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

The utility of multiple assessments in infancy and toddlerhood to predict middle childhood ADHD symptoms: Temperamental, behavioral, and genetic contributions

BACKGROUND

Early intervention is effective for reducing ADHD symptoms and related impairments, yet methods of identifying young children in need of services are lacking. Most early predictors of ADHD previously identified are of limited clinical utility. This study examines several theoretically relevant predictors of ADHD in infancy and toddlerhood and whether assessment at multiple time points improves prediction. We also examine whether links between early risk factors and middle childhood ADHD are driven by shared genetic and/or environmental mechanisms to identify potential early intervention targets.

METHOD

614 twins (52.12 % female, 58.50 % non-Hispanic White) participated in a larger study on genetic and environmental contributions to mental health outcomes. Caregiver-reported attention and behavior problems in infancy (M = 12.67 months) and toddlerhood (M = 32.18 months) and caregiver-reported temperament (attentional focusing, impulsivity, inhibitory control) in toddlerhood were used to predict caregiver-reported ADHD symptoms in middle childhood (M = 8.78 years).

RESULTS

Only behavior problems in infancy and toddlerhood were robust predictors of caregiver-reported ADHD symptoms in middle childhood. Using multiple timepoints did not improve predictive ability. The relationship between infant behavior problems and caregiver reported middle childhood ADHD symptoms was explained by both environmental and genetic influences, whereas environmental influences almost entirely explained the relationship between toddler behavior problems and caregiver-reported middle childhood ADHD symptoms.

IMPLICATIONS

Behavior problems in toddlerhood showed the strongest predictive utility, and links to later ADHD were largely driven by environmental factors, suggesting that psychosocial interventions modifying the child's environment may be particularly effective for reducing ADHD risk.

Physical and neurophysiological maturation associated with ADHD among previously institutionalized children: a randomized controlled trial

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental outcome among children with a history of early institutional care. Prior research on institutionalized children suggested that accelerated physical growth in childhood is a risk factor for ADHD outcomes.

METHODS

The current study examined physical and neurophysiological growth trajectories among institutionalized children randomized to foster care treatment (n = 59) or care as usual (n = 54), and never institutionalized children (n = 64) enrolled in the Bucharest Early Intervention Project (NCT00747396, clinicaltrials.gov). Participants completed physical and electroencephalography (EEG) assessments at six time points from infancy through adolescence, as well as structured diagnostic interviews at the 54-month and 12-year time points. A series of multilevel growth models and cross-lagged path models were estimated to examine associations among physical and neurophysiological maturation, treatment group, age of foster care placement, and ADHD diagnostic outcomes.

RESULTS

Twenty-seven percent of the institutionalized children met research criteria for ADHD at one or both time points. Slowed, prolonged growth of height and head circumference were associated with both ADHD and delayed foster care placement. Placement in foster care versus care as usual, but not ADHD, was associated with maturation of the peak alpha frequency. Among children randomized to foster care, average theta-beta ratio was lower among those with ADHD. There was no evidence that rapid physical maturation led to atypical cortical activity.

CONCLUSIONS

Delayed, prolonged physical growth and atypical neurophysiology from infancy through adolescence is associated with ADHD among institutionalized children, over and above the protective effects of foster care.

Factors Associated with Mental Health Service Use Among Children with ADHD from Adolescence to Early Adulthood

Childhood attention-deficit/hyperactivity disorder (ADHD) is common and is associated with lifelong adverse outcomes. Little is known about factors associated with mental health service use (MHSU) among children with ADHD from adolescence to early adulthood. This retrospective cohort study aims to investigate factors associated with MHSU among children with ADHD from adolescence to early adulthood using secondary data from Waves I to III of the National Longitudinal Study of Adolescent Health (n = 554). Multivariable Poisson regression and Generalized Estimating Equation were used to estimate adjusted relative risks and 95% confidence intervals. Results indicate that factors significantly associated with MHSU from adolescence to early adulthood included race/ethnicity, a routine physical exam last year, and a history of suicidal ideation or attempt. Findings of the study extend the current understanding by identifying predictors and barriers for MHSU and inform the development of targeted intervention programs for increasing MHSU among children with ADHD.

How does the predictive capacity of a virtual-reality CPT for children with ADHD differ by country? A transcultural study with Argentine and Spanish Children

BACKGROUND

Although many studies have analyzed the effectiveness of novel Continuous Performance Tests (CPTs) in diagnosing ADHD, very few studies have examined how cultural factors influence that effectiveness.

AIMS

The present study aimed to analyze performance in a Virtual-Reality CPT in a sample of children resident in Spain and Argentina.

METHODS AND PROCEDURES

138 students participated in this study. They were aged between 6 and 16 years old, with a mean age of 10.38 (SD = 2.46) and had been diagnosed with ADHD.

OUTCOMES AND RESULTS

Commissions was the only significant variable in both discriminant models. In the Spanish population, the commissions variable was shown to correctly classify 49.4 % of the three types of ADHD presentation. However, in the Argentine population, the commissions variable correctly classified 68.3 %.

CONCLUSIONS AND IMPLICATIONS

These results may have been biased by the severity of the different types of presentation. In fact, it seems reasonable to think that the greater the severity, the better Aula Nesplora would predict the three types of presentation of ADHD. These results emphasize the need to consider other variables with a notable impact on daily life as children develop.

Temperament and executive functioning correlates of ADHD symptom severity during early versus middle childhood

BACKGROUND

This study investigated associations among temperament, executive functioning (EF), and attention-deficit/hyperactivity disorder (ADHD) symptom severity at two developmental stages.

METHODS

Participants were 61 4-year-old children and 165 8-11-year-old children (126 ADHD, 39 typically developing [TD]). Caregivers reported on temperament (effortful control [EC], negative affect, and surgency), and ADHD symptoms. Three aspects of EF (working memory, inhibitory control, and processing speed) were measured with neuropsychological tests.

RESULTS

Among 4-year-olds, variance in ADHD symptom severity was only explained by the temperament variables. EC was not significantly correlated with any of the EFs in this cohort. Among school-aged children, low EC, high surgency, high negative affect, and reduced working memory were associated with greater ADHD symptom severity. EC was significantly and positively correlated with processing speed in the school-aged children.

CONCLUSIONS

Results are consistent with a neurodevelopmental model of ADHD, wherein dysregulated temperament is associated with ADHD in young children, while both dysregulated temperament and cognitive skills are associated with ADHD in middle childhood. Results could inform the selection of clinical tools for diagnostic evaluation of pediatric ADHD symptoms and clinical follow-up.

Developmental and Psychiatric Conditions Among 5-7 Year Old Children with Non-persistent and Persistent Autism

To describe the types and frequency of developmental and psychiatric conditions (DPCs) in early school-age children who were diagnosed with ASD as toddlers and to compare rates of DPCs in children whose ASD persists ("persistent ASD") versus those in whom it does not ("non-persistent ASD"). Children with a clinical ASD diagnosis at 12-36 months old underwent a research assessment at 5-7 years old. Research assessments included measures of ASD symptoms and cognitive and adaptive functioning. A research psychologist assigned an ASD diagnosis (yes or no) based on the child's current functioning. Information about DPCs was obtained from parent and/or research psychologist report. Intellectual disability was defined as cognitive standard score < 70. Of the 213 children diagnosed with ASD at initial clinical assessment, at the research assessment 134 (62.6%) had persistent ASD and 79 (37%) had non-persistent ASD. Overall, the most common DPCs were ADHD (n = 58; 27.2%); speech disorder (n = 46; 21.6%); and intellectual disability (n = 46; 21.6%). Of children with non-persistent ASD, 29.1% had ≥ 1 DPC, and 19% had ADHD. Children with persistent ASD were over 5 times more likely (OR = 5.72) to have an additional DPC, compared to those with non-persistent ASD. Children with non-persistent ASD may manifest several different DPCs, with an increased rate of ADHD compared to population norms. Children with persistent ASD have higher rates of DPCs than those with non-persistent ASD. Follow-up care for children diagnosed with ASD at a young age should include assessment for other DPCs.

Girls With Social and/or Attention Deficit Re-Examined in Young Adulthood: Prospective Study of Diagnostic Stability, Daily Life Functioning and Social Situation

OBJECTIVE

Investigate diagnostic stability, daily life functioning and social situation in women diagnosed with ADHD and/or ASD in childhood.

METHODS

Prospective 17 to 20-year follow-up study of 100 girls of whom 92 diagnosed in childhood with main DSM-IV ADHD or ASD, and 60 comparison girls. Ninety and 54 of these women were examined (M = 27, 4 years old) with semi-structured interviews and questionnaires, close relatives were interviewed.

RESULTS

At follow-up, 89% of women with ADHD or ASD in childhood still met the criteria for either of these diagnoses. Very few women were "in remission." In 34% the main diagnosis shifted from ADHD to ASD. Women with ADHD and ASD had significantly more disability and unfavorable social situation than comparison women.

CONCLUSION

Women with ADHD and/or ASD in childhood had impairing problems 17 to 20 years later. Early ADHD changed to ASD in adulthood in some cases. Nearly all with ASD met criteria for ADHD as adults.

Identification and Characterization of Influential Factors in Susceptibility to Attention Deficit Hyperactivity Disorder Among Preschool-Aged Children

Attention deficit hyperactivity disorder (ADHD) is the most common childhood-onset neurodevelopmental disorder. Currently, increasing amounts of attention have been focused on the epidemiologic profiling of ADHD in children, viewed as a continuously distributed risk dimension throughout the whole lifespan. This study aimed to identify and characterize potential influential factors susceptible to ADHD-related symptoms among preschool-aged children. A comprehensive questionnaire was self-designed for both children and their parents or guardians and was distributed to 30 kindergartens from Beijing and Hebei, collecting potential influential factors in susceptibility to ADHD. ADHD was assessed by the Conner’s Abbreviated Symptom Questionnaire (C-ASQ), and 7,938 children were analyzed. Least absolute shrinkage and selection operator (LASSO) regression and hierarchical degree of adjustment were used to control possible covariates. Five factors, namely, children’s secondhand smoking exposure, breastfeeding duration, sleep mode, maternal pregnancy smoking exposure, and parental self-rating for patience, were identified to be independently and significantly associated with ADHD susceptibility. Meanwhile, dose–response relationships were observed between breastfeeding duration, parental self-rating for patience, and ADHD-related symptoms. Finally, a nomogram model was created for predicting ADHD susceptibility based on significant and conventional attributes under each criterion.

A measure of functioning in adults With ADHD: Psychometric properties of the general life functioning scale-parent version

OBJECTIVE

The General Life Functioning Scale (GLF) was developed to provide a complementary alternative to existing measures of impairment. We examined the psychometric properties of the GLF-Parent version (GLF-P), given the known value of informant ratings.

METHODS

The GLF-P was administered to parents of adults with attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood and a nonADHD comparison group in the Pittsburgh ADHD Longitudinal Study. GLF-P ratings described 334 participants (ADHD = 186; comparison = 148) rated at age 25 (Mage  = 24.80 years, SDage  = 0.46, range = 24-26) and 401 participants (ADHD = 237; comparison = 164) rated at age 30 (Mage  = 29.30, SDage  = 0.64, range = 28-33). Exploratory (EFA) and confirmatory (CFA) factor analyses were used.

RESULTS

EFAs suggested and CFAs confirmed a five-factor solution. We found measurement invariance across diagnostic and age groups, satisfactory internal consistency, construct validity, and known-group validity.

CONCLUSION

Psychometric results suggest the GLF-P as a helpful adjunctive measure of functioning. Further research is needed to determine the utility of the GLF across diverse settings.