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Merrill BM, Hare MM, Piscitello J, Schatz NK, Fabiano GA, Wells EL, Robertson EL, Aloe AM, Pelham WE, Macphee F, Ramos M, Zhao X, Altszuler AR, Javadi N, Morris SSJ, Smyth A, Ward L, Jones HA. Diversity and representation in ADHD psychosocial treatment research: A comprehensive synthesis with data from over 10,000 participants. Clin Psychol Rev 2024; 112:102461. [PMID: 38945033 DOI: 10.1016/j.cpr.2024.102461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 07/02/2024]
Abstract
Demographic data from nearly 50 years of treatment research for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are synthesized. Comprehensive search identified ADHD treatment studies that were between-group designs, included a psychosocial, evidence-based treatment, and were conducted in the United States. One hundred and twenty-six studies that included 10,604 youth were examined. Reporting of demographics varied with 48% of studies (k = 61) reporting ethnicity, 73% (k = 92) reporting race, 80% (k = 101) reporting age (M age = 8.81, SD = 2.82), and 88% (k = 111) reporting gender. Most participants identified as non-Hispanic/Latine (15.99% Hispanic/Latine), White (62.54%), and boys (74.39%; 24.47% girls). Since the 1970s, zero youth in ADHD treatment studies identified as Middle Eastern/North African, 0.1% were American Indian/Alaskan Native or Native Hawaiian Pacific Islander, 1.77% were Asian, 15.10% were Black, and 3.14% were Multiracial. Based on publication year, the proportions of girls, racially minoritized youth, and Hispanic/Latine youth included in ADHD treatment research have increased over time. Girls, non-binary and non-cisgender youth, young children, adolescents, Hispanic/Latine youth, and youth from all racial groups other than White are underrepresented in ADHD treatment research. Research gaps are discussed, and recommendations for comprehensive demographic reporting in child and adolescent psychological research are provided.
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Chacko A, Merrill BM, Kofler MJ, Fabiano GA. Improving the efficacy and effectiveness of evidence-based psychosocial interventions for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Transl Psychiatry 2024; 14:244. [PMID: 38851829 PMCID: PMC11162428 DOI: 10.1038/s41398-024-02890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 06/10/2024] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent, chronic, and impairing mental health disorder of childhood. Decades of empirical research has established a strong evidence-based intervention armamentarium for ADHD; however, limitations exist in regards to efficacy and effectiveness of these interventions. We provide an overview of select evidence-based interventions for children and adolescents, highlighting potential approaches to further improving the efficacy and effectiveness of these interventions. We conclude with broader recommendations for interventions, including considerations to moderators and under-explored intervention target areas as well as avenues to improve access and availability of evidence-based interventions through leveraging underutilized workforces and leveraging technology.
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Fabiano GA, Lupas K, Merrill BM, Schatz NK, Piscitello J, Robertson EL, Pelham WE. Reconceptualizing the approach to supporting students with attention-deficit/hyperactivity disorder in school settings. J Sch Psychol 2024; 104:101309. [PMID: 38871418 PMCID: PMC11331420 DOI: 10.1016/j.jsp.2024.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/19/2023] [Accepted: 03/16/2024] [Indexed: 06/15/2024]
Abstract
The long-term academic outcomes for many students with attention-deficit/hyperactivity disorder (ADHD) are strikingly poor. It has been decades since students with ADHD were specifically recognized as eligible for special education through the Other Health Impaired category under the Education for all Handicapped Children Act of 1975, and similarly, eligible for academic accommodations through Section 504 of the 1973 Rehabilitation Act. It is time to acknowledge that these school-policies have been insufficient for supporting the academic, social, and behavioral outcomes for students with ADHD. Numerous reasons for the unsuccessful outcomes include a lack of evidence-based interventions embedded into school approaches, minimizing the importance of the general education setting for promoting effective behavioral supports, and an over-reliance on assessment and classification at the expense of intervention. Contemporary behavioral support approaches in schools are situated in multi-tiered systems of support (MTSS); within this article we argue that forward-looking school policies should situate ADHD screening, intervention, and maintenance of interventions within MTSS in general education settings and reserve special education eligibility solely for students who require more intensive intervention. An initial model of intervention is presented for addressing ADHD within schools in a manner that should provide stronger interventions, more quickly, and therefore more effectively.
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Merrill BM, Macphee FL, Burrows-MacLean L, Coles EK, Wymbs BT, Chacko A, Walker K, Wymbs F, Garefino A, Robb Mazzant J, Gnagy EM, Waxmonsky JG, Massetti GM, Waschbusch DA, Fabiano GA, Pelham WE. Single and Combined Effects of Multiple Intensities of Behavioral Modification and Methylphenidate for Children with ADHD in the Home Setting. Res Child Adolesc Psychopathol 2023; 51:1481-1495. [PMID: 37382748 PMCID: PMC11103974 DOI: 10.1007/s10802-023-01093-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
Behavioral treatment, stimulants, and their combination are the recommended treatments for childhood attention-deficit/hyperactivity disorder (ADHD). The current study utilizes within-subjects manipulations of multiple doses of methylphenidate (placebo, 0.15, 0.30, and 0.60 mg/kg/dose t.i.d.) and intensities of behavioral modification (no, low, and high intensity) in the summer treatment program (STP) and home settings. Outcomes are evaluated in the home setting. Participants were 153 children (ages 5-12) diagnosed with ADHD. In alignment with experimental conditions implemented during the STP day, parents implemented behavioral modification levels in three-week intervals, child medication status varied daily, and the orders were randomized. Parents provided daily reports of child behavior, impairment, and symptoms and self-reported parenting stress and self-efficacy. At the end of the study, parents reported treatment preferences. Stimulant medication led to significant improvements across all outcome variables with higher doses resulting in greater improvement. Behavioral treatment significantly improved child individualized goal attainment, symptoms, and impairment in the home setting and parenting stress and self-efficacy. Effect sizes indicate that behavioral treatment combined with a low-medium dose (0.15 or 0.30 mg/kg/dose) of medication results in equivalent or superior outcomes compared to a higher dose (0.60 mg/kg/dose) of medication alone. This pattern was seen across outcomes. Parents overwhelmingly reported preferring treatment with a behavioral component as a first-choice treatment (99%). Results underscore the need to consider dosing as well as parent preference when utilizing combined treatment approaches. This study provides further evidence that combining behavioral treatment and stimulant medication may reduce the stimulant dose needed for beneficial effects.
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Merrill BM, Monopoli WJ, Rejman E, Fabiano GA. Supporting Parents of Children with ADHD During COVID-19 School Closures: A Multiple-Baseline Trial of Behavioral Parent Training for Home Learning. SCHOOL MENTAL HEALTH 2023; 15:1-14. [PMID: 36777457 PMCID: PMC9899333 DOI: 10.1007/s12310-023-09569-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/07/2023]
Abstract
During the COVID-19 pandemic, schools rapidly changed from in-class instruction to remote learning. Parent involvement and management of the home learning situation was greatly emphasized, and this presented challenges and opportunities for parents of children with attention-deficit/hyperactivity disorder (ADHD). There was an urgent need for effective parent support in the home learning situation, particularly for parents of youth with ADHD. The current study implemented a behavioral parent training (BPT) program, an evidence-based intervention for childhood ADHD, modified to target home learning and be delivered via telehealth. The intervention was evaluated in a multiple baseline trial across families of youth with ADHD (n = 3). The primary outcome was daily, parent-reported academic engagement during home learning. Parents also completed daily ratings of their child's respectful and disruptive behavior, and remote, home observations of academic tasks were recorded at baseline and post-treatment. Based on visual analysis of baseline, treatment and post-treatment daily ratings, two of the three participants had a positive response to treatment indicated by improved academic engagement. These findings provide preliminary support for the home-learning, telehealth-delivered BPT program in supporting families during the COVID pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s12310-023-09569-y.
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Merrill BM, Raiker JS, Mattfeld AT, Macphee FL, Ramos MC, Zhao X, Altszuler AR, Schooler JW, Coxe S, Gnagy EM, Greiner AR, Coles EK, Pelham WE. Mind-Wandering and Childhood ADHD: Experimental Manipulations across Laboratory and Naturalistic Settings. Res Child Adolesc Psychopathol 2022; 50:1139-1149. [PMID: 35247108 PMCID: PMC11103794 DOI: 10.1007/s10802-022-00912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
The conceptual overlap between mind-wandering and attention-deficit/hyperactivity disorder (ADHD)-related impairments is considerable, yet little experimental research examining this overlap among children is available. The current study aims to experimentally manipulate mind-wandering among children with and without ADHD and examine effects on task performance. Participants were 59 children with ADHD and 55 age-matched controls. Participants completed a novel mind-wandering sustained attention to response task (SART) that included non-self-referential and self-referential stimuli to experimentally increase self-referential mind-wandering, reflected by increases in reaction time variability (RTV) following self-referential stimuli. The ADHD group participated in a classroom study with analogue conditions aimed at encouraging self-referential future-oriented thinking (free play/movie before and after class work) compared to a control condition (newscast) and a cross-over methylphenidate trial. The significant interaction between ADHD status and self-referential stimuli on SART performance indicated that self-referential stimuli led to greater RTV among children with ADHD (within-subject d = 1.29) but not among controls. Methylphenidate significantly reduced RTV among youth with ADHD across self-referential (d = 1.07) and non-self-referential conditions (d = 0.72). In the ADHD classroom study, the significant interaction between mind-wandering condition and methylphenidate indicated that methylphenidate led to higher work completion (ds > 5.00), and the free-play mind-wandering condition had more consistent detrimental effects on productivity (ds ≥ 1.25) than the movie mind-wandering condition. This study is the first to manipulate mind-wandering and assess effects among children with ADHD using a behavioral task. Results provide evidence that children with ADHD are uniquely susceptible to mind-wandering interference.
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Pelham WE, Altszuler AR, Merrill BM, Raiker JS, Macphee FL, Ramos M, Gnagy EM, Greiner AR, Coles EK, Connor CM, Lonigan CJ, Burger L, Morrow AS, Zhao X, Swanson JM, Waxmonsky JG, Pelham WE. The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study. J Consult Clin Psychol 2022; 90:367-380. [PMID: 35604744 PMCID: PMC9443328 DOI: 10.1037/ccp0000725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Evaluate whether stimulant medication improves acquisition of academic material in children with attention deficit hyperactivity disorder (ADHD) receiving small-group, content-area instruction in a classroom setting. METHOD Participants were 173 children between the ages of 7 and 12 years old (77% male, 86% Hispanic) who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for ADHD and were participating in a therapeutic summer camp. The design was a triple-masked, within-subject, AB/BA crossover trial. Children completed two consecutive phases of daily, 25-min instruction in both (a) subject-area content (science, social studies) and (b) vocabulary. Each phase was a standard instructional unit lasting for 3 weeks. Teachers and aides taught the material to small groups in a summer classroom setting. Each child was randomized to be medicated with daily osmotic-release oral system methylphenidate (OROS-MPH) during either the first or second of the instructional phases, receiving placebo during the other. RESULTS Medication had large, salutary, statistically significant effects on children's academic seatwork productivity and classroom behavior on every single day of the instructional period. However, there was no detectable effect of medication on learning the material taught during instruction: Children learned the same amount of subject-area and vocabulary content whether they were taking OROS-MPH or placebo during the instructional period. CONCLUSIONS Acute effects of OROS-MPH on daily academic seatwork productivity and classroom behavior did not translate into improved learning of new academic material taught via small-group, evidence-based instruction. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Campez M, Raiker JS, Little K, Altszuler AR, Merrill BM, Macphee FL, Gnagy EM, Greiner AR, Musser ED, Coles EK, Pelham WE. An evaluation of the effect of methylphenidate on working memory, time perception, and choice impulsivity in children with ADHD. Exp Clin Psychopharmacol 2022; 30:209-219. [PMID: 33475395 PMCID: PMC8406432 DOI: 10.1037/pha0000446] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Individuals with Attention-Deficit Hyperactivity Disorder (ADHD) consistently exhibit a stronger preference for immediate rewards than for larger rewards available following a delay on tasks measuring choice impulsivity (CI). Despite this, however, there remains a dearth of studies examining the impact of stimulant treatment on CI as well as associated higher order (e.g., working memory [WM]) and perceptual (e.g., time perception) cognitive processes. The present study examines the effect of osmotic release oral system methylphenidate (OROS-MPH) on CI, WM and time perception processes as well as the relation among these processes before and after taking a regimen of OROS-MPH. Thirty-five children (aged 7-12 years) with a diagnosis of ADHD participating in a concurrent stimulant medication study were recruited to complete computerized assessments of CI, WM, and time perception. Children completed the assessments after administration of a placebo as well as their lowest effective dose of OROS-MPH following a 2-week titration period. The results from one-sample t-tests indicated that OROS-MPH improves both CI and WM in youth with ADHD but does not impact time perception. Further, results revealed no significant association among the various indices of cognitive performance while taking placebo or OROS-MPH. Overall, the findings suggest that while OROS-MPH improves both CI and WM in youth with ADHD, improvements in CI as a result of OROS-MPH are unlikely to be associated with the improvements in WM given the lack of association among the two. Future studies should consider alternate cognitive, emotional, and motivational mechanisms that may account for the impact of OROS-MPH on CI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Merrill BM, Morrow AS, Sarver D, Sandridge S, Lim CS. Prevalence and Correlates of Attention-Deficit Hyperactivity Disorder in a Diverse, Treatment-Seeking Pediatric Overweight/Obesity Sample. J Dev Behav Pediatr 2021; 42:433-441. [PMID: 34397571 PMCID: PMC8369036 DOI: 10.1097/dbp.0000000000000910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Attention-deficit hyperactivity disorder (ADHD) and obesity are highly prevalent, impairing, and costly conditions, affecting about 10% of children each. Research indicates heightened prevalence of childhood obesity among youth with ADHD. However, more research is needed, examining comorbid ADHD among youth with overweight/obesity (OV/OB) from diverse demographic backgrounds and effects on medically relevant behaviors. The aim of the current study was to examine the prevalence of ADHD in a racially diverse sample of youth in a weight management clinic. Furthermore, we examined the effects of race, rurality, and ADHD on weight status and health behaviors in this under-researched population. METHOD Participants included 1003 patients (Mage = 12.55; 58% female; 67% Black/African American; MBMI Z-Score = 2.54; 98.6% with obesity) in a pediatric weight management clinic serving a rural and urban/suburban area in the southern United States. Parent-reported demographics, ADHD diagnosis, and child health behaviors were recorded. RESULT In total, 17.6% (n = 177) of the sample had an ADHD diagnosis. ADHD status interacted with race to predict standardized body mass index (BMIz), and rurality predicted higher BMIz. Children with comorbid ADHD had significantly more meals per day and fewer active days compared with children with OV/OB without ADHD. CONCLUSION ADHD prevalence was higher in this diverse sample of children seeking obesity treatment (17.6%) compared with the prevalence nationally (9%-10%) and in other obesity samples. Comorbid ADHD was related to higher weight status among racial minority youth and increased engagement in unhealthy lifestyle behaviors often targeted in weight management treatment. It is critical to screen for ADHD in pediatric specialty clinics and assess healthy lifestyle behaviors.
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Merrill BM, Raiker JS, Evans SW, Gnagy EM, Pelham WE. Cognitive mechanisms of methylphenidate in ADHD: Do improvements in sustained attention mediate behavioral improvements in the natural environment? Child Neuropsychol 2021; 27:425-446. [PMID: 33525966 DOI: 10.1080/09297049.2020.1862074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The relation between sustained attention in the laboratory and behaviors exhibited in naturalistic settings among children with Attention Deficit/Hyperactivity Disorder (ADHD) remains unclear. Additionally, research on stimulant medication effects in these areas and their association with one another remains scarce. Twenty-one children with ADHD and 21 children without ADHD completed a novel continuous performance test (CPT) involving high cognitive demands (e.g., visual search). Participants with ADHD also attended a Summer Treatment Program and received three doses of stimulant medication (placebo, low, and high). Their behavior in classroom and peer settings was observed and recorded, and they completed the CPT in each medication condition. The CPT measures of bias and sensitivity were used in analyses. Results indicated that children with ADHD had impaired overall performance and worse bias during the second half of the task compared to controls. Methylphenidate improved both naturalistic behavior and overall CPT performance but did not specifically improve the sustained attention deficit. Despite improvements in overall CPT performance, medication-related improvement in CPT performance did not mediate medication-related improvement in observed behavior in classroom or recreational settings. As such, our findings suggest that although children with ADHD do demonstrate a sustained attention deficit, salutary psychostimulant effects on CPT performance are not indicative of, or causally linked to, psychostimulant effects on presenting problems in naturalistic settings.
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Babinski DE, Mazzant JR, Merrill BM, Waschbusch DA, Sibley MH, Gnagy EM, Molina BSG, Pelham WE. Lifetime caregiver strain among mothers of adolescents and young adults with attention-deficit/hyperactivity disorder. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2020; 34:342-352. [PMID: 31750692 PMCID: PMC7102920 DOI: 10.1037/fam0000609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The lifetime maternal caregiver strain (CS) associated with raising a child with attention-deficit/hyperactivity disorder (ADHD) into adolescence and young adulthood was examined in the Pittsburgh ADHD Longitudinal Study (PALS), a longitudinal study of individuals diagnosed with ADHD in childhood and recontacted in adolescence and young adulthood for yearly follow-up. Mothers of adolescents/young adults with (n = 364, 89.6% male; Mage = 19.79) and without childhood ADHD (n = 240, 88.8% male; Mage = 18.97) rated their lifetime maternal CS at Wave 3. Adolescent/young adult (AYA) ADHD and ODD severity measured at Wave 1, AYA delinquency measured at Wave 2, and school disciplinary actions combined from Waves 1 and 2 were explored as mediators of the association between childhood ADHD and lifetime maternal CS at Wave 3 using path analysis. AYA gender and age, parental marital status, maternal depression and ADHD, and highest parental education were included as covariates. Greater lifetime CS was reported among mothers of adolescents/young adults with versus without childhood ADHD. In the mediation model, direct effects of childhood ADHD on AYA ADHD and ODD severity, delinquency, and school discipline problems emerged, and direct effects of AYA ODD severity, delinquency, and school discipline problems on lifetime CS emerged. AYA ODD, delinquency, and school discipline mediated the association between childhood ADHD and lifetime maternal CS. These findings extend research on childhood ADHD to identify AYA sequelae contributing to maternal CS. Future research on the transaction between AYA functional impairment and maternal CS across the transition from adolescence into adulthood is needed to clarify opportunities for intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Macphee FL, Merrill BM, Altszuler AR, Ramos MC, Gnagy EM, Greiner AR, Coxe S, Raiker JS, Coles E, Burger L, Pelham WE. The Effect of Weighted Vests and Stability Balls With and Without Psychostimulant Medication on Classroom Outcomes for Children With ADHD. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.17105/spr-2017-0151.v48-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Merrill BM, Molina BSG, Coxe S, Gnagy EM, Altszuler AR, Macphee FL, Morrow AS, Trucco EM, Pelham WE. Functional Outcomes of Young Adults with Childhood ADHD: A Latent Profile Analysis. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:215-228. [PMID: 30689405 DOI: 10.1080/15374416.2018.1547968] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Adults with childhood attention-deficit hyperactivity disorder (ADHD) experience impairment in core functional domains (e.g., educational attainment, occupational status, social relationships, substance abuse, and criminal behavior), but it is currently unclear which impairments co-occur and whether subgroups experience differentiable patterns, none, or all aforementioned functional domains. Latent profile analysis (LPA) was used to characterize patterns of impairment. Data from the Pittsburgh ADHD Longitudinal Study were used. The 317 participants were 25 years old and had childhood ADHD. LPA characterized the variability across substance use (alcohol consumption, cigarette smoking, marijuana use), criminal behavior, peer impairment, educational attainment, maternal relationship, financial dependence, and sexual activity among young adults with childhood ADHD. Childhood predictors of profiles were examined, and ADHD profiles were compared to a matched comparison group without ADHD also followed longitudinally (n = 217). Five profiles were found: prototypic impairment group (54%), high binge-drinking group (17%), high marijuana use group (10%), high criminal activity group (3%), and high cross-domain impairment group (17%). All profiles were impaired compared to non-ADHD young adults. Childhood variables rarely significantly predicted profiles. Young adults with childhood ADHD have differentiable impairment patterns that vary based on substance use, criminal behavior, and number of clinically impaired domains. Nearly all young adult ADHD profiles were impaired in peer, educational, and financial domains, and there was not a nonimpaired ADHD profile. Use of specific substances was elevated among subgroups of, but not all, young adults with ADHD histories. Finally, the high cross-domain impairment profile was impaired in all domains.
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Merrill BM, Morrow AS, Altszuler AR, Macphee FL, Gnagy EM, Greiner AR, Coles EK, Raiker JS, Coxe S, Pelham WE. Improving homework performance among children with ADHD: A randomized clinical trial. J Consult Clin Psychol 2017; 85:111-122. [PMID: 27618639 PMCID: PMC5280087 DOI: 10.1037/ccp0000144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Evidence indicates that children with Attention Deficit Hyperactivity Disorder (ADHD) experience acute and prolonged academic impairment and underachievement including marked difficulty with completing homework. This study is the first to examine the effects of behavioral, psychostimulant, and combined treatments on homework problems, which have been shown to predict academic performance longitudinally. METHOD Children with ADHD (ages 5-12, N = 75, 71% male, 83% Hispanic/Latino) and their families were randomly assigned to either behavioral treatment (homework-focused parent training and a daily report card; BPT + DRC) or a waitlist control group. Children also participated in a concurrent psychostimulant crossover trial conducted in a summer treatment program. Children's objective homework completion and accuracy were measured as well as parent-reported child homework behaviors and parenting skills. RESULTS BPT + DRC had large effects on objective measures of homework completion and accuracy (Cohen's ds from 1.40 to 2.21, ps < .001). Other findings, including unimodal medication and incremental combined treatment benefits, were not significant. CONCLUSIONS Behavioral treatment focused on homework problems results in clear benefits for children's homework completion and accuracy (the difference between passing and failing, on average), whereas long-acting stimulant medication resulted in limited and largely nonsignificant acute effects on homework performance. (PsycINFO Database Record
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Altszuler AR, Morrow AS, Merrill BM, Bressler S, Macphee FL, Gnagy EM, Greiner AR, Coxe S, Raiker JS, Coles E, Pelham WE. The Effects of Stimulant Medication and Training on Sports Competence Among Children With ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2017; 48:S155-S167. [PMID: 28103159 PMCID: PMC6141352 DOI: 10.1080/15374416.2016.1270829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The current study examined the relative efficacy of behavioral sports training, medication, and their combination in improving sports competence among youth with attention deficit/hyperactivity disorder (ADHD). Participants were 73 youth (74% male; 81% Hispanic) between the ages of 5 and 12 diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed.) ADHD enrolled in a Summer Treatment Program (STP). The study consisted of a 2 (medication: methylphenidate, placebo) × 2 (sports training: instruction and practice, recreational play) between-groups design and was conducted over a 3-week period during the STP. Sports training was conducted with a novel sport, badminton, to limit previous sport knowledge and to differentiate it from concurrent sports training that occurred within the STP. Objective and subjective measures of sports skills, knowledge, and behavior were collected. Results indicated that, relative to recreational play, brief sports training improved observed and counselor-rated measures of sports competence including sports skills, knowledge, game awareness, effort, frustration, and enjoyment. During sports training, medication incrementally improved children's observed rule following behavior and counselor-rated sportsmanship relative to placebo. In the absence of sports training, medication improved behavior, effort, and sport knowledge. Training in sports skills and rules produced the largest magnitude effects on sports-related outcomes. Therefore, skills training, rather than medication alone, should be used in conjunction with behavioral intervention to teach sports to youth with ADHD. It is recommended that medication be used only as an adjunct to highly structured sports skills training for youth who display high rates of negative behavior during sports activities.
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Sibley MH, Campez M, Perez A, Morrow AS, Merrill BM, Altszuler AR, Coxe S, Yeguez CE. Erratum to: Parent Management of Organization, Time Management, and Planning Deficits among Adolescents with ADHD. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015. [DOI: 10.1007/s10862-015-9523-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sibley MH, Campez M, Perez A, Morrow AS, Merrill BM, Altszuler AR, Coxe S, Yequez CE. Parent Management of Organization, Time Management, and Planning Deficits among Adolescents with ADHD. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015; 38:216-228. [PMID: 28553010 DOI: 10.1007/s10862-015-9515-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Organization, Time Management, and Planning (OTP) problems are a key mechanism of academic failure for adolescents with ADHD. Parents may be well positioned to promote remediation of these deficits; yet, almost nothing is known about OTP management behaviors among parents of middle and high school students with ADHD. In a sample of 299 well-diagnosed adolescents with ADHD, a measure of parental OTP management was psychometrically validated. Latent Class Analysis was conducted to detect distinct patterns of parental OTP management and yielded four unique classes: Parental Control (18.7 %), Parent-Teen Collaboration (20.4 %), Homework Assistance (20.4 %), and Uninvolved (40.5 %). Logistic Regression analyses indicated that maladaptive parental OTP strategies were related to higher levels of parent and adolescent psychopathology. Parental OTP management did not relate to current adolescent OTP skills or GPA, indicating that parents did not select OTP management strategies in immediate response to adolescent functioning. Implications for parent-directed intervention are discussed.
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Sibley MH, Altszuler AR, Morrow AS, Merrill BM. Mapping the academic problem behaviors of adolescents with ADHD. SCHOOL PSYCHOLOGY QUARTERLY : THE OFFICIAL JOURNAL OF THE DIVISION OF SCHOOL PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION 2014; 29:422-437. [PMID: 24933215 PMCID: PMC4261004 DOI: 10.1037/spq0000071] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study possessed 2 aims: (a) to develop and validate a clinician-friendly measure of academic problem behavior that is relevant to the assessment of adolescents with attention deficit/hyperactivity disorder (ADHD) and (b) to better understand the cross-situational expression of academic problem behaviors displayed by these youth. Within a sample of 324 adolescents with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision diagnosed ADHD (age M = 13.07, SD = 1.47), parent, teacher, and adolescent self-report versions of the Adolescent Academic Problems Checklist (AAPC) were administered and compared. Item prevalence rates, factorial validity, interrater agreement, internal consistency, and concurrent validity were evaluated. Findings indicated the value of the parent and teacher AAPC as a psychometrically valid measure of academic problems in adolescents with ADHD. Parents and teachers offered unique perspectives on the academic functioning of adolescents with ADHD, indicating the complementary roles of these informants in the assessment process. According to parent and teacher reports, adolescents with ADHD displayed problematic academic behaviors in multiple daily tasks, with time management and planning deficits appearing most pervasive. Adolescents with ADHD display heterogeneous academic problems that warrant detailed assessment prior to treatment. As a result, the AAPC may be a useful tool for clinicians and school staff conducting targeted assessments with these youth.
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Stimmel JB, Merrill BM, Kuyper LF, Moxham CP, Hutchins JT, Fling ME, Kull FC. Site-specific conjugation on serine right-arrow cysteine variant monoclonal antibodies. J Biol Chem 2000; 275:30445-50. [PMID: 10880507 DOI: 10.1074/jbc.m001672200] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We have engineered a cysteine residue at position 442 (EU/OU numbering) in the third constant domain (C(H)3) of the heavy chain of several IgGs with different specificities, isoforms, and variants with the intent to introduce a site for chemical conjugation. The variants were expressed in NS0 mouse myeloma cells, where monomeric IgG is the major form and formation of aggregate was minimal. Monomeric IgG contained no free thiol; however, it was discovered that the engineered thiols were reversibly blocked and could be reduced under controlled conditions. Following reduction, reactive thiol was conjugated with a cysteine-specific bifunctional chelator, bromoacetyl-TMT to a humanized 323/A3 IgG4 variant. Conjugation had no significant effect on antibody affinity. To prove that the conjugation was site-specific, an antibody-TMT conjugate was labeled with lutetium-177 and subjected to peptide mapping followed by sequence analysis. Glu-C digestion demonstrated that 91% of the label was recovered in the COOH-terminal peptide fragment containing the engineered cysteine.
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Kim S, Merrill BM, Rajpurohit R, Kumar A, Stone KL, Papov VV, Schneiders JM, Szer W, Wilson SH, Paik WK, Williams KR. Identification of N(G)-methylarginine residues in human heterogeneous RNP protein A1: Phe/Gly-Gly-Gly-Arg-Gly-Gly-Gly/Phe is a preferred recognition motif. Biochemistry 1997; 36:5185-92. [PMID: 9136880 DOI: 10.1021/bi9625509] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Three sites of N(G),N(G)-arginine methylation have been located at residues 205, 217, and 224 in the glycine-rich, COOH-terminal one-third of the HeLa A1 heterogeneous ribonucleoprotein. Together with the previously determined dimethylated arginine at position 193 [Williams et al., (1985) Proc. Natl. Acad. Sci. U.S.A. 82, 5666-5670], it is evident that all four sites fall within a span of sequence between residues 190 and 233 that contains multiple Arg-Gly-(Gly) sequences interspersed with phenylalanine residues. These RGG boxes have been postulated to represent an RNA binding motif [Kiledjian and Dreyfuss (1992) EMBO J. 11, 2655-2664]. Dimethylation of HeLa A1 appears to be quantitative at each of the four positions. Arginines 205 and 224 have been methylated in vitro by a nuclear protein arginine methyltransferase using recombinant (unmethylated) A1 as substrate. This suggests A1 may be an in vivo substrate for this enzyme. Examination of sequences surrounding the sites of methylation in A1 along with a compilation from the literature of sites that have been identified in other nuclear RNA binding proteins suggests a methylase-preferred recognition sequence of Phe/Gly-Gly-Gly-Arg-Gly-Gly-Gly/Phe, with the COOH-terminal flanking glycine being obligatory. Taken together with data in the literature, identification of the sites of A1 arginine methylation strongly suggests a role for this modification in modulating the interaction of A1 with nucleic acids.
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Sheeley DM, Merrill BM, Taylor LC. Characterization of monoclonal antibody glycosylation: comparison of expression systems and identification of terminal alpha-linked galactose. Anal Biochem 1997; 247:102-10. [PMID: 9126378 DOI: 10.1006/abio.1997.2036] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CAMPATH-1H is a recombinant humanized murine monoclonal immunoglobulin (IgG1) which recognizes the CDw52 antigen of human lymphocytes, and has been the subject of clinical trials for the treatment of non-Hodgkin's lymphoma and rheumatoid arthritis. Peptide mapping by liquid chromatography-mass spectrometry was used to confirm the predicted amino acid sequences and profile glycosylation for two CAMPATH isotypes expressed in a murine myeloma cell line (NS0) and a single isotype expressed in both Chinese hamster ovary (CHO) and NS0 lines. The three major glycoforms identified in CAMPATH are fucosylated biantennary structures, containing zero, one, or two galactose residues. Glycosylation of the IgG1 form of CAMPATH expressed in CHO cells is consistent with normal human IgG. However, IgG1 and IgG4 expressed in NS0 cells include two potentially immunogenic glycoforms which contain either one or two nonreducing terminal alpha-linked galactose residues. Oligosaccharide structures were characterized by a combination of tandem mass spectrometry, methylation analysis, and exoglycosidase digestion. The strategy used here is designed to be widely applicable to recombinant glycoproteins.
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Halio SB, Blumentals II, Short SA, Merrill BM, Kelly RM. Sequence, expression in Escherichia coli, and analysis of the gene encoding a novel intracellular protease (PfpI) from the hyperthermophilic archaeon Pyrococcus furiosus. J Bacteriol 1996; 178:2605-12. [PMID: 8626329 PMCID: PMC177986 DOI: 10.1128/jb.178.9.2605-2612.1996] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
A previously identified intracellular proteolytic activity in the hyperthermophilic archaeon Pyrococcus furiosus (I. I. Blumentals, A. S. Robinson, and R. M. Kelly, Appl. Environ. Microbiol. 56:1992-1998, 1990) was found to be a homomultimer consisting of 18.8-kDa subunits. Dissociation of this native P. furiosus protease I (PfpI) into a single subunit was seen by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) but only after trichloroacetic acid precipitation; heating to 95 degrees C in the presence of 2% SDS and 80 mM dithiothreitol did not dissociate the protein. The gene (pfpI) coding for this protease was located in genomic digests by Southern blotting with probes derived from the N-terminal amino acid sequence. pfpI was cloned, sequenced, and expressed in active form in Escherichia coli as a fusion protein with a histidine tag. The recombinant protease from E. coli showed maximum proteolytic activity at 95 degrees C, and its half-life was 19 min at this temperature. This level of stability was significantly below that previously reported for the enzyme purified by electroelution of a 66-kDa band from SDS-PAGE after extended incubation of cell extracts at 98 degrees C in 1% SDS (>30 h). The pfpI gene codes for a polypeptide of 166 amino acid residues lacking any conserved protease motifs; no protease activity was detected for the 18.8-kDa PfpI subunit (native or recombinant) by substrate gel assay. Although an immunological relationship of this protease to the eukaryotic proteasome has been seen previously, searches of the available databases identified only two similar amino acid sequences: an open reading frame of unknown function from Staphylococcus aureus NCTC 8325 (171 amino acid residues, 18.6 kDa, 41% identity) and an open reading frame also of unknown function in E. coli (172 amino acid residues, 18.8 kDa, 47% identity). Primer extension experiments with P. furiosus total RNA defined the 5' end of the transcript. There are only 10 nucleotides upstream of the start of translation; therefore, it is unlikely that there are any pre- or pro-regions associated with PfpI which could have been used for targeting or assembly of this protease. Although PfpI activity appears to be the dominant proteolytic activity in P. furiosus cell extracts, the physiological function of PfpI is unclear.
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Porter DJ, Merrill BM, Short SA. Identification of the active site nucleophile in nucleoside 2-deoxyribosyltransferase as glutamic acid 98. J Biol Chem 1995; 270:15551-6. [PMID: 7797550 DOI: 10.1074/jbc.270.26.15551] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
2'-Fluoro-2'-deoxyarabinonucleosides are time-dependent inhibitors of nucleoside 2-deoxyribosyltransferase. 2,6-Diamino-9-(2'-deoxy-2'-fluoro-beta-D-arabinofuranosyl)-9H-purine (dFDAP) inhibited the enzyme by formation of a primary complex (Kd = 140 microM) that isomerized to a secondary complex with a first-order rate constant of 0.2 min-1. Inhibited enzyme contained stoichiometric amounts of covalently bound 2'-fluoro-2'-deoxyarabinosyl moiety, recovered less than 5% of its activity after storage for a week at 5 degrees C, but regained over 70% of the lost activity by treatment with 600 microM Ade. 6-Amino-9-(2'-deoxy-2'-fluoro-beta-D-arabinofuranosyl)-9H-purine (dFAdo) was a product of the reactivation reaction. Proteolysis of inhibited enzyme identified a modified fragment that spanned residues 82-107 which could not be sequenced past Gly-96. dFDAP-inhibited enzyme and enzyme reacted with normal substrates (i.e. dThd and dAdo) were hydrolyzed between Met-97 and Glu-98 by 0.1 M NaOH. These findings and model studies on the base lability of peptides containing glutamyl esters suggested that the gamma-carboxylate of Glu-98 was esterfied during catalysis. The role of Glu-98 was confirmed by changing this residue to alanine. The specific activity of wild-type enzyme was 3 orders of magnitude greater than that of the mutant enzyme. Collectively, chemical modification and mutagenesis studies have identified Glu-98 as the active site nucleophile of nucleoside 2-deoxyribosyltransferase.
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Burnette TC, Harrington JA, Reardon JE, Merrill BM, de Miranda P. Purification and characterization of a rat liver enzyme that hydrolyzes valaciclovir, the L-valyl ester prodrug of acyclovir. J Biol Chem 1995; 270:15827-31. [PMID: 7797586 DOI: 10.1074/jbc.270.26.15827] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Valaciclovir is an oral prodrug of the antiherpetic agent acyclovir. An enzyme that hydrolyzes valaciclovir to acyclovir, valaciclovir hydrolase (VACVase), was purified from rat liver and characterized. VACVase was a basic (pI 9.4) protein associated with mitochondria. It was monomeric and had a molecular mass of 29 kDa. Amino acid sequences of six VACVase peptides, including its NH2 terminus (13 amino acids) and accounting for approximately 20% of its complete sequence, were not found in the SwissProt protein data base. VACVase hydrolyzed other amino acid esters of acyclovir in addition to valaciclovir (kcat/Km = 58 mM-1 s-1), with a preference for the L-alanyl (kcat/Km = 226 mM-1 s-1) and L-methionyl (kcat/Km = 200 mM-1 s-1) esters. It did not hydrolyze other types of esters or numerous di- and tripeptides and aminoacyl-beta-naphthylamides. Hydrolysis of valaciclovir by VACVase was not inhibited by amastatin, antipain, aprotinin, bestatin, chymostatin, E-64, EDTA, ebelactone A, ebelactone B, elastatinal, leupeptin, pepstatin, or phosphoramidon. It was neither inhibited nor activated by Ca2+, Co2+, Mg2+, Mn2+, or Zn2+. Therefore, this enzyme is not a typical esterase or peptidase and, to our knowledge, it has not been described previously. Its physiological function is not known; however, it may play a significant role in the biotransformation of valaciclovir to acyclovir.
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Garvey EP, Tuttle JV, Covington K, Merrill BM, Wood ER, Baylis SA, Charles IG. Purification and characterization of the constitutive nitric oxide synthase from human placenta. Arch Biochem Biophys 1994; 311:235-41. [PMID: 7515611 DOI: 10.1006/abbi.1994.1232] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Human endothelial nitric oxide synthase (NOS) mRNA was detected in human placenta. In contrast, mRNAs for human neuronal NOS or for human inducible NOS were not detected in placenta. Subsequently, NOS was purified over 3800-fold from placental extract to greater than 80% homogeneity. A single band with an apparent molecular weight of 135 kDa was identified by [125I] calmodulin binding to proteins in a sodium dodecyl sulfate-polyacrylamide gel, which is consistent with the predicted size of the endothelial NOS. Furthermore, the sequence of eight internal peptides derived from this 135-kDa protein was identical to the published sequence of human endothelial NOS. As has been shown for all constitutive NOS isozymes, the purified NOS was absolutely dependent on calcium and calmodulin. NOS was also purified from human umbilical vein endothelial cells and, on the basis of similar kinetic parameters and dependence upon calcium and calmodulin, appeared to be the same as the purified placental NOS. Together, these data indicate that the placental NOS is the constitutive NOS isozyme from endothelial tissue.
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