Subclinical ADHD, stress, and coping in romantic relationships of university students

Coping strategies and symptoms of Adjustment Disorder among adults with Attention Deficit Hyperactivity Disorder (ADHD) during the Covid-19 pandemic

BACKGROUND

The current study examined whether coping strategies and symptoms of Adjustment Disorder in adults with ADHD differed from what was observed in the general adult population during the Covid-19 pandemic, and compared the extent to which coping strategies and symptom levels of Adjustment Disorder were related to ADHD.

METHOD

This cross-sectional study was based on survey data collected during the spring of 2021 from 231 adult ADHD patients in specialist care and 1148 volunteers without ADHD in Sweden. The survey included questions about sociodemographic and clinical characteristics, along with the Brief-COPE and Adjustment Disorder-New Module 8 questionnaires. Regression models adjusting for sociodemographic and clinical characteristics were used for between-group comparisons of coping strategies and symptoms of Adjustment Disorder.

RESULTS

There were some notable differences in the use of coping strategies between persons with and without ADHD; however, many of these differences were not observed in the adjusted models. The use of behavioral disengagement was more frequently observed among individuals with ADHD, whereas planning was more common among individuals without ADHD. Individuals with ADHD appeared to show higher symptom levels of Adjustment Disorder during the pandemic. Passive coping strategies, such as denial, self-blame, and behavioral disengagement, were associated with higher symptom levels of adjustment disorder in both individuals with and without ADHD.

CONCLUSION

In conclusion, the results highlight that persons with ADHD may need more support to adjust to large societal changes than the general public. Potential targets for intervention towards members of this group include reducing resignation and maladaptive coping strategies.

Self-esteem in children and adolescents with and without attention-deficit/hyperactivity disorder: A meta-analytic review

Meta-analytic methods were used to examine global and domain-specific (i.e., academic, social, behavioral) self-esteem in children and adolescents with and without ADHD. Potential moderators of effect size heterogeneity were also examined via meta-regressions within a three-level approach. Findings from 49 aggregated global self-esteem effect sizes (ADHDN = 2500, TDN = 9448), 12 academic self-esteem effect sizes (ADHDN = 386, TDN = 315), 11 social self-esteem effect sizes (ADHDN = 258, TDN = 254), and 8 behavioral self-esteem effect sizes (ADHDN = 231, TDN = 211) suggest that children and adolescents with ADHD experience moderate global (ES = 0.46, p < .001), academic (ES = 0.60, p = .009), and social (ES = 0.67, p = .001) self-esteem impairments compared to children and adolescents without the disorder. The aggregated behavioral self-esteem effect size (ES = 0.20, p = .54), however, was not significant, and the global self-esteem effect size was markedly smaller compared to effect sizes for the academic and social domains. Further, examination of potential moderators of effect size heterogeneity indicated null effects for medication status, diagnostic complexity, informant, age, sex, comorbid psychopathology, and self-esteem dimension. Collectively, findings suggest that children and adolescents with ADHD do not hold a ubiquitous negative self-perception of difficulties across academic, social, and behavioral domains of functioning, and unexamined domains that are distal to ADHD may serve to bolster global self-esteem.

A d factor? Understanding trait distractibility and its relationships with ADHD symptomatology and hyperfocus

People differ substantially in their vulnerability to distraction. Yet, many types of distractions exist, from external stimulation to internal thoughts. How should we characterize individual differences in their distractibility? Two samples of adult participants (total N = 1220) completed a large battery of questionnaires assessing different facets of real-world distractibility. Latent modeling revealed that these measures could be explained by three correlated-yet-distinct factors: external distraction, unwanted intrusive thoughts, and mind-wandering. Importantly, about 80% of the total variance in these three factors could be explained by a single higher-order factor (d) that could be construed in terms of a person's general distractibility, and this general distractibility model was replicated across the two samples. We then applied the general distractibility model to understand the nature of ADHD symptomatology and hyperfocus (an intense state of long-lasting and highly focused attention). d was substantially associated with self-reported ADHD symptoms. Interestingly, d was also positively associated with hyperfocus, suggesting that hyperfocus may, to some degree, reflect attention problems. These results also show marked consistencies across the two samples. Overall, the study provides an important step toward a comprehensive understanding of individual differences in distractibility and related constructs.

Age-related clinical characteristics of children and adolescents with ADHD

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) has been associated with difficulties in regulating aversion states, high functional impairment, and a high risk of psychopathology across the lifespan. ADHD is clinically heterogeneous, with a wide spectrum of severity and associated symptoms. Clinical characteristics need to be carefully defined in different periods of life as ADHD course, symptoms, and comorbidities may fluctuate and change over time. Adolescence usually represents the transition from primary to secondary education, with a qualitative and quantitative change in environmental and functional demands, thus driving symptoms' change.

METHODS

In order to characterize age-related clinical features of children (<11 years) and adolescents (≥11 years) with ADHD, we conducted a naturalistic study on 750 children and adolescents assessed for ADHD at our Neuropsychiatry Unit over the course of 3 years (2018-2020).

RESULTS

We found that ADHD symptoms were significantly higher in children than adolescents. More importantly, we found worse global functioning, lower adaptive skills, higher levels of anxiety and depressive symptoms, somatic complaints, emotional dysregulation, social problems, and aggression in adolescents, despite a lower severity of ADHD-specific symptoms.

CONCLUSION

These results should be confirmed in longitudinal observational studies of adequate sample size in order to reliably describe a potential course characterized by worsening of functioning, reduction in ADHD-specific symptoms and increase in general psychopathology during the transition from childhood to adolescence.

Key Factors Affecting Mathematics Teachers' Well-Being and Stress Levels: An Extended Engagement Theory

The mathematics teachers' profession often has many challenges. It also occupies important positions at the K-12 education level, in which mathematics knowledge is the basis of all scientific fields. This tends to cause high-stress levels and a negative effect on well-being. Mathematics teachers' well-being has been less examined, and therefore this study aims to determine the factors affecting mathematics teachers' well-being and stress levels. The 210 data points collected from Chinese mathematics teachers using a web-based questionnaire were analyzed for reliability and validity, then model fit and SEM were applied for model validation after removing 3 invalid data points and incomplete responses. The results showed that behavioral and cognitive engagements significantly affect teachers' well-being, while the affective engagement was insignificant. The TPMK was the strongest significant predictor that had a positive impact on improving well-being and reducing stress levels. In addition, the stress level of mathematics teachers was influenced by gender and age. Finally, it was proven that teachers' well-being significantly reduced stress levels. This study's implication was to provide information on how to reduce stress levels.

Validation of the executive function strategy awareness and use questionnaire (SAUQ) in a university student population

Objective: The aim of the study is to design and evaluate the Strategy Awareness and Use Questionnaire to estimate students' awareness and use of strategies that optimize control of attention and/or compensate for stress on an executive system due to environmental and/or neurobiological influences. Participants: One hundred and forty-eight undergraduate and graduate students from various disciplines at an urban Canadian university campus participated in the Spring 2019 semester. Methods: An item analysis was conducted that included an assessment of dimensionality and item trimming. Results: Findings from an exploratory factor analysis suggest a seven-factor solution is optimal; Comprehension Monitoring, Planning/Organization, Self-Reward, Self-Regulation, Organization with Mobile Phone Technology, Regulating Technology, and Organization of Materials. Conclusion: This measure is likely to benefit students, as well as counselors and coaches interested in improving EF strategy use among students in a university population.

Self-experienced sexual and reproductive health in young women with Attention Deficit Hyperactivity Disorder: A qualitative interview study

Background

Sexual risk behaviors and struggles in romantic relationships result in higher risk of unplanned pregnancy, sexually transmitted diseases, sexual victimization and lower satisfaction in relationships for young women with Attention Deficit Hyperactivity Disorder (ADHD). There is a need to better understand sexual behaviors and the consequences of relational difficulties to help health professionals promote sexual and reproductive health. To deepen knowledge in this area, this study aimed to identify and describe self-experienced sexual and reproductive health in young women with ADHD.

Methods

A qualitative design was used. Data was collected with individual and focus group interviews with 15 young women, aged 15–29, with an ADHD diagnosis, and analyzed with thematic analysis.

Results

Data analysis identified the themes Acceptance of being different and Feeling sexually secure. The women reveal feelings of being different from others without ADHD as they break norms of sexual behavior, struggle with romantic relationships, and have difficulties concentrating during sex. There is a need to be understood and accepted, to not feel judged, and to manage romantic relationships. Self-knowledge helps them to recognize needs for support and to develop strategies that can improve sexual satisfaction. Feeling sexually secure illustrates the women’s need to feel comfortable with their own sexuality and in control in the sexual situation. Low self-esteem and a negative self-image, described as a consequence of living with ADHD, can compromise communication in sexual situations and increase fear of being rejected. Further, misjudging sexual partners and situations can contribute to sexual victimization.

Conclusions

This study provides knowledge of how ADHD affects emotions and sexual behaviors in young women. The results highlight the need for understanding and acceptance by peers and partners. It accentuates the value of involving the partner in counselling and the importance of self-knowledge. Feeling insecure in sexual relationships further implies the importance of early diagnosis to prevent secondary outcomes of ADHD, and the need for sexual victimization screening in professional settings.

Parent ADHD Is Associated With Greater Parenting Distress in the First Year Postpartum

OBJECTIVE

Little is known about the experience of parenting infants when a mother or father has ADHD. This study examined cross-sectional predictors of parenting distress experienced by parents with and without ADHD who also have infants.

METHODS

Participants were 73 mother-father pairs (N = 146) of infants 6 to 10 months old. Half of the families included a parent with ADHD. Psychosocial predictors were tested using multilevel modeling.

RESULTS

Parent or partner ADHD, lower parent sleep quality, fewer social supports, and less infant surgency and effortful control were associated with greater parental distress. Infant negative affect and sleep were not associated.

CONCLUSIONS

Parents with ADHD and their partners experience greater parenting distress in the first year of their child's life than parents without ADHD. Addressing parent ADHD symptoms and co-occurring difficulties, including sleep disturbances, are potential targets for early interventions to maximize both parent and infant mental health outcomes.

Attachment Anxiety Moderates the Association Between ADHD and Psychological Distress

This study aims at examining the possible moderating role of attachment style in the association between ADHD and psychological distress, namely, anxiety and depression symptoms. Study included ninty nine participants: Sixty adults with ADHD diagnosis and thirty nine adults without ADHD or other neurological and/or psychiatric disorders. All participants completed the Patient Health Questionnaire (PHQ-9), State-Trait Anxiety (STAI) questionnaires, Emotion in Close Relationships (ECR-R) questionnaire and Adult ADHD Self-Report Scale-Version 1.1 (ASRS-v1.1). Adults with ADHD had greater symptoms of depression (p < .001) and anxiety (p < .001) than adults without ADHD. Process analysis yielded that attachment anxiety moderated the association between ADHD, anxiety and depression, therefore only adults with ADHD that had moderate to high attachment anxiety exhibited higher levels of depression (p < .01) and anxiety (p < .001). No moderating effect was observed for attachment avoidance. Moreover, we did not find correlations between ADHD, anxiety and depression when secure attachment was the moderator; indicating that secure attachment could serve as a "protective factor" against psychological distress among ADHD individuals. Among anxiously attached adults, ADHD was associated with higher levels psychological distress. These findings highlight the important role of attachment style in mental health of adults with ADHD.

Dependent Stress Mediates the Relation Between ADHD Symptoms and Depression

Objective: Depression and attention-deficit hyperactivity disorder (ADHD) are prevalent and highly comorbid. ADHD symptoms are associated with specific dependent (i.e., self-generated) stressors in children, and there is a strong link between dependent stress and depression. Despite continued comorbidity of ADHD and depressive symptoms into adulthood, it is unknown whether stress generation mediates the relation between ADHD and subsequent depressive symptoms in emerging adulthood, a period of heightened stress. Method: We tested this mediation model in a semester-long longitudinal study of 224 college students (aged 18-23 years). We additionally tested whether this model differed between inattentive versus hyperactive/impulsive ADHD symptoms given evidence that they vary in their relations to stress and depression. Results: Dependent stress mediated the association between total ADHD symptoms at baseline and later depressive symptoms; these effects were equivalent for inattentive versus hyperactive/impulsive ADHD symptoms. Conclusion: These findings suggest stress generation as a mechanism for increased depression in individuals with ADHD symptoms.

Adult ADHD and romantic relationships: What we know and what we can do to help

It has been widely maintained that enduring and healthy romantic relationships are critical to quality of life in adulthood, and can buffer the impact of adversity, including psychological disorder. Unfortunately, much research points toward adults with attention-deficit hyperactivity disorder (ADHD) having short-lived and discordant romantic relationships. Despite this ample evidence, relatively little research has focused on identifying specific factors that may strengthen or explain their relational difficulties, which would have obvious relationship distress prevention and intervention implications. The current study reviews the state of the literature on romantic relationships in adults with ADHD, including differences that have been established between ADHD and non-ADHD populations as well as distal and proximal factors that appear to increase risk of relationship distress of adults with ADHD. Finally, notable gaps in the literature are identified and implications are raised with regards to prevention and intervention efforts designed to address functional impairment in adults with ADHD.

A Preliminary Investigation of Attention-Deficit/Hyperactivity Disorder Characteristics in Adults Who Stutter

Purpose Recent studies have shown that many children who stutter may have elevated characteristics of attention-deficit/hyperactivity disorder (ADHD). Although childhood ADHD commonly persists into adulthood, it is unclear how many adults who stutter experience aspects of ADHD (e.g., inattention or hyperactivity/impulsivity). This study sought to increase understanding of how ADHD characteristics might affect individuals who stutter by evaluating (a) whether elevated ADHD characteristics are common in adults who stutter, (b) whether elevated ADHD characteristics in adults who stutter were significantly associated with greater adverse impact related to stuttering, and (c) whether individual differences in Repetitive Negative Thinking (RNT) and Effortful Control influenced this relationship. Method Two hundred fifty-four adults who stutter completed the Adult ADHD Self-Report Scale, the Perseverative Thinking Questionnaire, the Adult Temperament Questionnaire short form, and the Overall Assessment of the Speaker's Experience of Stuttering. Data were analyzed via multiple linear regression to determine whether the number of inattention or hyperactivity/impulsivity characteristics was significantly associated with RNT, Effortful Control, or Adverse Impact related to stuttering. Results Almost one quarter of participants (23.2%; 60/254) self-reported experiencing six or more inattention characteristics, while fewer participants (8.3%; 21/254) self-reported experiencing six or more hyperactivity/impulsivity characteristics. Participants with lower Effortful Control and higher levels of both RNT and Adverse Impact were significantly more likely to self-report experiencing more inattention characteristics. Discussion Many adults who stutter may exhibit previously unaccounted for characteristics of ADHD, especially inattention. Results highlight the value of continued research on the intersectionality of stuttering, ADHD, and attention, and the importance of individualizing therapy to the needs of each unique person who stutters.

The role of stress coping strategies for life impairments in ADHD

Attention-deficit/hyperactivity disorder (ADHD) is commonly accompanied by functional impairments within personal, professional, and social context as well as further psychological distress. The role of perceived stress has been examined in this regard, although little is known about the influence of stress coping strategies. We examined the dynamics between ADHD symptomatology, stress coping strategies, and life impairments in a sample of 230 clinical and non-clinical adult individuals. ADHD was associated with low probability of choosing adaptive but high probability of implementing maladaptive stress coping strategies as well as with increased life impairments. Adaptive stress coping showed little effects beyond the associations between ADHD and life impairments, whereas some maladaptive coping strategies increased current life impairments over and above the effects of ADHD and further psychological distress. The present findings emphasize the need of professional support in adults with ADHD and the necessity to include stress coping strategies in respective treatment approaches aimed at reducing life impairments.

Common Venues in Romantic Relationships of Adults With Symptoms of Autism and Attention Deficit/Hyperactivity Disorder

Introduction: Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD) figures among the most common neurodevelopmental disorders. Despite having opposite stereotypes, both ADHD and ASD compromise, though in different ways, skills such as social interactions, communication skills, and social thinking, which may underlie difficulties in romantic relationships. Methods: We evaluated 306 adults about their romantic relationships and the intensity of their love. Participants were from one of four groups:, individuals with ASD-only traits, a group with symptoms of ADHD-only, participants with neither ADHD nor ASD symptoms (control) or from a fourth group of individuals with both ADHD and ASD traits. Results: The ASD traits group had fewer married people and more people who have never been married, while the rate of divorce was higher in the ADHD traits group. Regarding the intensity of love, the mean scores of the ADHD and the ADHD+ASD traits groups were higher in the Passionate Love Scale than the mean score of the control group. Passionate love in the ASD group was no different from the other groups. Small positive correlations were found between passionate love and ADHD and ASD behavioral problems. Conclusion: Marital status was distinct depending on symptoms of a neurodevelopmental disorder in adulthood. Also, ADHD and ASD symptoms were associated with greater passionate love. Therefore, ADHD and ASD behavioral dimensions may impact long-term and short-term experiences of a person's relationship with a significant other in distinct ways. Understanding how people with neurodevelopmental disorders experience love might help us to better clarify the mechanisms associated with their relationship patterns.

The Effects of Family Transitions on Depressive Symptoms: Differences among Young Adults with and without Childhood Symptoms of Attention-Deficit/ Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is tied to higher levels of depression, but the social factors that shape these associations are not well understood. This study considers whether family transitions affect depressive symptoms differently for young adults with and without childhood symptoms of ADHD at subthreshold or diagnostic levels. Between-within regression analysis of nationally representative longitudinal survey data shows that transitions into cohabitation and parenthood affect depressive symptoms differently for young adults with and without childhood symptoms of ADHD. Specifically, within-person effects indicate that transitions into cohabitation and parenthood are tied to decreases in depressive symptoms, but only for young adults without childhood symptoms of ADHD. In contrast, transitions into marriage are tied to decreases in depressive symptoms, and transitions out of coresidential unions are tied to increases in depressive symptoms, regardless of childhood symptoms of ADHD. The results suggest that some family transitions may work to widen ADHD disparities in depression, under-scoring the importance of family contexts for shaping mental health throughout the life course.

Predictors of Prescription Stimulant Misuse in U.S. College Graduates

Background: Research has shown that prescription stimulant misuse (PSM) is prevalent among college students and that full-time college attendance is associated with PSM following graduation. Few studies, however, have examined predictors of PSM in college graduates. Objectives: We examined constructs from the Theory of Triadic Influence (TTI) to determine predictors of PSM in this population. Methods: We utilized Amazon's Mechanical Turk and snowball sampling in 2018-2019 to anonymously survey 219 adults in the United States (56% male, M_age = 32.5) with a college degree and history of college PSM. We assessed sensation seeking, ADHD symptoms, negative affect, social norms, workload, positive beliefs and perceived safety, other substance use, PSM motivations, and source(s) of prescription stimulants. Measures were administered online. Results: Over half (55%) of participants reported PSM after college; 36% used in the previous year. Ordinal logistic regressions for each domain of the TTI (i.e. intrapersonal, social/normative, cultural/attitudinal) showed that college graduates engaging in PSM in the previous year were younger and reported higher sensation seeking, more friends/coworkers who engaged in PSM, a heavier workload, and more positive beliefs about PSM. Chi-square analyses showed that college graduates engaging in PSM in the previous year also were more likely to use other substances (e.g. prescription opioids, tobacco/nicotine, cocaine) and to have misused stimulants in college to socialize or to get high. Conclusions: Preventive interventions could target college students and recent graduates who engage in PSM and who demonstrate the aforementioned risk factors, with the goal of curbing PSM and possibly other substance use.

Oppositional Defiant Disorder Dimensions: Associations with Traits of the Multidimensional Personality Model among Adults

The occurrence of Oppositional Defiant Disorder (ODD) behaviours among adults has been supported by a proportion of scholars. The current work examines potential ODD dimensions and their associations with the primary personality traits of Tellegen's [57] multi-dimensional conceptualization during adulthood. Two independent, general community, adult groups [Group 1: N = 214; mean age (SD) = 35.74 (16.60); Group 2: N = 205; mean age (SD) = 29.00 (12.42)] completed the Current Symptom Scale involving the eight ODD criteria. Group 2 additionally addressed the Multidimensional Personality Questionnaire -Brief Form (MPQ-BF). A series of Confirmatory Factor Analyses (CFA) were implemented. The three-dimensional ODD conceptualization of Burke and colleagues [14] referring to "Negative Affect", "Oppositional Behavior", and "Antagonistic Behavior" was confirmed. Considering personality traits, valuable associations were revealed between Oppositional Behavior and Aggression, Antagonistic Behavior and Social Potency as well as Harm Avoidance, and finally, Negative Affect and Stress Reaction, as well as Aggression. The dimensionality of ODD behaviours in adulthood and its correspondence with particular personality traits is approached in the context of psychological practice.

Explaining the Relationship Between ADHD Symptomatology and Amotivation in the Undergraduate Population: The Role of Basic Psychological Need Frustration

Recent research has shown that undergraduate students who experience both clinical and subclinical attention-deficit/hyperactivity disorder (ADHD) struggle academically. Furthermore, these students have cited academic amotivation as a factor in their academic difficulties. Self-determination theory (SDT) posits that a lack of motivation—known as amotivation—may be the result of the frustration of the basic psychological needs—autonomy, competence, and relatedness. For this reason, the current study examined whether basic psychological need frustration mediated the relationship between ADHD symptomatology and academic amotivation. A sample of undergraduate students completed an online questionnaire about their university experience. Data were analyzed using a mediational structural equation model. Results suggested significant relationships between all of the variables. Moreover, basic psychological need frustration fully mediated the relationship between ADHD symptomatology and academic amotivation. These results demonstrate the importance of fulfilling the basic psychological needs of undergraduate students experiencing ADHD symptomatology, as it may increase their academic motivation, and, subsequently, reduce their academic difficulties.

Lower Attentional Skills predict increased exploratory foraging patterns

When engaged in a search task, one needs to arbitrate between exploring and exploiting the environment to optimize the outcome. Many intrinsic, task and environmental factors are known to influence the exploration/exploitation balance. Here, in a non clinical population, we show that the level of inattention (assessed as a trait) is one such factor: children with higher scores on an ADHD (Attention Deficit/Hyperactivity Disorder) questionnaire exhibited longer transitions between consecutively retrieved items, in both a visual and a semantic search task. These more frequent exploration behaviours were associated with differential performance patterns: children with higher levels of ADHD traits performed better in semantic search, while their performance was unaffected in visual search. Our results contribute to the growing literature suggesting that ADHD should not be simply conceived as a pure deficit of attention, but also as a specific cognitive strategy that may prove beneficial in some contexts.

Inattention and Hyperactivity-Impulsivity: Their Detrimental Effect on Romantic Relationship Maintenance

OBJECTIVE

The aim of this study is to understand how ADHD symptoms correlate with romantic relationship maintenance and test theoretical pathways by which symptoms of ADHD lead to relationship difficulties.

METHOD

This study involved two phases of data collection, which were identical except for the population. Phase 1 ( n = 172) was a nonclinical sample of romantically involved young adults. Phase 2 ( n = 39) was a clinical sample of romantically involved young adults with ADHD. Participants in both phases reported on their levels of inattention and hyperactivity-impulsivity, their relationship maintenance activities, and their relationship quality.

RESULTS

ADHD symptoms were associated with greater relationship difficulties. In both samples, inattentive symptoms were associated with greater interest in relational alternatives and less constructive responses to partner's bad behaviors, whereas hyperactive-impulsive symptoms were associated with negative responses to bad behavior.

CONCLUSION

The results of this study have implications for developing cognitive-behavioral therapy interventions targeting relationship difficulties in young adults with ADHD.

Inattention and task switching performance: the role of predictability, working memory load and goal neglect

Inattention is a symptom of many clinical disorders including attention deficit hyperactivity disorder (ADHD) and is thought to be primarily related to limitations in working memory. In two studies, we investigated the implications of inattention for task switching performance. In study one, we measured task switching performance using predictable and unpredictable conditions in adults who self-rated inattention and other ADHD-related tendencies. Tasks required proactive control and reactive control, respectively, under both high and low working memory loads. Results revealed that inattentive, but not hyperactive/impulsive traits, predicted switch costs when switching was predictable and working memory load was high. None of the ADHD traits were related to unpredictable switch costs. Study two was designed to: (1) de-confound the role of proactive control and the need to keep track of task order in the predictable task switching paradigm; (2) investigate whether goal neglect, an impairment related to working memory, could explain the relationship between inattention and predictable task switching. Results revealed that neither predictability nor the need to keep track of the task order led to the association between switch costs and inattention, but instead it was the tendency for those high in inattention to neglect preparatory proactive control, especially when reactive control options were available.

The Compensatory ADHD Behaviors Scale (CABS): Development and Initial Validation

Several measures are available that assess inattention, hyperactivity/impulsivity, and executive functioning deficits. Treatments for adults with attention-deficit/hyperactivity disorder (ADHD) and skill-based academic interventions focus on improving compensatory strategies to ameliorate functional impairment; however, no measure exists that examines the compensatory behaviors adults utilize to compensate for the functional deficits associated with inattention and hyperactivity/impulsivity. The current study aimed to determine the psychometric properties of the Compensatory ADHD Behaviors Scale (CABS). Five-hundred participants (M_age = 36.83, SD = 11.57) completed measures of ADHD symptomatology, executive functioning, functional impairment, mood disorder symptoms, and the CABS. Analyses revealed that scales assessing both use and effectiveness of compensatory behaviors subscales had similar factor structures, reflecting present- and future-oriented behaviors. The present-, but not future-oriented, behaviors significantly related to ADHD symptomatology, executive dysfunction, and functional impairment; effectiveness of present-oriented compensatory behaviors demonstrated incremental validity in predicting impairment. Compensatory strategies may be a useful variable to measure when examining functional impairment associated with inattention and hyperactivity/impulsivity. The current study provides preliminary evidence of the ability of CABS to validly measure various strategies associated with (clinical and subclinical) ADHD symptomatology, executive functioning, and overall impairment.

Probe-caught spontaneous and deliberate mind wandering in relation to self-reported inattentive, hyperactive and impulsive traits in adults

Research has revealed a positive relationship between types of mind wandering and ADHD at clinical and subclinical levels. However, this work did not consider the relationship between mind wandering and the core symptoms of ADHD: inattention, hyperactivity and impulsivity. Given that the DMS-V attributes mind wandering to inattention only, and that only inattention is thought to result from impairment to the executive function linked to mind wandering, the present research sought to examine this relationship in 80 undiagnosed adults. Using both standard and easy versions of the Sustained Attention to Response Task (SART) we measured both spontaneous and deliberate mind wandering. We found that spontaneous mind wandering was related to self-reported inattentive traits when the task was cognitively more challenging (standard SART). However, hyperactive and impulsive traits were related to spontaneous mind wandering independent of task difficulty. The results suggest inattentive traits are not uniquely related to mind wandering; indeed, adults with hyperactive/impulsive traits were more likely to experience mind wandering, suggesting that mind wandering might not be useful diagnostic criteria for inattention.

The Romantic Relationships of Adolescents With ADHD

OBJECTIVE

This study compared the romantic relationships of adolescents with and without ADHD with regard to romantic involvement, relationship content, and relationship quality.

METHOD

A community sample of 58 participants (30 ADHD, 28 Comparison), ages 13 to 18, completed questionnaires assessing various features of romantic relationships.

RESULTS

Adolescents with ADHD reported having more romantic partners than their typically developing (TD) peers. Females with ADHD were found to have shorter romantic relationships than TD adolescents while males with ADHD reported their age of first intercourse to be nearly 2 years sooner than TD peers. Irrespective of gender, adolescents with ADHD had nearly double the number of lifetime sexual partners. However, the romantic relationships of adolescents with and without ADHD did not differ on levels of aggression or relationship quality.

CONCLUSION

Given the outcomes associated with poor-quality romantic relationships, comprehensive assessments of adolescents with ADHD should include queries into their romantic relationships.

ADHD Symptomology and Social Functioning in College Students

OBJECTIVE

ADHD is no longer considered a disorder that children simply outgrow. Adults experience ADHD at high rates (2.5%-5%) and are impaired in multiple life domains, including social impairment. The purpose of this study was to examine emerging adults with varying degrees of ADHD symptomology in respect to social impairment, state and trait anger, romantic relationship satisfaction, and intimate partner violence (IPV).

METHOD

College students, a subset of emerging adults, were recruited to complete measures online.

RESULTS

Data were analyzed using a series of multiple regressions. Higher levels of ADHD symptomology in college students were related to increased social impairment and higher levels of state and trait anger, but not romantic relationship satisfaction or rates of IPV.

CONCLUSION

Anger management and social skills training may be beneficial treatment components for this group.

Attentional Lapses in Attention-Deficit/Hyperactivity Disorder: Blank Rather Than Wandering Thoughts

People with attention-deficit/hyperactivity disorder (ADHD) have difficulties sustaining their attention on external tasks. Such attentional lapses have often been characterized as the simple opposite of external sustained attention, but the different types of attentional lapses, and the subjective experiences to which they correspond, remain unspecified. In this study, we showed that unmedicated children (ages 6-12) with ADHD, when probed during a standard go/no-go task, reported more mind blanking (a mental state characterized by the absence of reportable content) than did control participants. This increase in mind blanking happened at the expense of both focused and wandering thoughts. We also found that methylphenidate reverted the level of mind blanking to baseline (i.e., the level of mind blanking reported by control children without ADHD). However, this restoration led to mind wandering more than to focused attention. In a second experiment, we extended these findings to adults who had subclinical ADHD. These results suggest that executive functions impaired in ADHD are required not only to sustain external attention but also to maintain an internal train of thought.

Stress, attention deficit hyperactivity disorder (ADHD) symptoms and tobacco smoking: The i-Share study

BACKGROUND

The contribution of mental health to the risk of smoking is increasingly acknowledged but still insufficiently studied during the key period of student life. In particular, the simultaneous action of stress and Attention Deficit Hyperactivity Disorder (ADHD) symptoms on the risk of smoking remains poorly understood.

AIMS

To assess the effects of stress and ADHD symptoms on tobacco smoking.

METHOD

Multivariate modeling was conducted on the French i-Share study (n=8110, median age 20.3 years, 74.8% females, 32.9% regular/occasional smokers) to evaluate the associations between stress, ADHD symptoms and tobacco smoking, adjusting for potential family/socio-demographic confounders.

RESULTS

Students with high levels of stress were more likely to smoke>10 cigarettes/day (adjusted odds ratio (aOR): 1.48, 95% CI: 1.12-1.96) than those with low levels of stress. Students with high levels of ADHD symptoms were more likely to smoke>10 cigarettes/day (aOR: 2.08, 95% CI: 1.58-2.75) than those with low levels of ADHD symptoms.

CONCLUSIONS

Stress and ADHD contribute independently to the risk of smoking. Interventions targeting each condition are likely to reduce the burden of tobacco use in students.

Tracking Distraction

OBJECTIVE

Although earlier work has shown a link between mind-wandering and ADHD symptoms, this relationship has not been further investigated by taking into account recent advances in mind-wandering research.

METHOD

The present study provides a comprehensive assessment of the relationship between mind-wandering and ADHD symptomatology in an adult community sample ( N = 105, 71 females, M age = 23.1) using laboratory measures and experience sampling during daily life.

RESULTS

Mind-wandering and detrimental mind-wandering were positively associated with ADHD symptoms. Meta-awareness of mind-wandering mediated the relationship between ADHD symptomatology and detrimental mind-wandering, suggesting that some of the negative consequences can be ameliorated by strategies that facilitate meta-awareness. Interestingly, participants with low ADHD scores showed a positive relationship between detrimental mind-wandering and useful mind-wandering; however, participants with high ADHD scores failed to engage in this type of "strategic" mind-wandering.

CONCLUSION

These results provide new insights into the relationship between ADHD symptomatology and mind-wandering that could have important clinical implications.

Marital and Coparenting Relationships: Associations With Parent and Child Symptoms of ADHD

OBJECTIVE

To examine relations between symptoms of ADHD and reports of marital and coparenting functioning.

METHOD

Parents of 8- to 12-year-old boys with (n = 26) and without (n =38) ADHD participated.

RESULTS

Although mothers of children with ADHD had the highest levels of ADHD symptoms, their symptoms were typically not related to measures of the couples' functioning, particularly when controlling for family ADHD and comorbidities. Father ADHD symptoms were related to their reports of couple functioning, and fathers' ADHD symptoms were associated with their negative attributions for their wives' behavior, even with child and mother ADHD controlled. However, when fathers' depression and hostility symptoms were controlled, these were more important predictors of the attributions than ADHD symptoms.

CONCLUSION

It is important to consider parental levels of ADHD symptoms in the context of other family members' symptoms as well as other forms of psychopathology.

Co-occurring symptoms of attention deficit hyperactivity disorder (ADHD) in a population-based sample of adolescents screened for depression

BACKGROUND

Depression is common in adolescents, with a gender bias towards girls. Symptoms associated with attention deficit hyperactivity disorder (ADHD) tend to co-occur in depressed adolescents. This may be related to common features between the two symptom domains, but co-occurring ADHD symptoms may also inflate the severity of depression. The present study investigates the frequency and influence of ADHD symptoms co-occurring with depression in a gender balanced population-based sample of Norwegian adolescents.

METHODS

A sample of 9614 adolescents (16-19 years) completed a questionnaire including the short version of the Mood and Feelings Questionnaire (sMFQ) and the Adult ADHD Self-Report Scale (ASRS), with items reflecting symptoms associated with depression and ADHD, respectively. The sMFQ sum score was used as a proxy for severity of depression, and adolescents with a score equal to or above the 90th percentile were defined as depressed. A high response on any of the ASRS items was used to define the presence of an ADHD symptom, and the number of high scores was used to indicate severity.

RESULTS

ADHD symptoms were frequently reported by the adolescents, with a higher frequency in girls than in boys. The gender differences were, however, minor when the analysis was restricted to the adolescents defined as depressed. Each severe symptom reported on the ASRS contributed significantly to increase the sum score on the sMFQ, and more than 20 % of the adolescents defined as depressed reported six or more symptoms within the ASRS inattention subscale.

CONCLUSIONS

The results emphasize the importance of screening for symptoms associated with ADHD when assessing adolescents presenting symptoms indicating depression. Although girls reported higher frequency of symptoms within both domains, the gender bias was dependent on the overall symptom severity. Awareness of co-occurrence of symptoms and gender biases are of importance for both clinical work and future research on mental health and service use in adolescence.

Attention-deficit/hyperactivity disorder symptom levels and romantic relationship quality in college students

OBJECTIVE

The purpose of this study was to examine whether attention-deficit/hyperactivity disorder (ADHD) symptom levels in college undergraduates are associated with poorer romantic relationship quality, and to test whether emotion regulation difficulties, perceived stress, and hostile relationship conflict mediate this association.

PARTICIPANTS

The sample consisted of 189 undergraduate students aged 18 to 25.

METHODS

Self-report measures of ADHD symptoms, relationship quality, and the proposed mediators were collected via online survey from May through August 2011.

RESULTS

Participants who reported clinically significant levels of both hyperactivity-impulsivity and inattentiveness (consistent with ADHD-C) had lower relationship quality than those whose self-reported symptoms indicated no ADHD diagnosis. Further, for women only, both hyperactive-impulsive and inattentive symptom levels were negatively associated with relationship quality. Emotion regulation problems and hostile relationship conflict mediated this association.

CONCLUSION

Findings suggest that ADHD impairs relationship quality among young adults and suggest mechanisms through which this impairment might occur.

Prediction of ADHD to anxiety disorders: an 11-year national insurance data analysis in Taiwan

OBJECTIVE

To prospectively investigate prediction of ADHD to anxiety disorders (ANXs) in a national sample of Taiwan.

METHOD

From the Taiwan National Health Insurance Dataset (1997-2007), we collected 2,385 cases of new diagnoses of ADHD from 1999 to 2003 and 9,540 sex-, age- and index dates of the first diagnosis of ADHD-matched cohort controls without ADHD. The outcome is age of the first diagnosis of ANXs until December 31, 2007.

RESULTS

More cases of ADHD (17.7%) developed ANXs than did matched controls (1.9%) with a younger age onset (12.7 years vs. 17.9 years) and a shorter "survival time" (1.4 years vs. 5.0 years). Cox models revealed a significant prediction of ADHD to ANXs controlling for other psychiatric comorbidities [Hazard ratio (HR) = 15.83]. The magnitude of such association was greater in males and decreased with older age of first ADHD diagnosis.

CONCLUSION

The findings imply that early detection and treatment for ADHD may offset later development of ANXs.

An examination of prescription stimulant misuse and psychological variables among sorority and fraternity college populations

OBJECTIVE

The objective of this study was to examine nonmedical stimulant use among fraternity/sorority members and nonmembers and whether psychological variables (e.g., internal restlessness, depression, anxiety, and stress) were related to nonmedical stimulant use.

METHOD

The sample consisted of 1,033 undergraduate students from five universities located in the northeastern, southeastern, northwestern, southwestern, and midwestern regions of the United States.

RESULTS

The findings revealed that fraternity and sorority members reported a higher rate of nonmedical stimulant use than nonmembers. In addition, regression analyses revealed that higher ratings of anxiety, stress, internal impulsivity, and internal restlessness significantly predicted nonmedical stimulant use.

CONCLUSION

Current findings support further examination of nonmedical stimulant use among other college student subpopulations (i.e., athletic teams, honor societies, residence halls). In addition, there is a strong need to develop research-based intervention and preventive measures that target college populations identified as being at risk for nonmedical stimulant use.

Adolescent impulsivity phenotypes characterized by distinct brain networks

The impulsive behavior that is often characteristic of adolescence may reflect underlying neurodevelopmental processes. Moreover, impulsivity is a multi-dimensional construct, and it is plausible that distinct brain networks contribute to its different cognitive, clinical and behavioral aspects. As these networks have not yet been described, we identified distinct cortical and subcortical networks underlying successful inhibitions and inhibition failures in a large sample (n = 1,896) of 14-year-old adolescents. Different networks were associated with drug use (n = 1,593) and attention-deficit hyperactivity disorder symptoms (n = 342). Hypofunctioning of a specific orbitofrontal cortical network was associated with likelihood of initiating drug use in early adolescence. Right inferior frontal activity was related to the speed of the inhibition process (n = 826) and use of illegal substances and associated with genetic variation in a norepinephrine transporter gene (n = 819). Our results indicate that both neural endophenotypes and genetic variation give rise to the various manifestations of impulsive behavior.