Learning disabilities and risk-taking behavior in adolescents: a comparison of those with and without comorbid attention-deficit/hyperactivity disorder

Investigating the shared genetic architecture between attention-deficit/hyperactivity disorder and risk taking behavior: A large-scale genomewide cross-trait analysis

BACKGROUND

This study aims to explore the genetic architecture shared between Attention-Deficit/Hyperactivity Disorder (ADHD) and risk behavior.

METHODS

Based on the latest large-scale Genome-wide association studies (GWAS), we firstly employed Linkage disequilibrium score regression (LDSC) and Local Analysis of Variant Association (LAVA) to investigate the genetic correlation between risk behavior and ADHD. Then, we conducted cross-trait analysis to identified the Pleiotropic loci. Finally, bidirectional Mendelian randomization analysis (MR) was applied to examine the causal relationship.

RESULTS

We found a significant positive genetic correlation between ADHD and risk-taking behavior (rg = 0.351, p = 6.50E-37). The cross-trait meta-analysis identified 27 significant SNPs shared between ADHD and risk behavior. The most significant locus, located near the CADM2 gene on chromosome 3, had been identified associated with this two trait (pADHD = 3.07E-05 and prisk-taking behavior = 2.47E-30). The same situation can also be observed near the FOXP2 gene on chromosome 7 (rs8180817, pmeta = 5.72E-21). We found CCDC171 gene and other genes played a significant role in ADHD and risk behavior in mRNA level. Bidirectional MR analysis found a causal relationship between them.

LIMITATION

The majority of our data sources were of European origin, which may limit the generalizability of our findings to other ethnic populations.

CONCLUSION

This article reveals in depth the shared genetic structure between ADHD and risk-taking behavior, finding a significant positive genetic correlation between ADHD and risk-taking behavior. Providing insights for the future treatment and management of these two traits.

Mathematics Difficulties and Psychopathology in School-Age Children

This study investigated the relationship between mathematics difficulties and psychopathology in a large community sample (N = 881) of youth (8-18 years of age) in the United States. The primary aims of the study were to (a) test the associations between mathematics difficulties and specific components of internalizing, externalizing, attention, and social problems; (b) examine potential age and gender differences; and (c) investigate the longitudinal relationship between mathematics and psychopathology using 5-year follow-up data. Results indicated that individuals with mathematics difficulties exhibited elevations in most dimensions of psychopathology, including anxiety, depression, externalizing behaviors, attention problems, and social problems. Furthermore, mathematics impairment was associated with internalizing problems, rule-breaking behaviors, inattention, and social problems even after controlling for comorbid reading difficulties. Results suggested that the associations between mathematics and psychopathology are generally similar in males and females. Finally, preliminary longitudinal evidence suggested that initial mathematics difficulties predicted elevations of conduct disorder, rule-breaking behavior, inattention, hyperactivity, and social problems at follow-up, with several of these associations remaining significant even after controlling for initial reading. In contrast, there was no significant association between initial mathematics ability and internalizing symptoms at follow-up, demonstrating some amelioration of internalizing symptoms over time.

Specific learning disorders in young adults: Investigating pragmatic abilities and their relationship with theory of mind, executive functions and quality of life

BACKGROUND

Specific Learning Disorders (SLD) are lifelong conditions often associated with language difficulties, executive dysfunctions, and psychological problems. Previous research has shown that communicative-pragmatic ability may be impaired in SLD. However, the role of other cognitive abilities in explaining pragmatic difficulties has still not been fully investigated. The relationship between pragmatics and quality of life is not yet clear, as well.

AIMS

Firstly, the study assessed pragmatic comprehension abilities in adults with SLD. Secondly, we examined the relationship between pragmatics, theory of mind, executive functions and quality of life.

METHOD AND PROCEDURES

We enrolled 26 adults with SLD and 30 adults without SLD. Standardized tests assessing pragmatic comprehension, theory of mind and executive functions were used. The quality of life was investigated with a self-reported questionnaire.

OUTCOMES AND RESULTS

Pragmatic comprehension abilities were compromised in young adults with SLD. In this clinical population we also found a link between pragmatic comprehension and visual theory of mind. Finally, independently from the presence of SLD, pragmatics abilities were in relationship with quality of life.

CONCLUSIONS AND IMPLICATIONS

Overall, these data highlight the importance of including pragmatic abilities both in the clinical evaluation, as well as in psychological intervention for adults with SLD.

Probabilistic Decision-Making in Children With Dyslexia

Background

Neurocognitive mechanisms underlying developmental dyslexia (dD) remain poorly characterized apart from phonological and/or visual processing deficits. Assuming such deficits, the process of learning complex tasks like reading requires the learner to make decisions (i.e., word pronunciation) based on uncertain information (e.g., aberrant phonological percepts)-a cognitive process known as probabilistic decision making, which has been linked to the striatum. We investigate (1) the relationship between dD and probabilistic decision-making and (2) the association between the volume of striatal structures and probabilistic decision-making in dD and typical readers.

Methods

Twenty four children diagnosed with dD underwent a comprehensive evaluation and MRI scanning (3T). Children with dD were compared to age-matched typical readers (n = 11) on a probabilistic, risk/reward fishing task that utilized a Bayesian cognitive model with game parameters of risk propensity (γ+) and behavioral consistency (β), as well as an overall adjusted score (average number of casts, excluding forced-fail trials). Volumes of striatal structures (caudate, putamen, and nucleus accumbens) were analyzed between groups and associated with game parameters.

Results

dD was associated with greater risk propensity and decreased behavioral consistency estimates compared to typical readers. Cognitive model parameters associated with timed pseudoword reading across groups. Risk propensity related to caudate volumes, particularly in the dD group.

Conclusion

Decision-making processes differentiate dD, associate with the caudate, and may impact learning mechanisms. This study suggests the need for further research into domain-general probabilistic decision-making in dD, neurocognitive mechanisms, and targeted interventions in dD.

Manual-Based Personalized Intervention for Mothers of Children With SLD/ADHD: Effects on Maternal and Family Resources and Children's Internalizing/Externalizing Behaviors

Objective: This study explored manual-based personalized intervention for mothers of children with SLD and/or ADHD, as possibly contributing to (a) mothers' parenting-related emotional/coping resources, (b) family functioning, and (c) child adjustment, compared with a control group of mothers. Method: Participants were 73 mothers of a child formally diagnosed with SLD and/or ADHD ages 7-17. Mothers were assigned to an experimental (n=40) or control (n=33) group. Short-term intervention utilized a three-stage emotion-cognition-behavior model. Pre-post assessments included maternal affective resources (positive/negative affect, parenting stress), maternal coping resources (general coping strategies, coping specifically with diagnosed child's negative emotions), family cohesion/adaptability, and diagnosed child's externalizing/internalizing syndromes. Results: Significant interactions emerged between group (experimental/control) and time (pre/post) for most study variables. Conclusion: Findings clearly revealed the intervention's significant impact. Only the trained mothers demonstrated significant gains over time for most of the maternal, family, and child indices, whereas the untrained mothers did not.

Improved Educational Achievement as a Path to Desistance

In this article we present a summary of the literature on the associations between learning difficulties/disabilities and juvenile delinquency. This literature is almost a hundred years old, but, although reportedly demonstrating the low academic achievement-delinquency connection, contains numerous unanswered questions regarding the frequency, strength, direction, stability, and causality of these associations. We then use this literature to contextualize the research taking place at the Houston Learning Disabilities (LD) Hub, a member of the LD Centers and Hubs Network, supported by National Institute of Child Health and Human Development (NICHD). In doing so, we present our previous studies and our current research. We conclude by discussing a number of shortcomings in the literature, some-but far from all-of which we hope to address in our ongoing work.

Emotion dysregulation in attention-deficit/hyperactivity disorder and borderline personality disorder

There is ongoing debate on the overlap between Attention-Deficit/Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD), particularly regarding emotion dysregulation (ED). In this paper, we present a narrative review of the available evidence on the association of these two disorders from several standpoints. First, we discuss the unique and shared diagnostic criteria for ADHD and BPD, focusing particularly on ED. We consider the methodology of ecological momentary assessment and discuss why this approach could be an alternative and more accurate way to qualitatively distinguish between ADHD and BPD. We summarise key findings on the genetic and environmental risk factors for ADHD and BPD and the extent to which there are shared or unique aetiological and neurobiological risk factors. Finally, we discuss the clinical relevance of considering both disorders in the assessment of patients presenting with trait-like behavioural syndromes, distinguishing the two conditions and implications for treatment.

Attention Functioning Among Adolescents With Multiple Learning, Attentional, Behavioral, and Emotional Difficulties

Attention-deficit/hyperactivity disorder (ADHD) is characterized by high levels of inattention, hyperactivity, and impulsivity; however, these symptoms can result from a variety of reasons. To obtain a comprehensive understanding of the various difficulties of individuals with ADHD, especially when co-occurrence difficulties are present, it is essential to combine neuropsychological and subjective assessment tools. In the present field study the authors investigated a group of adolescents with multiple deficits (MD) using neuropsychological and subjective measures. Teachers' ratings verified extremely high levels of symptoms of oppositional behavior, inattention, hyperactivity-impulsivity, social problems, and emotional problems in this group. As expected, MD group participants showed decreased abilities to maintain attention on task for a long period of time, focus attention and effectively inhibit adjacent distractors, and resist conflicting irrelevant information. Importantly, although significant differences in the attention measures were observed at the group level, not all MD participants displayed deviant performance. Thus, we conclude that the heterogeneous group of adolescents with MD comprises individuals with primary attention deficits as well as those with other nonattentional deficits that show equivalent behavioral symptoms. Using neuropsychological tools can be useful in differentiating between different core deficits and in guiding appropriate interventions.

Perceived Close Relationships With Parents, Teachers, and Peers: Predictors of Social, Emotional, and Behavioral Features in Adolescents With LD or Comorbid LD and ADHD

This study examined the role of adolescents' perceived close relationships with significant others (attachment relationships with mothers/fathers, appraisal of homeroom teacher as secure base, and quality of peer friendship) in explaining differences in their socioemotional and behavioral functioning (peer-network/peer-dyadic loneliness, positive/negative affect, and externalizing/internalizing problems), among adolescents with learning disabilities (LD), with comorbid LD and attention-deficit/hyperactivity disorder (ADHD), or with typical development (TD). Participants were 280 adolescents in Grades 10 through 11 in three groups: LD (n = 90), comorbid LD and ADHD (n = 91), and TD (n = 98). Preliminary analyses yielded significant group differences on most socioemotional and behavioral measures. Structural equation modeling (SEM) analysis indicated high fit between the theoretical model and empirical findings and partially different patterns of relationships among the model's components for the three populations. The discussion focuses on the possible unique value of close relationships with each significant attachment figure for adolescents with LD, comorbid LD-ADHD, and TD.

Pathways from neurocognitive vulnerability to co-occurring internalizing and externalizing problems among women with and without attention-deficit/hyperactivity disorder followed prospectively for 16 years

Using a sample of 228 females with and without childhood attention-deficit/hyperactivity disorder followed prospectively across 16 years, we measured childhood neurocognitive vulnerability via executive dysfunction using teacher-reported cognitive and learning problems. We then ascertained relations between dimensionally measured internalizing and externalizing psychopathology during adulthood and showed that childhood neurocognitive vulnerability reliably predicted such associated psychopathology. We identified six serial mediation pathways from childhood neurocognitive vulnerability to adult psychopathology through three early- and late-adolescent domains: individual (self-control and delay of gratification), peer (rejection/conflict and acceptance/friendship), and school (academic performance and school failure). The serial indirect effects occurred for the pathways from childhood neurocognitive vulnerability through early-adolescent academic performance, to late-adolescent school failure, to adult associated psychopathology, and from neurocognitive vulnerability through adolescent self-control and then the ability to delay gratification, to adult psychopathology. Furthermore, these indirect effects, plus two others, were moderated by parental distress during childhood and early adolescence, such that under conditions of high distress, the serial indirect effects were weaker than when parental distress was low. We discuss the potential importance of behavioral self-regulation and educational success for later psychological functioning, especially among girls, as well as implications for ontogenic process models of psychopathology.

Risk-taking propensity and sensitivity to punishment in adolescents with attention deficit and hyperactivity disorder symptoms and/or reading disability

Many studies reported that adolescents with ADHD/RD more frequently engage in risk-taking behaviors. Very few have examined their risk taking patterns and the impact of their comorbidity. The present study compared the risk-taking propensity, sensitivity to punishment and delinquency outcome in Chinese adolescents with ADHD symptoms (AS) and/or RD using a simulated risk task, the Balloon Analogous Risk Task (BART). Adolescents with AS (n=37), RD (n=35), AS+RD (n=35), and control (n=36) were recruited from local secondary schools. Results showed that adolescents with ADHD, despite their great risk-taking propensity, were sensitive to immediate punishment whereas adolescents with RD were found to display normal risk-taking propensity, yet showed a tendency of being less sensitive to punishment. The comorbidity ADHD+RD group had the highest delinquency score, and exhibited greatest risk taking and least sensitivity to punishment, which provided further support that comorbid condition might have stronger impact on risk taking or even delinquency than the pure groups. The present findings provides a useful picture of the risk taking pattern associated with different groups, allowing for effective matching for future prevention and intervention program.

Prevalence of psychiatric disorders among juvenile offenders in Malaysian prisons and association with socio-demographic and personal factors

PURPOSE

The number of juvenile offenders admitted to Malaysian prisons is alarming. The purpose of this paper is to determine the presence of any psychiatric disorders and their association with personal characteristics of juvenile detainees in prisons across Peninsular Malaysia.

DESIGN/METHODOLOGY/APPROACH

Detainees were recruited from five different prisons in Peninsular Malaysia and interviewed by a psychiatrist using the MINI-Kid and FACES-IV, relevant personal and family information was also collected.

FINDINGS

A total of 105 detainees participated in the study. Almost all of the offenders (93.3 per cent) had at least one diagnosable psychiatric disorder and more than half (76.2 per cent) had two or more psychiatric diagnoses. Conduct disorder (CD) was the commonest disorder (59.0 per cent), while substance use disorders (SUD) was the commonest co-morbidity. A significant correlation was found between presence of CD, education level and SUD. Almost all (61/62, 98.4 per cent) of the detainees with CD, had not completed schooling (OR 8.03, 95 per cent CI 1.01-71.35), and detainees with this disorder were more likely to use substances than detainees without CD (OR 4.35, 95 per cent CI 1.90-9.99). Detainees with any psychiatric diagnosis were more likely to have four or more siblings in their families (OR 5.5, 95 per cent CI 1.1-26.9).

ORIGINALITY/VALUE

There is a high prevalence of psychiatric disorders among juvenile offenders in Malaysian prisons, detection and intervention would be important.

Undergraduate pediatric nursing education: issues, challenges and recommendations

The topic is a national review of content and clinical experiences in undergraduate pediatric nursing education with recommendations for strengthening the pediatric nursing curriculum. American Association of Colleges of Nursing member programs (N = 596) were surveyed with 344 schools responding. A 39-item survey collected school demographics, faculty characteristics, pediatric classroom and clinical information, and actual and perceived barriers to implementing the pediatric curriculum. Recommendations for change were offered by participants attending the 2011 Institute of Pediatric Nursing Nursing Forum. A mean of 33 (SD = 27) total undergraduate faculty included an average of 3.1 (SD = 3.11) faculty with graduate specialization and/or recent clinical experience in pediatrics. Within a mean of 43 (range = 0-136 hours) pediatric classroom hours, more than 59% of programs reported 2 hours or less in pediatric genetics, environmental health, and child nutrition. Content focused on acute and specialty care with programs using pediatric inpatient medical (68%) and surgical units (40%) for clinical learning. Recruiting pediatric faculty was a common issue and reported as extremely (23%) to moderately difficult (26%). Competition for clinical practice sites (76%) was a reported barrier. Adjustments in the pediatric undergraduate curriculum are recommended to highlight current health issues experienced by children including expansion of clinical learning experiences to settings where children live, learn, and play.

Measuring adjustment in Japanese juvenile delinquents with learning disabilities using Japanese version of Kaufman Assessment Battery for Children II

AIM

The aim of this study was to create a profile of the cognitive and academic abilities of juvenile delinquents (JD) in Japan using the newly validated Japanese version of the Kaufman Assessment Battery for Children, Second Edition (KABC-II-J).

METHODS

We administered the KABC-II-J to 22 JD (Mage  = 15.9 years, standard deviation [SD] = 1.4), 28 typically developing high school students (Mage  = 16.0 years, SD = 0.08), and (as controls) 12 special education students (Mage  = 16.9, SD = 0.83) with mild intellectual disabilities.

RESULTS

We observed significant differences between JD and typically developing students on learning index of the Mental Process Index, and the vocabulary, reading, writing, and mathematics indices on the Achievement Index. JD had lower scores than did typically developing high school students. Fourteen JD had a 1 SD discrepancy (43%) in scores on these indices. These cases were suspected of having learning disabilities.

CONCLUSION

The KABC-II-J is a suitable means of assessing academic and cognitive problems in JD; professionals working in the field of juvenile delinquency should recognize that offenders might have severe academic delays and learning disabilities.

Hyperactivity, increased nicotine consumption and impaired performance in the five-choice serial reaction time task in adolescent rats prenatally exposed to nicotine

RATIONALE

Prenatal exposure to nicotine has been linked to accelerated risk for different psychiatric disorders, including conduct disorder, attention deficit hyperactivity disorder (ADHD) and drug abuse. We examine a potential link between prenatal nicotine exposure, hyperactivity, anxiety, nicotine consumption, and cognitive performance in rats.

METHODS

Adolescent offspring of females exposed during pregnancy to 0.06 mg/ml nicotine solution as the only source of water and of a group of pair-fed females, used as a control for anorexic effects of nicotine, were evaluated in a battery of tests, including locomotor activity, the elevated plus maze, two-bottle free-choice nicotine solution consumption, the five-choice serial reaction time test (5-CSRTT) and a delay-discounting test. All tests were conducted between postnatal day (PND) 25 and PND 50.

RESULTS

Nicotine-exposed animals expressed hyperactivity, increased number of open arms entries in the elevated plus maze and increased numbers of anticipatory responses in the 5-CSRTT. Decreased aversion for nicotine solution in the free-choice test and decreased numbers of omission errors in the 5-CSRTT were observed both in nicotine-exposed and pair-fed offspring. Neither nicotine exposure nor pair-feeding had an effect on impulsive choice in a delay-discounting test.

CONCLUSIONS

Our study confirms deleterious effects of prenatal nicotine exposure on important aspects of behaviour and inhibitory control in adolescent rats and supports epidemiological findings that show increased levels of symptoms of ADHD and related disorders among those whose mothers smoked during their pregnancy. It also suggests a link between food restriction during pregnancy and addiction-related behaviours in offspring.

A systematic review of global publication trends regarding long-term outcomes of ADHD

There is increased global recognition of attention deficit hyperactivity disorder (ADHD) as a serious medical condition with long-term consequences. Although originally conceived of as a childhood disorder, ADHD is being increasingly recognized in adults. Individual geographic regions may have specific interests and objectives for the study of ADHD. A systematic review of long-term outcomes (LTOs) in ADHD was conducted to evaluate research on ADHD LTOs on a global scale. Studies that were at least 2 years in duration were examined. A total of 351 studies were identified in the final analysis. We identified nine outcomes of interest and classified studies by specific geographical regions, age groups studied and study design by region and over time. Published studies of LTOs in ADHD have increased in all geographical regions over the past three decades, with a peak number of 42 publications in 2008. This rise in publications on ADHD LTOs may reflect a rise in global interest and recognition of consequences and impairment associated with ADHD. Although many world regions have published on ADHD LTOs, the majority of studies have emerged from the US and Canada, followed by Europe. While investigators in the US and Canada were predominantly interested in drug addiction as a LTO, European researchers were more interested in antisocial behavior, and Eastern Asian investigators focused on both of these LTOs as well as self-esteem. Geographical differences in the focus of ADHD LTO studies may reflect regional variations in cultural values. Proportionally fewer prospective longitudinal studies and proportionally more retrospective and cross-sectional studies have been published in more recent decades. Finally, more studies focusing on ADHD in adolescents and adults have been conducted in recent years, and particularly adolescents in Eastern Asia. These changes in basic study design may reflect an increase in the recognition that ADHD is a lifetime chronic disorder. This systematic review analysis of publication trends in ADHD LTOs reflects geographically based interests that change over time.

Affinity for risky behaviors following prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study

BACKGROUND

Many studies of adults with acute and chronic solvent exposure have shown adverse effects on cognition, behavior and mood. No prior study has investigated the long-term impact of prenatal and early childhood exposure to the solvent tetrachloroethylene (PCE) on the affinity for risky behaviors, defined as smoking, drinking or drug use as a teen or adult.

OBJECTIVES

This retrospective cohort study examined whether early life exposure to PCE-contaminated drinking water influenced the occurrence of cigarette smoking, alcohol consumption, and drug use among adults from Cape Cod, Massachusetts.

METHODS

Eight hundred and thirty-one subjects with prenatal and early childhood PCE exposure and 547 unexposed subjects were studied. Participants completed questionnaires to gather information on risky behaviors as a teenager and young adult, demographic characteristics, other sources of solvent exposure, and residences from birth through 1990. PCE exposure was estimated using the U.S. EPA's water distribution system modeling software (EPANET) that was modified to incorporate a leaching and transport model to estimate PCE exposures from pipe linings.

RESULTS

Individuals who were highly exposed to PCE-contaminated drinking water during gestation and early childhood experienced 50-60% increases in the risk of using two or more major illicit drugs as a teenager or as an adult (Relative Risk (RR) for teen use = 1.6, 95% CI: 1.2-2.2; and RR for adult use = 1.5, 95% CI: 1.2-1.9). Specific drugs for which increased risks were observed included crack/cocaine, psychedelics/hallucinogens, club/designer drugs, Ritalin without a prescription, and heroin (RRs:1.4-2.1). Thirty to 60% increases in the risk of certain smoking and drinking behaviors were also seen among highly exposed subjects.

CONCLUSIONS

The results of this study suggest that risky behaviors, particularly drug use, are more frequent among adults with high PCE exposure levels during gestation and early childhood. These findings should be confirmed in follow-up investigations of other exposed populations.

The RT-18: a new screening tool to assess young adult risk-taking behavior

Risk-taking behavior is a major determinant of health and plays a central role in various diseases. Therefore, a brief questionnaire was developed to assess risk taking among young adults with known different levels of risk-taking behavior (social drinkers and recreational drug users). In Study 1, N = 522 university students completed the RT-18 risk taking questionnaire. N = 100 students were retested after 2 to 4 weeks and performed the Cambridge Gambling Task (CGT). Mean RT-18 score was 7.69 and Cronbach’s alpha was 0.886. The test-retest reliability was r = 0.94. Significant correlation was found between the RT-18 score and CGT scores of risk taking, bet proportion, and risk adjustment. In Study 2, N = 7834 young adult social drinkers, and recreational drug users, mean RT-18 score was 9.34 and Cronbach’s alpha was 0.80. Factor analysis showed that the RT-18 comprises two factors assessing level of risk-taking behavior and risk assessment. Men scored significantly higher than women on the RT-18. Recreational drug users had significantly higher scores when compared to social drinkers. In Study 3 of N = 1000 students, construct validity was confirmed by showing that the RT-18 outcome correlates significantly with scores on the Stimulating-Instrumental Risk Inventory. In conclusion, the RT-18 is a valid and reliable screening tool to differentiate levels of risk-taking behavior. This short scale is quick and practical to administer, imposing minimal demands on participants. The RT-18 is able to differentiate risk taking and risk assessment which can help target appropriate intervention strategies.