Late adolescent and young adult outcomes of girls diagnosed with ADHD in childhood: an exploratory investigation

ADHD Symptoms in Childhood and Big Five Personality Traits in Adolescence: A Five-Year Longitudinal Study in Girls

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental condition characterized by developmentally extreme and impairing symptoms of inattention and/or hyperactivity/impulsivity. Great interest has emerged in the ways ADHD and its underlying symptom dimensions relate to the development of personality traits. Much extant research on this topic is cross-sectional, relying on self-report measures and male samples. Herein, we present data from a prospective, longitudinal study of a socioeconomically and racially diverse sample of girls, including those with ADHD and a matched neurotypical comparison sample. We examined how parent- and teacher-reported ADHD in middle childhood relate to self-reported Big Five personality traits in adolescence. As expected, childhood ADHD diagnosis prospectively predicted lower self-reported Conscientiousness, lower Agreeableness, and higher Neuroticism in adolescence. With ADHD diagnosis covaried, Inattention (IA) predicted only low Conscientiousness, Hyperactivity/Impulsivity (HI) predicted only low Agreeableness, and neither predicted adolescent Neuroticism. An exploratory moderator analysis showed that family income moderated the effects of IA and HI on the negativity of adolescent self-descriptions of their own personalities, with more pronounced negative effects for girls in families with higher (rather than lower) income. Familial pressures to achieve in higher-income families may be linked to more pronounced negative ramifications of ADHD on personality development.

Diversity and representation in ADHD psychosocial treatment research: A comprehensive synthesis with data from over 10,000 participants

Demographic data from nearly 50 years of treatment research for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are synthesized. Comprehensive search identified ADHD treatment studies that were between-group designs, included a psychosocial, evidence-based treatment, and were conducted in the United States. One hundred and twenty-six studies that included 10,604 youth were examined. Reporting of demographics varied with 48% of studies (k = 61) reporting ethnicity, 73% (k = 92) reporting race, 80% (k = 101) reporting age (M age = 8.81, SD = 2.82), and 88% (k = 111) reporting gender. Most participants identified as non-Hispanic/Latine (15.99% Hispanic/Latine), White (62.54%), and boys (74.39%; 24.47% girls). Since the 1970s, zero youth in ADHD treatment studies identified as Middle Eastern/North African, 0.1% were American Indian/Alaskan Native or Native Hawaiian Pacific Islander, 1.77% were Asian, 15.10% were Black, and 3.14% were Multiracial. Based on publication year, the proportions of girls, racially minoritized youth, and Hispanic/Latine youth included in ADHD treatment research have increased over time. Girls, non-binary and non-cisgender youth, young children, adolescents, Hispanic/Latine youth, and youth from all racial groups other than White are underrepresented in ADHD treatment research. Research gaps are discussed, and recommendations for comprehensive demographic reporting in child and adolescent psychological research are provided.

Sexual and reproductive health in young women with ADHD from the view of health care professionals

BACKGROUND

Sexual risk-taking and struggles in managing romantic relationships may put young women with Attention Deficit Hyperactivity Disorder (ADHD) at risk of sexually transmitted diseases, unplanned pregnancies, and low relational satisfaction. To gain understanding of sexual behaviors and intimate relationships, this study aimed to identify and describe health care professionals' (HCPs) perceptions and experiences of sexual and reproductive health (SRH) in young women with ADHD.

METHODS

Qualitative interviews were performed with 16 HCPs. Data was analyzed using reflexive thematic analysis.

RESULTS

Analysis resulted in the themes Struggling to meet expectations, Sexual risk-taking, and Complex romantic relationships. HCPs' perceptions and experiences indicated that some women were afraid to be judged in clinical meetings when not living up to perceived expectations of sexual behaviors. Lack of impulse control was interpreted by HCPs to result in risk-taking behaviors leading to both negative and positive sexual experiences. Difficulties in assessing intentions of sexual partners were further perceived by HCPs to sometimes lead to sexual regrets or sexual victimization. The HCPs had experience of women wishing for romantic relationships but described these as being complicated by previous experiences, low self-esteem and conflict. ADHD medication and self-knowledge were perceived by HCPs to facilitate the women's relationship quality.

CONCLUSIONS

This study highlights that, from the perspective of HCPs, self-stigmatization and hesitation to raise issues concerning sexuality with HCPs may pose risks for young women with ADHD. It provides insight into sexual risk-taking behaviors, showing the link to regretted sex and sexual victimization. The study concludes that there is a need for HCPs to understand the influence of stigma concerning ADHD and female sexuality as well as how symptoms and outcomes of living with ADHD may impact SRH in order to promote healthy behaviors and relationships in young women.

The ADHD Phenotype in Black and White Girls From Childhood to Adolescence: Results From the Community-Based Pittsburgh Girls Study

OBJECTIVE

The goal of the present study is to describe the ADHD phenotype from childhood to adolescence in Black and White girls in a community sample.

METHOD

Primary caregivers enrolled in the population-based, longitudinal Pittsburgh Girls Study reported on girls' ADHD symptoms and impairment from ages 7 to 17; diagnostic subtypes were estimated based on meeting symptom criteria.

RESULTS

The prevalence of any subtype of ADHD ranged from 6.4 to 9.2% and from 2.3 to 6.4% for Black and White girls respectively; the inattentive subtype was most endorsed. A relatively equal number of new diagnoses at each age was observed. Persistence of ADHD diagnoses was typically 1 to 2 years.

CONCLUSIONS

ADHD in the community is relatively common, with the inattentive subtype as the most common phenotype for Black and White girls. Research on developmentally sensitive periods for symptom exacerbation or new onset of ADHD in girls is needed.

Sexual development in ADHD and internet pornography consumption

Development of sexual identity during adolescence is a major process of transition in individual life which in cases of ADHD specifically interacts with other ontogenetic, pathological and psychosocial conditions. According to recent findings growing consumption of internet pornography mainly in male ADHD population is closely related to compulsive sexual behavior and hypersexuality. Recent findings also indicate that consumption of internet pornography in ADHD individuals and other sexual activities may serve as a mood-altering "self-medication" which may help to cope with stressful events and decrease depression and anxiety. Taken together recent findings indicate that internet pornography consumption mainly in ADHD individuals is closely related to stressful experiences, anxiety, depression and identity problems in partnerships which significantly increase their vulnerability to the so-called "problematic pornography use" and other forms of addictive sexual behavior. From this developmental perspective "problematic pornography use" in ADHD individuals represents significant epidemiological problem which requires further research mainly with focus on clinical diagnostics and treatment.

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.

Sexuality in Adults With ADHD: Results of an Online Survey

Establishing a secure sexual identity is a major developmental goal of an individual's transition from childhood to adolescence and the years that follow. Attention deficit/hyperactivity disorder (ADHD) as a neurodevelopmental disorder defined by the core symptoms of inattention, hyperactivity, and impulsivity, but also with emotional dysregulation, oppositional behaviors, or disorganization appearing early in life, can affect several areas of an individual's personal and social development, including sexual health. Yet, the scientific knowledge about the relationship between ADHD and sexual functioning is still scarce. Using an anonymous online survey, we compared different sexual behaviors including risky sexual behaviors, hypersexual behaviors, and sexual dysfunctions between 206 individuals with (n = 139) and without (n = 76) ADHD. Individuals with ADHD reported significantly more hypersexual behaviors than non-ADHD individuals, whereas no differences were found concerning risky sexual behaviors or sexual dysfunctions. In women with ADHD, hypersexual behaviors, sexual risk-taking as well as sexual dysfunctions were closely related to symptoms of emotional dysregulation, impulsivity, and oppositional symptoms. In men with ADHD, the associations between ADHD symptomatology and the sexuality-related measures were less clear, however, signs of emotional dysregulation seemed to be relevant as well. Since individuals with ADHD seem to be at an increased risk of some peculiarities in sexual behavior, sexuality-related issues should be routinely addressed during clinical consultations to provide more holistic treatment in order to enhance individual well-being and quality of life.

Annual Research Review: Attention-deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions

Attention-deficit/hyperactivity disorder (ADHD) - and its underlying behavioral dimensions of inattention and hyperactivity-impulsivity - have been understudied in females. We first cover the conceptual issues of prevalence, diagnostic practices, diversity, comorbidity, and causal factors, plus forces limiting awareness of ADHD in females. After a narrative review of cross-sectional and longitudinal findings, we conclude the following. (a) Girls meet diagnostic criteria for ADHD at just under half the rates of boys, a ratio that becomes much closer to equal by adulthood. (b) Girls and women with ADHD show a predominance of inattention and associated internalizing problems; boys and men display greater levels of hyperactive-impulsive symptoms and associated externalizing problems. (c) Sex differences in ADHD symptoms and related outcomes depend heavily on the clinical versus nonreferred nature of the samples under investigation. (d) Females with ADHD experience, on average, serious impairments, with a particularly heightened risk for problems in close relationships and engagement in self-harm. (e) Clinicians may overlook symptoms and impairments in females because of less overt (but still impairing) symptom manifestations in girls and women and their frequent adoption of compensatory strategies. Our review of predictors and mediators of adult outcomes highlights (a) the potential for heterotypically continuous pathways in females with childhood ADHD and (b) developmental progressions to self-harm, intimate partner violence, unplanned pregnancy, and comorbid psychopathology. Focusing on ADHD in females is necessary to characterize causal and maintaining mechanisms with accuracy and to foster responsive interventions, as highlighted in our closing list of clinical implications and research priorities.

An evaluation of the effect of methylphenidate on working memory, time perception, and choice impulsivity in children with ADHD

Individuals with Attention-Deficit Hyperactivity Disorder (ADHD) consistently exhibit a stronger preference for immediate rewards than for larger rewards available following a delay on tasks measuring choice impulsivity (CI). Despite this, however, there remains a dearth of studies examining the impact of stimulant treatment on CI as well as associated higher order (e.g., working memory [WM]) and perceptual (e.g., time perception) cognitive processes. The present study examines the effect of osmotic release oral system methylphenidate (OROS-MPH) on CI, WM and time perception processes as well as the relation among these processes before and after taking a regimen of OROS-MPH. Thirty-five children (aged 7-12 years) with a diagnosis of ADHD participating in a concurrent stimulant medication study were recruited to complete computerized assessments of CI, WM, and time perception. Children completed the assessments after administration of a placebo as well as their lowest effective dose of OROS-MPH following a 2-week titration period. The results from one-sample t-tests indicated that OROS-MPH improves both CI and WM in youth with ADHD but does not impact time perception. Further, results revealed no significant association among the various indices of cognitive performance while taking placebo or OROS-MPH. Overall, the findings suggest that while OROS-MPH improves both CI and WM in youth with ADHD, improvements in CI as a result of OROS-MPH are unlikely to be associated with the improvements in WM given the lack of association among the two. Future studies should consider alternate cognitive, emotional, and motivational mechanisms that may account for the impact of OROS-MPH on CI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Birds of a Feather: An Examination of ADHD Symptoms and Associated Concerns in Partners of Adults with ADHD

OBJECTIVE

Adults often select romantic partners who behave like they do (i.e. assortative mating). However, little is known about whether assortative mating is common among adults with attention-deficit/hyperactivity disorder (ADHD) and whether it is related to associated problems.

METHOD

About 94 adults without ADHD, 43 adults with childhood ADHD histories but without current symptoms or impairment (ADHD-Desist), 27 adults with childhood ADHD histories and elevated current symptoms and impairment (ADHD-Persist) rated their partners' ADHD symptoms and their own associated problems (e.g., intimate partner violence, financial difficulties).

RESULTS

The ADHD-Persist group reported that their partners exhibited more ADHD symptoms than the ADHD-Desist group and those without ADHD. Adults in the ADHD-Persist group who had partners with elevated ADHD symptoms endorsed high intimate partner violence and financial difficulties.

CONCLUSION

Assortative mating appears to be common among adults with ADHD, especially those with persistent symptoms, and to increase risk of additional problems.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Presenting problem profiles for adolescents with ADHD: differences by sex, age, race, and family adversity

BACKGROUND

Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience developmentally distinct challenges from children and adults with ADHD. Yet no work in this age group identifies treatment-related phenotypes that can inform treatment matching, development of tailored treatments, and screening efforts.

METHOD

This study uses Latent Profile Analysis to detect unique presenting problem profiles among adolescents with ADHD and to test whether these profiles differ by key individual characteristics (age, sex, race, family adversity level). Participants were 854 ethnically diverse adolescents (ages 10-17) from the ADHD Teen Integrative Data Analysis Longitudinal (TIDAL) dataset who were assessed at clinical referral. Parent, adolescent, and teacher ratings, educational testing, and school records measured eight key presenting problems at intake.

RESULTS

A three-profile solution emerged. ADHD simplex (63.7%) was characterized by a mix of the ADHD-Inattentive and ADHD-Combined subtypes, moderate impairment levels, and infrequent comorbidities. ADHD + internalizing (11.4%) was characterized by higher likelihood of comorbid anxiety and/or depression. The disruptive/disorganized ADHD (24.9%) profile was characterized by severe organization, time management, and planning (OTP) problems, the ADHD-Combined subtype, and frequent disruptive behavior at school. Age did not vary across these phenotypes. More females were present in the ADHD + internalizing phenotype; males were more likely to be found in the disruptive/disorganized ADHD phenotype. Higher family adversity and African American race were associated with the disruptive/disorganized ADHD phenotype.

CONCLUSIONS

Adolescents with ADHD demonstrate varying presenting problem phenotypes that vary by sex, family adversity, and race/ethnicity. Consideration of these phenotypes may inform treatment matching and efforts to improve screening among under-diagnosed groups.

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.

Early Adolescence Prefrontal Cortex Alterations in Female Rats Lacking Dopamine Transporter

Monoamine dysfunctions in the prefrontal cortex (PFC) can contribute to diverse neuropsychiatric disorders, including ADHD, bipolar disorder, PTSD and depression. Disrupted dopamine (DA) homeostasis, and more specifically dopamine transporter (DAT) alterations, have been reported in a variety of psychiatric and neurodegenerative disorders. Recent studies using female adult rats heterozygous (DAT+/-) and homozygous (DAT-/-) for DAT gene, showed the utility of those rats in the study of PTSD and ADHD. Currently, a gap in the knowledge of these disorders affecting adolescent females still represents a major limit for the development of appropriate treatments. The present work focuses on the characterization of the PFC function under conditions of heterozygous and homozygous ablation of DAT during early adolescence based on the known implication of DAT and PFC DA in psychopathology during adolescence. We report herein that genetic ablation of DAT in the early adolescent PFC of female rats leads to changes in neuronal and glial cell homeostasis. In brief, we observed a concurrent hyperactive phenotype, accompanied by PFC alterations in glutamatergic neurotransmission, signs of neurodegeneration and glial activation in DAT-ablated rats. The present study provides further understanding of underlying neuroinflammatory pathological processes that occur in DAT-ablated female rats, what can provide novel investigational approaches in human diseases.

Initial Engagement in Oral Sex and Sexual Intercourse Among Adolescent Girls With and Without Childhood Attention-Deficit/Hyperactivity Disorder

We investigated initial engagement in oral sex and sexual intercourse, as well as number of sexual partners, among a prospectively followed sample of adolescent girls with and without a thorough childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD). Participants were adolescent girls (ages 12-19) followed longitudinally as part of a study of ADHD in females. A diverse sample of 140 girls with clinician-diagnosed ADHD (47 inattentive, 93 combined) and 88 age- and ethnicity-matched comparison girls were initially recruited and invited to partake in research summer programs. We utilized data on initial engagement in oral sex, sexual intercourse, and number of sexual partners, collected during follow-up interviews conducted 5 and 10 years after baseline participation. Girls with a childhood diagnosis of ADHD engaged in oral sex at a significantly younger age and reported nearly twice as many oral sex partners than their typically developing peers. Post hoc tests revealed that group differences were driven largely by girls with the combined presentation of ADHD (i.e., those with childhood histories of both inattention and hyperactivity/impulsivity). No significant differences emerged with respect to age of initial sexual intercourse or number of male sexual intercourse partners. In sum, adolescent girls with ADHD, particularly those with the combined presentation, were more likely to engage in oral sexual activity at a young age and with a greater number of both male and female partners. Findings highlight the need for longitudinal research that quantifies and distinguishes between various forms of sexual behavior and later reproductive and mental health outcomes.

Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women

BACKGROUND

There is evidence to suggest that the broad discrepancy in the ratio of males to females with diagnosed ADHD is due, at least in part, to lack of recognition and/or referral bias in females. Studies suggest that females with ADHD present with differences in their profile of symptoms, comorbidity and associated functioning compared with males. This consensus aims to provide a better understanding of females with ADHD in order to improve recognition and referral. Comprehensive assessment and appropriate treatment is hoped to enhance longer-term clinical outcomes and patient wellbeing for females with ADHD.

METHODS

The United Kingdom ADHD Partnership hosted a meeting of experts to discuss symptom presentation, triggers for referral, assessment, treatment and multi-agency liaison for females with ADHD across the lifespan.

RESULTS

A consensus was reached offering practical guidance to support medical and mental health practitioners working with females with ADHD. The potential challenges of working with this patient group were identified, as well as specific barriers that may hinder recognition. These included symptomatic differences, gender biases, comorbidities and the compensatory strategies that may mask or overshadow underlying symptoms of ADHD. Furthermore, we determined the broader needs of these patients and considered how multi-agency liaison may provide the support to meet them.

CONCLUSIONS

This practical approach based upon expert consensus will inform effective identification, treatment and support of girls and women with ADHD. It is important to move away from the prevalent perspective that ADHD is a behavioural disorder and attend to the more subtle and/or internalised presentation that is common in females. It is essential to adopt a lifespan model of care to support the complex transitions experienced by females that occur in parallel to change in clinical presentation and social circumstances. Treatment with pharmacological and psychological interventions is expected to have a positive impact leading to increased productivity, decreased resource utilization and most importantly, improved long-term outcomes for girls and women.

Association of Mental Disorder in Childhood and Adolescence With Subsequent Educational Achievement

IMPORTANCE

Onset of mental disorders during childhood or adolescence has been associated with underperformance in school and impairment in social and occupational life in adulthood, which has important implications for the affected individuals and society.

OBJECTIVE

To compare the educational achievements at the final examination of compulsory schooling in Denmark between individuals with and those without a mental disorder.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort study was conducted in Denmark and obtained data from the Danish Civil Registration System and other nationwide registers. The 2 cohorts studied were (1) all children who were born in Denmark between January 1, 1988, and July 1, 1999, and were alive at age 17 years (n = 629 622) and (2) all children who took the final examination at the end of ninth grade in both Danish and mathematics subjects between January 1, 2002, and December 31, 2016 (n = 542 500). Data analysis was conducted from March 1, 2018, to March 1, 2019.

EXPOSURES

Clinical diagnosis by a psychiatrist of any mental disorder or 1 of 29 specific mental disorders before age 16 years.

MAIN OUTCOMES AND MEASURES

Taking the final examination at the end of ninth grade and mean examination grades standardized as z scores with differences measured in SDs (standardized mean grade difference).

RESULTS

Of the total study population (n = 629 622; 306 209 female and 323 413 male), 523 312 individuals (83%) took the final examination before 17 years of age and 38 001 (6%) had a mental disorder before that age. Among the 542 500 individuals (274 332 female and 268 168 male), the mean (SD) age was 16.1 (0.33) years for the females and 16.2 (0.34) years for the males. Among the 15 843 female and 22 158 male students with a mental disorder, a lower proportion took the final examination (0.52; 95% CI, 0.52-0.53) compared with individuals without a mental disorder (0.88; 95% CI, 0.88-0.88). Mental disorders affected the grades of male individuals (standardized mean grade difference, -0.30; 95% CI, -0.32 to -0.28) more than the grades of their female peers (standardized mean grade difference, -0.24; 95% CI, -0.25 to -0.22) when compared with same-sex individuals without mental disorders. Most specific mental disorders were associated with statistically significantly lower mean grades, with intellectual disability associated with the lowest grade in female and male students (standardized mean grade difference, -1.07 [95% CI, -1.23 to -0.91] and -1.03 [95% CI, -1.17 to -0.89]; P = .76 for sex differences in the mean grades). Female and male students with anorexia nervosa achieved statistically significantly higher grades on the final examination (standardized mean grade difference, 0.38 [95% CI, 0.32-0.44] and 0.31 [95% CI, 0.11-0.52]; P = .54 for sex differences in the mean grades) compared with their peers without this disorder. For those with anxiety, attachment, attention-deficit/hyperactivity, and other developmental disorders, female individuals attained relatively lower standardized mean grades compared with their male counterparts.

CONCLUSIONS AND RELEVANCE

Results of this study suggest that, in Denmark, almost all mental disorders in childhood or adolescence may be associated with a lower likelihood of taking the final examination at the end of ninth grade; those with specific disorders tended to achieve lower mean grades on the examination; and female, compared with male, individuals with certain mental disorders appeared to have relatively more impairment. These findings appear to emphasize the need to provide educational support to young people with mental disorders.

The Transition of Youth with ADHD into the Workforce: Review and Future Directions

Previous research suggests that a majority of children with attention-deficit/hyperactivity disorder (ADHD) continue to experience increased impairment across multiple life domains into adulthood. A systematic review of the occupational impairments, and associated educational and financial difficulties, faced by individuals with childhood ADHD was conducted. Systematic searches from PsycINFO and PubMed databases and other sources (i.e., books and consultants with experts) yielded 35 relevant articles that described 19 longitudinal studies on adults with a history of ADHD or related symptoms. Multiple studies indicated that those with a history of ADHD had more educational impairment and were less likely to graduate from high school and college than their peers without a history of ADHD. Subsequently, they faced lower occupational attainment, had more job instability, and demonstrated more impaired job performance, and these outcomes were largely consistent regardless of sex, medication history, or symptom persistence. Similar results were found in clinical and representative national studies in both U.S. and abroad, although older studies tended to indicate less occupational impairment. In addition, ADHD was associated with a number of financial challenges, including lower annual income, more reliance on public aid, and increased risk for homelessness. Future research should use more varied informant sources and utilize innovative measures of occupational impairment at both a macro- and micro-level of analyses. In addition, studies of effective supports and interventions in occupational settings for individuals with ADHD are needed.

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.

Nonsuicidal Self-Injury and Suicidal Behaviors in Girls: The Case for Targeted Prevention in Preadolescence

Non-suicidal self-injury (NSSI) affects 15-20% of adolescents-disproportionately girls-and is a strong predictor of eventual suicide attempts and suicide. Many girls now initiate NSSI before age 10. These early-starters exhibit greater frequency of NSSI, use more diverse methods, and are hospitalized more often, yet there are no empirically supported prevention programs for preadolescents. Obstacles to prevention include ascertaining who is sufficiently vulnerable and specifying mechanistic intervention targets. Recent research indicates that (1) preadolescent girls with ADHD who are also maltreated are at alarming risk for NSSI and suicide attempts by adolescence, and (2) the conjoint effects of these vulnerabilities are sufficiently potent for targeted prevention. Research also indicates that existing interventions are effective in altering child- and family-level mechanisms of NSSI. These interventions alter neurobiological markers of vulnerability, which can be used as proximal efficacy signals of prevention response, without waiting for NSSI and suicide attempts to emerge.

Executive Functions in Girls With and Without Childhood ADHD Followed Through Emerging Adulthood: Developmental Trajectories

Using an all-female sample, we examined trajectories of executive functioning (EF) performance from childhood through emerging adulthood-and their prediction of key emerging-adult outcomes. One hundred forty girls carefully diagnosed with attention deficit/hyperactivity disorder (ADHD) and 88 matched comparison girls were administered EF measurements assessing global EF, response inhibition, and verbal working memory during childhood (M age = 9.5 years), adolescence (M age = 14.1 years), the earliest years of adulthood (M age = 19.6 years), and the end of emerging adulthood (M age = 25.6 years). Retention rates were excellent. Hierarchical linear modeling was used to estimate growth curves for each EF measure. The linear EF slopes were then used to explore how changes in EF interacted with each participant's persistence/remission of ADHD over time to influence behavioral, emotional, and academic impairment in emerging adulthood. Although all women experienced absolute improvements in EF performance across time, women with histories of ADHD consistently lagged behind comparison women, even if their ADHD symptoms had remitted by early adulthood. However, EF performance over time did not significantly influence the link between ADHD status and (a) maternal reports of associated behavioral and emotional impairment or (b) objective measures of academic achievement. These findings indicate that EF deficits should be considered when developing and implementing treatments for ADHD through emerging adulthood. Future research should be aimed at understanding the mechanisms behind these observed trajectory differences.

Sex Differences in Comorbidity Patterns of Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

To investigate sex differences in associations between attention-deficit/hyperactivity disorder (ADHD) and a spectrum of comorbid disorders.

METHOD

The study population included all children born in Denmark from 1981 through 2013 (N = 1,665,729). Data were merged from Danish registers and information was obtained on birth characteristics, socioeconomic status, familial psychiatric history, and diagnoses of ADHD (n = 32,308) and comorbid disorders. To estimate absolute and relative risks of comorbid disorders, incidence rates and adjusted hazard ratios (HRs) with 95% CIs were calculated for female and male individuals. In addition, interactions between ADHD and sex in association with comorbid disorders were estimated as HR ratios (HRRs) in female and male individuals (95% CIs).

RESULTS

Individuals diagnosed with ADHD had significantly increased absolute and relative risks of all 12 comorbid psychiatric disorders investigated. ADHD-sex interactions were found for some comorbid disorders. Compared with male individuals, ADHD in female individuals showed a stronger association with autism spectrum disorder (HRR 1.86, 95% CI 1.62-2.14), oppositional defiant/conduct disorder (HRR 1.97, 95% CI 1.68-2.30), intellectual disability (HRR 1.79, 95% CI 1.54-2.09), personality disorders (HRR 1.23, 95% CI 1.06-1.43), schizophrenia (HRR 1.21, 95% CI 1.02-1.43), substance use disorders (HRR 1.21, 95% CI 1.07-1.38), and suicidal behavior (1.28, 95% CI 1.12-1.47). The remaining disorders showed no significant sex differences in association with ADHD.

CONCLUSION

This study indicates that the association between ADHD and several comorbid disorders is stronger in female than in male individuals. These important findings add to the literature on sex differences in ADHD and suggest that female individuals diagnosed with ADHD are a more vulnerable group of patients.

Does level of attention deficit-hyperactivity disorder symptoms predicts poor transition into adulthood?

OBJECTIVES

Transition into adulthood is a risky period for young people with attention deficit-hyperactivity disorder (ADHD), but empirical studies on this topic are scarce. This study investigated the association between the level of ADHD symptoms and transition into adulthood.

METHODS

Data were collected in the Cohort Study of Substance Use and Risk Factors among a representative sample of young Swiss men (n = 4681) over three waves. Measures included the level of ADHD symptoms and emerging adulthood assessed with the Inventory of the Dimensions of Emerging Adulthood and indicators of successful transition into adulthood.

RESULTS

The level of ADHD symptoms was associated with a lower success in the transition into adulthood. Young people with high level of ADHD symptoms had a reduced increase in indicators of successful transition over time. Inattention symptoms were more strongly associated with emerging adulthood measures in comparison with hyperactive symptoms.

CONCLUSIONS

The level of ADHD symptoms may delay the transition into adulthood, especially inattentive symptoms. Providing tailored interventions to emerging adults with ADHD symptoms may decrease the substantial impairments adults with ADHD experience in life.

Attention-Deficit/Hyperactivity Disorder, Trait Impulsivity, and Externalizing Behavior in a Longitudinal Sample

Attention-deficit/hyperactivity disorder (ADHD) is highly comorbid with and predictive of externalizing behavior, yet is most often examined categorically, not dimensionally. We tested a recently proposed trait impulsivity model by dimensionally examining measures of childhood inattention and hyperactivity/impulsivity separately as predictors of later externalizing behavior in an all-female longitudinal sample of 228 young women. We also examined influences of parenting and peer relations, given the transactional nature and importance of environmental factors. We analyzed the relative contribution of hyperactive/impulsive (HI) and inattentive (IA) symptoms of girls with and without childhood-diagnosed ADHD (M age = 9.5; 140 ADHD and 88 Comparison) to the development of externalizing behaviors in adolescence (M age = 14.2) and early adulthood (M age = 19.6). Authoritarian parenting was examined as a moderator and adolescent externalizing behavior as a mediator of the relation between childhood HI and later externalizing behavior. Childhood HI symptoms significantly predicted multiple externalizing behaviors in adolescence and early adulthood, after accounting for IA and covariates (ΔR ² ranged from 2.6 to 7.5 %). Mother's authoritarian parenting moderated this relation. Adolescent externalizing behavior mediated the relation between childhood HI symptoms and early adult externalizing behavior. In no case did childhood IA significantly predict externalizing behavior after accounting for HI symptoms. Findings support a trait impulsivity model, as HI symptoms, but not IA symptoms, significantly predicted later externalizing behavior. Results support the importance of dimensional predictors of developmental trajectories. We discuss implications for assessment, intervention, and future research.

Risky decision-making in children with and without ADHD: A prospective study

Learning from past decisions can enhance successful decision-making. It is unclear whether difficulties in learning from experience may contribute to risky decision-making, which may be altered among individuals with attention-deficit/hyperactivity disorder (ADHD). This study follows 192 children with and without ADHD aged 5 to 10 years for approximately 2.5 years and examines their risky decision-making using the Balloon Emotional Learning Task (BELT), a computerized assessment of sequential risky decision-making in which participants pump up a series of virtual balloons for points. The BELT contains three task conditions: one with a variable explosion point, one with a stable and early explosion point, and one with a stable and late explosion point. These conditions may be learned via experience on the task. Contrary to expectations, ADHD status was not found to be related to greater risk-taking on the BELT, and among younger children ADHD status is in fact associated with reduced risk-taking. In addition, the typically-developing children without ADHD showed significant learning-related gains on both stable task conditions. However, the children with ADHD demonstrated learning on the condition with a stable and early explosion point, but not on the condition with the stable and late explosion point, in which more pumps are required before learning when the balloon will explode. Learning during decision-making may be more difficult for children with ADHD. Because adapting to changing environmental demands requires the use of feedback to guide future behavior, negative outcomes associated with childhood ADHD may partially reflect difficulties in learning from experience.

Longitudinal association between mental disorders in childhood and subsequent depression - A nationwide prospective cohort study

BACKGROUND

Depression ranges among the most impairing mental disorders worldwide, and early detection is a global health priority. Little is known about the association between non-affective mental disorders in childhood/adolescence and later depression.

METHODS

Nationwide register-based prospective cohort study, estimating cumulative incidences and incidence rate ratios (IRR) for later depression in individuals with and without non-affective mental disorders in early life.

RESULTS

475,213 females and 484,813 males born 1990-2007 were followed for a mean of 9.14 years (contributing a total of 8778,331 person-years of observation). In the cohort, 7963 (5451 females) were diagnosed with depression. Depression was more common in individuals with prior non-affective mental disorders in adolescence (15.98% in females and 7.02% in males) and in childhood (4.98% in females and 1.6% in males), than in the background population (3.94% and 1.3% in females; 1.37% and 0.47% in males). Eating and anxiety disorders in childhood/adolescence carried the highest absolute risk of depression. The relative risk of depression was particularly high the first year after the first non-affective disorder (IRR = 15.5; 14.07-17.10), but remained highly elevated more than five years after the first non-affective diagnosis (IRR = 2.05; 1.84-2.28), when compared to young people without such disorders.

LIMITATIONS

This study only included diagnoses given at hospital departments, representing the more severe mental disorders.

CONCLUSIONS

Children and adolescents with non-affective mental disorders were at substantially increased absolute and relative risk of developing depression in young adulthood, especially females diagnosed with anxiety- or eating disorders in adolescence. These findings may help identify groups of children and adolescents at very high risk of developing depression.

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.

Increased Risk of Smoking in Female Adolescents Who Had Childhood ADHD

OBJECTIVE

This study examined the effects of childhood attention deficit hyperactivity disorder (ADHD) symptoms, both inattention and hyperactivity-impulsivity, on the development of smoking in male and female adolescents.

METHOD

Twin difference methods were used to control for shared genetic and environmental confounders in three population-based, same-sex twin samples (N=3,762; 64% monozygotic). One cohort oversampled female adolescents with ADHD beginning in childhood. Regressions of childhood inattentive and hyperactive-impulsive symptoms were conducted to predict smoking outcomes by age 17. ADHD effects were divided into those shared between twins in the pair and those nonshared, or different within pairs.

RESULTS

Adolescents who had more severe ADHD symptoms as children were more likely to initiate smoking and to start smoking younger. The association of ADHD symptoms with daily smoking, number of cigarettes per day, and nicotine dependence was greater in females than in males. Monozygotic female twins with greater attentional problems than their co-twins had greater nicotine involvement, consistent with possible causal influence. These effects remained when co-occurring externalizing behaviors and stimulant medication were considered. Hyperactivity-impulsivity, while also more strongly related to smoking for female adolescents, appeared primarily noncausal.

CONCLUSIONS

Smoking initiation and escalation are affected differentially by ADHD subtype and gender. The association of inattention with smoking in female adolescents may be causal, whereas hyperactivity-impulsivity appears to act indirectly, through shared propensities for both ADHD and smoking.

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.

Inter-hemispherical asymmetry in default-mode functional connectivity and BAIAP2 gene are associated with anger expression in ADHD adults

Attention deficit hyperactivity disorder (ADHD) is accompanied by resting-state alterations, including abnormal activity, connectivity and asymmetry of the default-mode network (DMN). Concurrently, recent studies suggested a link between ADHD and the presence of polymorphisms within the gene BAIAP2 (i.e., brain-specific angiogenesis inhibitor 1-associated protein 2), known to be differentially expressed in brain hemispheres. The clinical and neuroimaging correlates of this polymorphism are still unknown. We investigated the association between BAIAP2 polymorphisms and DMN functional connectivity (FC) asymmetry as well as behavioral measures in ADHD adults. Resting-state fMRI was acquired from 30 ADHD and 15 healthy adults. For each subject, rs7210438 and rs8079626 within the gene BAIAP2 were genotyped. ADHD severity, impulsiveness and anger were assessed for the ADHD group. Using multivariate analysis of variance, we found that genetic features do have an impact on DMN FC asymmetry. In particular, polymorphism rs8079626 affects medial frontal gyrus and inferior parietal lobule connectivity asymmetry, lower for AA than AG/GG carriers. Further, when combining FC asymmetry and the presence of the rs8079626 variant, we successfully predicted increased externalization of anger in ADHD. In conclusion, a complex interplay between genetic vulnerability and inter-hemispherical DMN FC asymmetry plays a role in emotion regulation in adult ADHD.

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.

How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

The persistence of attention-deficit/hyperactivity disorder (ADHD) into adulthood, particularly in women, is an unresolved question. Using a diverse, prospectively followed female sample (ADHD: n = 140; comparison: n = 88), we examined (a) informant (parent- vs. self-report) and (b) symptom threshold (DSM-IV cutoffs vs. a developmentally referenced criterion [DRC]) with respect to estimates of ADHD persistence into young adulthood (M = 19.6 years). We also ascertained the linkages of ADHD status (as measured by each informant and via the different symptom cutoffs) with impairment in key outcome domains. Informant diagnostic concordance was significant but small (κ = 0.22). Via parent report, more childhood-ascertained probands (44 %) than comparison participants (1 %) met full ADHD criteria in adulthood (p < 0.001, ϕ = 0.47); parallel results were found via self-report (22 % vs. 2 %; p < 0.001, ϕ = 0.28). As expected, DRC designations yielded higher persistence estimates than DSM cutoffs. With control of key covariates, parent-reported ADHD was independently associated with poor outcomes on eight of nine measures but self-reported ADHD was associated only with low math scores. Also, participants who met the DRC cutoff but not the higher DSM threshold showed similar impairment to DSM-diagnosed participants, far greater than that of participants who met neither cutoff. A lowered symptom threshold in adulthood compared to childhood appears justified.

Childhood Psychiatric Disorders as Risk Factor for Subsequent Substance Abuse: A Meta-Analysis

OBJECTIVE

To assess the prospective risk of developing substance-related disorders after childhood mental health disorders (i.e., attention-deficit/hyperactivity disorder [ADHD], oppositional defiant disorder [ODD] or conduct disorder [CD], anxiety disorder, and depression) using meta-analysis.

METHOD

PubMed, Embase, and PsycInfo were searched for relevant longitudinal studies that described childhood (<18 years old) ADHD, ODD or CD, anxiety, or depression in relation to later alcohol-, nicotine-, or drug-related disorders or substance use disorders (SUDs) published in peer-reviewed journals in the English language from 1986 to May 2016. Two researchers conducted all review stages. Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed.

RESULTS

Thirty-seven studies including more than 762,187 participants were identified for quantitative analyses. These studies included 22,029 participants with ADHD, 434 participants with ODD or CD, 1,433 participants with anxiety disorder, and 2,451 participants with depression. Ninety-seven effects sizes were extracted for analyses. Meta-analysis showed a significantly increased risk for addiction in ADHD (n = 23, odds ratio [OR] 2.27, 95% CI 1.98-3.67; OR alcohol 2.15, 95% CI 1.56-2.97; OR drugs 1.52, 95% CI 1.52-5.27; OR nicotine 2.52, 95% CI 2.01-3.15; OR SUDs 2.61, 95% CI 1.77-3.84), ODD or CD (n = 8, OR 3.18, 95% CI 1.97-5.80; OR alcohol 1.73, 95% CI 1.51-2.00; OR drugs 4.24, 95% CI 1.3.21.5.59; OR nicotine 4.22, 95% CI 3.21-5.55; OR SUDs 4.86, 95% CI 3.09-7.56), and depression (n = 13, OR 2.03, 95% CI 1.47-2.81; OR alcohol 1.10, 95% CI 1.02-1.19; OR nicotine 2.56, 95% CI 1.89-3.48; OR SUDs 2.20, 95% CI 1.41-3.43), but not for anxiety disorders (n = 15, OR 1.34, 95% CI 0.90-1.55, not significant).

CONCLUSION

Childhood ADHD, ODD, CD, and depression increase the risk of developing substance-related disorders. Anxiety disorders do not seem to increase the risk for future substance-related disorders, although the findings are highly heterogeneous. These findings emphasize the need for early detection and intervention to prevent debilitating substance-related disorders in later life.

Girls with childhood ADHD as adults: Cross-domain outcomes by diagnostic persistence

OBJECTIVE

To ascertain adult outcomes in 10 domains reflecting symptomatology (internalizing, externalizing, self-injury, substance use), attainment (education, employment), and impairment (health, social, driving, overall) as a function of both childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and persistence of ADHD symptoms across time.

METHOD

We prospectively followed 140 grade-school-aged girls with rigorously diagnosed childhood ADHD and 88 age- and ethnicity-matched comparison girls for 16 years. Outcome measures were obtained via self- and parent-report questionnaires, interviews, and objective tests.

RESULTS

Childhood ADHD, whether it remitted or persisted, was a pernicious risk factor for a limited number of poor outcomes, including low educational attainment, unplanned pregnancy, body mass index (BMI), and clinician-rated impairment. Childhood ADHD that persisted over time, whether completely or partially, was associated with a number of additional detrimental outcomes in the externalizing, internalizing, self-injury, occupational, social, and overall impairment domains. Finally, in this all-female sample, ADHD was not associated with objective measures of employment, substance use, or driving outcomes.

CONCLUSIONS

We discuss the considerable impairments accruing from both childhood-limited and adult-persisting ADHD, with major implications for the health and well-being of females with this neurodevelopmental disorder. (PsycINFO Database Record

Childhood conduct problems and young adult outcomes among women with childhood attention-deficit/hyperactivity disorder (ADHD)

We tested whether conduct problems predicted young adult functioning and psychiatric symptoms among women diagnosed with attention-deficit/hyperactivity disorder (ADHD) during childhood, in the context of 3 potential adolescent mediators: internalizing problems, peer rejection, and school failure and disciplinary problems. We controlled for childhood ADHD severity, IQ, and demographic factors, and in the mediational tests, for adolescent conduct problems. Data came from 140 participants in the Berkeley Girls With ADHD Longitudinal Study. We used bootstrapping methods to assess indirect effects (mediators). Both childhood, F(1, 118) change = 9.00, p = .003, R2 change = .069, and adolescent, F(1, 109) change = 10.41, p = .002, R2 change = .083, conduct problems were associated with worse overall functioning during young adulthood, controlling for initial ADHD severity, child IQ, and demographics. Results were similar when predicting psychiatric symptoms. Adolescent school failure and disciplinary problems mediated the relations between childhood conduct problems and both young adult functioning and externalizing problems; adolescent internalizing problems and peer conflict mediated the relation between childhood conduct problems and young adult internalizing problems. As is true for boys, childhood and adolescent conduct problems are associated with poor adult outcomes among girls with ADHD, with school failure and disciplinary problems, internalizing problems, and peer conflict functioning as mediators of these relations.

ADHD and Emotion Dysregulation Among Children and Adolescents

Individuals with attention-deficit/hyperactivity disorder (ADHD) experience impairments in a number of functional domains. Although current evidence-based treatments for ADHD reduce symptoms and improve academic and behavioral functioning, they have minimal impact on social functioning or on risky behaviors (see Evans et al. in J Clin Child Adolesc Psychol, 43:527-551, 2014 for review). Preliminary evidence indicates that emotion dysregulation (ED) is associated with impairments across the developmental spectrum, such as social impairment and risky behaviors, and that its relative absence/presence is differentially associated with treatment response. It thus stands to reason that by incorporating a focus on ED in interventions targeting social impairment and risky behaviors, we may be able to increase the number of youth who respond to such interventions and decrease the prevalence or degree of these impairments and behaviors among youth and adults with ADHD. However, a number of questions remain unaddressed about the association between ADHD and ED, such as the portion of individuals with ADHD who experience ED, the extent to which ED is associated with the above impairments and behaviors, and whether or not ED is malleable. To begin addressing these questions, we summarize and critically evaluate the literature on the association between ADHD and ED and make recommendations for future basic, translational, and treatment outcome research.

Subthreshold and threshold attention deficit hyperactivity disorder symptoms in childhood: psychosocial outcomes in adolescence in boys and girls

OBJECTIVE

To examine the association between different levels of childhood attention deficit hyperactivity disorder (ADHD) symptoms and sex differences in psychosocial outcomes during adolescence.

METHOD

Swedish children (n = 4635) were screened for neuropsychiatric symptoms at age 9 or 12. ADHD symptoms were divided into three levels: screen-negative, screen-intermediate, and screen-positive. At follow-up (age 15), parents and teenagers filled out questionnaires regarding (i) hyperactivity/inattention, (ii) peer problems, (iii) school problems, (iv) internalizing problems, (v) antisocial behaviour, (vi) alcohol misuse, and (vii) drug misuse. All outcomes were controlled for symptoms of diagnostic categories other than ADHD.

RESULTS

Increasing levels of ADHD symptoms in childhood were associated with higher proportions of adolescents who displayed negative psychosocial outcomes. More girls than boys reported internalizing problems (all levels) and risky drug use (screen-intermediate and screen-positive only). More boys reported antisocial behaviour at the screen-negative and screen-intermediate levels, but at the screen-positive level, similar proportions of girls and boys displayed antisocial behaviour.

CONCLUSION

The findings support the view that ADHD symptoms, as well as their negative outcomes, are dimensionally distributed in the population and that adolescent girls and boys display different risk profiles. The findings confirm that ADHD symptoms are associated with higher risk of drug misuse in girls.

Attention-deficit/hyperactivity disorder casts a long shadow: findings from a population-based study of adult women with self-reported ADHD

BACKGROUND

To develop a sociodemographic and health profile of women with self-reported attention deficit/hyperactivity disorder (ADHD) in comparison to women without.

METHODS

Chi-square tests and logistic regression analyses were conducted on data from the nationally representative Canadian Community Health Survey-Mental Health (2012) comparing 107 women aged 20 to 39 years (inclusive) with ADHD to 3801 without ADHD. Depression, generalized anxiety disorder and substance abuse were measured using the WHO-CIDI.

RESULTS

Women with ADHD had triple the prevalence of insomnia, chronic pain, suicidal ideation, childhood sexual abuse and generalized anxiety disorder and double the prevalence of substance abuse, current smoking, depressive disorders, severe poverty and childhood physical abuse in comparison with women without ADHD (all P < 0.001). Even after adjustments for age, race, education and income, women with ADHD had substantially higher odds of a wide range of problems.

CONCLUSION

Our results suggest that women with ADHD are particularly vulnerable to early adversities, health and mental health problems.

Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women

Attention-deficit/hyperactivity disorder (ADHD) is associated with interpersonal dysfunction during childhood and adolescence, yet little is known about the romantic relationships of young women with childhood ADHD. In the present study, we draw from a longitudinal sample of girls followed prospectively into young adulthood, comparing those with (n = 114) and without (n = 79; comparisons) childhood ADHD in terms of their risk for physical victimization by an intimate partner (physical IPV; e.g., slapping, punching) by 17-24 years of age. We examined ADHD both diagnostically and dimensionally, at the same time establishing reliable indicators of young adult physical IPV. Externalizing and internalizing problems, and academic achievement during adolescence, were tested as potential mediators. Overall, participants with a childhood diagnosis of ADHD experienced more physical IPV than did comparisons (30.7% vs. 6.3%). In parallel, IPV was associated with higher levels of childhood ADHD symptomatology (d = 0.73). Young women with persistent ADHD stood the highest risk of experiencing IPV (37.3%), followed by those with transient ADHD (19.0%) and those never-diagnosed (5.9%). Academic achievement measured during adolescence was a significant partial mediator of the childhood ADHD symptomatology-young adult IPV relationship, even with control of sociodemographic, psychiatric, and cognitive factors, including childhood reading and math disorders. Findings indicate that in young women, childhood ADHD is a specific and important predictor of physically violent victimization in their intimate relationships. This vulnerable population requires IPV prevention and intervention, with academic empowerment as a key target.

Medical Comorbidity of Attention-Deficit/Hyperactivity Disorder in US Adolescents

Understanding patterns of medical comorbidity in attention-deficit/hyperactivity disorder (ADHD) may lead to better treatment of affected individuals as well as aid in etiologic study of disease. This article provides the first systematic evaluation on the medical comorbidity of ADHD in a nationally representative sample (National Comorbidity Replication Survey-Adolescent Supplement; N = 6483) using formal diagnostic criteria. Survey-weighted odds ratios adjusted for demographics, additional medical, and mental disorders were calculated for associations between ADHD and medical conditions. Models adjusted for demographics revealed significantly increased odds of allergy, asthma, enuresis, headache/migraine, and serious stomach or bowel problems. After adjusting for comorbidity, across the medical conditions, enuresis and serious stomach problems were the strongest correlates of ADHD. These findings confirm the pervasive medical comorbidity of ADHD reported in previous clinical and community-based studies. The intriguing salience of enuresis and serious stomach or bowel conditions may also provide an important clue to multisystem involvement in ADHD.

Cigarette smoking and ADHD: An examination of prognostically relevant smoking behaviors among adolescents and young adults

Attention-deficit/hyperactivity disorder (ADHD) is associated with health risks in adolescence which includes the potential for smoking cigarettes, early smoking initiation, and rapid progression to daily smoking. Much less is known, however, about prognostically relevant smoking behaviors among individuals with childhood ADHD. Further research in this area is important for identifying individuals at pronounced risk for nicotine addiction, and for developing effective interventions for this population. This study examined initiation of cigarette smoking, progression to regular smoking, quantity of use, indicators of tobacco dependence, and quit rates among adolescents and young adults with (n = 364) and without (n = 240) childhood ADHD. Individuals with, versus without, ADHD histories were significantly more likely to become daily smokers independent of conduct disorder (CD). They were also more likely to initiate smoking at younger ages and to progress to regular smoking more quickly. There were no significant group differences in cigarettes smoked per day, Fagerström Test of Nicotine Dependence (FTND), or Nicotine Dependence Syndrome Scale (NDSS) scores or in smoking within 30 min of waking. However, smokers with ADHD reported more intense withdrawal and craving during periods of abstinence than non-ADHD smokers. There were no significant group differences in number of quit attempts. Lastly, there were no significant differences among symptom persisters and desisters in daily smoking and amount. Individuals with ADHD histories are at high risk for persistent smoking given their early onset, rapid course, and abstinence characteristics. Smoking cessation programs may need to be adapted or otherwise intensified for those with ADHD. (PsycINFO Database Record

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.

Similarities between emotional dysregulation in adults suffering from ADHD and bipolar patients

BACKGROUND

Emotional dysregulation in subjects with attention deficit and hyperactivity disorder (ADHD) is a topic of growing interest among clinicians and researchers. The present study aims at investigating components of emotional dysregulation in adults ADHD compared to subjects suffering from bipolar disorder (BD).

METHODS

A total of 150 adults ADHD, 335 adults BD subjects and 48 controls were assessed using the Affective Lability Scale (ALS) and the Affect Intensity Measure (AIM), measuring respectively emotion lability and emotion responsiveness.

RESULTS

ADHD and BD subjects scored significantly higher on the ALS compared to controls (p=0.0001). BD subjects scored above ADHD ones (3.07 (SD=0.66) vs. 2.30 (SD=0.68); p<0.0001). The average total scores achieved on the AIM were significantly different for the three groups (p=0.0001) with significantly higher scores for ADHD subjects compared to BD ones (3.74 (SD=0.59) vs. 3.56 (SD=0.69); p<0.0001).

LIMITATIONS

Suspected cases of ADHD in the BD and control groups were derived from the Wender Utah Rating Scale (WURS). This study is a retrospective one.

CONCLUSION

Our study thus highlights the importance of emotional dysregulation in adults suffering from ADHD, showing that they display higher emotional intensity than bipolar disorder subjects and controls. Although the current diagnostic criteria of ADHD do not contain an emotional dimension, a better recognition of the significance of emotional responsiveness in ADHD patients can improve the care afforded to these patients, beyond the inattentive and hyperactive/impulsive components.

Maternal ADHD, Parenting, and Psychopathology Among Mothers of Adolescents With ADHD

OBJECTIVE

This study describes the parenting and psychopathology of mothers with ADHD of adolescents with ADHD (MCA), non-ADHD mothers of adolescents with ADHD (CA), and non-ADHD mothers of adolescents without ADHD (COMP).

METHOD

Two sets of pairwise comparisons: (a) COMP versus CA and (b) CA versus MCA were conducted. We hypothesized that CA would experience greater distress in parenting and psychopathology compared with COMP and that MCA would experience even more impairment compared with CA.

RESULTS

Few differences emerged in comparisons of CA and COMP, with the exception of CA reporting greater parent-adolescent conflict and internalizing problems. In contrast, differences consistently emerged in comparisons of MCA and CA showing more difficulty for MCA in parenting and psychopathology.

CONCLUSION

These findings underscore the need for treatments that address parental ADHD when adolescent ADHD is the intended target.

Early-adult correlates of maltreatment in girls with attention-deficit/hyperactivity disorder: Increased risk for internalizing symptoms and suicidality

We examined whether maltreatment experienced in childhood and/or adolescence prospectively predicts young adult functioning in a diverse and well-characterized sample of females with childhood-diagnosed attention-deficit/hyperactivity disorder (N = 140). Participants were part of a longitudinal study and carefully evaluated in childhood, adolescence, and young adulthood (M age = 9.6, 14.3, and 19.7 years, respectively), with high retention rates across time. A thorough review of multisource data reliably established maltreatment status for each participant (M κ = 0.78). Thirty-two (22.9%) participants experienced at least one maltreatment type (physical abuse, sexual abuse, or neglect). Criterion variables included a broad array of young adult measures of functioning gleaned from multiple-source, multiple-informant instruments. With stringent statistical control of demographic, prenatal, and family status characteristics as well as baseline levels of the criterion variable in question, maltreated participants were significantly more impaired than nonmaltreated participants with respect to self-harm (suicide attempts), internalizing symptomatology (anxiety and depression), eating disorder symptomatology, and well-being (lower overall self-worth). Effect sizes were medium. Comprising the first longitudinal evidence linking maltreatment with key young adult life impairments among a carefully diagnosed and followed sample of females with attention-deficit/hyperactivity disorder, these findings underscore the clinical importance of trauma experiences within this population.

Brain structural deficits and working memory fMRI dysfunction in young adults who were diagnosed with ADHD in adolescence

When adolescents with ADHD enter adulthood, some no longer meet disorder diagnostic criteria but it is unknown if biological and cognitive abnorma lities persist. We tested the hypothesis that people diagnosed with ADHD during adolescence present residual brain abnormalities both in brain structure and in working memory brain function. 83 young adults (aged 20-24 years) from the Northern Finland 1986 Birth Cohort were classified as diagnosed with ADHD in adolescence (adolescence ADHD, n = 49) or a control group (n = 34). Only one patient had received medication for ADHD. T1-weighted brain scans were acquired and processed in a voxel-based analysis using permutation-based statistics. A sub-sample of both groups (ADHD, n = 21; controls n = 23) also performed a Sternberg working memory task whilst acquiring fMRI data. Areas of structural difference were used as a region of interest to evaluate the implications that structural abnormalities found in the ADHD group might have on working memory function. There was lower grey matter volume bilaterally in adolescence ADHD participants in the caudate (p < 0.05 FWE corrected across the whole brain) at age 20-24. Working memory was poorer in adolescence ADHD participants, with associated failure to show normal load-dependent caudate activation. Young adults diagnosed with ADHD in adolescence have structural and functional deficits in the caudate associated with abnormal working memory function. These findings are not secondary to stimulant treatment, and emphasise the importance of taking a wider perspective on ADHD outcomes than simply whether or not a particular patient meets diagnostic criteria at any given point in time.

Adolescent Health and Adult Education and Employment: A Systematic Review

OBJECTIVE

Poor health in adolescence has the potential to disrupt education and employment pathways. This study is the first systematic review of the literature examining education and employment outcomes in adulthood of poor adolescent mental and physical health.

METHODS

We conducted searches using a standardized search protocol in 8 electronic databases: PsycINFO, Medline, Embase, ERIC, British Education Index, Australian Education Index, Social Sciences Citation Index, and CINAHL Plus. We identified studies that longitudinally compared adult education and employment outcomes of those with an adolescent chronic condition of clinical severity with healthy controls. We conducted meta-analyses using odds ratios (for dichotomous variables) and Cohen's d (for continuous variables) as our main summary statistics.

RESULTS

We identified 27 studies incorporating 70 relevant analyses. Our meta-analyses suggested that overall, poor health in adolescence was associated with poorer education and employment outcomes in adulthood. However, evidence was much stronger for mental health conditions than for physical health conditions, for which less evidence was available and mixed findings emerged. Compared with mental health conditions, we identified few studies investigating the long-term outcomes of physical health conditions. Age and follow-up times varied considerably across our studies, which potentially resulted in some heterogeneity in effect sizes. The majority of included studies were conducted in the United States, raising questions about the generalizability of the results internationally.

CONCLUSIONS

Health in adolescence contributes to adult attainment and life chances. The results suggest that investment in health may improve life chances and that policy interventions may improve outcomes for those with adolescent chronic conditions.

The efficacy of atomoxetine for the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a comprehensive review of over a decade of clinical research

Atomoxetine was first licensed to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents in the US in 2002. The aim of this paper is to comprehensively review subsequent publications addressing the efficacy of atomoxetine in 6- to 18-year-olds with ADHD. We identified 125 eligible papers using a predefined search strategy. Overall, these papers demonstrate that atomoxetine is an effective treatment for the core ADHD symptoms (effect sizes 0.6-1.3, vs. placebo, at 6-18 weeks), and improves functional outcomes and quality of life, in various pediatric populations with ADHD (i.e., males/females, patients with co-morbidities, children/adolescents, and with/without prior exposure to other ADHD medications). Initial responses to atomoxetine may be apparent within 1 week of treatment, but can take longer (median 23 days in a 6-week study; n=72). Responses often build gradually over time, and may not be robust until after 3 months. A pooled analysis of six randomized placebo-controlled trials (n=618) indicated that responses at 4 weeks may predict response at 6-9 weeks, although another pooled analysis of open-label data (n=338) suggests that the probability of a robust response to atomoxetine [≥40% decrease in ADHD-Rating Scale (ADHD-RS) scores] may continue to increase beyond 6-9 weeks. Atomoxetine may demonstrate similar efficacy to methylphenidate, particularly immediate-release methylphenidate, although randomized controlled trials are generally limited by short durations (3-12 weeks). In conclusion, notwithstanding these positive findings, before initiating treatment with atomoxetine, it is important that the clinician sets appropriate expectations for the patient and their family with regard to the likelihood of a gradual response, which often builds over time.