADHD that considers the familial environment and situational context of symptoms.

Pre- and Perinatal Risk for Attention-Deficit Hyperactivity Disorder: Does Neuropsychological Weakness Explain the Link?

Etiological investigations of attention-deficit hyperactivity disorder (ADHD) and disruptive behavior problems support multiple causal pathways, including involvement of pre- and perinatal risk factors. Because these risks occur early in life, well before observable ADHD and externalizing symptoms emerge, the relation between risk and symptoms may be mediated by neurodevelopmental effects that manifest later in neuropsychological functioning. However, potential dissociable effects of pre/perinatal risk elements on ADHD and familial confounds must also be considered to test alternative hypotheses. 498 youth aged 6-17 years (55.0 % male) completed a multi-stage, multi-informant assessment including parent and teacher symptom reports of symptoms and parent ratings of pre/perinatal health risk indicators. Youth completed a neuropsychological testing battery. Multiple mediation models examined direct effects of pre- and perinatal health risk on ADHD and other disruptive behavior disorder symptoms and indirect effects via neuropsychological functioning. Parental ADHD symptoms and externalizing status was covaried to control for potential familial effects. Effects of prenatal substance exposure on inattention were mediated by memory span and temporal processing deficits. Further, effects of perinatal health risk on inattention, hyperactivity-impulsivity, and ODD were mediated by deficits in response variability and temporal processing. Further, maternal health risks during pregnancy appeared to exert direct rather than indirect effects on outcomes. Results suggest that after controlling for familial relatedness of ADHD between parent and child, early developmental health risks may influence ADHD via effects on neuropsychological processes underpinning the disorder.

Parent and Family Processes Related to ADHD Management in Ethnically Diverse Youth

BACKGROUND

Previous research has shown major disparities in attention deficit hyperactivity disorder (ADHD) for diverse youth across America. We do not fully understand, however, how parent and family processes are related to the identification, care-seeking approaches, treatment preferences, and engagement with care systems and services for youth with ADHD.

OBJECTIVES

The present study aimed to explore parent and family processes related to the management of ADHD in racially and ethnically diverse youth.

DESIGN

This integrative review was structured with the methodology proposed by Whittemore and Knafl.

RESULTS

Three major electronic databases yielded a final sample of 32 articles (24 quantitative, 6 qualitative, and 2 mixed methods). Nine themes emerged within three overarching meta-themes.

CONCLUSIONS

Understanding the unique perspectives of families from diverse backgrounds is essential for clinicians, researchers, and policymakers, who are dedicated to understanding racial and ethnic perspectives and developing ecologically appropriate and family-based interventions for youth with ADHD.

The role of socio-economic disadvantage in the development of comorbid emotional and conduct problems in children with ADHD

Previous research shows that, compared to children without ADHD, children with ADHD have worse socio-emotional outcomes and more experience of socio-economic disadvantage. In this study, we explored if and how the increased emotional and behavioural difficulties faced by children with ADHD may be accounted for by their more disadvantaged socio-economic circumstances. Our study, using data from 180 children (149 boys) with ADHD from the Millennium Cohort Study, had two aims. First, to examine the role of socio-economic disadvantage in the trajectories of emotional and conduct problems in children with ADHD at ages 3, 5, 7 and 11 years. Second, to explore the roles of the home environment (household chaos) and parenting (quality of emotional support, quality of the parent-child relationship and harsh parental discipline) in mediating any associations between socio-economic disadvantage and child emotional and conduct problems. Using growth curve models, we found that socio-economic disadvantage was associated with emotional and conduct problems but neither the home environment nor parenting attenuated this association. Lower quality of the parent-child relationship and harsher discipline were associated with more conduct problems. It appears that socio-economic disadvantage and parenting contribute independently to the prediction of comorbid psychopathology in children with ADHD.

Maternal Depression History Moderates Parenting Responses to Compliant and Noncompliant Behaviors of Children with ADHD

Maternal depression and parenting are robust predictors of developmental outcomes for children with attention-deficit/hyperactivity disorder (ADHD). However, methods commonly used to examine parent-child interactions in these families do not account for temporal associations between child and parent behavior that have been theorized to maintain negative child behavior. Moreover, studies examining associations between maternal depression and parenting in families of children with ADHD have not compared mothers who were currently depressed, remitted, and never clinically depressed. This study utilized sequential analysis to examine how maternal reinforcement of compliant and noncompliant child behavior differs as a function of maternal depression history. Within the 82 participating mother-child dyads, 21 mothers were currently depressed, 29 mothers had a lifetime history of depression but were in remission for at least 1 month, and 32 mothers had never been clinically depressed. 24 girls (29.6 %) and 57 boys (70.4 %) between the ages of 6-12 years old (M = 8.7, SD = 2.0) and were diagnosed with ADHD. Results indicated that all mothers were less likely to respond optimally than non-optimally to child compliant and noncompliant behaviors during observed parent-child interactions; however, currently depressed mothers were least likely to reinforce child compliance and responded most coercively to child noncompliance relative to the other groups. Remitted mothers in this sample were more coercive than never clinically depressed mothers, but were more likely to follow through with commands than never clinically depressed mothers. Implications for behavioral parent training programs aimed at skill development for depressed mothers of children with ADHD are discussed.

Neuropsychological performance measures as intermediate phenotypes for attention-deficit/hyperactivity disorder: A multiple mediation analysis

Genetic influences on dopaminergic neurotransmission have been implicated in attention-deficit hyperactivity disorder (ADHD) and are theorized to impact cognitive functioning via alterations in frontal-striatal circuitry. Neuropsychological functioning has been proposed to account for the potential associations between dopamine candidate genes and ADHD. However, to date, this mediation hypothesis has not been directly tested. Participants were 498 youth ages 6-17 years (mean M = 10.8 years, SD = 2.4 years, 55.0% male). All youth completed a multistage, multiple-informant assessment procedure to identify ADHD and non-ADHD cases, as well as a comprehensive neuropsychological battery. Youth provided a saliva sample for DNA analyses; the 480 base pair variable number of tandem repeat polymorphism of the dopamine active transporter 1 gene (DAT1) and the 120 base pair promoter polymorphism of the dopamine receptor D4 gene (DRD4) were genotyped. Multiple mediation analysis revealed significant indirect associations between DAT1 genotype and inattention, hyperactivity-impulsivity, and oppositionality, with specific indirect effects through response inhibition. The results highlight the role of neurocognitive task performance, particularly response inhibition, as a potential intermediate phenotype for ADHD, further elucidating the relationship between genetic polymorphisms and externalizing psychopathology.

Variation in Parasympathetic Dysregulation Moderates Short-term Memory Problems in Childhood Attention-Deficit/Hyperactivity Disorder

Although attention deficit/hyperactivity disorder (ADHD) is associated with impairment in working memory and short-term memory, up to half of individual children with ADHD perform within a normative range. Heterogeneity in other ADHD-related mechanisms, which may compensate for or combine with cognitive weaknesses, is a likely explanation. One candidate is the robustness of parasympathetic regulation (as indexed by respiratory sinus arrhythmia; RSA). Theory and data suggest that a common neural network is likely tied to both heart-rate regulation and certain cognitive functions (including aspects of working and short-term memory). Cardiac-derived indices of parasympathetic reactivity were collected during short-term memory (STM) storage and rehearsal tasks from 243 children (116 ADHD, 127 controls). ADHD was associated with lower STM performance, replicating previous work. In addition, RSA reactivity moderated the association between STM and ADHD - both as a category and a dimension - independent of comorbidity. Specifically, conditional effects revealed that high levels of withdrawal interacted with weakened STM but high levels of augmentation moderated a positive association predicting ADHD. Thus, variations in parasympathetic reactivity may help explain neuropsychological heterogeneity in ADHD.

Item Response Theory Analysis of ADHD Symptoms in Children With and Without ADHD

Item response theory (IRT) was separately applied to parent- and teacher-rated symptoms of attention-deficit/hyperactivity disorder (ADHD) from a pooled sample of 526 six- to twelve-year-old children with and without ADHD. The dimensional structure ADHD was first examined using confirmatory factor analyses, including the bifactor model. A general ADHD factor and two group factors, representing inattentive and hyperactive/impulsive dimensions, optimally fit the data. Using the graded response model, we estimated discrimination and location parameters and information functions for all 18 symptoms of ADHD. Parent- and teacher-rated symptoms demonstrated adequate discrimination and location values, although these estimates varied substantially. For parent ratings, the test information curve peaked between -2 and +2 SD, suggesting that ADHD symptoms exhibited excellent overall reliability at measuring children in the low to moderate range of the general ADHD factor, but not in the extreme ranges. Similar results emerged for teacher ratings, in which the peak range of measurement precision was from -1.40 to 1.90 SD Several symptoms were comparatively more informative than others; for example, is often easily distracted ("Distracted") was the most informative parent- and teacher-rated symptom across the latent trait continuum. Clinical implications for the assessment of ADHD as well as relevant considerations for future revisions to diagnostic criteria are discussed.

Gender differences in adults with attention-deficit/hyperactivity disorder: A narrative review

Certain characteristics of attention-deficit/hyperactivity disorder (ADHD) in children have long been known to differ by gender. What has not been as widely studied is whether gender is similarly associated with ADHD differences in adults. In this review, the relation between gender and adult ADHD prevalence, persistence, impairment, comorbidity, cognitive functioning, and treatment response was examined across 73 studies. Although gender was related to several characteristics and correlates of adult ADHD, it appeared that many of these gender differences may be at least be partially attributed to methodological artifacts or social and cultural influences, rather than fundamental differences in the expression of ADHD in men and women. We highlight how understanding the nature of the relation between gender and ADHD across the lifespan is complicated by a number of methodological difficulties, and offer recommendations for how emerging research and clinical practice can better incorporate gender into the conceptualization of ADHD in adulthood.

Comorbidity of ADHD and incontinence in children

ADHD and incontinence are common childhood disorders which co-occur at much higher rates than expected by chance. The aim of this review was to provide an overview both of the comorbidity of nocturnal enuresis (NE), daytime urinary incontinence (DUI) and faecal incontinence (FI) in children with ADHD; and, vice versa, of the co-occurrence of ADHD in children with NE, DUI and FI. Most clinical studies have focussed on the association of ADHD and NE. Population-based studies have shown that children with DUI have an even greater risk for ADHD than those with NE. While children with FI have the highest overall comorbidity rates of psychological disorders, these are heterogeneous with a wide range of internalising and externalising disorders--not necessarily of ADHD. Genetic studies indicate that ADHD and NE, DUI and FI do not share the same genetic basis. The comorbidity is conferred by non-genetic factors. Possible aetiological and pathogenetic links between ADHD and incontinence are provided by neurophysiological, imaging and pharmacological studies. The co-occurrence has clinical implications: children with ADHD and NE, DUI and FI are more difficult to treat, show lower compliance and have less favourable treatment outcomes for incontinence. Therefore, both groups of disorders have to be assessed and treated specifically.

Parental involvement moderates etiological influences on attention deficit hyperactivity disorder behaviors in child twins

Although few would now contest the presence of Gene × Environment (G × E) effects in the development of child psychopathology, it remains unclear how these effects manifest themselves. Alternative G × E models have been proposed (i.e., diathesis-stress, differential susceptibility, bioecological), each of which has notably different implications for etiology. Child twin studies present a powerful tool for discriminating between these models. The current study examined whether and how parental involvement moderated etiological influences on attention deficit hyperactivity disorder (ADHD) within 500 twin pairs aged 6-11 years. Results indicated moderation of genetic and nonshared environmental contributions to ADHD by parental involvement, and moreover, suggested both differential susceptibility and bioecological models of G × E. Results highlight the utility of child twin samples in testing different manifestations of G × E effects.

The comorbidity of ADHD and autism spectrum disorder

ADHD and autism spectrum disorder are common psychiatric comorbidities to each another. In addition, there is behavioral, biological and neuropsychological overlap between the two disorders. There are also several important differences between autism spectrum disorder and ADHD. Treatment strategies for the comorbid condition will also be reviewed. Future areas of research and clinical need will be discussed.

Growing up after extremely preterm birth: lifespan mental health outcomes

There is growing interest in the long-term mental health sequelae of extremely preterm birth. In this paper we review literature relating to mental health outcomes across the lifespan. Studies conducted in the preschool years, school age and adolescence, and adulthood show continuity in outcomes and point to an increased risk for inattention, socio-communicative problems and emotional difficulties in individuals born extremely preterm. Both behavioural and neuroimaging studies also provide evidence of a neurodevelopmental origin for mental health disorders in this population. Here we summarise contemporary evidence and highlight key methodological considerations for carrying out and interpreting studies in this field.

Bifactor latent structure of ADHD/ODD symptoms: predictions of dual-pathway/trait-impulsivity etiological models of ADHD

OBJECTIVE

To determine if ADHD/ODD symptoms are better represented by a bifactor model of disruptive behavior [general disruptive behavior factor along with specific inattention (IN), specific hyperactivity/impulsivity (HI), and specific oppositional defiant disorder (ODD) factors] than an ADHD-IN, ADHD-HI, and ODD three-factor model.

METHOD

Mothers' and fathers' ratings of ADHD-IN, ADHD-HI, and ODD symptoms in a community sample of 4,658 children and adolescents (53% female) from Brazil, Thailand, and the US were used to evaluate the measurement models.

RESULTS

The bifactor model of disruptive behavior provided a better fit than the three factor model. The bifactor model also occurred with mothers' and fathers' ratings of male and female children and adolescents.

CONCLUSIONS

Consistent with predictions derived from recently articulated dual-pathway and trait-impulsivity models of externalizing liability, and from behavioral genetics studies indicating near complete overlap in vulnerability to ADHD and ODD, ADHD and ODD symptoms arose from a single, general disruptive behavior factor, which accounted for all of the variance in HI subscale scores and over half of the variance IN and ODD subscales. Thus, IN, HI, and ODD subscale scores strongly reflect a general disruptive behavior factor – not the specific content of their respective constructs.

Globalization and cognitive enhancement: emerging social and ethical challenges for ADHD clinicians

Globalization of ADHD and the rise of cognitive enhancement have raised fresh concerns about the validity of ADHD diagnosis and the ethics of stimulant drug treatment. We review the literature on these two emerging phenomena, with a focus on the corresponding social, scientific and ethical debates over the universality of ADHD and the use of stimulant drug treatments in a global population of children and adolescents. Drawing on this literature, we reflect on the importance of ethically informed, ecologically sensitive clinical practices in relation to ADHD diagnosis and treatment.

Behavioural outcomes and psychopathology during adolescence

Preterm birth is associated with a high risk of residual neurodevelopmental disability and cognitive impairment. These problems are closely associated with psychiatric disorders and thus it is unsurprising that preterm birth also confers high risk for poor long term mental health. The risk associated with preterm birth is not a general one, but appears to be specific to symptoms and disorders associated with anxiety, inattention and social and communication problems, and manifest in a significantly higher prevalence of emotional disorders, ADHD and Autism. Adolescence is a key period for mental health and studies have shown that problems evident in childhood persist over this time and are more stable amongst preterm individuals than term-born peers. There is also modest evidence for an increased prevalence of psychotic symptoms in preterm adolescents. The high prevalence of psychiatric disorders, present in around 25% of preterm adolescents, requires long term screening and intervention.