Correlation Between Life Satisfaction and Symptoms of ADHD in Dental Students: The Mediation of Resilience

OBJECTIVE

This study explores the correlation between life satisfaction and ADHD symptoms. It also discusses whether resilience mediates the correlation between ADHD symptoms and life satisfaction.

METHOD

We surveyed 297 dental students. A total of 291 completed a self-report scale consisting of the Adult ADHD Self-Report Scale, Wender Utah Rating Scale, Life Satisfaction Scale, and Conner-Davidson Resilience Scale. The study used hierarchical linear regression analysis, resampling, and asymptotic strategies for data processing.

RESULTS

The ADHD screening results of the self-report scale were positive for 6.87% of the students. This positive rate differed among participants of diverse ages and varying paternal education levels. ADHD symptoms were negatively correlated with life satisfaction and resilience. Life satisfaction was observably positively associated with resilience. Resilience serves as a mediating role between life satisfaction and the two symptoms of ADHD.

CONCLUSION

Resilience intervention programs can enhance the life satisfaction of dental students, especially those with positive ADHD symptoms screening.

The longitudinal associations between internet addiction and ADHD symptoms among adolescents

Background and aims

Internet addiction has been linked to ADHD-related symptoms. However, the direction of the relationship and its potential for reciprocal relations is not well understood. This study examined the potential reciprocal relations between the three components of ADHD and Internet addiction, as well as the moderating effects of gender on these relations.

Methods

Using a longitudinal design, we collected data of 865 Chinese adolescents across three waves (Mage = 13.78, SD = 1.56 in wave 1), with a time interval of 6 months.

Results

Cross-lagged analyses revealed bidirectional associations between hyperactivity, inattention, impulsivity, and Internet addiction over time. Multi-group analyses did not yield any significant gender differences in these relationships.

Discussion and conclusions

These findings enhance our understanding of the complex link between ADHD components and Internet addiction and have implications for interventions aimed at reducing the prevalence of Internet addiction and ADHD.

ADHD Symptoms and Sleep Problems During Middle Childhood: The Indirect Effect of Peer Victimization

The present cross-sectional study evaluated whether traditional and/or cyber peer victimization served as mechanisms linking ADHD symptoms to sleep disturbance and sleep impairment in a sample of 284 third- through fifth-grade students (51.9% boys; 50.4% Hispanic/Latine) from two elementary schools in the United States. ADHD symptoms were assessed using teacher ratings. Children provided reports of their traditional and cyber victimization as well as their sleep disturbance and impairment. Results from path analysis models revealed significant indirect effects of traditional victimization on the links from ADHD symptoms to sleep disturbance and impairment. There was also a significant indirect effect of cyber victimization on the link from ADHD symptoms to sleep impairment. These findings suggest that experiences of traditional and cyber peer victimization may need to be addressed among children exhibiting ADHD symptoms in order to mitigate their risk for sleep problems and downstream effects on other domains of psychosocial functioning.

Relationship between attention deficit hyperactive disorders with life satisfaction among medical students in city of Hail, KSA

BACKGROUND

Attention deficit hyperactive disorder (ADHD) begins in childhood, and its symptoms persist into adulthood. Students with ADHD symptoms will be at increased risk of antisocial behavior, depression, and loss of inhibition. This study determines the relationship between ADHD and life satisfaction level among medical students in the city of Hail, KSA.

MATERIALS AND METHODS

This is a cross-sectional study that was conducted in a public-sector medical college. A total of 200 students were recruited through stratified cluster sampling. Validated, structured scales of ADHD and life satisfaction were used, and known psychiatric disorders among students were excluded from the study. Correlation and linear regression analyses were used to determine the relationship between ADHD and life satisfaction and identify the determinants of ADHD. P value < 0.05 was considered statistically significant.

RESULT

The prevalence rate of ADHD among medical students was 33.3%. Female gender, third-year academic year student, and 21-26-year-old age group were the high-risk groups of ADHD. Inattention (r = -0.263, P value -0.000) and hyperactivity (r = -0.260, P value 0.000) were significantly correlated with life satisfaction level, with 92% of the variability in life satisfaction determined by inattention and hyperactivity.

CONCLUSION

The burden of ADHD is high among medical students, and it negatively correlates with life satisfaction level. Students' academic and social functioning was affected due to ADHD. There is a need to address this issue with early diagnosis and management of this disorder.

Structured physical exercise interventions and children and adolescents with attention deficit hyperactivity disorder: A systematic review and meta-analysis

BACKGROUND

The efficacy of structured physical exercise (SPE) has been examined in empirical studies to treat attention deficit hyperactivity disorder (ADHD). This review aimed (i) to systematically review and quantify the effects of SPE on ADHD symptomology and executive function (primary outcomes) and on physical health, physical fitness and mental health issues (secondary outcomes) in children/adolescents with ADHD; (ii) to evaluate the study quality and explore moderation of the effects of SPE; and (iii) to summarize the design of SPE interventions.

METHODS

An extensive literature search in the databases of PubMed, Web of Science and EBSCOhost was conducted to identify eligible intervention studies for meta-analysis. A descriptive account of the features of the studies is provided, including assessment of risk/quality (ROB-2/ROBINS-I). Standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated with random effects models to compare post-intervention effects.

RESULTS

A total of 18 studies were included in the review. The majority of the studies examined the effects of SPE lasting for 3-12 weeks. Assessment of bias/quality indicated half of the included studies as high quality. The meta-analysis (pooled n = 627) revealed that SPE had a positive effect on primary and secondary outcomes, that is, inattention (SMD = -1.79), executive function (SMD = 2.19), physical fitness (SMD = 1.39) and mental health issues (SMD = -0.89). Subgroup analysis showed that long-term practice of SPE, featured/tailored SPE, non-Chinese participants, taking methylphenidate and study with low quality had larger effects.

CONCLUSIONS

There is emerging evidence that SPE is a promising option to enhance symptom management and physical/mental health in children/adolescents with ADHD.

Young Adult ADHD Symptoms in the General Population and Neurocognitive Impairment

OBJECTIVE

Neurocognitive impairments are associated with child and adult ADHD in clinical settings. However, it is unknown whether adult ADHD symptoms in the general population are associated with the same pattern of cognitive impairment. We examined this using a prospective, population-based cohort spanning birth to age 25 years.

METHODS

We examined associations between self-reported adult ADHD symptoms and cognitive task performance (attention and response inhibition) in adulthood and childhood.

RESULTS

Self-rated ADHD symptoms at age 25 were associated with poorer performance in age 25 cognitive tasks capturing ADHD-related functioning (attention B = -0.03, 95% CI [0.05, -0.01], p = .005; response inhibition B = -0.03, 95% CI [-0.05, -0.01], p = .002).

CONCLUSIONS

Neurocognitive impairments linked to adult ADHD symptoms in the general population, are similar to those found in people with childhood ADHD symptoms and are consistent with findings in adult ADHD clinical samples.

Attention-deficit/hyperactivity disorder symptoms and subsequent cardiometabolic disorders in adults: investigating underlying mechanisms using a longitudinal twin study

BACKGROUND

Emerging research suggests that attention-deficit/hyperactivity disorder (ADHD) increases the risk for cardiovascular (CVDs) and metabolic disorders (i.e., cardiometabolic disorders) in adulthood. Yet, available studies are scarce and have mainly been focused on individuals receiving clinical ADHD diagnoses. We aimed to investigate the prospective associations of ADHD symptoms in young and mid-adulthood with subsequent cardiometabolic disorders and the underlying mechanisms.

METHODS

We studied 10,394 twins from the Swedish Twin Registry (STR), born between 1958 and 1985 without previous medical history of cardiometabolic disorders. They provided self-assessment of ADHD symptoms (score range 0-36) via a validated, DSM-IV-based scale in a web-based questionnaire/telephone interview within the Study of Twin Adults: Genes and Environment (STAGE), in 2005-2006 (aged 19-47 years), and were followed until the end of 2018 (33-59 years) to identify incident clinical diagnoses/medication prescriptions for cardiometabolic disorders acquired from Swedish national registers. We used Cox regression models to investigate the associations between ADHD symptoms score and cardiometabolic outcomes, with and without adjustment for relevant covariates, and a co-twin control design to study familial confounding.

RESULTS

A one-unit increase in the level of ADHD symptoms was associated with a 2% increase in the rate of CVDs (hazard ratio [HR] = 1.02, 95% confidence interval 1.01-1.04) and a 3% increase in the rate of metabolic disorders (HR = 1.03, 1.02-1.05), after adjusting for birth year and sex. The associations were no longer significant after adjusting for educational attainment, lifestyle factors, and comorbid psychiatric disorders. The associations remained significant after adjusting for familial factors shared by dizygotic twin pairs but became nonsignificant after adjusting for factors shared by monozygotic twin pairs. However, the strength of the associations attenuated significantly in monozygotic twins compared to dizygotic twins for CVDs only, suggesting genetic confounding.

CONCLUSIONS

ADHD symptom score is associated with a higher risk for cardiometabolic disorders, which may be explained by lower educational attainment, adverse lifestyle factors, and psychiatric comorbidities. Moreover, the associations appear to be partly confounded by shared genetic factors, especially for CVDs. Further research is needed to investigate the identified associations at the level of individual cardiometabolic disorders and to follow-up participants until a more advanced older age.

Psychological impact of six weeks of strict home confinement in Spanish families having school-aged children with attention-deficit/hyperactivity disorder

After the COVID-19 outbreak, early publications reported worsening symptoms and increased caregiver burden in families having children with Attention-Deficit/Hyperactivity Disorder (ADHD). In the present study, we launched an online survey to examine the psychological impact of the 41 days of strict home confinement implemented in Spain in families having children with ADHD compared to families having children with typical development (TD). We achieved a representative sample of 190 school-aged children (NADHD =100 and NTD=90) from 181 families. Respondents were mainly mothers (≈96%). We found that mother reports of hyperactive-impulsive symptoms significantly increased during home confinement regardless of ADHD diagnosis. During the lockdown, we also found that perceived stress significantly increased in mothers of ADHD and TD children, but, unexpectedly, this increase was much more noticeable for the latter group. Moreover, our study suggests that children having parents working in frontline jobs or living in families with higher household conflicts might display increased ADHD symptoms during the lockdown, irrespective of ADHD diagnosis. Our results highlight the need to provide psychological support to families most exposed to the pandemic and target household problems and mothers' well-being at intervention processes, in both ADHD and TD families.

Influence of game features on attention in adults

Introduction

The incorporation of game features into cognitive tasks can inform us about the influence of reward and motivation on attention. Continuous performance tasks (CPTs), designed to assess attention abilities, are examples of cognitive tasks that have been targeted for the addition of game features. However, previous results have been mixed regarding how game elements affect attention abilities and task performance.

Methods

Here, we studied if there were factors that predict which individuals exhibit changes in attention from game features added to a CPT. Participants (N = 94, aged 21-71) played a traditional CPT and a game CPT with identical mechanics, but featured engaging game elements (aesthetics, storyline, competition, feedback, and reward).

Results

We first found corroborating evidence that game features have mixed effects on attention performance: most attention metrics of interest exhibited no overall difference between the traditional and game CPT, while game elements reduced performance for a few metrics. Importantly, we also found that specific behavioral and demographic profiles predicted individual differences in performance on the game CPT compared to the traditional CPT. Those with more attention difficulties (ADHD symptoms), more reward responsiveness, and younger adults performed better on the game CPT while, conversely, those with fewer ADHD symptoms, less reward responsiveness, and older adults performed better on the traditional CPT.

Discussion

These findings provide insights into how game features can influence attention in different individuals and have important implications for the use of game elements in cognitive tasks and training interventions.

Processing of social and monetary rewards in autism spectrum disorders

BACKGROUND

Reward processing has been proposed to underpin the atypical social feature of autism spectrum disorder (ASD). However, previous neuroimaging studies have yielded inconsistent results regarding the specificity of atypicalities for social reward processing in ASD.

AIMS

Utilising a large sample, we aimed to assess reward processing in response to reward type (social, monetary) and reward phase (anticipation, delivery) in ASD.

METHOD

Functional magnetic resonance imaging during social and monetary reward anticipation and delivery was performed in 212 individuals with ASD (7.6-30.6 years of age) and 181 typically developing participants (7.6-30.8 years of age).

RESULTS

Across social and monetary reward anticipation, whole-brain analyses showed hypoactivation of the right ventral striatum in participants with ASD compared with typically developing participants. Further, region of interest analysis across both reward types yielded ASD-related hypoactivation in both the left and right ventral striatum. Across delivery of social and monetary reward, hyperactivation of the ventral striatum in individuals with ASD did not survive correction for multiple comparisons. Dimensional analyses of autism and attention-deficit hyperactivity disorder (ADHD) scores were not significant. In categorical analyses, post hoc comparisons showed that ASD effects were most pronounced in participants with ASD without co-occurring ADHD.

CONCLUSIONS

Our results do not support current theories linking atypical social interaction in ASD to specific alterations in social reward processing. Instead, they point towards a generalised hypoactivity of ventral striatum in ASD during anticipation of both social and monetary rewards. We suggest this indicates attenuated reward seeking in ASD independent of social content and that elevated ADHD symptoms may attenuate altered reward seeking in ASD.

Age-related clinical characteristics of children and adolescents with ADHD

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Screening of ADHD symptoms in primary school students and investigation of parental awareness of ADHD and its influencing factors: A cross-sectional study

Objective

The present study aimed to compare the differences in positive screening rates of attention deficit hyperactivity disorder (ADHD) symptoms between parents and teachers in the same sample of primary school students. Concurrently, parental awareness and information sources of ADHD were investigated, and possible relevant factors affecting parental awareness and their influence on positive screening rate of ADHD were analyzed.

Methods

A cross-sectional study was conducted in Changchun, China, between September 2020 and January 2021. Parents of 1,118 primary school students and 24 head teachers were recruited in the survey. Data were collected through a structured self-administered questionnaire. It consisted of socio-demographic characteristics, ADHD symptom screening questionnaire, parental awareness, and information sources of ADHD.

Results

Among the 1,118 primary school students, 30 (2.7%) and 60 (5.4%) students were positive for Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) screening in the parent version and teacher version, respectively. Parents had lower positive screening rates for ADHD symptoms than teachers. Relationship with children (mother, OR = 1.552, 95% CI = 1.104-2.180), bachelor degree or above of parents (OR = 1.526, 95% CI = 1.054-2.210), children's sex (girl, OR = 1.442, 95% CI = 1.093-1.904), and age (OR = 1.344, 95% CI = 1.030-1.754), children's grade (grade 2, OR = 0.522, 95% CI = 0.310-0.878; grade 3, OR = 0.388, 95% CI = 0.185-0.782), information sources of ADHD (medical staff, OR = 1.494, 95% CI = 1.108-2.015; family/relative/friend, OR = 1.547, 95% CI = 1.148-2.083; TV/Internet, OR = 3.200, 95% CI = 2.270-4.510) were the factors related to the parental awareness of ADHD.

Conclusion

Parents and teachers of primary school students recognize ADHD symptoms differently. The positive screening rate of ADHD among teachers was significantly higher than that of parents. Relationship with children, educational level of parents, children's sex, age, and grade, and information sources of ADHD are the relevant factors affecting parental awareness of ADHD. More efforts should be made to disseminate ADHD knowledge through mass media, and medical staff. Fathers, parents with low educational level, and parents of grade 2 and 3 pupils should be encouraged to acquire more knowledge on ADHD to improve the early recognition rate of ADHD symptoms.

Clinical trial registration

[http://www.chictr.org.cn/showproj.aspx?proj=54 072], identifier [ChiCTR2000033388].

ADHD and dangerous driving in emerging adults: The moderating role of family climate for road safety

Dangerous driving accounts for 95% of driving fatalities among emerging adults. Emerging adult drivers exhibiting symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) are at greater risk for motor vehicle crashes and engaging in unsafe driving practices; however, not all individuals with ADHD symptoms exhibit such risk. Several studies have found that drivers' perceptions of their family's values and priorities related to driving practices predict driving outcomes among emerging adults; these factors have not been examined in the context of ADHD symptomology. We examined family climate for road safety as a moderator of ADHD symptoms and dangerous driving behaviors in a sample of college students. A total of 4,392 participants completed surveys measuring self-reported ADHD symptoms, dangerous driving behavior, and family climate for road safety. Results indicated that higher levels of parental feedback weakened the relation between ADHD symptoms and aggressive driving; higher levels of parental monitoring strengthened this relationship. Higher levels of parental monitoring strengthened the association between ADHD symptoms and negative emotion while driving. When participants perceived their parents as having high levels of noncommitment to road safety, the association between ADHD symptoms and self-reported risky driving increased. Higher levels of open communication about unsafe driving attenuated the relation between ADHD and risky driving. Overall, some but not all components of family climate for road safety appear to affect the relation between ADHD symptoms and dangerous driving in the expected direction.

Associations Between ADHD Symptoms and Maternal and Birth Outcomes: An Exploratory Analysis in a Multi-Country Cohort of Expectant Mothers

OBJECTIVE

ADHD symptoms can adversely impact functioning in a range of domains relevant for maternal well-being and fetal development; however, there has been almost no research examining their impact during pregnancy. We aimed to address this gap.

METHOD

We used data (n = 1,204) from a longitudinal birth cohort study spanning eight countries to address this gap.

RESULTS

ADHD symptoms in the third trimester of pregnancy were associated with lower social support from family (b = -0.16, p = .031), friends (b = -0.16, p = .024), and significant others (b = -0.09, p = .001); higher stress (b = 0.34, p < .001) and depressive symptoms (b = 0.31, p < .001), and increased likelihood of an unwanted pregnancy (b = 0.30, p = .009). Significant associations with tobacco use (b = 0.36, p = .023) and premature birth (b = 0.35, p = .007) did not survive correction for multiple comparisons and there were no significant associations with alcohol use, low birth weight, or unplanned pregnancy.

CONCLUSION

Results suggest that women with ADHD symptoms could benefit from earlier, more regular screening for mental health difficulties and greater mental health support during pregnancy.

An Observational Study of the Morning and Evening Behavior of Individuals With and Without Attention-Deficit/Hyperactivity Disorder

Evidence of ADHD symptoms and impairments were documented in the morning and evening hours for individuals diagnosed with ADHD. These results illustrate additional areas in need of attention in the refinement of treatments for adults with ADHD.

Working Conditions, Work Productivity, Quality of Life, and Depressive Symptoms in Undiagnosed Adults with and without Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms During the COVID-19 Pandemic

PURPOSE

This study aims to evaluate the impact of the COVID-19 pandemic on employment status, work productivity, quality of life (QOL), and depressive symptoms in undiagnosed adults with and without attention-deficit/hyperactivity disorder (ADHD) symptoms in Japan.

METHODS

An observational study used baseline data from a Japanese Medilead Healthcare Panel before the COVID-19 pandemic (October-December 2019). Eligible panel participants were then surveyed during the pandemic (March 2021). ADHD symptoms were screened using the Adult ADHD Self-Report Scale. Changes in QOL (EuroQol 5-Dimensions 5-Levels; EQ-5D-5L) and productivity impairment (Work Productivity and Activity Impairment scale; WPAI) from before to during the pandemic were analyzed in undiagnosed adults with and without ADHD symptoms. Unemployment rate and depressive symptoms (Patient Health Questionnaire; PHQ-9) during the pandemic were compared between groups.

RESULTS

Participants with (N=949) and without (N=942) ADHD symptoms completed the survey. The unemployment rate was not significantly different between participants with and without ADHD symptoms. Participants with ADHD symptoms were more likely to change jobs or employers during the pandemic. PHQ-9 scores in participants with ADHD symptoms were significantly higher than in those without ADHD symptoms (8.96 vs 3.57, respectively) during the pandemic. Before the pandemic, WPAI scores were significantly higher and EQ-5D-5L scores lower in participants with ADHD symptoms than in those without. Productivity improved and QOL was not altered during the pandemic in both groups, but productivity and QOL remained poorer among participants with ADHD symptoms than in those without.

CONCLUSION

Productivity was improved among all participants during the COVID-19 pandemic, contrary to expectations. However, adults with ADHD symptoms consistently had lower productivity, poorer QOL, and more depressive symptoms than those without ADHD symptoms.

A retrospective medical chart review of clinical outcomes in children and adolescents with attention-deficit/hyperactivity disorder treated with guanfacine extended-release in routine Canadian clinical practice

OBJECTIVE

This study evaluated clinical outcomes in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) treated with the α₂-adrenoceptor agonist guanfacine extended-release (GXR) in routine Canadian clinical practice.

METHODS

This retrospective chart review focused on patients with ADHD aged 6-17 years initiating treatment with GXR as monotherapy or adjunctive therapy. Patients were followed for up to 12 months after GXR initiation and, if they had received prior ADHD pharmacotherapy, for 12 months before GXR initiation. The primary outcome was change in ADHD symptoms and functionality based on physician assessments, classified as improvement, no change, or worsening relative to the time of GXR initiation. Treatment-emergent adverse events (TEAEs) were evaluated. Clinical outcomes were also analyzed post hoc according to whether GXR treatment was received as monotherapy or adjunctive therapy, and by select psychiatric comorbidities. Exploratory analyses were conducted in patients who had received prior ADHD pharmacotherapy to evaluate clinical outcomes after initiating GXR.

RESULTS

Improvements in ADHD symptoms were reported for 232/330 (70.3%) patients. Functional improvements in school performance and home life were reported for 213/330 (64.5%) and 209/330 (63.3%) patients, respectively. The most frequent TEAEs (≥ 5%) were somnolence, headache, insomnia, presyncope, and decreased appetite. Improvements in ADHD symptoms were observed when GXR was received as either monotherapy (35/60 [58.3%]) or adjunctive therapy (197/270 [73.0%]). Improvements in ADHD symptoms and functionality were observed in the majority of patients with select psychiatric comorbidities. Among patients who had experienced worsening of symptoms with prior ADHD pharmacotherapy, 44/54 (81.5%) experienced symptom improvement, 33/44 (75.0%) who had previously experienced worsening of school performance improved, and 34/48 (70.8%) who had previously experienced worsening of home life improved.

CONCLUSION

In Canadian routine clinical practice, most children and adolescents with ADHD treated with GXR experienced improvements in ADHD symptoms and in functionality both at school and at home.

Parental Prenatal Symptoms of Depression and Offspring Symptoms of ADHD: A Genetically Informed Intergenerational Study

Objective: The primary aim of the present study was to separate the direct effect of maternal prenatal depression on offspring ADHD from the passive transmission of genetic liability. Method: A children-of-twins and siblings design including 17,070 extended-family units participating in the Norwegian Mother and Child Cohort Study was used. Self-ratings were obtained from parents using the Symptom Checklist during pregnancy. Maternal ratings using Conner's Parent Rating Scale were obtained when the children were 5 years of age. Results: Genetic influences were important for explaining similarity between parents and offspring. There was also evidence for a maternal effect after accounting for genetic transmission (m = 0.06, 95% confidence interval [CI] = [0.02, 0.09]). Conclusion: Our results were consistent with hypotheses suggesting that maternal prenatal depression influences symptoms of ADHD in offspring. However, the effect was weak and a substantial portion of the association could be accounted for by shared genetic influences.

The subject matters: relations among types of anxiety, ADHD symptoms, math performance, and literacy performance

In this study, we extended a model of the relations among ADHD symptoms, anxiety, and academic performance. Undergraduates (N = 515) completed self-report measures of anxiety (i.e. trait, test, math, and literacy) and ADHD symptoms. During the study, they completed math and literacy measures and reported their current (i.e. state) anxiety three times. There were significant correlations among ADHD symptoms and all measures of anxiety. However, neither ADHD symptoms nor trait anxiety were correlated with math or literacy performance. Test-anxious students reported increasing state anxiety as the study progressed. In contrast, math-anxious students reported increased state anxiety following the math tasks but not the literacy tasks and literacy-anxious students reported increased state anxiety following the literacy tasks but not the math tasks. With respect to performance, math-anxious students had worse math performance and literacy-anxious students had worse literacy performance whereas test anxiety was not directly related to performance on either math or literacy tasks. Patterns of relations did not differ for men and women, but, except for literacy anxiety, women reported higher levels of all types of anxiety. These results could help educators understand how affective responses are related to university students' academic performance.

ADHD symptoms, the current symptom scale, and exploratory structural equation modeling: A psychometric study

The aim of the study was to use exploratory structural equation modelling (ESEM) to investigate support for an ADHD factor model with group factors for inattention (IA), hyperactivity (HY), and impulsivity (IM), as proposed in in ICD-10. A total of 202 adults (121 females and 81 males), aged between 18 and 35 years, from the general community, completed the Current Symptoms Scale (CSS). The results for the model showed good global fit, good convergent and divergent validities. However, the IA and IM factors, but not the HY factor, were clearly defined and demonstrated acceptable reliabilities. Taken together, these finding indicate that a revised ESEM model without the HY factor (i.e. with only the IA and IM symptoms) is an appropriate structure for modeling adult ratings of the ADHD behaviors described in the CSS. The taxonomic, theoretical and clinical implications of the findings for ADHD in general are discussed.

Maternal seafood consumption during pregnancy and child attention outcomes: a cohort study with gene effect modification by PUFA-related genes

BACKGROUND

There is a need to test the fetal programming theoretical framework in nutritional epidemiology. We evaluated whether maternal seafood intake during pregnancy was associated with 8-year-old attention outcomes after adjusting for previous child seafood intake and cognitive function. We also explored effect modification by several single nucleotide polymorphisms (SNPs) related with polyunsaturated fatty acid (PUFA) metabolism.

METHODS

Our final analyses included 1644 mother-child pairs from the prospective INMA (INfancia y Medio Ambiente) cohort study (Spain, recruitment between 2003 and 2008). We used food frequency questionnaires to assess prenatal and postnatal seafood consumption of the mother-child pairs. We evaluated attention function of the children through the computer-based Attention Network Test (ANT) and we used the number of omission errors and the hit reaction time standard error (HRT-SE). Parents reported child attention deficit hyperactivity disorder (ADHD) symptoms using the Revised Conners' Parent Rating Scale Short Form (CPRS-R: S). We measured seven candidate SNPs in a subsample of 845 children. We estimated associations using regression models, adjusting for family characteristics, child seafood intake and cognitive functions at early ages, and to explore SNP effect modifications.

RESULTS

Higher total seafood intake during early pregnancy was associated with a reduction of child ANT omission errors, 5th quintile (median = 854 g/week) vs 1st quintile (median = 195 g/week), incidence risk ratio (IRR) 0.76; 95% CI = 0.61, 0.94. Similar results were observed after adjusting the models for child seafood intake and previous cognitive status. Lean, large and small fatty fish showed similar results, and generally similar but less robust associations were observed with the other attention outcomes. Shellfish and canned tuna showed weaker associations. The association patterns were weaker in late pregnancy and null in child seafood consumption. Child rs1260326 (glucokinase regulator, GCKR) and child/maternal rs2281591 (fatty acid elongase 2, ELOVL2) polymorphisms showed nominal P-value for interactions <0.10 between total seafood intake and ANT outcomes.

CONCLUSIONS

After adjusting for previous child cognitive functions and child seafood intake, high pregnancy consumption (total, lean, small and large fatty fish) was independently associated with improvements of some 8-year-old attention outcomes. Genetic effect modification analyses suggest PUFA intake from seafood as a potential biological mechanism of such association.

ADHD symptoms and callous-unemotional traits as predictors of violent media use in adolescence

We investigated ADHD symptoms and CU traits as predictors of violent media use in adolescence, controlling for delinquency and ODD symptoms. The effects on of disinhibition and arousal to negative stimuli, core characteristics of ADHD symptoms and CU traits, and of gender were investigated. At age 15, 88 adolescents, 50 % boys reported on CU traits, ADHD symptoms and delinquency. Parents rated the adolescents' CU traits, ADHD- and ODD symptoms. At age 16, adolescents reported on their media habits and performed tests of disinhibition and arousal to negative stimuli. Boys had higher levels of CU traits and violent media use and girls had higher levels of arousal to negative pictures. CU traits and inattention symptoms predicted violent media use, the latter association applying only to boys, with CU traits being the strongest predictor. Low arousal to threat pictures explained variance in violent media use, above CU traits. Attraction to violent media seems affected by problem behaviors, with CU traits coming forth as especially important.

Maternal Ferritin Levels during Pregnancy and ADHD Symptoms in 4-Year-Old Children: Results from the INMA-INfancia y Medio Ambiente (Environment and Childhood) Prospective Birth Cohort Study

Ferritin status during prenatal brain development may influence the risk of attention deficit and hyperactivity disorder (ADHD) symptoms in childhood. We investigated the association of maternal ferritin in pregnancy and ADHD-like symptoms in offspring. A total of 1095 mother-child pairs from three birth cohorts of the INMA Project (Spain) were studied. Maternal plasma ferritin in pregnancy was measured at 11.57 weeks of gestation. Children′s ADHD-like symptoms at ages 4–5 years were assessed using the ADHD Rating Scale-IV. The count model of the zero-inflated Poisson regression model showed a significant inverse association between ferritin (continuous variable) and inattention, β = −0.19 (−0.32, −0.07), for boys. Comparing ferritin level by tertiles, significant differences were observed between the first tertile ([1.98, 20.92]) and the second ([20.92, 38.79]) and third tertiles ([38.79, 216.5]) (mg/L).The number of symptoms was lower for those in the third tertile, β = −0.3 (−0.55, −0.5), and for those in the second one, β = −0.37 (−0.6, −0.14). The model stratification by sex also showed this inverse association for boys only, β = −0.21 (−0.34, −0.08). No associations were found between ferritin level and hyperactivity or total ADHD symptoms. High ferritin levels during pregnancy show a protective association with child inattentive-type ADHD symptoms.

Adult ADHD screening scores and hospitalization due to pedestrian injuries: a case-control study

BACKGROUND

The aim of this study was to investigate the association between adult ADHD screening scores and hospitalization due to pedestrian injuries in a sample of Iranian pedestrians.

METHODS

Through a case-control study, a case population of 177 pedestrians injured by the vehicles in road traffic crashes were compared with 177 controls who lacked a record of intentional or unintentional injuries enrolled from various wards of Imam Reza University Hospital which is a specialty teaching hospital located in the same city with similar referral level. The cases and controls had an age range of 18-65 years and were matched on gender and age. ADHD symptom profile was assessed using the Persian Self-report Screening Version of the Conner's Adult ADHD Rating Scales (CAARS-S:SV). The association of ADHD screening score and pedestrian injuries was investigated using multiple binary logistic regression to investigate the independent effect of ADHD index score on belonging to case group. Both crude and adjusted odds ratios were reported.

RESULTS

Men comprised 86.4% of the study subjects. The crude odds ratios for all the four ADHD subscales to be associated with pedestrian injuries were 1.05, 1.08, and 1.04 for the subscales A (attention deficit), B (hyperactivity/impulsiveness) and ADHD index respectively. However, the association for subscale A was not statistically significant with a borderline p-value. The final multivariate analysis showed that variables associated with pedestrian injuries in the road traffic crashes were ADHD Index score (OR = 1.06, 95% CI: 1.01-1.12); economic status (including household income and expenditure capacity); educational level and total walking time per 24 h.

CONCLUSIONS

Adult ADHD screening score can predict pedestrian injuries leading to hospitalization independently from sex, age, economic status, educational level and pedestrian exposure to traffic environment (average walking time).

Disentangling autism spectrum and attention-deficit/hyperactivity symptoms over development in fragile X syndrome

Even genetic disorders associated with monogenic aetiologies are characterized by complex and variable risk for poor outcomes, highlighting the need to follow trajectories longitudinally. Here, we investigated the longitudinal relationships between attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) symptoms in a population at high risk for both: boys with fragile X syndrome. 59 boys with fragile X syndrome aged 3-10 years old at entry participated in this study, and were followed up one and two years after their first visit. As expected, we found strong relationships over three timepoints for ADHD symptoms (as measured by the parent-rated Conners scale) and ASD symptoms (as measured by the Social Communication Questionnaire [SCQ]). In addition, using structural equation modeling (SEM) we found that ADHD symptoms at time 2 predicted ASD symptoms at time 3, suggestive of a causal relationship. Importantly, these relationships hold when including chronological age at entry to the study, as well as when including severity of impairment as measured by IQ, and their effects on both ASD and ADHD symptoms do not reach significance. This result highlights the need to study outcomes longitudinally and it informs the comorbidity of the two symptom domains in FXS as well as their potential directionality, both of which have been little researched. In addition, our findings may suggest a future need to study how ADHD symptoms and their treatment impact individuals with ASD.

Childhood and adult attention deficit hyperactivity disorder symptoms in fibromyalgia: associations with depression, anxiety and disease impact

Objective: The first aim of this study was to determine the prevalence of childhood and current attention deficit hyperactivity disorder (ADHD) symptoms in patients with fibromyalgia. The second aim is to assess the role of depression and anxiety on the relationship between childhood and adult ADHD symptoms with disease impact in this population.Methods: Sixty-four patients with fibromyalgia were compared to matched 58 healthy controls. All participants completed the Wender Utah Rating Scale (WURS), Adult ADHD Self-Report Scale (ASRS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Fibromyalgia Impact Questionnaire (FIQ).Results: Patients with fibromyalgia had significantly higher mean scores of depression (BDI), anxiety (BAI), childhood ADHD symptoms (WURS) and adult ADHD symptoms (ASRS total, ASRS hyperactivity/impulsivity subscale and ASRS attention deficit subscale) than the control group. Fibromyalgia impact (FIQ) was significantly correlated with depression (BDI; r = 0.57, p < .001), anxiety (BAI; r = 0.56, p < .001) and childhood ADHD symptoms (WURS; r = 0.41, p < .001) in fibromyalgia group. There was no significant correlation between fibromyalgia impact (FIQ) and adult ADHD symptoms (ASRS total or sub-scale scores). Hierarchical multiple regression indicated that childhood ADHD symptoms (WURS), anxiety (BAI) and depression (BDI) predicted fibromyalgia impact. Both anxiety (BAI) and depression (BDI) mediated the relationship between childhood ADHD symptoms (WURS) and fibromyalgia impact (FIQ).Conclusion: Childhood ADHD symptoms may be a contributory factor to poorer functioning in the patients with fibromyalgia. The relationship was more pronounced in the presence of depression and anxiety symptoms. Evaluation of childhood and adult ADHD symptoms in patients with fibromyalgia is important for recognition and treatment of ADHD comorbidity and also for attenuating the severity of the disease.

Comparison of the effects of treadmill and vibration training in children with attention deficit hyperactivity disorder: A randomized controlled trial

OBJECTIVE

The aim of this study was to compare the effects of treadmill training (TT) and whole body vibration training (WBVT) on attention, severity of attention deficit hyperactivity disorder (ADHD) symptoms and impairment of executive function behaviors, and quality of life in children with ADHD.

METHODS

Thirty children (7-11 years of age) with ADHD were randomly assigned to either the 'TT' group or the 'WBVT in addition to TT' group (TT + WBVT). Both groups received TT for 8 weeks (3 days/week). The TT + WBWT group also received WBVT for 15 minutes. Stroop Test TBAG form, Behavior Rating Inventory of Executive Function (BRIEF), Conners' Rating Scale (CRS) and Pediatric Quality of Life Inventory (PedsQL) were applied at baseline and after 8 weeks of training.

RESULTS

All assessment results significantly improved in both groups at the end of the program compared to baseline values (p < 0,05). There were significant differences between groups regarding improvements in CTRS-R/L and BRIEF-Teacher form in favor of the TT + WBVT group.

CONCLUSIONS

The findings suggest that exercise training including TT and WBVT might be used in the treatment of ADHD but further research is required to provide evidence of the effectiveness of the whole body vibration training in the management of ADHD.

Examining the Role of Genetic Risk and Longitudinal Transmission Processes Underlying Maternal Parenting and Psychopathology and Children's ADHD Symptoms and Aggression: Utilizing the Advantages of a Prospective Adoption Design

Although genetic factors may contribute to initial liability for ADHD onset, there is growing evidence of the potential importance of the rearing environment on the developmental course of ADHD symptomatology. However, associations between family-level variables (maternal hostility, maternal depressive symptoms) and child behaviors (developmental course of ADHD and aggression) may be explained by genes that are shared by biologically related parents and children. Furthermore, ADHD symptoms and aggression commonly co-occur: it is important to consider both simultaneously to have a better understanding of processes underlying the developmental course of ADHD and aggression. To addresses these issues, we employed a longitudinal genetically sensitive parent-offspring adoption design. Analyses were conducted using Cohort I (n = 340) of the Early Growth and Development Study with cross-validation analyses conducted with Cohort II (n = 178). Adoptive mother hostility, but not depression, was associated with later child ADHD symptoms and aggression. Mothers and their adopted children were genetically unrelated, removing passive rGE as a possible explanation. Early child impulsivity/activation was associated with later ADHD symptoms and aggression. Child impulsivity/activation was also associated with maternal hostility, with some evidence for evocative gene-environment correlation processes on adoptive mother depressive symptoms. This study provides novel insights into family-based environmental influences on child ADHD and aggression symptoms, independent of shared parental genetic factors, implications of which are further explicated in the discussion.

ADHD Symptoms in Adolescents' Everyday Life: Fluctuations and Symptom Structure Within and Between Individuals

Objective: This study investigated whether self-reported ADHD symptoms fluctuate substantially within adolescents from day to day, and examined the underlying symptom factor structure on a within- and between-person level. Method: Adolescents (N = 166) rated their ADHD symptoms over the phone on eight consecutive evenings (total ratings: n = 1,264). Results: ADHD symptoms showed substantial fluctuations within adolescents from day to day, as indicated by within-person standard deviations and intraclass correlation coefficients. Both a two-level factor model with three correlated factors (inattention, hyperactivity, impulsivity) and a two-level bifactor model with a general ADHD symptom factor and a specific inattention factor provided acceptable to good accounts of the structure underlying daily ADHD symptom ratings on the between- and the within-person level. Conclusion: The study demonstrates that adolescents' ADHD symptoms fluctuate from day to day and highlights the need for intensive diagnostic processes with repeated symptom assessments and interventions that address symptom fluctuations.

Confirmatory Factor Analysis and Exploratory Structural Equation Modeling of the Structure of Attention-Deficit/Hyperactivity Disorder Symptoms in Adults

This study examined the structure of attention-deficit/hyperactivity disorder (ADHD) symptoms in an adult community sample using first-order confirmatory factor analysis, exploratory structural equation modeling (ESEM), and bifactor confirmatory factor analysis and ESEM models, with two group factors (inattention [IA] and hyperactivity/impulsivity [HY/IM]) and two different three group factors (IA, hyperactivity [HY], and impulsivity [IM]; and IA, motoric HY/IM, and verbal HY/IM). A total of 738 adults (males = 374 and females = 364) between 17 and 72 years of age completed the Adult ADHD Self-Report Scale. The results provided most support for the ESEM model with group factors for IA, motoric HY/IM, and verbal HY/IM. The factors in this model were reasonably well defined, had good internal consistency omega reliabilities, and had support for their external validities, thereby making it a suitable model for ratings of the ADHD symptoms presented in the Adult ADHD Self-Report Scale. The theoretical and clinical implications of the findings are discussed.

Children With ADHD Symptoms: Who Can Do Without Specialized Mental Health Care?

Objective: A new Dutch Child and Youth Act should reduce specialized mental health care for children with symptoms of ADHD. Characteristics of children referred to a specialized ADHD clinic are explored to give direction to this intention. Method: Data of 261 children who underwent a multidisciplinary best practice evaluation (including rating scales, and demographic, psychological, and somatic findings) were analyzed. Univariable and multivariable logistic regression models were used to find predictive variables for the need of specialized mental health care. Results: Collected data were heterogeneous. (Sub)clinical total scores on the Teacher Report Form (TRF) and Child Behavior Checklist (CBCL) were predictive variables for specialized mental health care. Also children with divorced parents were more often referred to specialized care. Conclusion: (Sub)clinical scores on the CBCL and TRF increased the need for specialized care, but comprehensive assessment of every child with ADHD symptoms was necessary to differentiate between levels of care.

Do Individual Differences in Early Affective and Cognitive Self-Regulation Predict Developmental Change in ADHD Symptoms From Preschool to Adolescence?

OBJECTIVE

The role of heterogeneous self-regulation deficits in ADHD has long been emphasized. Yet, longitudinal studies examining distinct self-regulation processes as prospective predictors of developmental change in ADHD symptoms spanning wide developmental periods are scarce. The aim of the current study was to examine affective and cognitive self-regulation as predictors of developmental change in ADHD symptoms from preschool to adolescence in a sample with one third of the children being at risk for developing an ADHD and/or ODD diagnosis.

METHOD

At 5 years laboratory measures for hot and cool executive function (EF) and parental and teacher ratings were used for regulation of positive and negative emotionality. Symptoms of ADHD and ODD were measured at 5 and 13 years using parental and teacher ratings based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV).

RESULTS

Converging developmental paths in hyperactivity/impulsivity across time were found for those high versus low in early cognitive self-regulation, whereas the development of inattention symptoms diverged across time for those high versus low in early affective self-regulation.

CONCLUSION

These results support the idea that different aspects of self-regulation are important for developmental change in the two separate ADHD symptom domains from preschool to adolescence.

Assessment of Susceptibility Risk Factors for ADHD in Imaging Genetic Studies

OBJECTIVE

ADHD consists of a count of symptoms that often presents heterogeneity due to overdispersion and excess of zeros. Statistical inference is usually based on a dichotomous outcome that is underpowered. The main goal of this study was to determine a suited probability distribution to analyze ADHD symptoms in Imaging Genetic studies.

METHOD

We used two independent population samples of children to evaluate the consistency of the standard probability distributions based on count data for describing ADHD symptoms.

RESULTS

We showed that the zero-inflated negative binomial (ZINB) distribution provided the best power for modeling ADHD symptoms. ZINB reveals a genetic variant, rs273342 (Microtubule-Associated Protein [MAPRE2]), associated with ADHD ( p value = 2.73E-05). This variant was also associated with perivascular volumes (Virchow-Robin spaces; p values < 1E-03). No associations were found when using dichotomous definition.

CONCLUSION

We suggest that an appropriate modeling of ADHD symptoms increases statistical power to establish significant risk factors.

Structure of ADHD/ODD Symptoms in Spanish Preschool Children: Dangers of Confirmatory Factor Analysis for Evaluation of Rating Scales

Confirmatory factor analysis (CFA) is often used to evaluate attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptom ratings by parents and teachers. An ADHD-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and ODD three-factor model is usually the best model. Acceptable CFA models, however, can hide symptoms with poor convergent and discriminant validity. To demonstrate this issue, CFA models (i.e., cross-loadings set to zero) along with exploratory CFA models (i.e., cross-loadings allowed) were applied to parent (n = 308) and teacher (n = 258) ratings of ADHD/ODD symptoms with Spanish preschool children (M_age = 4.78, SD = .84, 56% boys). While the three-factor CFA model provided an acceptable-fit with moderate to substantial symptom-factor loadings, the three-factor exploratory CFA model, however, found a large number of the symptoms failed to show convergent and discriminant validity. These outcomes argue for the use of exploratory CFA procedures in the initial evaluation of ADHD/ODD rating scales.

Children's Attention-Deficit/Hyperactivity Disorder Symptoms Predict Lower Diet Quality but Not Vice Versa: Results from Bidirectional Analyses in a Population-Based Cohort

BACKGROUND

As an adjuvant for medication, dietary changes focused on specific nutrients have been proposed to prevent or reduce attention-deficit/hyperactivity disorder (ADHD) symptoms. However, whether an overall healthy dietary pattern is associated with ADHD symptom severity during childhood remains unclear. Furthermore, it is not clear what the direction of this association is.

OBJECTIVES

We aimed to examine the association between dietary patterns and ADHD symptoms in school-aged children. In addition, we aimed to identify the temporal direction of this association-that is, whether dietary patterns predict ADHD symptoms or vice versa.

METHODS

We analyzed data from 3680 children participating in the Generation R Study, a prospective cohort in Rotterdam, Netherlands. ADHD symptoms were assessed with parent-report questionnaires at ages 6 and 10 y using the Child Behavior Checklist. Dietary intake was assessed at the age of 8 y with a validated food-frequency questionnaire. We computed a diet quality score reflecting adherence to dietary guidelines. We examined bidirectional associations of diet quality with ADHD symptom scores using multivariable linear regression analysis and cross-lagged modeling.

RESULTS

Linear regressions showed that more ADHD symptoms at age 6 y were associated with a lower diet quality score at age 8 y (SD score = -0.08; 95% CI: -0.11, -0.05) but that diet quality at age 8 y was not associated with ADHD symptoms at age 10 y. Cross-lagged models confirmed a unidirectional relation from ADHD symptoms to diet quality but not vice versa. Associations did not differ by overweight status or between boys and girls.

CONCLUSION

Our study suggests that children with more ADHD symptoms may be at higher risk of an unhealthy diet but that overall diet quality does not affect ADHD risk.

Head circumference and child ADHD symptoms and cognitive functioning: results from a large population-based cohort study

The aim of this study is to understand the association between prenatal, newborn and postnatal head circumference (HC) and preschool neurodevelopment in a large population-based birth cohort. The INMA project followed 1795 children from 12 weeks of pregnancy to preschool years. HC measurements were carried out prospectively, and following a standardized protocol during pregnancy (12, 20 and 34 weeks), birth, and child ages of 1-1.5 and 4 years old; and z-scores were further estimated. Prenatal head growth was assessed using conditional z-scores between weeks 12-20 and 20-34. Several neuropsychological tests [MSCA (cognition), CPT (attention)] and behavioral rating scales [DSM-IV-ADHD, CAST (autism), CPSCS (social competence)] were carried out during the last follow-up (5 years old). Multivariable models adjusted for family and child characteristics were applied to analyze associations between HC and neurodevelopment. In fully adjusted models, prenatal HC and head growth showed little or no associations with the neurodevelopment outcomes. Independent associations were observed between HC z-scores at birth, 1-1.5 years and 4 years and MSCA global cognitive scores and DSM-IV inattention symptoms. Specifically, z-score at birth was positively associated with general cognitive scores [β 1.22, 95% confidence interval (CI) 0.59, 1.85], and we observed a protective association with ADHD-DSM-IV total symptoms, mean ratio (MR) 0.85 (0.75, 0.96). Prenatal HC and head growth measurements gave little information about child cognitive abilities and behavior at preschool years. However, HC at birth and early childhood was positively associated with a range of neuropsychological outcomes, including protective associations with ADHD symptoms.

A Potential Role for the STXBP5-AS1 Gene in Adult ADHD Symptoms

We aimed to detect Attention-deficit/hyperactivity (ADHD) risk-conferring genes in adults. In children, ADHD is characterized by age-inappropriate levels of inattention and/or hyperactivity-impulsivity and may persists into adulthood. Childhood and adulthood ADHD are heritable, and are thought to represent the clinical extreme of a continuous distribution of ADHD symptoms in the general population. We aimed to leverage the power of studies of quantitative ADHD symptoms in adults who were genotyped. Within the SAGA (Study of ADHD trait genetics in adults) consortium, we estimated the single nucleotide polymorphism (SNP)-based heritability of quantitative self-reported ADHD symptoms and carried out a genome-wide association meta-analysis in nine adult population-based and case-only cohorts of adults. A total of n = 14,689 individuals were included. In two of the SAGA cohorts we found a significant SNP-based heritability for self-rated ADHD symptom scores of respectively 15% (n = 3656) and 30% (n = 1841). The top hit of the genome-wide meta-analysis (SNP rs12661753; p-value = 3.02 × 10^-7) was present in the long non-coding RNA gene STXBP5-AS1. This association was also observed in a meta-analysis of childhood ADHD symptom scores in eight population-based pediatric cohorts from the Early Genetics and Lifecourse Epidemiology (EAGLE) ADHD consortium (n = 14,776). Genome-wide meta-analysis of the SAGA and EAGLE data (n = 29,465) increased the strength of the association with the SNP rs12661753. In human HEK293 cells, expression of STXBP5-AS1 enhanced the expression of a reporter construct of STXBP5, a gene known to be involved in "SNAP" (Soluble NSF attachment protein) Receptor" (SNARE) complex formation. In mouse strains featuring different levels of impulsivity, transcript levels in the prefrontal cortex of the mouse ortholog Gm28905 strongly correlated negatively with motor impulsivity as measured in the five choice serial reaction time task (r² = - 0.61; p = 0.004). Our results are consistent with an effect of the STXBP5-AS1 gene on ADHD symptom scores distribution and point to a possible biological mechanism, other than antisense RNA inhibition, involved in ADHD-related impulsivity levels.

Mindfulness-based cognitive therapy v. treatment as usual in adults with ADHD: a multicentre, single-blind, randomised controlled trial

BACKGROUND

There is a high need for evidence-based psychosocial treatments for adult attention-deficit hyperactivity disorder (ADHD) to offer alongside treatment as usual (TAU). Mindfulness-based cognitive therapy (MBCT) is a promising psychosocial treatment. This trial investigated the efficacy of MBCT + TAU v. TAU in reducing core symptoms in adults with ADHD.

METHODS

A multicentre, single-blind, randomised controlled trial (ClinicalTrials.gov: NCT02463396). Participants were randomly assigned to MBCT + TAU (n = 60), an 8-weekly group therapy including meditation exercises, psychoeducation and group discussions, or TAU only (n = 60), which reflected usual treatment in the Netherlands and included pharmacotherapy and/or psychoeducation. Primary outcome was ADHD symptoms rated by blinded clinicians. Secondary outcomes included self-reported ADHD symptoms, executive functioning, mindfulness skills, self-compassion, positive mental health and general functioning. Outcomes were assessed at baseline, post-treatment, 3- and 6-month follow-up. Post-treatment effects at group and individual level, and follow-up effects were examined.

RESULTS

In MBCT + TAU patients, a significant reduction of clinician-rated ADHD symptoms was found at post-treatment [M difference = -3.44 (-5.75, -1.11), p = 0.004, d = 0.41]. This effect was maintained until 6-month follow-up. More MBCT + TAU (27%) than TAU participants (4%) showed a ⩾30% reduction of ADHD symptoms (p = 0.001). MBCT + TAU patients compared with TAU patients also reported significant improvements in ADHD symptoms, mindfulness skills, self-compassion and positive mental health at post-treatment, which were maintained until 6-month follow-up. Although patients in MBCT + TAU compared with TAU reported no improvement in executive functioning at post-treatment, they did report improvement at 6-month follow-up.

CONCLUSIONS

MBCT might be a valuable treatment option alongside TAU for adult ADHD aimed at alleviating symptoms.

ADHD symptoms and body composition changes in childhood: a longitudinal study evaluating directionality of associations

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is linked to increased risk of overweight/obesity among children and adults. Studies have also implicated obesity as a risk factor for ADHD. However, no studies have evaluated bidirectional, longitudinal associations between childhood fat mass and ADHD symptom severity.

OBJECTIVES

We investigate bidirectional associations between ADHD symptoms and measures of body composition between ages 1.5 and 9. We further examine effects of specific eating patterns linked to ADHD on associations between symptom severity and body composition.

METHODS

The study utilized data from children (N = 3903) participating in the Generation R cohort (Netherlands). Children were enrolled at birth and retained regardless of ADHD symptoms over time. Cross-lagged and change models examined bidirectional associations between body composition (body mass index/dual-energy X-ray absorptiometry) and ADHD symptoms at four time points in childhood.

RESULTS

A child with a clinically concerning ADHD symptom z-score two standard deviations above the mean at age 6 would be expected to experience about 0.22 kg greater fat mass gain measured via dual-energy x-ray absorptiometry between ages 6 and 9, even if they displayed healthy eating patterns (95% CI: 0.11 - 0.28, p < 0.001). Conversely, fat mass at any age did not predict worse ADHD symptoms later.

CONCLUSIONS

Beginning in early childhood, more ADHD symptoms predict higher fat mass at later ages. We did not find evidence of a reverse association. Based on these and prior findings, lifestyle counselling during treatment for children with a diagnosis of ADHD should be considered, even if they are diagnosed in early childhood and do not yet have a body mass index of clinical concern.

Distribution of ADHD symptoms, and associated comorbidity, exposure to risk factors and disability: Results from a general population study

The aim of this study was to examine whether ADHD is a dimensional trait in the adult general population. We studied whether an increased number of ADHD symptoms was associated with higher comorbidity, exposure to risk factors (childhood abuse and parental psychopathology), and disability. We ascertained whether even low numbers of ADHD symptoms were associated with an increased burden of disease. Data were used from the second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2, N = 5303). NEMESIS-2 is a nationally representative face-to-face survey on mental health of the Dutch general population. ADHD symptoms, mental comorbidity, and disability were assessed using the Adult ADHD Self-Report Scale Screener, the Composite International Diagnostic Interview version 3.0, and the Medical Outcomes Study Short Form Health Survey, respectively. Dose-response relationships were found between the number of ADHD symptoms and Axis I and II mental disorders; exposure to risk factors; and mental and physical disability. Our study supports the notion that ADHD is a dimensional trait in the adult general population. Even low numbers of symptoms were associated with an increased burden of disease, and therefore these should be identified and treated.

Maternal alcohol use during pregnancy and offspring attention-deficit hyperactivity disorder (ADHD): a prospective sibling control study

Background

Maternal alcohol use during pregnancy has repeatedly been associated with development of attention-deficit hyperactivity disorder (ADHD) in the offspring. It is, however not known whether this reflects a direct casual intra-uterine effect or a non-causal relationship due to confounding. We used three different approaches to control for measured and unmeasured confounding: statistical adjustment for covariates, negative control comparison against maternal pre-pregnancy alcohol use, and comparison among differentially exposed siblings.

Methods

The sample comprised 114 247 children (34 283 siblings) from 94 907 mothers, recruited to the Norwegian Mother and Child Birth Cohort Study between 1999 and 2008. Self-reported measurements of alcohol use were obtained in week 30 during the pregnancy. Mothers rated offspring ADHD symptoms at 5 years on two measures. Clinical ADHD diagnoses were obtained from the Norwegian Patient Registry.

Results

We found an overall positive association between maternal alcohol use during pregnancy and offspring ADHD symptoms, which was only marginally attenuated after inclusion of measured covariates. Both the negative control and the sibling comparison analysis further attenuated the estimated association, but it remained greater than zero [β = 0.017, 95% confidence interval (CI) = 0.005-0.030). No association was found between maternal alcohol use during pregnancy and offspring ADHD diagnosis.

Conclusions

For offspring ADHD symptoms we found a weak, but possibly causal association with maternal alcohol use during pregnancy, but no such effect was observed for clinical ADHD diagnosis.

Associations between symptoms of attention-deficit/ hyperactivity disorder and life satisfaction in medical students: the mediating effect of resilience

BACKGROUND

Research on symptoms of attention-deficit/hyperactivity disorder (ADHD) in medical students is rather scant. Studying the disorder in this population, especially its associations with positive psychological constructs can further the understanding of mental health in future physicians. The objectives of the present study were to investigate the prevalence of ADHD symptoms in medical students, to examine the relationships between ADHD symptoms and life satisfaction, and to explore the mediating role of resilience on the associations.

METHODS

This cross-sectional study was carried out at one medical university in China, in June 2016. Self-reported questionnaires consisting of Adult ADHD Self-Report Scale (ASRS), Wender Utah Rating Scale (WURS), Conner-Davidson Resilience Scale (CD-RISC), Satisfaction With Life Scale (SWLS), and socio-demographic characteristics, were distributed to the students. Hierarchical linear regression analyses were used to examine the effects of ADHD symptoms on life satisfaction, and asymptotic and resampling strategies were used to explore the mediating role of resilience.

RESULTS

A total number of 521 medical students became final subjects. Based on the cutoffs of the scales, 1.54% of the medical students were highly likely to have ADHD, and 6.91% of the students were likely to have ADHD. Only inattention was negatively correlated with life satisfaction in the students. Resilience functioned as a mediator in the relationship between inattention and life satisfaction.

CONCLUSIONS

The prevalence of ADHD symptoms among Chinese medical students could be relatively high. Inattention is significantly related to life satisfaction among the students. Early identification of medical students with ADHD symptoms should be warranted. Resilience intervention programs might be undertaken to enhance life satisfaction in medical students, especially for those with inattention symptoms.

Attention-Deficit Hyperactivity Disorder (ADHD) Symptoms in Children Adopted from Poland and their Atypical Association Patterns: a Bayesian Approach

Although high rates of attention-deficit hyperactivity disorder (ADHD) symptoms have been observed among internationally adopted children, research on these symptoms in Polish adoptees is lacking. Therefore, we examined ADHD symptoms in Polish adoptees and their relationship to pre-adoptive risk factors, that is, time in institutional care, early deprivation, and prenatal alcohol exposure. We further compared the association patterns and gender distribution of ADHD symptoms in children adopted from Poland to those reported in the literature for ADHD symptoms in non-adopted children. Dutch adoptive parents of 121 Polish adoptees (52% boys; M age = 10.9 years, range 6.2-15.6; M ageadoption = 3.0 years, range 0.8-6.9) completed questionnaires regarding ADHD symptoms, pre-adoptive risk factors, attachment problems, conduct problems, and executive functioning deficits. Bayesian evaluation of informative hypotheses showed that Polish adoptees had increased levels of ADHD symptoms, compared to Dutch children in the general population. Time in institutional care, early deprivation, and prenatal alcohol exposure were not associated with ADHD symptoms. ADHD symptoms in Polish adoptees were more strongly associated with attachment problems and executive functioning deficits, but less strongly with conduct problems, compared to ADHD symptoms in non-adoptees. Furthermore, ADHD symptoms were more equally distributed among boys and girls than they are in non-adopted children. The findings indicate that Polish adoptees and their adoptive parents need special attention and support. The dissimilarities between ADHD symptoms in Polish adoptees and non-adoptees might indicate a different underlying causal mechanism, which may have important implications for clinical practice.

The links between healthy, problematic, and addicted Internet use regarding comorbidities and self-concept-related characteristics

Background Addicted Internet users present with higher rates of comorbidities, e.g., attention-deficit hyperactivity disorder (ADHD), depressive, and anxiety disorders. In addition, deficits in self-concept-related characteristics were found in addicted Internet gamers and social network users. The aim of this study was to examine the links between healthy, problematic, and addicted Internet use regarding comorbidities and self-concept-related characteristics. The association between recently developed ADHD-like symptoms without an underlying diagnosis and addictive Internet use was also examined. Methods n = 79 healthy controls, n = 35 problematic, and n = 93 addicted Internet users were assessed for comorbidities, social and emotional competencies, body image, self-esteem, and perceived stress. Apart from an ADHD-diagnosis, recently developed ADHD-like symptoms were also assessed. Results Addicted users showed more self-concept-related deficits and higher rates of comorbidities with ADHD, depressive, and anxiety disorders. Addicted and problematic users showed similarities in the prevalence of cluster B personality disorders and decreased levels of characteristics related to emotional intelligence. Participants with recently developed ADHD-like symptoms scored higher in lifetime and current severity of Internet use compared with those without ADHD symptoms. Addicted participants with recently developed ADHD symptoms showed higher lifetime Internet use severity compared with those without any symptoms. Conclusions Our findings indicate that cluster B personality disorders and premorbid problems in emotional intelligence might present a link between problematic and addictive Internet use. Furthermore, the findings provide a first indication that addictive Internet use is related to ADHD-like symptoms. Symptoms of ADHD should therefore be assessed against the background of possible addicted Internet use.

Hair cortisol concentration in preschoolers with attention-deficit/hyperactivity symptoms-Roles of gender and family adversity

OBJECTIVE

Previous studies on the association between hypothalamic-pituitary-adrenal axis (HPAA) activity and ADHD yielded inconsistent findings, particularly in younger children. This might be due to the heterogeneity of the disorder, making moderator effects of variables probable, which circumscribe more homogenous subgroups. There have been indications of moderator effects on this association by gender of child and exposure to family adversity. Moreover, difficulties in capturing long-term basal HPAA activity in younger children might have contributed to the inconsistencies. We therefore analyzed moderator effects of gender and family adversity while using the hair cortisol concentration (HCC) to assess integrated long-term HPAA.

METHODS

The community-based sample consisted of 122 4-5-year-old preschoolers (71 screened positive for elevated ADHD symptoms). ADHD symptoms were measured by a clinical parent interview and parent and teacher questionnaires. HCC in the most proximal 3-cm scalp hair segment was analyzed using luminescence immunoassay. An extended family adversity index was used.

RESULTS

Hierarchical linear regression analyses yielded an interaction effect (p<.05) between ADHD symptom groups and gender on HCC, indicating a low HCC in boys with elevated ADHD symptoms. Further exploratory analyses revealed that this interaction effect was most pronounced under the condition of family adversity. The results held after controlling for oppositional, anxiety, and depressive symptoms.

CONCLUSION

Low HCC might indicate a specific pathogenic mechanism in boys with elevated ADHD symptoms. This mechanism might further involve an exposure to family adversity. However, the results need to be cross-validated before definitive conclusions can be drawn.

Impact of theory of mind, verbal working memory, ADHD symptoms, and structural language

The primary aim of this study is to increase the existing knowledge about the pragmatic skills of children with autism spectrum disorders (ASD). Specifically, the study has two objectives. The first is to provide a profile of characteristics based on The Children's Communication Checklist (CCC-2) pragmatics scales (inappropriate initiation, stereotyped language, use of context, nonverbal communication, and general pragmatics) and narrative task indicators. To this end, children with ASD will be compared to children with typical development (TD), controlling the effects of sex and structural language (speech, syntax, semantics, coherence). The second objective is to analyze whether theory of mind (ToM), verbal working memory, ADHD symptoms, and structural language can predict pragmatic competence in children with ASD without intellectual disability (ID). The results showed worse performance in the group with ASD on the majority of the pragmatic aspects evaluated. In addition, the application of ToM skills and structural language were significant predictors of the pragmatic skills of the children with ASD. These findings reinforce the importance of focusing intervention programs on mentalist abilities through experiences in real social scenarios, along with strengthening structural language components.

First-Dose Methylphenidate-Induced Changes in Brain Functional Connectivity Are Correlated With 3-Month Attention-Deficit/Hyperactivity Disorder Symptom Response

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) symptoms are most commonly treated with stimulant medication such as methylphenidate (MPH); however, approximately 25% of patients show little or no symptomatic response. We examined the extent to which initial changes in brain functional connectivity (FC) associated with the first MPH dose in boys newly diagnosed with ADHD predict MPH-associated changes in ADHD inattentiveness and hyperactivity symptoms at 3 months.

METHODS

Brain FC was estimated using steady-state visual evoked potential partial coherence before and 90 minutes after the administration of the first MPH dose to 40 stimulant drug-naïve boys newly diagnosed with ADHD while they performed the AX version of the continuous performance task. The change in parent-rated inattention and hyperactivity scores over the first 3 months of MPH medication was correlated with the initial 90-minute MPH-mediated FC changes.

RESULTS

Hyperactivity improvements at 3 months were associated with first-dose MPH-mediated FC reductions restricted to frontal-prefrontal sites following the appearance of the "A" and at frontal and right temporal sites during the appearance of the "X." Corresponding 3-month inattention score improvement was associated with initial MPH-mediated FC reductions restricted to occipitoparietal sites following the appearance of the "A."

CONCLUSIONS

These findings are discussed in the context of MPH effects on the default mode network and the possible role of the default mode network in MPH-mediated improvements in inattention and hyperactivity symptom scores.

Assessment of executive function in ADHD adolescents: contribution of performance tests and rating scales

This study aimed to analyze performance on measures of neuropsychological and behavioral executive functions (EF) in adolescents with attention deficit hyperactivity disorder (ADHD), and to evaluate the utility of performance-based tests for predicting scores on behavioral EF ratings. One hundred eighteen adolescents (75 ADHD and 43 controls) aged 12-16 years performed neuropsychological tests and completed a behavior rating scale of EF. The ADHD group presented significantly lower scores than controls on Full Scale IQ (FSIQ) and all indexes of the WISC-IV, except the verbal comprehension index (VCI). The ADHD group had significantly lower scores on performance-based tests of working memory, planning and inhibition, and on EF rating scales. Scores on the cognitive EF working memory, planning and flexibility modestly predicted performance on behavioral EF. The results suggest that the combined use of performance-based tests and rating scales provides valuable complementary information that can improve the assessment of executive domains in ADHD.

Nice guys: Homozygocity for the TPH2 -703G/T (rs4570625) minor allele promotes low aggressiveness and low anxiety

BACKGROUND

Tryptophan hydroxylase (TPH) is the rate-limiting enzyme in the synthesis of serotonin. We examined whether the TPH2 polymorphism -703G/T (rs4570625) is associated with aggressiveness and impulsivity, and the prevalence of psychiatric disorders, in a population-representative sample.

METHODS

We used self and proxy reports on aggressive behaviour in the younger birth cohort of the longitudinal Estonian Children Personality, Behaviour and Health Study collected at age 25, and earlier collected impulsivity and related data of both ECPBHS cohorts.

RESULTS

The TT homozygous males reported less aggressive behaviour in the Life History of Aggression interview at age 25. They also had significantly lower scores in Illinois Bully Scale peer reports, and less ADHD symptoms rated by teachers both at ages 9 and 15. The TT homozygotes of both sexes had the lowest Maladaptive Impulsivity at ages 18 and 25, and the highest Adaptive Impulsivity at age 25. The TT homozygotes also had low depressiveness and trait anxiety by age 25, and the odds ratio for the prevalence of anxiety disorders was 9.38 for the G-allele carriers.

LIMITATIONS

The main limitation of the study is the naturally occurring low number of subjects with the TT genotype.

CONCLUSIONS

Subjects with the TPH2 rs4570625 TT genotype, especially males, exhibit less aggression and a favourable impulsivity profile, and develop anxiety disorders by young adulthood less often.

Neuropsychological Functioning and Attachment Representations in Early School Age as Predictors of ADHD Symptoms in Late Adolescence

This study aimed to examine relations between parent and child attachment representations and neuropsychological functions at age 8, as well as relations between these constructs and ADHD symptoms over a 10-year period. A community-based sample of 105 children (52 boys) participated. Measures of attachment representations and a range of neuropsychological functions were collected at age 8. Parents rated emotion dysregulation and ADHD symptoms at age 8 and ADHD symptoms again at age 18. Significant, although modest, relations were found between disorganized attachment and some aspects of neuropsychological functioning in childhood. When studying outcomes in late adolescence and controlling for early ADHD symptom levels, spatial working memory and disorganized attachment remained significant in relation to both ADHD symptom domains, and one measure of inhibition remained significant for hyperactivity/impulsivity. When examining independent effects, spatial working memory and disorganized attachment were related to inattention, whereas spatial working memory and dysregulation of happiness/exuberance were related to hyperactivity/impulsivity. Our findings showing that disorganized attachment is longitudinally related to ADHD symptoms over and above the influence of both neuropsychological functioning and early ADHD symptom levels highlights the importance of including measures of attachment representations when trying to understand the development of ADHD symptoms. If replicated in more "at-risk" samples, these findings could also suggest that parent-child attachment should be taken into consideration when children are referred for assessment and treatment of ADHD.