Effect of Anodal and Cathodal Transcranial Direct Current Stimulation on DLPFC on Modulation of Inhibitory Control in ADHD

OBJECTIVE

The purpose of this study was to improve the inhibitory control functions through transcranial direct current stimulation (tDCS) in adolescents with ADHD symptoms.

METHOD

Twenty high school students with ADHD symptoms participated in this single-blinded, crossover, sham-controlled study. All the participants were tested during the application of Stroop and Go/No-Go tasks that is used to measure inhibitory control, using 1.5 mA of tDCS for 15 min over the left dorsolateral prefrontal cortex (DLPFC).

RESULTS

Anodal stimulation on left DLPFC had no effect on interference inhibition during the Stroop task and increased the proportion of correct responses in the "Go stage" of the Go/No-Go test compared with sham condition. Cathodal stimulation on the left DLPFC increased the inhibition accuracy in the inhibition stage during Go/No-Go task in comparison with sham.

CONCLUSION

tDCS over the left DLPFC of adolescents who suffer from ADHD symptoms can improve inhibitory control in prepotent response inhibition.

ADHD and Psychiatric Comorbidity: Functional Outcomes in a School-Based Sample of Children

Objective: Investigate the prevalence and impact of psychiatric comorbidities in community-based samples of schoolchildren with/without ADHD. Method: Teachers and parents screened children in South Carolina (SC; n = 4,604) and Oklahoma (OK; n = 12,626) for ADHD. Parents of high-screen and selected low-screen children received diagnostic interviews (SC: n = 479; OK: n = 577). Results: Psychiatric disorders were increased among children with ADHD and were associated with low academic performance. Conduct disorder/oppositional defiant disorder (CD/ODD) were associated with grade retention (ODD/CD + ADHD: odds ratio [OR] = 3.0; confidence interval [CI] = [1.5, 5.9]; ODD/CD without ADHD: OR = 4.0; CI = [1.7, 9.7]). School discipline/police involvement was associated with ADHD alone (OR = 3.2; CI = [1.5, 6.8]), ADHD + CD/ODD (OR = 14.1, CI = [7.3, 27.1]), ADHD + anxiety/depression (OR = 4.8, CI = [1.6, 14.8]), and CD/ODD alone (OR = 2.8, CI = [1.2, 6.4]). Children with ADHD + anxiety/depression had tenfold risk for poor academic performance (OR = 10.8; CI = [2.4, 49.1]) compared to children with ADHD alone. This should be interpreted with caution due to the wide confidence interval. Conclusion: Most children with ADHD have psychiatric comorbidities, which worsens functional outcomes. The pattern of outcomes varies by type of comorbidity.

How Is ADHD Assessed and Documented? Examination of Psychological Reports Submitted to Determine Eligibility for Postsecondary Disability

Objective: To examine how ADHD evaluations are documented for postsecondary students requesting disability eligibility. Method: A total of 100 psychological reports submitted for eligibility determination were coded for documentation of Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, methods and instruments used in the evaluations, and recommended academic accommodations. Results: Results showed that a minimal number of reports (≤1%) documented that students met all DSM criteria for ADHD. Psychologists rarely documented childhood impairment, symptoms across settings, or the use of rule-outs. Symptom severity was emphasized over current impairment. The majority of psychologists utilized a multi-informant, multi-method evaluation approach, but certain methods (e.g., symptom validity tests, record reviews) were limited in use. Most reports included recommendations for academic accommodations, with extended time being the most common (72%). Conclusion: This study raises awareness to the aspects of adequate ADHD evaluation and subsequent documentation that can be improved by psychologists. Recommendations are made regarding valid documentation of ADHD for disability determination purposes.

Social Cognition in Children With ADHD

Objective: Despite evidence of social skill deficits in children with ADHD, there is no consensus regarding a social cognitive profile and whether these skills predict behavior. Therefore, a comprehensive battery was used to investigate the relationship between social cognition and behavioral functioning. Method: Children ages 7 to 13 with ADHD (n = 25) and controls (n = 25) completed tests assessing social cognitive domains (affect recognition and theory of mind [ToM]). Parents completed measures of social cognition (pragmatic language ability and empathy), behavioral symptoms, and adaptive functioning. Results: Children with ADHD performed significantly worse on measures of cognitive ToM and affect recognition and received lower ratings of pragmatic language and cognitive empathy than typically developing peers. These domains, particularly pragmatic language, predicted parent ratings of problematic and adaptive behaviors. Conclusion: Results establish a relationship between specific social cognitive abilities and daily functioning, which has implications for treatment.

The Effectiveness of Daily Behavior Report Cards for Children With ADHD: A Meta-Analysis

Objective: This meta-analysis examined group-design studies investigating the effectiveness of Daily Behavior Report Cards (DBRC) as a school-based intervention to manage the classroom behavior of students with ADHD. Methods: A search of three article databases (PsycINFO, ERIC and Medline) identified seven group design evaluations of DBRC interventions. This meta-analysis included a total of 272 participants, with an average age of 7.9 years old. Three of the studies compared a control group to a treatment group with randomized group assignment, one study compared a control group to three treatment groups, two studies compared pre-and post-treatment scores in the same group, and one study compared pre-and post-treatment results of two intervention groups without random assignment. Dependent measures for these studies were teacher ratings (n = 5) and systematic direct observation of student academic and social behaviour (n = 2). Standardized mean differences (Hedge's g) were calculated to obtain a pooled effect size using fixed effects. Results: DBRCs were associated with reductions teacher-rated ADHD symptoms, with a Hedge's g of 0.36 (95% CI: 0.12-0.60, z=2.93, p ≤ .005) with low heterogeneity (Q-value: 2.40, I² = 0.00). This result excluded two studies that used observational coding instead of standardized tests to evaluate the effects of the intervention. A moderator analysis indicated that the effect size for systematic direct observation was large (Hedge's G = 1.05[95% CI: 0.66-1.44, z=5.25, p ≤ .00]), with very high heterogeneity (Q-value: 46.34, I²: 93.53). A second moderator analysis found differences in the effects of DBRCs for comorbid externalizing symptoms with an overall effect size of 0.34 (95%CI: -0.04-0.72, z=1.76 p =0.08) with high heterogeneity (Q-value: 3.98, I²: 74.85). Conclusions: DBRCs effectively reduce the frequency and severity of ADHD symptoms in classroom settings. Additionally, they have a significant effect on co-occuring externalizing behaviors. It appears that systematic direct observation may be a more sensitive measure of treatment effects compared to teacher ratings of ADHD symptoms.

Understanding and Measuring Functional Impairment in Diverse Children With ADHD: Development of the ADHD-FX Scale With an At-Risk, Community Sample

OBJECTIVE

The current study sought to develop a culturally appropriate measure of functional impairment related to ADHD for diverse families, as research suggests that functional impairment may be a more culturally universal construct than symptomatology.

METHOD

Seventy-four low-acculturated Latino parents (49 mothers and 25 fathers) of school-aged children provided quantitative and qualitative responses about problem recognition after viewing a language-free video of a child displaying symptoms and behaviors consistent with ADHD.

RESULTS

Thirty-two items were developed for the ADHD-FX scale based on most common responses given from participants. The scale is available in Spanish and English and instructs parents to consider how much each item affects their child in his or her everyday life (from 0 = not at all to 3 = a lot).

CONCLUSIONS

The scale can provide an overall impairment score, as well as subscale scores in the theoretically derived domains of academic, peer, and familial impairment. (J. of Att. Dis. 2016; 20(6) 487-500).

The use of compensatory strategies in adults with ADHD symptoms

This study examined the use of compensatory strategies reported by adults with ADHD symptoms and their relation to measures of functioning. Forty-nine adults (55.1 % female) completed a structured diagnostic interview to assess ADHD, and responses were coded for compensatory strategies: Adaptation, Paying Attention, Organization, External Support, and Avoidance. The majority of adults with ADHD symptoms reported using compensatory strategies, and their reported strategy use in childhood was related to their use in adulthood. No gender differences were found in the use of strategies, although Organization and External Support were used more often for inattention than for hyperactive/impulsive symptoms. Use of the compensatory strategy, Adaptation, was significantly related to measures of functioning, and the use of strategies reduced the negative relationship between ADHD symptoms and parenting difficulties. Results encourage the development of compensatory strategies among adults with ADHD symptoms, as well as provide recommendations for treatment programs.

Profiles of Diagnosed and Undiagnosed College Students Meeting ADHD Symptom Criteria

Objective: This study compared the psychological profiles of college students who self-reported an ADHD diagnosis in contrast to students without a diagnosis who reported above-threshold ADHD symptoms. Method: A large sample of college students yielded four subgroups: students with a self-reported diagnosis who met symptom criteria (Diagnosed, n = 40), students with a self-reported diagnosis who did not meet symptom criteria (Low Symptoms, n = 47), students who had no diagnosis and did not meet symptom criteria (Controls, n = 87), and students who had no diagnosis yet met symptom criteria (Undiagnosed, n = 38). All participants completed a battery of self-report rating scales assessing a variety of symptom and impairment domains. Results: The Diagnosed and Undiagnosed groups differed significantly from Controls on all domains, while the Low Symptom group did not differ significantly from Controls in any domain. Conclusion: Implications for engaging with reported diagnosis of ADHD in the college population are discussed.

Prevalence and Correlates of ADHD Among Adolescent Students in Nigeria

OBJECTIVE

To determine the prevalence and psychosocial correlates of ADHD among adolescents in Jos, Nigeria.

METHOD

A cross-sectional descriptive two-stage study of 487 randomly selected participants using Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL), Raven's Standard Progressive Matrix (SPM) and the Children's Global Assessment Score (CGAS).

RESULTS

The prevalence of ADHD was 8.8%. The subtypes found were inattentive (3.08%), hyperactive-impulsive (2.05%), and combined (3.08%); male:female ratio of 1.4:1. ADHD was significantly associated with use of substance by father (odds ratio [OR] = 0.35; 95% confidence interval [CI] = [0.154, 0.781]), use of substance by mother (OR = 0.2; 95% CI = [0.055, 0.711]), and lower education of mother (OR = 0.3 95% CI = [0.116, 0.693]). Poor quality of handwriting (χ² = 8.120; p = .010) and impaired global functioning ( t test = 10.756; p < .001) were significantly associated with ADHD in the adolescents.

CONCLUSION

Given the burden of ADHD, efforts should be made to establish a system for the early identification and management.

Executive Functioning and Impairment in Emerging Adult College Students With ADHD Symptoms

Objective: To better understand current issues with adult ADHD assessment contributing to adult ADHD being under recognized and undertreated. Method: This study examined the relationship between symptoms, impairment, and executive functioning (EF) in a college sample. Results: Among individuals screening negative for ADHD, those higher in EF experienced significantly less impairment than those lower in EF. Executive functioning was shown to have a negative relationship with impairment while ADHD symptomology was shown to have a positive relationship with impairment. In addition, impairment was significantly predicted by ADHD symptom level and EF, and there was a significant interaction between EF and ADHD symptom level in predicting impairment. However, high EF did not significantly protect against impairment in individuals reporting a significant level of ADHD symptoms. Conclusion: Further research is needed to clarify the relationships between these variables in emerging adult college students.

Possible Age-Related Progression of Attentional Impairment in ADHD and Its Attenuation by Past Diagnosis and Treatment

Objective: The aim of the study is to evaluate attentional impairment in different age groups with ADHD. Method: In all, 58 children, 73 adolescents, and 104 adults with ADHD were evaluated using the Test of Variables of Attention (TOVA). Subjects with comorbidities or psychotropic treatment were not included. Results: Considering Response Time Variability (RTV), adults were 10.6 and 4.0 times more likely to be severely impaired (standard score < 40) than children and adolescents, respectively. Adults were twice as likely as adolescents to be very impaired (standard score< 70) in Omissions. Considering d' (decrement of attentional performance over time), all severely impaired participants were adults. Age predicted impairment in Attention Performance Index (API), RTV, and d', but not Omissions or Commissions. Past treatment with stimulants predicted less impairment in d', past diagnosis predicted less impairment in RTV, and each predicted less impairment in Omissions and API. Conclusion: Adults had more attentional impairment than children and adolescents. Past diagnosis and treatment were associated with less ADHD-related attentional impairment.

Impact of ADHD on Household Chores

Objective: To assess the relationship between ADHD and performance of household chores. Method: A 72-question online questionnaire was developed to collect demographic/clinical information as well as parents' assessment of their child's performance of self-care (SC) and family-care (FC) chores. Results: The sample consists of 797 primary caregivers of children with ADHD. The overwhelming majority of parents believed that ADHD to some extent affected their child's ability to independently and satisfactorily complete SC and FC chores. An inverse relationship was noted between parent ratings of a child's ability to do chores independently and satisfactorily and the likelihood they believed ADHD affected chore performance. There was no difference in chore performance between children with or without co-morbid oppositional defiant disorder. Conclusion: Given that household routines, including chores, play an important role in children's development and psychosocial adjustment, clinicians must be sensitive to the adverse impact that ADHD may have in this regard.

Event Perception and Social Skills in Undergraduates with ADHD Symptoms

BACKGROUND

Event perception provides a promising, novel approach for investigating underlying cognitive mechanisms of the social impairment associated with symptoms of ADHD.

AIMS

The goal of this study was to establish the relationship among event perception, symptoms of ADHD, and social skills.

METHODOLOGY

Eighty-three undergraduates were recruited from the University of Ottawa first year psychology courses (38 with ADHD, 45 without ADHD). They performed an event perception task and completed self-report questionnaires assessing social functioning and symptoms of ADHD (The Social Skills-Improvement System and the Conner's CBRS-SR).

RESULTS

Bootstrapping mediation analyses revealed that symptoms of inattention and hyperactivity mediated the relationship between event perception and social skills. A model with predictor and mediator reversed was also tested, and was not significant, providing strength to the directionality of the relationships. Results highlight the applicability of event perception to understanding the association between social impairment and symptoms of ADHD.

Incremental Clinical Utility of ADHD Assessment Measures With Latino Families

Objective: This study examined the incremental clinical utility of parent and teacher reports of ADHD symptomatology and functional impairment in Latino youth, as well as parent and teacher agreement with the final clinical judgment on a diagnostic structured interview. Method: Participants included 70 Latino youth (47 males, 23 females; M age = 8.13 years, SD = 2.51 years) and their parents and teachers; 60 participants were diagnosed with ADHD. Correlations, percent agreement, kappas, and regressions were utilized. Results: Results demonstrated that teachers agreed with the final clinical judgment more often than did parents. Results additionally demonstrated that functional impairment did not statistically significantly improve diagnostic models already including ADHD symptoms; follow-up analyses were run and are discussed. Finally, results demonstrated that teacher reports statistically significantly improved diagnostic models already including parent reports. Conclusion: The current findings suggest the importance of including both parent and teacher reports of both ADHD symptomatology and functional impairment when assessing ADHD in Latino youth.

Impact of Medication on Performance of Household Chores by Children with ADHD

OBJECTIVE

To investigate associations between ADHD medication and household chore performance by children with ADHD.

METHODS

A parent questionnaire collected information about the adequacy and quality of their child's performance of two self-care and six family-care chores. Parent perceptions of ADHD medication effect duration were used to identify children with after-school medication benefits (ASMB). Mann-Whitney U tests compared children with and without ASMB across measures of chore performance.

RESULTS

A total of 565 parents of children with ADHD that regularly take medication completed the questionnaire. Children with ASMB were more likely to meet parental expectations for five of eight household chores and were more likely to be able to independently complete both self-care and family-care chores than those without ASMB. No differences were noted regarding their need for reminders or assistance with chores.

CONCLUSION

Improvement in chore performance may be an additional consideration with respect to medication selection for children with ADHD.

Disregarding Impairment in ADHD Diagnosis Inflates Its Prevalence

Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-V) diagnostic criteria for attention-deficit hyperactivity disorder (ADHD) has reemphasized impairment although many studies have demonstrated that such approach may inflate prevalence rates. However, there is no consensus on how impairment should be measured and a myriad of approaches in different studies make comparisons difficult. Objective: To investigate whether impairment measured using a previous validate quantitative measure modifies prevalence rates in a sample of Brazilian children and adolescents. Method: Of 109 children (72 males, 37 females), mean age of 12.4 years, 68 were with ADHD (according to DSM criteria, except for impairment) and 41 were typically developing children. All were evaluated with semi-structured interviews and completed the Functional Impairment Scale (FIS). Results: Thirty-five percent of ADHD cases had impairment in one single domain or no impairment at all (among school performance, social life, family life, and self-perception) in the FIS. Conclusion: Disregarding impairment clearly inflates ADHD diagnosis.

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.