Measuring ADHD and ODD symptoms and impairment using high school teachers' ratings

Black Mothers of Children With and Without ADHD: Relationships Among Maternal Psychopathology, Parenting Stress, and Parenting Cognitions

INTRODUCTION

Parents of children with attention-deficit/hyperactivity disorder (ADHD) endorse increased parenting stress and lower levels of parenting efficacy and satisfaction as compared to parents of children without ADHD. Additionally, maternal ADHD and depression differentiate children with and without ADHD, with children with ADHD being more likely to have a mother with psychopathology.

METHOD

With a focus on an understudied population, we investigated the extent to which maternal self-reported ADHD and depression were associated with self-reported parenting stress and parenting cognitions in 70 Black mothers of children with (maternal Mage = 35.52, SD = 6.49) and without ADHD (maternal Mage = 35.39, SD = 6.53) recruited from a metropolitan area in the southeastern United States.

RESULTS

Analyses indicated that Black mothers of children with ADHD reported higher levels of parenting stress, lower levels of parenting efficacy, and lower levels of parenting satisfaction. However, there were no significant differences between groups on measures of maternal ADHD or depression. Maternal depression significantly accounted for variability in both parenting satisfaction and parenting stress beyond child ADHD and maternal education. With maternal depression in the models, the association between maternal ADHD and parenting stress and parenting satisfaction lost significance.

DISCUSSION

Given the racial disparities in the treatment of ADHD, future research should focus on investigating the linkages between maternal depression, parenting stress, parenting satisfaction, and parenting behaviors in Black mothers in order to delineate whether there are cultural adaptations that may improve treatment utilization rates for child ADHD within this population.

ADHD in Black Youth: A Content Analysis of Empirical Research from 1972 to 2023

OBJECTIVE

The purpose of this content analysis study was to characterize patterns of research on Black youth with ADHD.

METHOD

Relevant articles were identified through searching psychology and medical databases and cross-referencing citations in previously published review articles. The 204 empirical articles included in this study (1) were conducted in the United States, (2) had a predominantly child or adolescent sample, (3) had more than 80% Black youth/families in the study sample and/or conducted separate analyses for Black youth/families, and (4) examined ADHD symptoms or diagnoses. Articles were categorized into five primary content areas: Assessment, Treatment, Perceptions, Prevalence, and Associated Correlates. Journal characteristics, sample characteristics, and methodological characteristics are presented across these content areas.

RESULTS

Findings show a relatively low representation of Black youth with ADHD in the literature, with most studies using race comparative approaches and secondary data analyses, and many being published in medical journals.

CONCLUSION

Based on these results, changes are recommended both at the individual study and broader systems levels (e.g., funding agencies). More research, funding, and publications centering Black youth with ADHD are vital to understanding and correcting long-standing health disparities for this community.

Reconceptualizing the approach to supporting students with attention-deficit/hyperactivity disorder in school settings

The long-term academic outcomes for many students with attention-deficit/hyperactivity disorder (ADHD) are strikingly poor. It has been decades since students with ADHD were specifically recognized as eligible for special education through the Other Health Impaired category under the Education for all Handicapped Children Act of 1975, and similarly, eligible for academic accommodations through Section 504 of the 1973 Rehabilitation Act. It is time to acknowledge that these school-policies have been insufficient for supporting the academic, social, and behavioral outcomes for students with ADHD. Numerous reasons for the unsuccessful outcomes include a lack of evidence-based interventions embedded into school approaches, minimizing the importance of the general education setting for promoting effective behavioral supports, and an over-reliance on assessment and classification at the expense of intervention. Contemporary behavioral support approaches in schools are situated in multi-tiered systems of support (MTSS); within this article we argue that forward-looking school policies should situate ADHD screening, intervention, and maintenance of interventions within MTSS in general education settings and reserve special education eligibility solely for students who require more intensive intervention. An initial model of intervention is presented for addressing ADHD within schools in a manner that should provide stronger interventions, more quickly, and therefore more effectively.

Development of a human-analogue, 3-symptom domain Dog ADHD and Functionality Rating Scale (DAFRS)

The family dog, in its natural environment, exhibits neuropsychological deficits redolent of human psychiatric disorders, including behaviours that are similar to human attention-deficit/hyperactivity disorder (ADHD) symptoms. Based on standard questionnaire methods in humans, we aimed to develop and validate a detailed, psychometrically improved tool to assess owner views on relevant dog behaviours. We modified available questionnaires by adding items that allow for separate analysis of impulsivity, and items on functional impairment. We collected data from 1168 owners for different validation steps of the new questionnaire and, similarly to assessment of humans where teachers also evaluate as an expert control, we collected data from dog trainers. Exploratory and confirmatory factor analysis revealed 3 factors: inattention (IA), hyperactivity (H) and impulsivity (I), corresponding to all three human symptom dimensions in dogs. Test-retest analyses showed excellent agreement between measurements for all factors. Similarly to findings with humans, trainer-owner rating comparisons showed fair (IA) to moderate (H, I) agreement. As in humans, greater ADHD scores were associated with greater functional impairment scores. We suggest that in dogs, similarly to humans, parallel examination of (extreme) ADHD and functional impairment scores could help distinguish diagnosable individuals, after further validation of the questionnaire using a relevant behaviour test.

Harmonizing DSM-IV and DSM-5 Versions of ADHD "A Criteria": An Item Response Theory Analysis

The transition from Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) attention deficit/hyperactivity disorder (ADHD) checklists included item wording changes that require psychometric validation. A large sample of 854 adolescents across four randomized trials of psychosocial ADHD treatments was used to evaluate the comparability of the DSM-IV-TR and DSM-5 versions of the ADHD symptom checklist. Item response theory (IRT) was used to evaluate item characteristics and determine differences across versions and studies. Item characteristics varied across items. No consistent differences in item characteristics were found across versions. Some differences emerged between studies. IRT models were used to create continuous, harmonized scores that take item, study, and version differences into account and are therefore comparable. DSM-IV-TR ADHD checklists will generalize to the DSM-5 era. Researchers should consider using modern measurement methods (such as IRT) to better understand items and create continuous variables that better reflect the variability in their samples.

Impairment's Role in the Pathway From Externalizing Psychopathology to Depressive Symptoms in Adolescents With ADHD

OBJECTIVE

This study examined the role of academic, social, and family impairment in the pathway from externalizing psychopathology to depression among young adolescents with ADHD in a multiple mediation model.

METHOD

The sample included adolescents with ADHD enrolled in an intervention trial. Parent ratings of externalizing psychopathology were measured at eligibility assessment, adolescent self-reported depressive symptoms were measured at eligibility and at the end of treatment, and parent-rated impairment was measured in the middle of treatment. A multiple mediation model was used to examine mediating effects of impairment types in the pathway from externalizing psychopathology to depression.

RESULTS

Parent-reported family impairment significantly mediated the association between externalizing psychopathology and depressive symptoms.

CONCLUSIONS

Results suggest family impairment mediates the association between externalizing psychopathology and depressive symptoms beyond academic and social impairment for youth with ADHD. Findings implicate the importance of targeting family functioning during early adolescence to prevent depression.

An Observational Study of the Morning and Evening Behavior of Individuals With and Without Attention-Deficit/Hyperactivity Disorder

Evidence of ADHD symptoms and impairments were documented in the morning and evening hours for individuals diagnosed with ADHD. These results illustrate additional areas in need of attention in the refinement of treatments for adults with ADHD.

Evaluating ADHD Assessment for Dogs: A Replication Study

The family dog, in its natural environment, exhibits neuropsychological deficits redolent of human psychiatric disorders, including behaviours similar to human Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms. For dogs, Vas and colleagues developed a 13-item questionnaire to measure inattention and hyperactivity/impulsivity (Dog ARS; 2007). We re-assessed, in a large sample of dogs (N = 319), psychometric properties of the Dog ARS, to identify possible limitations as a basis for further development. We examined the cross-study stability of factor structure and 40-day temporal stability of item and subscale scores and compared owner-report with expert (dog trainer)-report (n = 86), paralleling human parent/teacher assessments. To identify ambiguous items, we administered a modified version (including “I don’t know” options, N = 520) to a different sample. We could replicate the factor structure with evidence of good internal consistency and test–retest reliability of both subscales. Agreement between owner and trainer ratings was fair (inattention) and moderate (hyperactivity/impulsivity). Three ambiguous items were identified. Overall, we claim that the Dog ARS is a reliable tool to assess ADHD-like behaviour in dogs, but in its current form, it is not suitable to detect diagnosable individuals, as it does not comprise items assessing functional impairment, and also, the inclusion of owner-expert ratings in the evaluation process would be necessary.

Parenting Stress during Late Adolescence in Mothers of Individuals with ADHD with and without ODD

Although children with ADHD continue to experience impairment well into adolescence, research exploring the experiences of their parents during late adolescence is lacking. Thus, we examined changes in parenting stress and family conflict in mothers of adolescents with ADHD during the transition to early adulthood. We also explored predictors of these changes in addition to investigating differences in these trajectories due to comorbid ODD. Forty-nine mothers of adolescents with ADHD only and thirty-seven mothers of adolescents with ADHD/ODD reported on parenting stress and perceptions of family conflict at baseline (mean age = 16.88) and at 3-month, 9-month, and 15-month follow up assessments. Growth curve modeling indicated that both groups of mothers reported relative declines in parenting stress and family conflict across time. However, the mothers of adolescents with ADHD/ODD persistently reported more stress and conflict. Furthermore, decreases in family conflict were more predictive of reduced parenting stress in families of adolescents only diagnosed with ADHD. Our findings suggest that comorbid ODD is associated with parenting stress during late adolescence. Thus, interventions should focus on further reducing this stress as adolescents with ADHD/ODD transition to adulthood.

Impaired cognitive flexibility following NMDAR-GluN2B deletion is associated with altered orbitofrontal-striatal function

A common feature across neuropsychiatric disorders is inability to discontinue an action or thought once it has become detrimental. Reversal learning, a hallmark of executive control, requires plasticity within cortical, striatal and limbic circuits and is highly sensitive to disruption of N-methyl-d-aspartate receptor (NMDAR) function. In particular, selective deletion or antagonism of GluN2B containing NMDARs in cortical regions including the orbitofrontal cortex (OFC), promotes maladaptive perseveration. It remains unknown whether GluN2B functions to maintain local cortical activity necessary for reversal learning, or if it exerts a broader influence on the integration of neural activity across cortical and subcortical systems. To address this question, we utilized in vivo electrophysiology to record neuronal activity and local field potentials (LFP) in the orbitofrontal cortex and dorsal striatum (dS) of mice with deletion of GluN2B in neocortical and hippocampal principal cells while they performed touchscreen reversal learning. Reversal impairment produced by corticohippocampal GluN2B deletion was paralleled by an aberrant increase in functional connectivity between the OFC and dS. These alterations in coordination were associated with alterations in local OFC and dS firing activity. These data demonstrate highly dynamic patterns of cortical and striatal activity concomitant with reversal learning, and reveal GluN2B as a molecular mechanism underpinning the timing of these processes.

Adolescents Treated for Attention-Deficit/Hyperactivity Disorder in Pediatric Primary Care: Characterizing Risk for Stimulant Diversion

OBJECTIVE

To describe the clinical and psychosocial characteristics, and their hypothesized interrelations, as it pertains to risk for stimulant diversion (sharing, selling, or trading) for adolescents in pediatric primary care treatment for attention-deficit/hyperactivity disorder.

METHODS

Baseline data for 341 adolescents in a cluster-randomized controlled trial of stimulant diversion prevention in pediatric primary care (NCT_03080259) were used to (1) characterize diversion and newly measured risk factors, (2) examine their associations with age and sex, and (3) test whether associations among risk factors were consistent with model-implied predictions. Data were collected through multi-informant electronic surveys from adolescents and parents.

RESULTS

Diversion was rare (1%) in this sample (Mage = 15, SD = 1.5, 74% male participants). Older age was associated with being approached to divert (r = 0.25, p < 0.001) and higher risk on variables pertinent to stimulant treatment, such as treatment disclosure (r = 0.12, p < 0.05), tolerance for stimulant misuse and diversion (r = 0.17, p < 0.05), and peer norms favorable to stimulant misuse and diversion (r values = 0.15-0.34, p < 0.001). Sex differences were minimal. Variables from our conceptual model and specific to stimulants (e.g., perceived likelihood of negative consequences from diversion and schoolmate stimulant misuse/diversion) were related in multivariable regressions to hypothesized immediate precursors of diversion (e.g., diversion intentions).

CONCLUSION

Although diversion was rare for these primary care-treated adolescents, risk levels appear to be higher for older adolescents. Prevention may be most effective by capitalizing on current psychosocial strengths and discussing stimulant-specific attitudes, behaviors, and social norms before vulnerability to diversion increases in the final years of high school and into college.

Organization interventions as a mediator of change in grades in the Challenging Horizons Program

This study evaluated whether an organization intervention was a mediator of change for grade point average (GPA) in a randomized clinical trial of a school-based treatment program for adolescents with attention deficit hyperactivity disorder (ADHD). A demographically diverse sample of 148 participants (105 males) with a diagnosis of ADHD were recruited from nine middle schools. Comprehensive diagnostic evaluations were completed and participants were randomized into one of three conditions (two active treatment conditions, one control condition) for a randomized clinical trial that lasted an entire school year. The results of the trial are reported elsewhere (Evans et al., 2016; Schultz et al., 2017); in this study we evaluated four of the criteria for determining mediation as reported by Kazdin (2007) to determine whether response to the organization intervention in this school-based treatment program mediated the relationship between dosage and GPA beyond previous GPA. The results provided evidence that response to the organization intervention mediated the relationship between intervention dosage and change in GPA.

Psychopathologic Profiles and Clusters in Tertiary Clinic Referred Patients with Adult Attention Deficit Hyperactivity Disorder: A Person-Centered Analysis

OBJECTIVE

Adult attention deficit hyperactivity disorder (ADHD) has a heterogeneous clinical presentation with patients showing very frequent emotional problems. In the present study, patients with adult ADHD were subtyped based on their psychopathology using a person-centered approach.

METHODS

In the present chart review study, detailed findings of psychological evaluation conducted as part of routine care were utilized. A total of 77 subjects with adult ADHD were included in the analysis. Detailed ADHD symptoms, psychiatric comorbid Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, and severity of mood and anxiety symptoms were evaluated in the person-centered analysis.

RESULTS

Three clusters were generated using clustering analysis. DSM comorbid conditions did not significantly impact the clustering. Cluster 1 consisted of ADHD combined presentation (ADHD-C) with less mood symptoms, cluster 2 of ADHD predominantly inattentive presentation and cluster 3 of ADHD-C with significant mood symptoms. Patients in cluster 3 had adulthood functional impairment more frequently compared with patients in cluster 1. Patients in cluster 3 showed recurrent thoughts of death and suicidal ideation more frequently compared with patients in cluster 1.

CONCLUSION

Further studies are needed to confirm the relationships observed in the present study.

Adult ADHD: Prevalence and Clinical Correlates in a Sample of Italian Psychiatric Outpatients

Objective: ADHD remains a largely underdiagnosed disorder in Europe and especially in Italy. Aims of the present study were to assess the prevalence of ADHD and its clinical and demographic correlates in a large sample of Italian outpatients. Method: 634 outpatients accessing psychiatric services were assessed with the Mini-International Neuropsychiatric Interview (MINI) Plus V. 5.0.0 interview and the Adult ADHD self-report Scale Symptoms Checklist (ASRS)-V 1.1 Short Form. Patients positive to the ASRS-V 1.1 were assessed with the Diagnostic Interview for ADHD in Adults (DIVA) 2.0. Results: Of the total patients' sample, 81 (12.8%) were positive on the ASRS-V 1.1. After performing the DIVA 2.0, 44 patients (6.9%) met the criteria for Adult ADHD. Significant clinical and demographic differences between ADHD positive and negative groups were found. Conclusion: The prevalence and correlates of ADHD comorbidity in our outpatient psychiatric population were comparable to those found in other high-income countries. Considering the prevalence of ADHD and its impact on functioning, implementing specific knowledge on this subject is needed.

Interpersonal Problems of Young Adults With and Without Attention-Deficit/Hyperactivity Disorder

Objective:Interpersonal functioning is a core area of impairment for young adults with Attention-Deficit/Hyperactivity Disorder (ADHD), yet the assessment of their interpersonal problems has not been approached using a comprehensive model of interpersonal behaviors. Method: Interpersonal problems of young adults with ADHD (n = 24) were compared to non-ADHD peers (n = 26) by self- and collateral-report using the Inventory of Interpersonal Problems-Circumplex-Item Response Theory (IIP-C-IRT). Results: Both self- and collateral-reports yielded significantly higher scores across interpersonal problem domains, except for self-reported Hostile-Dominant (HD) interpersonal problems. Discrepancy scores between self- and collateral-report supported larger differences in the ADHD versus non-ADHD groups for HD problems. Large correlations between collateral-reported family relationship impairments and HD problems were found only for the ADHD group. Conclusion: Young adults with ADHD have higher levels of interpersonal problems relative to their non-ADHD peers, but also appear to underreport HD interpersonal problems relative to non-ADHD peers, suggesting the presence of a bias. (J. of Att. Dis. XXXX; XX[X] XX-XX).

Relative Age and Attention-Deficit/Hyperactivity Disorder: Data From Three Epidemiological Cohorts and a Meta-analysis

OBJECTIVE

To investigate the effect of relatively younger age on attention-deficit/hyperactivity disorder (ADHD) symptoms and diagnosis through three population-based cohorts and a meta-analysis.

METHOD

This study included participants of three community-based cohorts in Brazil: 1993 Pelotas Cohort (N = 5,249), 2004 Pelotas Cohort (N = 4,231), and Brazilian High-Risk Study for Psychiatric Disorders (HRC study) (N = 2,511). We analyzed the effect of relatively younger age on ADHD symptoms and diagnosis. For the meta-analysis, we searched MEDLINE, PsycINFO, and Web of Science from inception through December 25, 2018. We selected studies that reported measures of association between relative immaturity and an ADHD diagnosis. We followed the Meta-analysis Of Observational Studies in Epidemiology guidelines. The protocol for meta-analysis is available on PROSPERO (CRD42018099966).

RESULTS

In the meta-analysis, we identified 1,799 potentially eligible records, from which 25 studies including 8,076,570 subjects (164,049 ADHD cases) were analyzed with their effect estimates. The summarized relative risk of an ADHD diagnosis was 1.34 (95% CI, 1.26-1.43, p < .001) for children born in the first 4 months of the school year (relatively younger). Heterogeneity was high (I² = 96.7%). Relative younger age was associated with higher levels of ADHD symptoms in the 1993 Pelotas Cohort (p = .003), 2004 Pelotas Cohort (p = .046), and HRC study (p = .010).

CONCLUSION

Children and adolescents who are relatively younger compared with their classmates have a higher risk of receiving an ADHD diagnosis. Clinicians should consider the developmental level of young children when evaluating ADHD symptoms.

The ADHD teen integrative data analysis longitudinal (TIDAL) dataset: background, methodology, and aims

BACKGROUND

The Attention Deficit Hyperactivity Disorder (ADHD) Teen Integrative Data Analysis Longitudinal (TIDAL) dataset integrates data from four randomized trials.

METHOD

Participants with ADHD (N = 854; 72.5% male, 92.5% racial/ethnic minority, ages 10-17) were assessed three times across 12 months. Data includes parent, self, and teacher ratings, observations, and school records. The battery was harmonized using an Integrative Data Analysis (IDA) approach to form variables that assign unique values to all participants.

RESULTS

The data will be used to investigate: (1) profiles that organize the heterogeneous population into clinically meaningful subgroups, (2) whether these profiles predict treatment response, (3) heterogeneity in treatment response and variables that predict this response, (4) how treatment characteristics and adjunctive supports predict treatment response, and (5) mediators of treatment and whether these mechanisms are moderated by treatment characteristics.

CONCLUSIONS

The ADHD TIDAL Dataset will be openly shared with the field to maximize its utility.

Multi-rater developmental trajectories of hyperactivity-impulsivity and inattention symptoms from 1.5 to 17 years: a population-based birth cohort study

The developmental course of hyperactivity-impulsivity and inattention symptoms from infancy to adolescence has not been documented in a population sample. The aim of this study was to describe the developmental course of hyperactivity-impulsivity and inattention symptoms from 1.5 to 17 years using multiple informants, and to identify perinatal risk factors associated with following elevated (high-risk) trajectories. Using a population-based birth cohort (n = 1374), symptom ratings from mothers (1.5-8 years), teachers (6-13 years) and participant self-reports (10-17 years) were combined using group-based multi-trajectory modeling to identify informants' convergence in identifying high-symptom trajectories of hyperactivity-impulsivity and inattention over time. Perinatal risk factors associated with high-symptom trajectories were identified using stepwise logistic regression. The study found that symptoms of hyperactivity-impulsivity broadly declined from 1.5 to 17 years while symptoms of inattention remained constant. 21.4% of participants followed elevated trajectories of hyperactivity-impulsivity and 20.2% followed elevated trajectories of inattention; 11.6% followed elevated trajectories of both types of symptoms concurrently. Risk factors for high-risk trajectories of hyperactivity-impulsivity were low maternal education, prenatal alcohol exposure, non-intact family, maternal depression, and low child IQ; for high-risk inattention they were prenatal street drug exposure, early motherhood, low maternal education, maternal depression and low child IQ. Risk factors for trajectories of high-risk hyperactivity-impulsivity and inattention concurrently were low maternal education, maternal depression, and low child IQ. The combination of longitudinal assessments from multiple informants (i.e., mother, teacher, participant-reports) provides a new way to characterize hyperactivity-impulsivity and inattention phenotypes over time.

High versus Low Intensity Summer Treatment for ADHD Delivered at Secondary School Transitions

Spikes in symptom severity are noted for adolescents with attention deficit/hyperactivity disorder (ADHD) at the transitions to middle and high school that are attributed to developmental maladjustment. This study evaluated the effectiveness of high-intensity (HI; 412 hr, $4,373 per participant) versus low-intensity (LI; 24 hr, $97 per participant) skills-based summer intervention delivered to adolescents with ADHD by local school district staff. Participants were 325 ethnically diverse rising sixth and ninth graders with ADHD randomized to HI versus LI (n = 218) or recruited into an untreated comparison group (n = 107). Group × Time 1-year outcome trajectories were compared using linear mixed models. Both interventions possessed high fidelity and were viewed by families as enjoyable and beneficial. Youth attendance was higher for HI (~80%) versus LI (~45%). Parent training attendance was uniform across groups (~50%). Parent and student attendance did not impact trajectories. Primary benefits of HI over LI were to note taking (d = .50), parent contingency management (d = .43), and parent-rated ADHD symptoms (d = .40-.46; ninth grade only). Secondary analyses suggested that HI may produce additional benefits compared to no treatment for home organization skills (HI vs. untreated d = .54), parent-teen conflict (HI vs. untreated d = .39), and grade point average (HI vs. untreated d = .47, ninth grade only). Summer HI treatment was superior to LI in engagement and uptake of certain skills. However, the extent to which these medium benefits on a limited number of outcomes justify high costs compared to LI remains an open question. Delivering treatment during the summer instead of school year may limit generalizability.

Impaired cognitive flexibility following NMDAR-GluN2B deletion is associated with altered orbitofrontal-striatal function

A common feature across neuropsychiatric disorders is inability to discontinue an action or thought once it has become detrimental. Reversal learning, a hallmark of executive control, requires plasticity within cortical, striatal and limbic circuits and is highly sensitive to disruption of N-methyl-D-aspartate receptor (NMDAR) function. In particular, selective deletion or antagonism of GluN2B containing NMDARs in cortical regions including the orbitofrontal cortex (OFC), promotes maladaptive perseveration. It remains unknown whether GluN2B functions to maintain local cortical activity necessary for reversal learning, or if it exerts a broader influence on the integration of neural activity across cortical and subcortical systems. To address this question, we utilized in vivo electrophysiology to record neuronal activity and local field potentials (LFP) in the orbitofrontal cortex and dorsal striatum (dS) of mice with deletion of GluN2B in neocortical and hippocampal principal cells while they performed touchscreen reversal learning. Reversal impairment produced by corticohippocampal GluN2B deletion was paralleled by an aberrant increase in functional connectivity between the OFC and dS. These alterations in coordination were associated with alterations in local OFC and dS firing activity. These data demonstrate highly dynamic patterns of cortical and striatal activity concomitant with reversal learning, and reveal GluN2B as a molecular mechanism underpinning the timing of these processes.

Differenzielle Analysen zum Zusammenhang zwischen Kreativität und ADHS bei Kindern und Jugendlichen

Zusammenfassung. Befunde zur Kreativität bei Kindern und Jugendlichen mit ADHS sind widersprüchlich. Zur Erfassung von Kreativität wird oft auf quantitative Leistungsmaße wie divergentes Denken in Speed-Tests zurückgegriffen anstelle von qualitativen Aspekten wie Unkonventionalität und Humor. Diese Studie untersucht, ob sich Kinder und Jugendliche mit ADHS hinsichtlich quantitativer und qualitativer Kreativitätsmerkmale von einer Kontrollgruppe unterscheiden. Die Stichprobe schließt N = 71 Kinder und Jugendliche (10 – 14 Jahre) ein, davon 17 mit klinischer ADHS-Diagnose und 16 mit ADHS-Symptomen gemäß DISYPS-II. In einem standardisierten Kreativitätstest erreichen die ADHS-Gruppen unabhängig von Alter und Geschlecht signifikant bessere Gesamtleistungen als die Kontrollgruppe. Unterschiede bestehen vor allem in den Bereichen Humor und emotionale Expressivität zeichnerischer Darstellungen. Die Ergebnisse unterstreichen die Bedeutung ressourcenorientierter Perspektiven auf Kinder und Jugendliche mit ADHS.

The Difficulties in Emotion Regulation Scale-Parent Report: A Psychometric Investigation Examining Adolescents With and Without ADHD

Emotion dysregulation is associated with attention deficit/hyperactivity disorder (ADHD) and confers risk for behavior problems and functional impairment; however, there is little guidance on best practices for measurement in adolescents. We developed a parent-report version of the Difficulties in Emotion Regulation Scale (DERS-P). Evidence of reliability and validity was evaluated in a large community online sample (Study 1: n = 978; M_age = 13.52 years; SD = 1.93) and in two samples of adolescents with ADHD (Study 2, Sample 1: n = 78; M_age = 12.12 years, SD = 0.91; Sample 2: n = 206; M_age = 15.35 years; SD = 0.85). A four-factor solution of the DERS-P was obtained in Study 1 and confirmed in Study 2, with factors demonstrating acceptable internal consistency. The community sample was generally rated as less dysregulated than the ADHD samples. Support was obtained for convergent, concurrent, and incremental validity evidence. These findings provide preliminary evidence for the DERS-P as a psychometrically sound parent-report measure of emotion dysregulation in 11- to 17-year-old adolescents.

Measuring impairment when diagnosing adolescent ADHD: Differentiating problems due to ADHD versus other sources

The DSM-5 requires clinicians to link ADHD symptoms to clinically meaningful impairments in daily life functioning. Measuring impairment during ADHD assessments may be particularly challenging in adolescence, when ADHD is often not the sole source of a youth's difficulties. Existing impairment rating scales are criticized for not specifying ADHD as the source of impairment in their instructions, leading to potential problems with rating scale specificity. The current study utilized a within subjects design (N = 107) to compare parent report of impairment on two versions of a global impairment measure: one that specified ADHD as the source of impairment (Impairment Rating Scale-ADHD) and a standard version that did not (Impairment Rating Scale). On the standard family impairment item, parents endorsed greater impairment as compared to the IRS-ADHD. This finding was particularly pronounced when parents reported high levels of parenting stress. More severe ADHD symptoms were associated with greater concordance between the two versions. Findings indicate that adolescent family related impairments reported during ADHD assessments may be due to sources other than ADHD symptoms, such as developmental maladjustment. To prevent false positive diagnoses, symptom-specific wording may optimize impairment measures when assessing family functioning in diagnostic assessments for adolescents with ADHD.

Factor Structure and Convergent Validity of the Stress Index for Parents of Adolescents (SIPA) in Adolescents With ADHD

Parenting stress is common in families with an adolescent with attention-deficit/hyperactivity disorder (ADHD). The Stress Index for Parents of Adolescents (SIPA) was developed to assess parenting stress but has not been validated outside of the original development work. This study examined the factor structure and sources of convergent validity of the SIPA in a sample of adolescents diagnosed with ADHD (M_age = 12.3, N = 327) and their caregivers. Three first-order models, two bifactor models, and one higher order model were evaluated; none met overall model fit criteria but the first-order nine-factor model displayed the best fit. Convergent validity was also assessed and the SIPA adolescent domain was moderately correlated with measures of family impairment and conflict after accounting for ADHD symptom severity. Implications of these findings for use of the SIPA in ADHD samples are discussed along with directions for future research focused on parent stress and ADHD.

The Impact of DSM-5 A-Criteria Changes on Parent Ratings of ADHD in Adolescents

OBJECTIVE

Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) A-criteria for ADHD were expanded to include new descriptors referencing adolescent and adult symptom manifestations. This study examines the effect of these changes on symptom endorsement in a sample of adolescents with ADHD (N = 259; age range = 10.72-16.70).

METHOD

Parent ratings were collected and Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) and DSM-5 endorsement of ADHD symptoms were compared.

RESULTS

Under the DSM-5, there were significant increases in reported inattention, but not hyperactivity/impulsivity (H/I) symptoms, with specific elevations for certain symptoms. The average adolescent met criteria for less than one additional symptom under the DSM-5, but the correlation between ADHD symptoms and impairment was attenuated when using the DSM-5 items. Impulsivity items appeared to represent adolescent deficits better than hyperactivity items. Results were not moderated by demographic factors.

CONCLUSION

In a sample of adolescents with well-diagnosed DSM-IV-TR ADHD, developmental symptom descriptors led parents to endorse slightly more symptoms of inattention, but this elevation is unlikely to be clinically meaningful.

Psychometric Properties of the Impairment Rating Scale in Samples of Adults With Attention Deficit Hyperactivity Disorder

Adults with attention deficit hyperactivity disorder (ADHD) are impaired in numerous domains. However, psychometrically sound measures assessing broad-ranging impairment, particularly brief scales for diagnostic purposes, are scarce. The Impairment Rating Scale (IRS), originally developed to assess ADHD-related impairment in children, has been adapted to a 12-item self-report measure of impairment in adults. In this study, the psychometric properties of the adult IRS were examined in three samples. In Studies 1 and 2, the adult IRS demonstrated good convergent, divergent, and incremental validity among college students and an online sample of adults, respectively. In the same studies, an appropriate clinical cutoff score was identified (IRS item score ≥1) using diagnostic tests. In Study 3, the adult IRS demonstrated good interrater reliability between ratings provided by romantic partners. Overall, findings support the clinical utility of the adapted IRS for assessing the impairment diagnostic criterion for ADHD in adults.

Bifactor Models of Attention Deficit/Hyperactivity Symptomatology in Adolescents: Criterion Validity and Implications for Clinical Practice

This study evaluated the fit and criterion validity of a bifactor model for 18 DSM-IV attention deficit/hyperactivity disorder (ADHD) symptoms, along with nine supplementary symptoms that represented the manifestation of inattention and hyperactivity-impulsivity in adolescence and early adulthood. Participants included N = 172 adolescents who were diagnosed with combined type ADHD and who were enrolled in a treatment study. A bifactor model provided reasonably good fit to combined parent- and teacher-reported DSM symptoms and supplemental items at baseline prior to treatment. Across models, the general factor was characterized by high reliability (ω = .93, .95), while specific inattentive and hyperactive-impulsive factors were characterized by poor reliability (ω = .30-.50). With respect to criterion validity, the general ADHD and specific inattentive factors were uniquely associated with home and school impairment (R² = .13-.29) but not adolescent risk-tasking behavior. Results are discussed with respect to the ways in which bifactor models of ADHD inform the diagnostic criteria for ADHD.

Behavioural and Psychiatric Phenotypes in Men and Boys with X-Linked Ichthyosis: Evidence from a Worldwide Online Survey

BACKGROUND

X-linked ichthyosis (XLI) is a rare dermatological condition arising from deficiency for the enzyme steroid sulfatase (STS). Preliminary evidence in boys with XLI, and animal model studies, suggests that individuals lacking STS are at increased risk of developmental disorders and associated traits. However, the behavioural profile of children with XLI is poorly-characterised, and the behavioural profile of adults with XLI has not yet been documented at all.

MATERIALS AND METHODS

Using an online survey, advertised worldwide, we collected detailed self- or parent-reported information on behaviour in adult (n = 58) and younger (≤18yrs, n = 24) males with XLI for comparison to data from their non-affected brothers, and age/gender-matched previously-published normative data. The survey comprised demographic and background information (including any prior clinical diagnoses) and validated questionnaires assaying phenotypes of particular interest (Adult ADHD Self-Report Scale v1.1, Barrett Impulsiveness Scale-11, adult and adolescent Autism Quotient, Kessler Psychological Distress Scales, and Disruptive Behaviour Disorder Rating Scale).

RESULTS

Individuals with XLI generally exhibited normal sensory function. Boys with XLI were at increased risk of developmental disorder, whilst adults with the condition were at increased risk of both developmental and mood disorders. Both adult and younger XLI groups scored significantly more highly than male general population norms on measures of inattention, impulsivity, autism-related traits, psychological distress and disruptive behavioural traits.

CONCLUSIONS

These findings indicate that both adult and younger males with XLI exhibit personality profiles that are distinct from those of males within the general population, and suggest that individuals with XLI may be at heightened risk of psychopathology. The data are consistent with the notion that STS is important in neurodevelopment and ongoing brain function, and with previous work suggesting high rates of developmental disorders in boys with XLI. Our results suggest that individuals with XLI may require medical care from multidisciplinary teams, and should help to inform genetic counselling for the condition.

Identifying ADHD Symptoms Most Associated with Impairment in Early Childhood, Middle Childhood, and Adolescence Using Teacher Report

The purpose of this study was to examine the relationships between ADHD symptoms and impairment within a sample that includes children in early childhood (n = 250), middle childhood (n = 269) and adolescence (i.e., high school; n = 269). Nested multivariate regression analyses were used to examine the extent to which each ADHD symptom dimension (inattention and hyperactivity/impulsivity) is most associated with impairment in academic, social, and behavioral functioning within and across three developmental levels. Results indicated for academic impairment, inattention is more predictive than hyperactivity/impulsivity at all ages. For social functioning, both with peers and teachers, hyperactivity/impulsivity is more predictive than inattention but only for early childhood students; at the high school level, inattention is a significant predictor of social impairment. For behavioral functioning in the classroom, the pattern is mixed across dimensions and ages with HI decreasing in predictive utility across the three age groups and IA increasing in predictive utility. Forward stepwise regression was used to determine which of the 18 ADHD symptom items are most associated with impairment within and across developmental levels. Findings indicate that the symptoms that were most predictive of impairment varied by age group and by domain of impairment. Implications for assessment are discussed.

Predictors of Informant Discrepancies Between Mother and Middle School Teacher ADHD Ratings

A diagnosis of attention-deficit/hyperactivity disorder (ADHD) according to the Diagnostic and Statistical Manual, 5th Eldition (DSM-5) is assessed in youth using ratings from both a parent and a teacher. However, individual and contextual differences between informants may lead to discrepancies in these ratings. The purpose of this study was to examine predictors of discrepancies between mother and middle school teacher reports of ADHD symptoms and related impairment. In an ethnically diverse sample of middle school students with well-diagnosed DSM-IV-TR ADHD (N = 112), we examined a range of mother and school setting characteristics that may contribute to informant discrepancies in this population. Hierarchical multiple regression analyses suggested that mothers with higher levels of education and psychopathology (i.e., ADHD symptom severity, parenting stress) may be most likely to report adolescent ADHD symptom severity that is higher than reported by teachers. Reports from general education teachers (vs. special education) were associated with lower symptom severity compared to mothers. Finally, a documented diagnosis of ADHD in the school was predictive of more severe reports from mothers. We discuss explanations for these findings and implications for assessment of middle school students with ADHD.

Conditional loss of GluN2B in cortex and hippocampus impairs attentional set formation

The ability to attend to appropriate stimuli, to plan actions and then alter those actions when environmental conditions change, is essential for an organism to thrive. There is increasing evidence that these executive control processes are mediated in part by N-methyl-D-aspartate receptors (NMDAR). NMDAR subunits confer different physiological properties to the receptor, interact with distinct intracellular postsynaptic scaffolding and signaling molecules and are differentially expressed during development. Recent findings have suggested that the GluN2B subunit may play a unique role in both the acquisition of adaptive choice and the behavioral flexibility required to shift between choices. Here we investigated the role of GluN2B containing NMDARs in the ability to learn, reverse and shift between stimulus dimensions. Mutant mice (floxed-GluN2B x CaMKII-Cre) lacking GluN2B in the dorsal CA1 of the hippocampus and throughout the cortex were tested on an attentional set-shifting task. To explore the role that alterations in motor behavior may have on these behaviors, gross and fine motor behaviors were analyzed in mutant and floxed-control mice. Results show that corticohippocampal loss of GluN2B selectively impaired an initial reversal in a stimulus specific manner and impaired the ability of mutant mice to form an attentional set. Further, GluN2B mice showed normal motor behavior in both overall movement and individual limb behaviors. Together, these results further support the role of NMDAR, and GluN2B in particular, in aspects of executive control including behavioral flexibility and attentional processes.

Multi-Informant Assessment of ADHD Symptom-Related Impairments Among Children and Adolescents

Existing methods of assessing attention-deficit/hyperactivity disorder (ADHD) are limited because they do not examine impairments in relation to symptoms of ADHD. This study investigated parent and teacher ratings of multiple domains of impairment, assessed in relation to the symptom dimensions of ADHD using the ADHD Rating Scale-5. Nationally representative samples of children rated by parents and teachers were recruited through commercial research firms. One sample included 2,079 parents who rated one of their children of age 5 to 17 years. The second sample included 1,070 teachers in grades K to 12 who rated 2 randomly selected students on their class rosters. Informants rated the extent to which each child displayed the 18 behaviors symptomatic of ADHD over the previous 6 months, as well as symptom-related impairments in the areas of family/teacher relationships, peer relationships, academics, behavior problems, homework, and self-esteem. Respondents were asked to complete the 6 impairment items after rating each of the Inattention and Hyperactivity/Impulsivity symptom items. For both informants a 6-factor model that combined impairment items across source of impairment was adequate and superior to a 2-factor structure based on source of impairment (i.e., impairment due to Inattention vs. Hyperactivity-Impulsivity). Impairment ratings were impacted by child demographic factors, but effect sizes were low. In contrast, impairment ratings were strongly related to ratings on the ADHD symptom dimensions. The study provides support for assessing 6 symptom-related domains of impairment but does not support differentiating whether Inattention or Hyperactivity-Impulsivity is the source of impairment.

Long-term course of ADHD symptoms from childhood to early adulthood in a community sample

Comparatively little information is available from population-based studies on subgroup trajectories of attention-deficit/hyperactivity disorder (ADHD) core symptoms of inattention and hyperactivity-impulsivity (particularly as defined by DSM-IV and ICD-10). Recent report of a subgroup with high and increasing inattention symptoms across development requires replication. To identify the different trajectory subgroups for inattention, hyperactivity-impulsivity and total symptoms of ADHD in children and adolescents aged 7-19 years. Eleven birth cohorts from 2,593 families with children and adolescents who had parent ratings for the outcome measures of inattention, hyperactivity-impulsivity or total symptoms were considered. Data were analysed using an accelerated longitudinal design and growth mixture modelling was applied to detect subgroups. For all three outcome measures, three trajectories with low (78.3-83.3 %), moderate (13.4-18.8 %) and high (2.8-3.2 %) symptom levels were detected. Course within these subgroups was largely comparable across outcome domains. In general, a decrease in symptoms with age was observed in all severity subgroups, although the developmental course was stable for the high subgroups of inattention and total symptoms. About 3 % of children in a community-based sample follow a course with a high level of ADHD symptoms. In this high trajectory group, hyperactivity-impulsivity symptoms decrease with age from 7 to 19 years, whilst inattention and total symptoms are stable. There was no evidence for an increase in symptoms across childhood/adolescence in any of the severity groups.

Mapping the academic problem behaviors of adolescents with ADHD

This study possessed 2 aims: (a) to develop and validate a clinician-friendly measure of academic problem behavior that is relevant to the assessment of adolescents with attention deficit/hyperactivity disorder (ADHD) and (b) to better understand the cross-situational expression of academic problem behaviors displayed by these youth. Within a sample of 324 adolescents with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision diagnosed ADHD (age M = 13.07, SD = 1.47), parent, teacher, and adolescent self-report versions of the Adolescent Academic Problems Checklist (AAPC) were administered and compared. Item prevalence rates, factorial validity, interrater agreement, internal consistency, and concurrent validity were evaluated. Findings indicated the value of the parent and teacher AAPC as a psychometrically valid measure of academic problems in adolescents with ADHD. Parents and teachers offered unique perspectives on the academic functioning of adolescents with ADHD, indicating the complementary roles of these informants in the assessment process. According to parent and teacher reports, adolescents with ADHD displayed problematic academic behaviors in multiple daily tasks, with time management and planning deficits appearing most pervasive. Adolescents with ADHD display heterogeneous academic problems that warrant detailed assessment prior to treatment. As a result, the AAPC may be a useful tool for clinicians and school staff conducting targeted assessments with these youth.

The role of early childhood ADHD and subsequent CD in the initiation and escalation of adolescent cigarette, alcohol, and marijuana use

Adolescents with attention deficit/hyperactivity disorder (ADHD) are at an increased risk for substance use but the pathways through which this risk emerges are insufficiently understood. Tobacco, alcohol, and marijuana outcomes were compared between adolescents diagnosed with ADHD in early childhood (N = 113) and demographically similar controls (N = 65). Participants were assessed from age 5 until age 18. A comprehensive history of adolescent substance use was compiled for each participant and growth in ADHD and conduct disorder (CD) were modeled as they related to substance use outcomes. Results indicated that when compared with controls, adolescents with ADHD were more likely to try cigarettes, initiate alcohol use at early ages, and smoke marijuana more frequently. Furthermore, adolescents with ADHD were 4 to 5 times more likely than controls to escalate to heavy cigarette and marijuana use after trying these substances once. Adolescents with ADHD who escalated to heavy use patterns were more likely to display early cigarette use and marked problems with family members, but displayed fewer peer problems. There was evidence of baseline effects (latent intercept, measured at age 5) for both ADHD and CD on substance use outcomes. Furthermore, growth in ADHD symptoms accounted for much of the growth in CD symptoms, and consequently, escalating CD symptoms in childhood (latent slope) were viewed as a mediator of the relationship between ADHD and cigarette and marijuana use. Maternal drinking in early childhood was the strongest predictor of early adolescent alcohol use. These findings are discussed with respect to the role of ADHD in the development of adolescent risk outcomes.

Parenting behaviors during risky driving by teens with attention-deficit/hyperactivity disorder

Parenting practices for teen drivers with ADHD were observed via a video monitor installed in vehicles. All teens had recently completed a driver education course and were in the driving permit stage of a graduated driver-licensing program. Parent behaviors were coded during drives when teens were driving safely and during drives when teens engaged in risky driving. The overall frequency of positive parenting strategies was low, regardless of whether teens drove safely or engaged in risky driving. Although the rate of negative feedback was also low, parents engaged in significantly more criticism and were rated by an observer to appear angrier when teens were driving in a risky manner. No other differences in parent behaviors associated with the quality of teen driving were observed. The inconsistencies between observed parenting behaviors and those parenting practices recommended as effective with teens with ADHD are discussed. The need for further research addressing effective strategies for teaching teens with ADHD to drive is highlighted.

Pharmacological and psychosocial treatments for adolescents with ADHD: an updated systematic review of the literature

Smith, Waschbusch, Willoughby, and Evans (2000) reviewed a small treatment literature on ADHD in adolescents and concluded that methylphenidate stimulant medication was a well-established treatment and behavior therapy (BT) demonstrated preliminary efficacy. This review extends and updates the findings of the prior one based on the previous 15years of research. Studies published since 1999 were identified and coded using standard criteria and effect sizes were calculated where appropriate. Highlights of the last 15years of research include an expansion of pharmacological treatment options and developmentally appropriate psychosocial treatment packages for adolescents with ADHD. Additionally, nonstimulant medications (e.g., atomoxetine) are now approved for the treatment of ADHD in adolescence. The review concludes that medication and BT produce a similar range of therapeutic effects on the symptoms of adolescents with ADHD. However, results suggest that BT may produce greater overall benefits on measures of impairment. There was no evidence that cognitive enhancement trainings, such as working memory training or neurofeedback improved the functioning of adolescents with ADHD. Whether to use medication, BT, or their combination to treat an adolescent with ADHD is complicated and we provide evidence-informed guidelines for treatment selection. The reviewed evidence does not support current American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry professional guidelines, which state that stimulant medication is the preferred treatment for adolescents with ADHD. Recommendations for assessment, practice guidelines, and future research are discussed.

What specific facets of executive function are associated with academic functioning in youth with attention-deficit/hyperactivity disorder?

The purpose of the study was to evaluate the relation between ratings of Executive Function (EF) and academic functioning in a sample of 94 middle-school-aged youth with Attention-Deficit/Hyperactivity Disorder (ADHD; Mage = 11.9; 78 % male; 21 % minority). This study builds on prior work by evaluating associations between multiple specific aspects of EF (e.g., working memory, inhibition, and planning and organization) as rated by both parents and teachers on the Behavior Rating Inventory of Executive Function (BRIEF), with multiple academic outcomes, including school grades and homework problems. Further, this study examined the relationship between EF and academic outcomes above and beyond ADHD symptoms and controlled for a number of potentially important covariates, including intelligence and achievement scores. The EF Planning and Organization subscale as rated by both parents and teachers predicted school grades above and beyond symptoms of ADHD and relevant covariates. Parent ratings of youth's ability to transition effectively between tasks/situations (Shift subscale) also predicted school grades. Parent-rated symptoms of inattention, hyperactivity/impulsivity, and planning and organization abilities were significant in the final model predicting homework problems. In contrast, only symptoms of inattention and the Organization of Materials subscale from the BRIEF were significant in the teacher model predicting homework problems. Organization and planning abilities are highly important aspects academic functioning for middle-school-aged youth with ADHD. Implications of these findings for the measurement of EF, and organization and planning abilities in particular, are discussed along with potential implications for intervention.