Analysis of personal and family factors in the persistence of attention deficit hyperactivity disorder: results of a prospective follow-up study in childhood

PENDAH program for parents with children with attention deficit hyperactivity disorder. French adaptation of a behavioral parent training group: pilot study

Behavioral parent training (BPT) is recognized as an effective part of the care offered to children with attention deficit hyperactivity disorder (ADHD). The aim of this pilot study was to objectively examine the effect that this intervention may have on motor activity, in addition to the measures classically found in this type of study. Parents of 24 school-aged children (6-12 year) with ADHD who met eligibility criteria were enrolled in the study. Before, after and five months after the intervention, we used three-dimensional accelerometers over one-week periods to measure the children's motor activity, and questionnaires for parental stress, quality of life, ADHD symptoms, anxiety and sensory disorders. To measure motor activity, a control group of normotypic children matched for age, sex and socio-professional category was set up. The experimental group showed slight decreases in motor activity compared with the control group, particularly in the classroom. The intervention showed improvements for parents in average stress and quality of life, and for children in average intensity global ADHD symptom, inattention, opposition and aggression, in line with previous studies on the effectiveness of BPT. The trial is the first clinical study to assess the effects of BPT on motor activity in children with ADHD.

Assessment of hyperactivity-impulsivity and attention deficit in adolescents by self-report and its association with psychopathology and academic performance

The scientific literature highlights the risk of the appearance of internalizing and externalizing symptoms, together with difficulties in the academic area, linked to diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). This is normally assessed by teachers and primary caregivers, disregarding the self-perception of the adolescents themselves, which limits detection of this disorder at an evolutionary stage. Our aim was to analyze the psychometric properties of a self-report for ADHD in adolescence and its relationship with psychopathology and academic performance. This study assessed an incidental sample of 267 students from secondary schools in the Region of Murcia, Spain, using the EDAH questionnaire adapted for self-report, in order to analyze its psychometric properties in assessing ADHD. The Youth Self-Report (YSR) and the Brief Self-Control Scale (BSCS) were also used to determine their association with psychopathological, self-control and academic performance variables. An ADHD prevalence of between 3.7 and 13.1% was observed depending on the established cut-off point. The adapted EDAH showed adequate reliability indices (α = 0.818; ω = 0.817) and explained a high variance percentage (50.655%). Adolescents with anxiety/depression difficulties, dissocial behavior, aggressiveness, and poor performance in mathematics showed a higher amount of ADHD symptoms. Moreover, self-control, dissocial behavior, age, and performance in Social Sciences acted as predictors of the disorder. The good psychometric properties of this questionnaire and its adequate correspondence with other variables of interest suggest it is an appropriate self-report instrument to assess ADHD in adolescence.

Mothers' stress and behavioral and emotional problems in children with ADHD. Mediation of coping strategies

The present study compared mothers' stress and the behavioral/emotional problems of children with attention deficit hyperactivity disorder (ADHD) and children with typical development (TD). Furthermore, the relationships among the mothers' stress, the children's behavioral/emotional problems, and the mothers' coping strategies in both groups were identified. The contribution of behavioral/emotional problems to parenting stress in children with ADHD was also studied through mediation effects of the mothers' coping strategies. The parenting stress, coping orientation to problems, and strengths and difficulties questionnaires were administered to 72 mothers of children from 7 to 11 years old: 35 with a clinical diagnosis of ADHD and 37 with typical development. The comparison analyses showed that the mothers' stress and the behavioral/emotional problems of their children were significantly higher in the group with ADHD than in the group without ADHD. Correlation analyses revealed different correlation patterns in the two groups, with behavioral/emotional problems significantly associated with parenting stress and with the disengagement and cognitive reframing coping reported by the mothers of children with ADHD. In addition, the disengagement coping strategy was a significant mediator in the relationship between behavioral/emotional problems and mothers' stress, according to the mediation analysis. The findings illustrate the need to include training in both behavioral strategies and coping strategies in counseling in order to help mothers buffer the impact of stress. This work is supported by the project PSI2016-78109 (AEI/FEDER, UE) and by University of Valencia UV-INV-PREDOC15-265889.

ADHD symptoms across adolescence: the role of the family and school climate and the DRD4 and 5-HTTLPR genotype

We examined bidirectional relations between attention-deficit/hyperactivity disorder (ADHD) symptoms and family and school climate, and the possible role of DRD4 and/or 5-HTTLPR genotypes herein. Three-wave longitudinal data of 1860 adolescents (mean ages 11, 13.5, and 16 years) from the general population and clinic-referred cohort of TRacking Adolescents' Individual Lives Survey were used. Using a multigroup Random Intercept Cross-Lagged Panel Model, we tested between-person (i.e., stable trait levels) and within-person (i.e., causal processes) associations across ADHD symptoms, family and school climate, and the extent to which these depended on genotype. Findings indicated no influence of genotype. Results did show significant between-person differences (ADHD symptoms with family climate r = .38; and school climate r = .23, p values < .001), indicating that higher stable levels of ADHD symptoms were associated with a less favorable family and school climate. Regarding within-person causal processes, ADHD symptoms predicted a less favorable family climate in early adolescence (β = .16, p < .01), while ADHD symptoms predicted a more favorable family climate in the later phase of adolescence (β = - .11, p < .01), a finding which we explain by normative developmental changes during adolescence. Overall, this study showed that negative associations between ADHD symptoms and both family and school climate are largely explained by stable between-person differences. We recommend applying the Random Intercept Cross-Lagged Path Model to developmental data to tease stable associations and change processes apart.

Working Memory Training for Adults With ADHD

Objective: The aim of this study was to examine the effects of Cogmed training on working memory in adults with ADHD, including the generalization of effects to nonverbal reasoning, executive function in daily life, and ADHD symptoms. Method: Adults of ages 18 to 63 with ADHD were randomly assigned to an experimental group that received the working memory training or to a placebo group that received a low-intensity comparison version of the training. Results: participants in the experimental group showed greater improvement in verbal and visuospatial working memory capacity. Effects persisted 6 months after intervention completion. However, effects did not generalize elsewhere. Conclusion: The results challenge the claims made by Cogmed to the effect that the program is effective in treating attention problems and improving performance in daily life over the long term in adults with ADHD.

Empirical examination of executive functioning, ADHD associated behaviors, and functional impairments in adults with persistent ADHD, remittent ADHD, and without ADHD

BACKGROUND

Previous studies suggest that childhood attention deficit hyperactivity disorder (ADHD) may continue in adulthood, producing adverse effects. Therefore, identifying factors that help to differentiate characteristics of ADHD persistence and remission has practical implications for evaluation and treatment. The first aim of this study was to analyze differences in executive functions (shift, working memory, inhibition, and plan/organize), symptoms associated with ADHD (inattention, hyperactivity, emotional lability, and self-concept), and functional impairments in adults with persistent ADHD (ADHD-P), with remittent ADHD (ADHD-R), and without ADHD (N-ADHD). The second aim was to study the contribution of functional impairments in these three groups based on executive functions and associated ADHD behaviors.

METHODS

Participants were 115 adults, 61 with a childhood ADHD diagnosis (40 persisters and 21 remitters) and 54 individuals with typical development. Self-reports were collected on executive functions, symptoms associated with ADHD, and functional impairments. Multivariate Analyses of Variance were conducted to test differences between the ADHD-P, ADHD-R, and N-ADHD groups on the evaluated variables. In addition, analyses were performed using two structural equation models with observed variables (path analyses).

RESULTS

The results indicated that significant executive and behavioral impairments and adverse functional outcomes in different life domains are related to the diagnostic persistence of ADHD. Recovery from the disorder is associated with better results, although hyperactivity/restlessness behaviors and plan/organize deficits continue to be present in remitter individuals.

CONCLUSIONS

The ADHD-P and ADHD-R groups showed some differences in their executive, behavioral, and functional impairments. Furthermore, the impairments in each group can be predicted by different executive functions and other symptoms associated with the disorder. These results should be taken into account in order to improve clinical practice.

The Relationship Between Maternal Stress and Boys' ADHD Symptoms and Quality of Life: An Australian Prospective Cohort Study

PURPOSE

This study prospectively examined the role of maternal stress in boys' attention deficit hyperactivity disorder (ADHD) symptoms and quality of life (QoL).

METHODS

Children with ADHD (5-13 years) were recruited from 21 pediatric practices and followed up 12 months later (n = 166). Maternal stress was examined at baseline, and boys' ADHD symptoms and QoL were examined at baseline and 12 months later. Linear regressions examined whether baseline maternal stress predicted child ADHD symptoms and QoL 12 months later in a series of adjusted models that accounted for child age, ADHD medication use, neighborhood disadvantage, comorbidities and baseline ADHD symptoms or QoL (full model).

RESULTS

In the unadjusted model, maternal stress at baseline was significantly associated with more severe parent-reported ADHD symptoms at 12 months, accounting for 5.7% of the variance in ADHD symptoms, but this association was attenuated after adjustments in the full model. Baseline maternal stress was associated with poorer QoL at 12 months in boys in the unadjusted model, accounting for 12.4% of the variance, which remained significant in the full adjusted model.

CONCLUSIONS

Maternal stress is associated with lowered QoL in boys, and may pose a risk for boys' later QoL.

PRACTICE IMPLICATIONS

Stress management interventions with mothers of children with ADHD experiencing heightened stress are warranted, and are likely to have a positive impact on mothers as well as children.

A multicentre randomized controlled trial on trans-generational attention deficit/hyperactivity disorder (ADHD) in mothers and children (AIMAC): an exploratory analysis of predictors and moderators of treatment outcome

OBJECTIVE

We examined predictors and moderators of treatment outcome in mothers and children diagnosed with ADHD in a large multicentre RCT.

METHOD

In total, 144 mother-child dyads with ADHD were randomly assigned to either a maternal ADHD treatment (group psychotherapy and open methylphenidate medication, TG) or to a control treatment (individual counselling without psycho- or pharmacotherapy, CG). After maternal ADHD treatment, parent-child training (PCT) for all mother-child dyads was added. The final analysis set was based on 123 dyads with completed primary outcome assessments (TG: n = 67, CG: n = 56). The primary outcome was the change in each child's externalizing symptoms. Multiple linear regression analyses were performed.

RESULTS

The severity of the child's externalizing problem behaviour in the family at baseline predicted more externalizing symptoms in the child after PCT, independent of maternal treatment. When mothers had a comorbid depression, TG children showed more externalizing symptoms after PCT than CG children of depressive mothers. No differences between the treatment arms were seen in the mothers without comorbid depression.

CONCLUSIONS

Severely impaired mothers with ADHD and depressive disorder are likely to need additional disorder-specific treatment for their comorbid psychiatric disorders to effectively transfer the contents of the PCT to the home situation (CCTISRCTN73911400).

Childhood Factors Affecting Persistence and Desistence of Attention-Deficit/Hyperactivity Disorder Symptoms in Adulthood: Results From the MTA

OBJECTIVE

To determine childhood factors that predict attention-deficit/hyperactivity disorder (ADHD) persistence and desistence in adulthood.

METHOD

Regression analyses were used to determine associations between childhood factors and adult ADHD symptom persistence in 453 participants (mean age, 25 years) from the Multimodal Treatment Study of Children with ADHD (MTA). Childhood IQ, total number of comorbidities, child-perceived parenting practices, child-perceived parent-child relationships, parental mental health problems, marital problems of parents, household income levels, and parental education were assessed at a mean age of 8 years in all participants. Adult ADHD persistence was defined using DSM-5 symptom counts either with or without impairment, as well as mean ADHD symptom scores on the Conners' Adult ADHD Rating Scale (CAARS). Age, sex, MTA site, and childhood ADHD symptoms were covaried.

RESULTS

The most important childhood predictors of adult ADHD symptom persistence were initial ADHD symptom severity (odds ratio [OR] = 1.89, standard error [SE] = 0.28, p = .025), comorbidities (OR = 1.19, SE = 0.07, p = .018), and parental mental health problems (OR = 1.30, SE = 0.09, p = .003). Childhood IQ, socioeconomic status, parental education, and parent-child relationships showed no associations with adult ADHD symptom persistence.

CONCLUSION

Initial ADHD symptom severity, parental mental health, and childhood comorbidity affect persistence of ADHD symptoms into adulthood. Addressing these areas early may assist in reducing adult ADHD persistence and functioning problems.