Journal of Attention Disorders RSS feed -- OnlineFirst Articles

Current Literature in ADHD

Goldstein, S. — Fri, 06 Nov 2009 12:56:38 PST

The Comorbidity of ADHD in the General Population of Saudi Arabian School-Age Children

Alqahtani, M. M. — Thu, 22 Oct 2009 15:07:33 PDT

Objective: To investigate comorbidity of oppositional-defiant disorder (ODD), conduct disorder (CD), anxiety, and depression and to investigate the impaired social and academic developments among children with ADHD in primary school settings in Saudi Arabia. Method: Data for the purpose of this study are obtained from parent and teachers of 652 primary school children attending Grades 1 to 3 (children aged between 7 and 9 years). Vanderbilt ADHD diagnostic rating scale, which has relevance and found to be reliable by previous studies, is used in the study. Results: ODD and CD are reported to be present in close to two thirds (73%) of children with ADHD, as assessed with DSM-IV-TR criteria. Anxiety and depression disorder are estimated to be present in 36% of children with ADHD. Children with ADHD show high levels of impairment in academic achievements (63%) and social performance (90%), compared with non-ADHD children. Conclusion: These findings suggest that a significant minority of disruptive children may have their difficulties compounded by the presence of ADHD, which raises the question whether their problems are known and whether they have received appropriate help. It is important to develop a specific set of psychological clinical intervention for helping children with ADHD, ODD, CD, and other related problems. Educating teachers and parents about ADHD and its comorbidity is considered essential in this regard.

Order of Conners' CPT-II Administration Within a Cognitive Test Battery Influences ADHD Indices

Erdodi, L. A., Lajiness-O'Neill, R., Saules, K. K. — Thu, 15 Oct 2009 09:58:43 PDT

Objective: To study the effect of administration sequence on Conner’s continuous performance test (CPT-II) scores in clients requesting psychological assessment. It was hypothesized that when administered at the end rather than beginning of a test battery, the test scores will show higher symptom severity. If present, order effects may cause the over- or underdiagnosing of ADHD. Method: Participants were recruited at a Midwestern university’s training clinic (16 men, 9 women; mean age = 22.4, SD = 10.2). The CPT-II was administered twice to each client: once at the beginning of the testing session and once at the end of their appointment. The clients completed at least a full Wechsler intelligence battery in between the CPT-II administrations. Results: Clients’ ADHD index score (interpreted as percent confidence in an ADHD diagnosis) is more impaired at Time 2 (M = 53.3, SD = 29.0) compared to Time 1 (M = 39.4, SD = 22.5): t(24) = 3.93, p < .05, Cohen’s d = .79. The number of T-scores above 60 on the subscales also changed from Time 1 (M = 1.92, SD = 1.73) to Time 2 (M = 3.12, SD = 2.05): t(24) = 3.47, p < .01, Cohen’s d = .71. Conclusions: If the CPT-II is administered later in a sequence of tests, it is more likely to yield scores in the impaired range. Order effects are more pronounced in individuals diagnosed with ADHD. Recommendations include the adoption of a standardized administration sequence, further research to investigate the nature of order effects, and a strategic use of order effects in ADHD assessment. (J. of Att. Dis. 2007; XX(X) xx-xx)

Subclinical ADHD, Stress, and Coping in Romantic Relationships of University Students

Overbey, G. A., Snell, W. E., Callis, K. E. — Thu, 08 Oct 2009 11:43:01 PDT

Objective: To examine how the subclinical symptoms of adult ADHD and those of oppositional-defiant disorder (ODD) affect relationship satisfaction and stress and to determine whether different patterns of coping strategies emerge when undergraduates have symptoms of one or both disorders. Method: Participants (N = 497) complete self-report surveys assessing ADHD and ODD symptoms, relationship satisfaction, stress, and coping strategies used in their intimate relationships. Results: ADHD and ODD symptoms are significantly related to a number of stressors and different patterns of coping strategies. University students with symptoms of both ADHD and ODD display a different pattern of stressors and different patterns of coping than those with symptoms of ADHD only. Conclusion: Screenings for both ADHD and ODD and the provision of services that offer students more constructive coping alternatives to deal with stress in their intimate relationships are needed on university campuses. (J. of Att. Dis. XXXX; XX(X) XX-XX)

A Verbal Planning Impairment in Adult ADHD Indexed by Script Generation Tasks

Desjardins, C., Scherzer, P., Braun, C. M.J., Godbout, L., Poissant, H. — Thu, 08 Oct 2009 11:43:01 PDT

Though juvenile and adult ADHD cases are well known to have a nonverbal planning impairment, a verbal-planning impairment has been demonstrated only in juvenile ADHD. The purpose of this investigation is to determine whether a verbal planning impairment also characterizes adult ADHD. A cohort of 30 adult ADHD clients of a university psychological clinic are compared to 30 age-, education-, gender-, and IQ-matched persons recruited from the general population who did not have ADHD. The dependent measure is a set of 6 paper/pencil 10-item script generation tasks. The findings reveal that the ADHD cohort was significantly impaired on the script task and the script task correlated significantly with severity of ADHD (CAARS index + WURS), whereas several neuropsychological measures of executive function (Stroop, COWA, Rey’s Complex Figure, D2, CVLT, CPT-II) did not. Findings further showed that the script measure was weakly correlated with the other established neuropsychological measures of executive function (r < .46, shared variance of less than 21%). On the basis of the study findings, it is concluded that verbal planning measured with script generation tasks is distinctly impaired in clinically referred adult ADHD.

Getting Clued In: Inferential Processing and Comprehension Monitoring in Boys With ADHD

Berthiaume, K. S., Lorch, E. P., Milich, R. — Thu, 08 Oct 2009 11:43:00 PDT

Objective: The present study examines the ability of children with ADHD to make inferences and monitor ongoing understanding of texts, to shed light on their academic difficulties. Method: A total of 29 boys with ADHD and 41 comparison boys between the ages of 7 and 12 participated. Three tasks measure how boys create and evaluate inferences, particularly explanatory inferences, and how they monitor their understanding of story events and the connections among them. Results: Boys with ADHD are less able than their comparison peers to make appropriate inferences, particularly explanatory inferences. They also have more trouble identifying text inconsistencies. Conclusions: Findings suggest that difficulties in making inferences and monitoring ongoing comprehension among children with ADHD may contribute to story comprehension problems and in turn to academic difficulties experienced by these children. Interventions specifically focusing on understanding causal connections, creating inferences, and monitoring ongoing understanding of stories need to be investigated. (J. of Att. Dis. 2007; XX(X) 1-XX)

Attention Training for School-Aged Children With ADHD: Results of an Open Trial

Mon, 05 Oct 2009 11:55:21 PDT

Objective: The article discusses a feasibility study conducted to examine whether Pay Attention!, an intervention training sustained, selective, alternating, and divided attention, could be utilized in a clinical setting with children diagnosed with ADHD, and whether children who received the intervention made attention and executive functioning gains. Method: After a diagnostic and baseline evaluation, 23 school-aged children with ADHD participate in up to 16 sessions of Pay Attention! and the outcomes are evaluated. Results: Results show the intervention is feasible to administer and acceptable to participants. Parents and clinicians rate fewer ADHD symptoms following the intervention and report improvements in executive function. Child performance on neuropsychological tests showed improvements in fluid reasoning and cognitive flexibility and working memory. Conclusion: The findings suggest that a randomized clinical trial of Pay Attention! is warranted to investigate its viability as a treatment for attention and executive functioning deficits in ADHD. (J. of Att. Dis. 2007; XX(X) 1-XX)

Shared and Nonshared Symptoms in Youth-Onset Psychosis and ADHD

Karatekin, C., White, T., Bingham, C. — Mon, 05 Oct 2009 11:55:21 PDT

Objective: We compared ratings of behavior and attention problems between youth-onset psychosis and ADHD, two disorders in which attentional impairments play a key role, and examined the effect of psychostimulant use on age of onset in psychosis. Method: Parent and teacher ratings of behavioral problems and ADHD symptoms were collected using the Achenbach CBCL, TRF, and SNAP-IV Teacher Rating Scales on 42 participants with psychosis, 36 with ADHD and 57 controls (ages 8-19). Results and Conclusions: Results suggested that academic, externalizing, and attention problems reflect symptoms shared between the disorders, whereas internalizing, social and thought problems reflect factors that differ between disorders. Furthermore, participants with psychosis who had been prescribed psychostimulants had a younger age of onset of psychotic symptoms than those who had not. This difference could reflect dissimilarities in symptom severity symptom between subgroups or potentially harmful effects of psychostimulants in individuals predisposed to develop psychosis. (J. of Att. Dis. 2007; XX(X) 1-XX)

Maternal Anxiety and Attention Problems in Children at 5 and 14 Years

Mon, 05 Oct 2009 11:55:21 PDT

Objective: This study examines the association between maternal anxiety from pregnancy to 5 years and child attention problems at 5 and 14 years. Method: Birth cohort of 3,982 individuals born in Brisbane between 1981 and 1983 are assessed. Self-reported measures of maternal anxiety are assessed at four time points. Maternal reports of child attention problems using Achenbach’s Child Behavior Checklist are assessed at 5 and 14 years. Results: Children of mothers experiencing anxiety during or after pregnancy are at greater risk of experiencing attention problems at 5 and 14 years. After adjusting for maternal age and child’s gender, antenatal anxiety is strongly associated with persistent attention problems (OR = 3.65, 95% CI = 2.19, 6.07). Children with chronically anxious mothers are 5.67 (95% CI = 3.56, 9.03) times more likely to have persistent attention problems. These associations remain consistent after adjusting for potential confounders. Conclusions: Maternal anxiety appears to increase the rate of child attention problems and identifies a need for treatment programs to have a dual focus—the mother and her child. (J. of Att. Dis. 2009; XX(X) 1-XX)

Validation of the Adult ADHD Investigator Symptom Rating Scale (AISRS)

Wed, 30 Sep 2009 13:16:16 PDT

Objective: Validation of the Adult ADHD Investigator Symptom Rating Scale (AISRS) that measures aspects of ADHD in adults. Method: Psychometric properties of the AISRS total and AISRS subscales are analyzed and compared to the Conners’ Adult Attention-Deficit/Hyperactivity Disorder Rating Scale-Investigator Rated: Screening Version (CAARSInv: SV) and the Clinical Global Impression-ADHD-Severity Scale using data from a placebo-controlled 6-month clinical trial of once-daily atomoxetine. Results: The AISRS has high internal consistency, good convergent, and discriminant validities; modest divergent validity; and small ceiling and floor effects (≤1%). It correlates highly with the CAARSInv: SV. Factor analysis confirms 2 AISRS subscales, hyperactivity-impulsive scale and inattention. The AISRS total and AISRS subscales perform stably. All scales demonstrate responsiveness to change with medication. Conclusion: The AISRS and its subscales are robust, valid efficacy measures of ADHD symptoms in adult patients. Its anchored items and semistructured interview are advancements over existing scales. (J. of Att. Dis. 2007; XX(X) 1-XX)

The Identification of Attention Complaints in the General Population and Their Effect on Quality of Life

Wed, 30 Sep 2009 13:16:15 PDT

Objective: To provide more insight into subjective attention complaints in a healthy adult and elderly population and how these affect Quality of Life (QoL). Method: A group of 1,550 healthy Dutch participants complete a postal questionnaire including items from the Maastricht Attention and Memory Checklist (MAC).The impact of attention complaints on QoL is investigated in a subsample of 499 participants. Results: Factor analysis (N =1,550) reveals two factors:Attention and Memory.Attention complaints are related to depressed mood, anxiety, vitality, and sleep problems that can have serious consequences for daily life functioning and QoL (n =499). Memory complaints are related to other aspects of health, such as pain and changes in health. Conclusion: Attention complaints in the healthy population are common and related to depression, anxiety, and sleep and several aspects of QoL, such as problems with social functioning, emotional problems, and vitality.

Fading Memories: Retrospective Recall Inaccuracies in ADHD

Miller, C. J., Newcorn, J. H., Halperin, J. M. — Wed, 30 Sep 2009 13:16:15 PDT

Objective: This longitudinal study examines the recall accuracy of childhood ADHD symptoms in late adolescence and early adulthood by youth and their parents, compared with reports obtained during childhood. Method: Participants (N = 94) are initially evaluated when they are aged between 7 and 11 and reassessed when they are aged between 16 and 22 years. All participants meet full DSM-IV diagnostic criteria for ADHD in childhood. Assessments at baseline and follow-up include clinical interviews and ADHD checklists. Results: Results indicate that both youth and their parents have limited retrospective recall of childhood symptoms. Current ADHD symptoms improve accuracy of recall. Specifically, when current symptoms are endorsed, participants are more likely to recall clinically significant childhood ADHD symptoms. Conclusion: These results suggest that late adolescents and young adults with ADHD and their parents have limited ability to accurately recall childhood symptoms, with reporting of past symptoms influenced by reports of severity of current symptoms. (J. of Att. Dis. 2007; XX(X) 1-XX)

Reduced Capacity in a Dichotic Memory Test for Adult Patients With ADHD

Dige, N., Maahr, E., Backenroth-Ohsako, G. — Fri, 25 Sep 2009 16:10:19 PDT

Objective: To evaluate whether a dichotic memory test would reveal deficits in short-term working-memory recall and long-term memory recall in a group of adult patients with ADHD. Methods: A dichotic memory test with ipsilateral backward speech distraction in an adult ADHD group (n = 69) and a control group (n = 66) is used to compare performance between the groups and inside the subgroups of ADHD diagnosed with DSM-IV. Results: The ADHD participants showed significant impairment in the dichotic memory test compared with control participants when controlled for age, sex, and education. Study findings reveal that there is no difference in subdivision in the three ADHD subgroups of DSM-IV. A discriminant analysis shows an overall classification rate of 78% and specific in ADHD 80%. Conclusions: The results indicate that the dichotic test is measuring one of the important ADHD deficits.

Parental Attributions for Success in Managing the Behavior of Children With ADHD

Coles, E. K., Pelham, W. E., Gnagy, E. M. — Fri, 25 Sep 2009 16:10:20 PDT

Objective: The current study evaluated the effects of differing intensities of behavior modification and medication on parents’ self-reported success in managing their child*rsquo;s misbehavior and the attributions parents gave for success or failure. Method: Children were randomized to receive in counterbalanced orders different levels of behavior modification, each for 3-week cycles. In addition, medication was manipulated using a medication assessment procedure. Parents reported daily how successful they were in managing their child’s misbehavior and the attributions for either their success or failure. Results: Parents of children with ADHD generally felt successful in managing their child’s behavior, regardless of treatment condition. In the high behavior modification condition, they were more likely to endorse items that attributed their success to their own effort. Conclusion: In conditions in which parents were given more intensive tools to manage misbehavior they were more likely to attribute their success to their own effort.

Short-Term Effects of Playing Computer Games on Attention

Tahiroglu, A. Y., Celik, G. G., Avci, A., Seydaoglu, G., Uzel, M., Altunbas, H. — Tue, 22 Sep 2009 18:09:38 PDT

Objective: The main aim of the present study is to investigate the short-term cognitive effects of computer games in children with different psychiatric disorders and normal controls. Method: 101 children are recruited for the study (aged between 9 and 12 years). All participants played a motor-racing game on the computer for 1 hour. The Stroop TBAG test was applied to all participants twice (pretest: before playing the computer game, posttest: then immediately after playing the game. Results: Participants with improved posttest scores, compared to their pretest scores, used the computer on average 0.67 ± 1.1 hr/day, while the average use of computers was measured at 1.6 ± 1.4 hr/day and 1.3 ± 0.9 hr/day for participants with worsened or unaltered scores, respectively. According to the regression model, male gender, younger ages, duration of daily computer use, and ADAD (attention deficit hyperactivity disorder) inattention type were found to be independent risk factors for worsened posttest scores. Conclusions: Time spent playing computer games can exert a shortterm effect on attention as measured by the Stroop test. (J. of Att. Dis. 2007; XX(X) 1-XX)

Potential Impact of ADHD With Stimulant Medication Label on Teacher Expectations

Batzle, C. S., Weyandt, L. L., Janusis, G. M., DeVietti, T. L. — Tue, 22 Sep 2009 18:09:39 PDT

Objective: The present study investigated how teachers rated children’s Behavior, IQ, and Personality contingent on the presence or absence of an Attention Deficit Hyperactivity Disorder (ADHD) label. Method: Teachers from K-12 read a hypothetical description of either a male or female child with no label, an ADHD label, or an ADHD with stimulant treatment label. Teachers responded to 30, 7-point Likert rating scales anchored with descriptors related to Behavior, IQ, and Personality. Results: Teachers rated the child with an ADHD label and ADHD with stimulant treatment label significantly less favorably than the child with no label. Results partially supported that teachers rated the child with an ADHD label significantly less favorably than the child with an ADHD with stimulant treatment label. Conclusion: Teachers rated the children with ADHD and ADHD with stimulant treatment label less favorably than the child with no label. Implications for educators and future research are discussed. (J. of Att. Dis. 2007; XX(X) 1-XX)

Childhood Attention Deficit Hyperactivity Disorder, Substance Use, and Adult Functioning Among Incarcerated Women

Hennessey, K. A., Stein, M. D., Rosengard, C., Rose, J. S., Clarke, J. G. — Tue, 22 Sep 2009 18:09:38 PDT

Objective: To estimate prevalence of childhood ADHD among incarcerated women and determine its association with substance use and adult functioning. Method: 192 female participants are recruited from the Department of Corrections in Rhode Island. Childhood ADHD is defined as scoring >46 on the Wender Utah Rating Scale. Results: The findings reveal that 46% met criteria for childhood ADHD. Multivariate analysis reveal that women meeting WURS criteria were more likely to be inconsistently employed (OR = 0.23, 95% CI = 0.10-0.54), recently homeless (OR = 2.09, 95% CI = 1.02-4.30), lifetime incarceration of more than 90 days (OR = 3.00, 95% CI = 1.37-6.57), current smokers (OR = 2.99, 95% CI = 1.24-7.20), and ever used marijuana regularly (OR = 3.47, 95% CI = 1.61-7.45). Conclusion: Among incarcerated women, childhood ADHD is associated with negative social and health behaviors.

Is the Inattentive Subtype of ADHD Different From the Combined/Hyperactive Subtype?

Grizenko, N., Paci, M., Joober, R. — Fri, 18 Sep 2009 17:11:42 PDT

Objective: To compare the ADHD combined/hyperactive subtype (ADHD/CH) to the ADHD inattentive subtype (ADHD/I) on the level of comorbidity, treatment response, and possible etiological factors. Method: A total of 371 clinically referred children diagnosed with ADHD aged between 6 and 12 years are recruited for a double-blind, placebo-controlled trial of methylphenidate. Comorbidity, treatment response, and stress during pregnancy are assessed for each participant. Genotyping is done for the DAT, DRD4, and 5-HTT genes. Mothers report smoking or alcohol consumption during their pregnancy and their child’s birth weight. Results: The ADHD/CH children show both a higher frequency of conduct disorder and good response to treatment, are exposed to more moderate stress during their mothers’ pregnancy, and show a higher frequency of L/L genotype for the 5-HTT-linked polymorphic region. Conclusion: The significant differences found between the ADHD/CH and the ADHD/I subtypes raise the possibility that the two may be separate disorders.

Resilience and Well-being in College Students With and Without a Diagnosis of ADHD

Wilmshurst, L., Peele, M., Wilmshurst, L. — Fri, 18 Sep 2009 17:11:41 PDT

Objective: The study examines psychological well-being and self-concept in college students diagnosed with ADHD. Method: We surveyed 17 undergraduate college students with ADHD and 19 undergraduate controls concerning academic and emotional support received from family and friends. All students completed the Connor’s Continuous Performance Test (CPT-II), Connor’s Adult Rating Scale (CAARS), Tennessee Self-Concept Scale (TSCS:2) and Psychological Well-Being Scale (PWB). Results: Between group differences were significant for the CAARS and CPT-II, but not total self-concept (TSC) or global PWB. The strongest predictors for TSC were environmental mastery (PWB) for the ADHD group and positive relations with others (PWB) for the controls. Students with ADHD reported significantly higher paternal support than controls who reported significantly greater support from friends. Conclusion: College students with a diagnosis of ADHD may represent an especially resilient group. Future studies should investigate competencies of students with ADHD who have achieved success against the odds.

Short-Term Effectiveness of Medication and Psychosocial Intervention in a Cohort of Newly Diagnosed Patients With Inattention, Impulsivity, and Hyperactivity Problems

Falissard, B., Coghill, D., Rothenberger, A., Lorenzo, M. — Fri, 18 Sep 2009 17:11:42 PDT

Objective: The article discusses the ADHD Observational Research in Europe (ADORE) study that examined the impact of early treatment choices on outcome within the first few months, in previously untreated children with impairing inattention, impulsivity, and hyperactivity. Methods: Data are collected from a longitudinal, observational study conducted in 10 European countries that involve 1,478 children (aged 6 to 18 years) with symptoms of hyperactivity, impulsivity, or inattentiveness. Linear model with a propensity score adjustment compares the decrease in ADHD-RS scores between baseline and last recorded visit across treatment groups (2 to 5 months). Results: At baseline, 49.9% of participants are prescribed pharmacotherapy and 44.3% a psychosocial intervention. Analysis of the effect of treatment on the evolution of ADHD-RS scores shows a positive effect of medications and either an insignificant or negative effect of psychosocial intervention. Conclusions: Early use of medication effectively reduces ADHD symptoms in routine clinical practice in Europe. The effect of psychosocial intervention has to be interpreted cautiously because the number, length, and level of standard of the sessions are not taken into account in the analyses. (J. of Att. Dis. 2007; XX(X) xx-xx).

Parent Perceived Impact of Spaniard Boys' and Girls' Inattention, Hyperactivity, and Oppositional Defiant Behaviors on Family Life

Fri, 18 Sep 2009 17:11:42 PDT

Objective: This study examined the impact of inattention, hyperactivity, and oppositional defiant disorder (ODD) behaviors and gender on family life. Method: We created scales for the Family Experiences Inventory (FEI) in a nonclinical sample of Spaniard families with children ages 6 to 12 years (N = 369) and analyzed the perceived impact of these three behavior dimensions on family experiences. Results: Multiple regression analyses indicated that ODD behaviors were uniquely correlated with Total FEI and its dimensions. Inattention was also uniquely related to higher negative Impact on School Relations and lower Positive Impact on Parents scales. Finally, gender–hyperactivity interactions indicated that boys with higher hyperactivity scores were more likely to score higher on the FEI Total, School Relations, and Siblings scales, and more likely to score lower on the Positive Impact on Parents scale than girls. Conclusions: These findings suggested that parents perceive greater child-related impact and place greater burden from having a male child with hyperactivity. Inattention, hyperactivity, and oppositional defiant behaviors are associated with global parent–child interactive stress but the pattern of associations will vary depending upon the behavior, child gender, and context of family life examined.J. of Att. Dis. 2007; XX(X) 1-XX

Hyperactive-Impulsive Symptoms Associated With Self-Reported Sleep Quality in Nonmedicated Adults With ADHD

Mahajan, N., Hong, N., Wigal, T. L., Gehricke, J.-G. — Fri, 18 Sep 2009 17:11:41 PDT

Objective: Individuals with ADHD often report sleep problems. Though most studies on ADHD and sleep examined children or nonclinically diagnosed adults, the present study specifically examines nonmedicated adults with ADHD to determine whether inattentive and hyperactive-impulsive symptoms are associated with sleep problems. Method: A total of 22 nonmedicated adults diagnosed with ADHD are assessed with a DSM-IV-based interview and the Pittsburg Sleep Quality Index (PSQI). Results: The number of hyperactive-impulsive symptoms indicate a positive correlation with sleep duration, habitual sleep efficiency, and global PSQI score. No significant associations are found between inattentive symptoms and sleep quality. Conclusion: The results show that sleep problems are associated with hyperactive and impulsive symptoms in nonmedicated adults with ADHD. These findings provide information on the nature of sleep problems without the confounding effects of medication associated with ADHD. Treatment of sleep problems, especially in those with hyperactive-impulsive symptoms, may help ameliorate ADHD symptomatology. (J. of Att. Dis. 2009; XX(X) xx-xx)

Clinical Commentary: Coaching for ADHD

Ratey, N., Murphy, K., Maynard, S., Sussman, S., Wright, S. D. — Tue, 25 Aug 2009 13:16:51 PDT

Pediatricians' Attitudes and Practices on ADHD Before and After the Development of ADHD Pediatric Practice Guidelines

Wolraich, M. L., Bard, D. E., Stein, M. T., Rushton, J. L., O'Connor, K. G. — Tue, 25 Aug 2009 13:16:51 PDT

Purpose: The study aims to assess the changes in attitudes and practices about ADHD reported by AAP fellows between 1999 and 2005 during which AAP ADHD guidelines, training, and quality improvement initiatives occurred. Method: The study assesses AAP-initiated surveys that were conducted between 1999 and 2005 and involving a random sample of 1,000 and 1,603 pediatricians, respectively. Results: The findings reveal that significant, although modest, increases occurred in pediatric practitioners’ self-reported adherence to the guidelines. About 81% of respondents reported routine use of formal diagnostic criteria (up from 67%), and 67% of the respondents routinely use ADHD teacher rating scales (compared to 49% in the 1999 survey). Findings further reveal that treatment with stimulant medications was used extensively by pediatricians from both surveys; more pediatricians in the 2005 survey reported use of a second stimulant if the first did not work, and still more reported almost always providing parent training, although the estimated number remained only about a quarter of the total; and greater familiarity with the initiatives predicted better reported adherence to the guidelines. Conclusion: The reported behaviors of practitioners have moved in the direction of greater adherence with the recommended AAP ADHD guidelines, and there was a positive response to, and a greater use of, the materials developed to enhance practice. The authors infer that practice changes may be due to many factors, including AAP guidelines and associated implementation efforts. Changing physician practices needs to be sustained through a continuing process that requires multiple, varying, sustained efforts directed at physicians, other providers, and families. (J. of Att. Dis. 2007; XX(X) 1-XX)

Atomoxetine Treatment for ADHD: Younger Adults Compared with Older Adults

Durell, T., Adler, L., Wilens, T., Paczkowski, M., Schuh, K. — Tue, 25 Aug 2009 13:16:51 PDT

Objective: Atomoxetine is a nonstimulant medication for treating child, adolescent, and adult ADHD. This meta-analysis compared the effects in younger and older adults. Method: A post hoc analysis was conducted using data from two double-blind, placebo-controlled clinical trials. Data from patients aged 18-25 years were compared with data from patients older than 25 years. Results: In younger adults (mean age = 21.7), atomoxetine produces greater improvement than placebo on the Conners’ Adult ADHD Rating Scale’s total ADHD symptom score (p = .041, effect size = .797) and the clinical global impressions severity (p = .006, effect size = 1.121). In older adults (mean age = 43.4 years), atomoxetine also produces significant benefit on the CAARS–Inv:SV (p < .001, effect size = .326) and CGI-ADHD-S (p < .001, effect size = .346). The study findings reveal response rates to be 56.4% and 47.8% for the younger and older adults, respectively (p = .188). Tolerability is similar although older adults reported more sexual side effects. Conclusion: Younger and older adults show similar improvements at endpoint. The effect size is higher in younger adults, but this is due primarily to greater variability of response in older patients.

Research Brief: A Longitudinal Investigation of Inattention and Preliteracy Development

Walcott, C. M., Scheemaker, A., Bielski, K. — Tue, 14 Jul 2009 14:32:41 PDT

Objective: The link between significant attention problems and reading difficulties among school-age children is clear, but few have examined the impact of early inattention on preliteracy development. This longitudinal study examines this link. Method: A total of 47 children had repeated measures of teacher-rated attention problems and three key preliteracy skills (phonemic awareness, letter knowledge, and rapid naming) in both preschool and kindergarten. Results: Teacher-reported attention problems in preschool significantly and negatively predicted both phonemic awareness and letter naming scores 1 year later, even after controlling for initial language ability and preschool performance on these tasks. Levels of preschool inattention did not significantly predict rapid automatic naming 1 year later. Likewise, preschool preliteracy scores did not predict attention problems in kindergarten. Conclusion: Early attention problems may interfere with the acquisition of certain preliteracy skills. Implications of these findings and directions for future research are presented. (J. of Att. Dis. 2009; XX(X) xx-xx)

Girls With Social and/or Attention Deficits: A Descriptive Study of 100 Clinic Attenders

Kopp, S., Berg Kelly, K., Gillberg, C. — Thu, 18 Jun 2009 10:45:38 PDT

Objective: Examine clinical correlates and distinguishing features of autism spectrum disorders (ASD), ADHD, and tic disorders in girls referred for social impairment, attention/academic deficits, and/or tics. Method: One hundred 3- to 18-year-old girls referred for social impairment and attention symptoms were assessed in detail. Sixty of these girls, 7 to 16 years of age (IQ ≥ 80) were compared with age-matched girls (IQ ≥ 80) from the community. Results: Main diagnoses of ASD, ADHD, tic disorders, and "other psychiatric disorder" were made in 46, 46, 3, and 5, respectively, of the referred girls. The ASD and ADHD groups (mean age at diagnosis 8.8 and 13.0 years, respectively) had the same types and high rates of psychiatric comorbidity. Girls with ASD had more problems with global functioning and adaptive levels of daily living skills than girls with ADHD. Differences between these girls referred for investigation and the community sample of girls were very considerable across a range of factors. Conclusions: Girls referred for social and/or attention deficits usually meet diagnostic criteria for either ASD or ADHD. They have severe psychiatric comorbidities and low global levels of functioning. (J. of Att. Dis. XXXX; XX(X) XX-XX)

Ethnicity as a Moderator of Treatment Effects on Parent-Child Interaction for Children With ADHD

Tue, 16 Jun 2009 15:04:15 PDT

Objective: To examine ethnic differences in observed parenting and child behavior and the moderating effects of ethnicity on the relationship between treatment and parent and child behavior. Method: Observations of 508 children with ADHD (ages 7–9) and their caregivers, collected during the Multimodal Treatment Study of ADHD, were analyzed using univariate and mixed-model ANOVAs. Results: Although baseline parenting practices differed by ethnic group, ethnicity did not moderate the relationship between treatment and either parenting or child behavior. Conclusion: Consistent with data from normative samples, parents of children with ADHD differed by ethnicity in their utilization of certain parenting strategies. However, different ethnic groups did not differ on benefit received from treatments for ADHD, measured by parent and child behavior. Although ethnicity did not emerge as a moderator, ethnic minority family engagement in treatment may be increased by recognizing different parenting strategies and modifying interventions accordingly. (J. of Att. Dis. 2009; XX(X) 1-XX)

Impaired Behavior Regulation Under Conditions of Concurrent Variable Schedules of Reinforcement in Children With ADHD

Lincoln, A. J., Taylor, D., Foster, S. L. — Thu, 11 Jun 2009 15:21:35 PDT

Objective: To bridge theory of response inhibition and learning in children with ADHD. Method: Thirty ADHD and 30 non-ADHD children (ages 9-12) were compared under concurrent variable interval (VI-15 sec., VI-30 sec. and VI-45 sec.) reinforcement schedules that required the child to switch between the three schedules under conditions of experimentally controlled inhibition (change over delay [COD] vs. No COD). Classical matching law was used to evaluate children’s success in maximizing reinforcement opportunities. Results: Children with ADHD showed normal matching only when immediate reinforcement for responding was blocked by the presence of a 3-s COD. Without a COD, ADHD children failed to conform to the normal matching law. Non-ADHD children’s behavior fit the matching law (i.e., rate of response was proportional to rate of reinforcement) whether a COD was present or absent. Conclusions: Results supported other findings that response inhibition is a key mechanism in responses to reinforcement schedules by children with ADHD and that the absence of contingencies that inhibit impulsive responding might impair complex learning in which the child must choose between many different behavioral options, each with associated reinforcement schedules. (J. of Att. Dis. XXXX; XX(X) xx-xx)

Cultural Structures of the Persian Parents' Ratings of ADHD

Ghanizadeh, A., Jafari, P. — Mon, 01 Jun 2009 12:08:40 PDT

Objective: The objective was to study the cultural structure of Farsi-speaking parents’ ratings with diagnostic definitions of ADHD. Method: The children with ADHD and their parents were interviewed. The parents rated their children on the Farsi-speaking parents’ ADHD rating questionnaire. Results: The principal components analysis extracted the two factors of inattention and hyperactivity– impulsivity. The items "often has trouble playing or enjoying leisure activities quietly," "Is often ‘on the go’ or often acts as if ‘driven by a motor,’" and "Often talks excessively" were loaded on the impulsivity, not the hyperactivity factor. Conclusion: The Farsi version of the items of the DSM-IV ADHD criteria consisted of two separate factors of hyperactivity–impulsivity and inattentiveness. In addition, the factor of hyperactivity–impulsivity consisted of two separate factors of hyperactivity and impulsivity. There are some differences in the items loading from previous studies in other cultures. (J. of Att. Dis. XXXX; XX(X) XX-XX)

Work Performance Differences Between College Students With and Without ADHD

Shifrin, J. G., Proctor, B. E., Prevatt, F. F. — Wed, 27 May 2009 17:51:59 PDT

Objective: This study examines the difference between college students with and without Attention Deficit/ Hyperactivity Disorder (ADHD) in regard to their work performance. Method: A series of ANOVAs analyzed group differences in symptoms experienced at work. The independent variable was group (i.e., ADHD, Controls). The dependent variables include items from Barkley’s "Work Performance Rating Scale" (Barkley & Murphy, 1998), which assesses the degree to which symptoms of inattention, hyperactivity and impulsivity are evident on the job. For the group with ADHD, the relationship between symptom severity and indicators of work performance (e.g., number of times fired, overall rating of work performance) was also examined, using correlational analyses. Descriptive analyses were also used to examine which items were most frequently endorsed by the group with ADHD, as well as which areas of work were most affected by ADHD symptoms. Results: Results reveal that ADHD has a detrimental impact on the work performance of college students in multiple areas. Severity of symptoms was unrelated to number of times fired from a job and the overall indicator of work performance. Conclusion: College students with ADHD do exhibit more on-the-job difficulties than their non-ADHD peers, and thus may require extra support with their work-related endeavors.

Increase in Teachers' Knowledge About ADHD After a Week-Long Training Program: A Pilot Study

Syed, E. U., Hussein, S. A. — Wed, 27 May 2009 17:52:00 PDT

Objectives: ADHD affects 3% to 5% of school-age children. Clinical and community based epidemiological studies in Pakistan have shown a high prevalence of ADHD among school going children. A thorough review of literature shows that no studies of teachers’ training programs regarding ADHD have been published in Pakistani research literature. The aim of the present study is the development and evaluation of an ADHD training program for teachers. Methods: A teachers’ training program for ADHD was designed and a pilot run in 3 schools of Karachi, Pakistan. Teachers knowledge regarding signs and symptoms of ADHD was tested before and after the workshop and then again after 6 months using an ADHD knowledge questionnaire. Results: Forty-nine teachers, all of them women, completed the questionnaires before and after the training program, and 35 of them filled it out at the 6-month interval. Mean scores of these tests were compared using a paired t test. The authors found the difference of mean score of 1.48 ± 2.95, and this was statistically significant (p < .005). Conclusion: The authors conclude that the workshop improved the knowledge of the school teachers regarding ADHD symptomatology, and it remained significant even after 6 months of training (J. of Att. Dis. XXXX; XX(X) XX-XX).

Atomoxetine Versus Stimulants in the Community Treatment of Children With ADHD: An Electronic Diary Study

Wed, 27 May 2009 17:52:00 PDT

Objective: To compare the morning and afternoon/evening functioning of children with ADHD treated in the community with either atomoxetine or long-acting stimulants and reported to be doing well. Method: 109 8- to 12-year-olds and their mothers participated in one of three groups: stimulants (STIM, N = 26), atomoxetine (ATMX, N = 25), or comparison (COMP, N = 58). Mothers completed morning and evening electronic diaries installed on personal digital assistants throughout an entire week, rating the child’s behaviors and moods as well as their own moods and perceptions. Results: There was no evidence that ongoing pharmacotherapy fully normalized the behaviors of children with ADHD: Mothers in both ADHD groups reported higher rates of child inattention, hyperactivity/impulsivity, oppositionality, and negative affect and lower levels of parenting efficacy and positive affect than did COMP mothers. Although the behavioral profiles were generally comparable for the STIM and ATMX groups, there were indications of better functioning in the ATMX group during mornings only. Conclusion: Children treated in the community with either STIM or ATMX appear to have similar behavioral profiles, suggesting that medication decisions be guided by other factors such as comorbid disorders, child and parent preferences, and effects on nontargeted behaviors and moods. (J. of Att. Dis. XXXX; XX(X) xx-xx)

Predictors of Nonmedical ADHD Medication Use by College Students

Fri, 22 May 2009 17:28:23 PDT

Objective: To identify the predictors of nonmedical ADHD medication use by college students. Participants: A total of 843 undergraduates attending one public or one private university in southeastern United States. Method: Students completed a Web-based survey inquiring about ADHD medication use during the first semester freshman of their year and a second time during the second semester of their sophomore year. Results: A total of 45 participants (5.3%) reported the onset of nonmedical ADHD use between the two survey administrations. The majority of these students were high substance users as freshman. Attention difficulties also predicted the onset of nonmedical use, especially in the absence of excessive substance use. Compared with other nonmedical users of ADHD medication, those reporting attention difficulties had lower GPAs, greater academic concerns, and higher levels of depressive symptoms. Conclusion: Attention difficulties contribute to the onset of nonmedical ADHD medication use in a significant minority of nonmedical users. These students may begin using ADHD medication to address attention problems they experience as undermining their academic success.

Cultural Proficiency: A Hispanic Woman With ADHD--A Case Example

Waite, R., Ramsay, J. R. — Fri, 22 May 2009 17:28:22 PDT

Background: Guidelines for assessment, diagnosis, and treatment of ADHD have been drawn from research focused primarily on Caucasian males generating, in part, the need to redress health disparities. Diagnostic criteria may therefore be limited, especially regarding gender differences and other associated cultural, familial, socio-environmental, and individual influences. Objective: To examine how one woman with ADHD managed social, academic, interpersonal, and familial roles and to discuss the need for culturally proficient practice and treatment frameworks that are gender-sensitive to diagnosis and treatment. Method: A case example of a 29-year-old Hispanic woman. Findings: There is a gap in early diagnosis and treatment for some woman and individuals from ethnic minority and diverse groups. Conclusion: Cultural competence in practice and research are critical to mitigate the disparities in accurate and timely diagnosis and treatment of adult ADHD among the American population.

Open-Label Trial of Atomoxetine Hydrochloride in Adults With ADHD

Johnson, M., Cederlund, M., Rastam, M., Areskoug, B., Gillberg, C. — Wed, 20 May 2009 15:13:47 PDT

Background: While atomoxetine is an established treatment for attention-deficit/hyperactivity disorder in children, few studies have examined its efficacy for adults. Methods: Open-label trial of atomoxetine in 20 individuals with ADHD, aged 19-47 years, for 10 weeks, and a total of one year for responders. Results: Ten patients met primary efficacy criteria at 10 weeks. Only one patient completed the whole study. Six patients discontinued before 10 weeks and thirteen at 10 weeks or later, mainly because of side-effects (aggression, depressed mood, raised liver enzymes, thyroid hormones, diastolic blood pressure), decreasing efficacy or non-compliance. Conclusion: Fifty percent responded to treatment, but only one patient (5%) felt sufficient improvement to continue for one year. Dosage may have been too low, and baseline impairment too high, for atomoxetine to have sufficient effect on ADHD symptoms in our group of adults. The majority had few side-effects, but several terminated treatment because of adverse effects.

The Effect of Happiness and Sadness on Alerting, Orienting, and Executive Attention

Finucane, A. M., Whiteman, M. C., Power, M. J. — Fri, 15 May 2009 12:38:21 PDT

Objective: According to the attention network approach, attention is best understood in terms of three functionally and neuroanatomically distinct networks—alerting, orienting, and executive attention. An important question is whether the experience of emotion differentially influences the efficiency of these networks. Method: This study examines 180 participants were randomly assigned to a happy, sad, or control condition and undertook a modified version of the Attention Network Test. Results: The results showed no effect of happiness or sadness on alerting, orienting, or executive attention. However, sad participants showed reduced intrinsic alertness. Conclusion: This suggests that sadness reduces general alertness rather than impairing the efficiency of specific attention networks. (J. of Att. Dis. XXXX X(X) XX-XX)

Validity of the Factor Structure of Conners' CPT

Egeland, J., Kovalik-Gran, I. — Fri, 15 May 2009 12:38:21 PDT

Objective: A previous factor analysis of the Conners’ Continuous Performance Test (CCPT) indicates that the test measures 5 sub-functions of attention, namely focused attention, hyperactivity/impulsivity, sustained attention, vigilance, and change in control. The present study further analyzes the results from Egeland & Kowalik-Gran to test the construct-and criterion-validity of these factors. Method: Construct validity is tested by analyzing whether clinical groups known to be impaired in specified subprocesses actually differ with regard to factor scores. Comparison of CCPT factor scores from 282 individuals with ADHD, schizophrenia, affective disorders, brain injury, language disorders, and normal individuals gives validity to 4 factors, but not to the vigilance factor. Results: Other tests of controlled attention correlate only with focused attention, thus giving criterion validity to this factor and differential validity to the remaining 4 factors. Conclusion: Grouping scores on the CCPT into 4 or 5 sub-functions of attention may provide the clinician with a tool to differentiate between clinical groups. (J. of Att. Dis. XXXX; XX(X) xx-xx)

Ability of College Students to Simulate ADHD on Objective Measures of Attention

Booksh, R. L., Pella, R. D., Singh, A. N., Gouvier, W. D. — Wed, 13 May 2009 14:48:19 PDT

Objective: The authors examined the ability of college students to simulate ADHD symptoms on objective and self-report measures and the relationship between knowledge of ADHD and ability to simulate ADHD. Method: Undergraduate students were assigned to a control or a simulated ADHD malingering condition and compared with a clinical AD/HD group. The authors used several clinical attentional measures and symptom validity tests to differentiate experimental groups via a series of multivariate procedures. Results: Simulators successfully feigned ADHD symptoms on a retrospective self-report measure. Moreover, knowledge of ADHD was unrelated to objective attentional measure performance. Overall, participants who simulated ADHD on some objective measures (i.e., specific Wechsler Adult Intelligence Scale–III [WAIS-III] subtests) showed similar performance to the clinical ADHD comparison sample. Conclusion: The implications of these findings highlight the importance of relying on multiple vectors of information, be it objective, observational, self-report, or reports by others, when diagnosing ADHD and assessing factors related to potential secondary gain. (J. of Att. Dis. XXXX; XX(X) XX-XX)

Ethnic Differences in Parental Beliefs of Attention-Deficit/Hyperactivity Disorder and Treatment

Pham, A. V., Carlson, J. S., Kosciulek, J. F. — Mon, 04 May 2009 11:38:44 PDT

Objective: A survey study was conducted to explore ethnic differences in parental beliefs about the causes and treatments of ADHD and whether these beliefs predicted treatment preference. Method: Ethnically diverse parents of 5- to 12-year-old children with ADHD (n = 58) and without ADHD (n = 61) completed a questionnaire developed by the authors that asked them to rate statements about biological and psychological causes of ADHD and their beliefs about medication and behavioral treatment. Results: There were no significant ethnic differences in how parents viewed causes of ADHD. Beliefs about behavioral treatment revealed significant group differences, as ethnic minority (e.g., African American, Latino) parents rated behavioral treatments more positively than did Caucasian parents. Beliefs about biological causes predicted medication treatment and combined treatment use. Conclusion: Dissemination of information regarding evidence-based treatments should be given special attention as it may influence parents’ decisions to pursue specific treatments based on their beliefs.

Predicting Response of ADHD Symptoms to Methylphenidate Treatment Based on Comorbid Anxiety

Blouin, B., Maddeaux, C., Firestone, J. S., van Stralen, J. — Tue, 28 Apr 2009 11:12:55 PDT

Objective: In this small pilot study, the association of comorbid anxiety with the treatment of ADHD is studied. Methods: Eighteen volunteers from a pediatric clinic are tested for ADHD and anxiety and assessed for behavioral and cognitive ADHD symptomology. Response to methylphenidate as treatment for ADHD symptoms is measured 2 to 3 weeks, and again 4 to 6 weeks following the diagnosis of ADHD. Results: Methylphenidate proves effective for treating ADHD symptoms (both behavioral and cognitive). Participants are categorized into two groups, those with ADHD and comorbid anxiety and those with ADHD alone. Behaviorally, no statistically significant differences are seen in response between the two groups; however; cognitively, the non-anxious group improves significantly more than the anxious group. Conclusion: Although anxiety may not affect behavioral response to stimulant medication in ADHD, it does appear to affect the medication response of more subtle symptoms of cognitive performance in ADHD patients. J of Att. Dis. XXXX; XX(X) xx-xx

Behavioral Approach in ADHD: Testing a Motivational Dysfunction Hypothesis

Mitchell, J. T. — Fri, 24 Apr 2009 10:24:17 PDT

Objective: Etiological models of attention-deficit hyperactivity disorder (ADHD) increasingly support the role of a motivational dysfunction pathway, particularly for hyperactive-impulsive symptoms. Overactive behavioral approach tendencies are implicated among these motivational accounts. However, other externalizing disorder symptoms, such as the psychopathy dimension, are also associated with behavioral approach and frequently co-occur with ADHD. The current study tested the hypothesis that behavioral approach is differentially associated with hyperactive-impulsive ADHD and psychopathy symptoms. Method: A sample of young adults (n = 220) completed self-report measures assessing behavioral approach and inhibition, ADHD symptoms, and psychopathy symptoms. Results: Structural equation analyses supported the hypothesis that behavioral approach predicts hyperactive-impulsive ADHD symptoms while considering symptom overlap with psychopathy symptoms. Conclusion: These findings support motivational accounts that behavioral approach tendencies are predictive of ADHD symptoms and address concerns about externalizing comorbidity. Implications for ADHD etiology are discussed. (J. of Att. Dis. 2009; XX(X) X-XX)

Usefulness of a Clinician Rating Scale in Identifying Preschool Children With ADHD

Halperin, J. M., Gopin, C., Healey, D., Castelli, K., Marks, D. — Fri, 24 Apr 2009 10:24:15 PDT

Objective: To ascertain the psychometric properties and clinical utility of the Behavioral Rating Inventory for Children (BRIC), a novel clinician inventory for preschoolers. Method: Completion of the BRIC for 214 preschoolers follows 2 evaluation sessions, generally separated by less than 2 weeks. Items are submitted to a Principal Components Analysis (PCA) with Varimax rotation. Test-retest reliability and validity relative to other measures are assessed. Results: PCA yields a 2-factor solution representing a "Symptom Triad" and a "Mood/Sociability Factor." Test-retest reliability of the triad and factor are .78 (p <.001) and .55 (p < .001), respectively. Correlations between parent and teacher ratings of ADHD-related behaviors and the Symptom Triad range from .39-.47 (all p <.001); similar correlations are found with laboratory measures of activity level (r = .35-.49, all p <.001). Conclusion:The Symptom Triad of the BRIC appears to be a reliable and valid tool that may assist researchers and clinicians in studying and diagnosing ADHD in preschoolers, particularly in cases where teacher ratings are unavailable. J. of Att. Dis. XXXX; XX(X) xx-xx

Life Impairments in Adults with Medication-Treated ADHD

Safren, S. A., Sprich, S. E., Cooper-Vince, C., Knouse, L. E., Lerner, J. A. — Fri, 24 Apr 2009 10:24:15 PDT

Objective: In developing psychosocial approaches to augment outcomes for medication-treated adults with ADHD, it is important to understand what types of life-impairments are most affected by continued ADHD symptoms that occur despite medication treatment. This may assist in delineating targets for interventions, as well as assessments of functional outcomes that are sensitive to change in this population. Method: The sample consists of 105 adults with ADHD presenting for entry into clinical trials of CBT for residual ADHD. Life impairments are rated by a clinician using the LIFE-RIFT, which has subscales for work impairment, interpersonal impairment, life-satisfaction, and recreation, ADHD symptoms using the ADHD Rating Scale, overall ADHD severity using the clinical global impression, and associated distress using the Hamilton Depression and Anxiety Rating Scales. Results: The most problematic impairments are in the domain of work, followed by interpersonal. Generally, the subscales of the LIFE-RIFT are associated, at the bivariate level, with all 4 symptom indices. Work and interpersonal impairments are uniquely associated with overall severity of ADHD symptoms using both the CGI and the ADHD Rating Scale. However interpersonal and life-satisfaction impairments are uniquely associated with depression, and life-satisfaction is uniquely associated with anxiety. Conclusion: In medication-treated adults with ADHD, work and interpersonal impairments appear to be the most problematic areas of life-impairment, which are uniquely associated with ADHD severity. Life-satisfaction appears to be uniquely associated with distress as defined by anxiety and depression symptoms, with interpersonal impairments also playing a role. Psychosocial treatments for medication treated adults should target work and interpersonal domains and should include skills for managing associated distress. (J. of Att. Dis. 2009; XX(X) xx-xx)

Effects of Extended-Release Guanfacine on ADHD Symptoms and Sedation-Related Adverse Events in Children with ADHD

Faraone, S. V., Glatt, S. J. — Fri, 24 Apr 2009 10:24:14 PDT

Guanfacine extended release (GXR) is a selective _2A-adrenoceptor agonist that is shown to be an effective nonstimulant treatment for the symptoms of attention-deficit/hyperactivity disorder. Objective: This report documents the time course and predictors of symptom efficacy and sedation-related adverse events (AEs) that emerge during GXR treatment throughout 3 randomized, placebo-controlled, double-blind trials of the drug. Method: Analysis of data from 3 GXR clinical trials. Results: Few variables related to the study participants or their treatment regimen affects the emergence or magnitude of sedation-related AEs. The best predictor of sedation is treatment duration, with the likelihood of sedation-related AEs decreasing with increasing time on medication. Sedation-related AEs are not predicted by the actual dose a participant receives, the magnitude of any dose changes, or the relationship between dose received and the magnitude of dose changes. Rates of discontinuation because of sedation-related side effects average 6.3% for GXR-treated participants and 0.5% for placebo-treated participants across the three trials. Conclusion: These results suggest that acclimation to GXR may minimize the risk for, and magnitude of, sedation-related AEs. (J. of Att. Dis. XXXX; XX(X) xx-xx)

Memory for Object Locations in Boys With and Without ADHD

Landau, S., Reck, S. G., Hund, A. M. — Fri, 24 Apr 2009 10:24:15 PDT

Objective: To determine whether 7- to 12-year-old boys with ADHD, relative to non-ADHD age-mates, exhibit greater difficulty learning and remembering object locations. The second purpose was to examine the functional utility of mnemonic strategies, specifically speech-to-self, used by boys with and without ADHD. Method: Boys with and without ADHD were videotaped while completing a well-established, laboratory-based object location learning and memory task. Results: Boys with ADHD evinced a deficit while learning the location of objects and employed less sophisticated forms of private speech during the memory task. Conclusion: These findings reveal details about the utility of private speech during spatial working memory performance and further a theoretical understanding of ADHD.

A National Study on the Development of Visual Attention Using the Cognitive Assessment System

Lehman, E. B., Naglieri, J. A., Aquilino, S. A. — Mon, 20 Apr 2009 10:36:38 PDT

Objective: Developmental changes in the performance of children and adolescents are studied using the Cognitive Assessment System (CAS) which is an individually administered test of 4 basic cognitive processes. Method: The test measures the Planning, Attention, Simultaneous, and Successive (PASS) processes as a theory of intelligence that can provide the framework for an alternative to traditional IQ tests. The CAS, which includes a scale of attention comprising 3 subtests, each of which is presented visually, provides an opportunity to study the development of visual attention for 2,200 children and adolescents aged 5- to 17-years-old who participated in the national standardization sample. A subsample (n = 1,395) is also administered the Woodcock-Johnson Tests of Achievement – Revised (WJ-R). Results: On all 3 CAS attention subtests, the mean scores improve with age, and the rate of change between adjacent age groups is moderate-to-large up to 15-yearsold. At all ages the CAS Attention standard score is moderately related to WJ-R Achievement Cluster scores. Conclusion: The results are discussed in light of conclusions about the development of attention based on the standardization sample of the NEPSY–A Developmental Neuropsychological Assessment. (J. of Att. Dis. 2009; XX(X) xx-xx)

Comorbidity of Enuresis in Children With Attention-Deficit/Hyperactivity Disorder

Ghanizadeh, A. — Mon, 20 Apr 2009 10:36:37 PDT

Objective: To compare parental psychopathology and psychiatric disorders in ADHD children with and those without enuresis. Method: The participants of the clinical sample interviewed according to DSM-IV diagnostic criteria were 35 children with ADHD and enuresis, 153 ADHD children without enuresis, 115 fathers, and 172 mothers. Results: Only ODD comorbidity was the predictor of enuresis. Conduct disorder, tic disorder, major depressive disorder, separation anxiety disorder, bruxism, generalized anxiety disorder, obsessive compulsive disorder, and nail biting were not statistically more frequent in ADHD children with enuresis than in the ADHD children without enuresis. The only parental psychiatric disorder that was related to the groups was father’s major depressive disorder. Conclusion: Enuresis in ADHD has a relationship with ODD. Physicians who treat patients with ADHD and enuresis should routinely inquire about the presence of major depression in the fathers. (J. of Att. Diss. 2009; XX(X) xx-xx)

The Moderating Role of Sensory Overresponsivity in HPA Activity: A Pilot Study With Children Diagnosed With ADHD

Reynolds, S., Lane, S. J., Gennings, C. — Thu, 16 Apr 2009 12:57:14 PDT

Objective: To determine if sensory overresponsivity (SOR) is a moderating condition impacting the activity of the Hypothalamic Pituitary Adrenal (HPA) Axis in children with ADHD. Method: Participants were children with (n = 24) and without ADHD (n = 24). Children in the ADHD group were divided into SOR (ADHDs) and non-SOR (ADHDt) groups using the Sensory Over-Responsivity Inventory. All children participated in the Sensory Challenge Protocol. Salivary cortisol was used as a measure of HPA activity. Two prechallenge and seven postchallenge samples of saliva were taken. Cortisol patterns between groups were examined using a mixed-effects ANOVA. Results: There was a borderline significant difference found between the ADHDt and ADHDs group (p = .056) and a significant difference between ADHDt and the typical group (p = .014). Conclusion: Preliminary results support the premise that SOR may be a moderating variable used to create subgroups in diagnostic populations such as ADHD. (J. of Att. Dis. 2009; XX(X) XX-XX)

The Importance of ADHD Subtype Classification for Educational Applications of DSM-V

Barnard, L., Stevens, T., To, Y. M., Lan, W. Y., Mulsow, M. — Thu, 16 Apr 2009 12:57:13 PDT

Objective: An examination of the academic achievement of children with ADHD by stimulant treatment status must consider this heterogeneity of the disorder. With the dissemination of the final wave of data, the Special Education Elementary Longitudinal Study presents an opportunity to examine the academic achievement of students with ADHD using a large, community-based, and nationally representative sample over 4 years. Method: In Study 1, the association between stimulant treatment and academic achievement is examined over 4 years. In Study 2, the association between stimulant treatment and academic achievement is examined acknowledging the influence of subtype symptoms of ADHD using growth mixture modeling. Results: Results indicate significant differences in academic achievement according to long-term stimulant treatment status within each subtype symptom class. Conclusion: Research should acknowledge the influence of subtype symptoms when examining outcomes such as academic achievement. The upcoming DSM-V should consider the results as indicating the educational relevance of ADHD subtype classification.

Accuracy of the DSM-Oriented Attention Problem Scale of the Child Behavior Checklist in Diagnosing Attention-Deficit Hyperactivity Disorder

Aebi, M., Metzke, C. W., Steinhausen, H.-C. — Thu, 16 Apr 2009 12:57:14 PDT

Objective: The present study aimed at testing the Child Behavior Checklist (CBCL) including an adapted five-item DSM Oriented Attention Problem Scale for predicting attention deficit hyperactivity disorders (ADHD). Methods: CBCL ratings were made both in a community sample (N = 390) and an outpatient child psychiatric sample (N = 392). Four different prediction models were analyzed in a community subsample (n = 195) and an outpatient subsample (n = 196) and crossvalidated in two further subsamples of the same size. Results: The adapted DSM Oriented Attention Problem Scale was superior to the original Attention Problem Scale in the identification of ADHD participants. A raw score of 5 to 6 on the reduced DSM Oriented Attention Problem Scale was the best discriminator between cases and noncases. Conclusions: The adapted DSM Oriented Attention Problem Scale of the CBCL is a useful screening instrument for ADHD with adequate diagnostic accuracy in community and outpatient samples.

Atomoxetine's Effect on Societal Costs in Sweden

Svanborg, P., Myren, K.-J., Thernlund, G., Nylen, A., Schacht, A. — Mon, 13 Apr 2009 15:18:30 PDT

Objective: To compare societal costs between patients treated with atomoxetine and placebo in Sweden. Method: Ninety-nine pediatric ADHD patients were randomized to a 10-week double-blind treatment with atomoxetine (n = 49) or placebo (n = 50). All parents received four sessions of psycho-education. Parents filled out a resource utilization questionnaire covering the 10 weeks prior to treatment and the 10-week on-treatment period. Published unit costs/prices were used to calculate costs. Results: Mean on-treatment costs in the atomoxetine group (SEK [Swedish Krona] 4,558) were significantly lower compared with placebo (SEK 7,684) after adjusting for baseline costs and site (p = .007). All 99 patients entered an open atomoxetine extension phase. Both groups had numerical reductions in direct and indirect costs while on atomoxetine treatment during the extension phase. The atomoxetine medication costs were offset by the reductions in direct nonmedical and indirect costs. Conclusions: These data provide preliminary evidence that atomoxetine together with parental psycho education reduces nonmedication costs associated with ADHD in Sweden. (J. of Att. Dis. XXXX; XX(X) xx-xx)

Symptom Prevalence of ADHD in a Community Residential Substance Abuse Treatment Program

McAweeney, M., Rogers, N. L., Huddleston, C., Moore, D., Gentile, J. P. — Mon, 13 Apr 2009 15:18:30 PDT

Objective: ADHD is a common comorbid condition with substance use disorder. This study seeks to examine the discrepancy in the prevalence rate between those previously diagnosed with ADHD and those diagnosed while in treatment. It is hypothesized that clients with ADHD would have earlier unsuccessful terminations from treatment than non-ADHD clients and that the ADHD Self-Report Scale (ASRS Version 1.1) would be a reliable predictor. Method: Participants (N = 87) are admitted to a publicly funded 28-day residential treatment program. All participants are screened with the ASRS and participate in a clinical assessment evaluation. Results: A significant difference is found between the clinical record rate of 3.44% and the 43.68% rate found during treatment. The ASRS significantly predicts ADHD. Conclusions: The use of the ASRS is recommended and should be incorporated into standard intake assessment protocols. Careful diagnostic interviews are urged to determine if clients in residential treatment have ADHD. (J. of Att. Dis. XXXX; XX(X) xx-xx)

Attention Deficit/Hyperactivity Disorder: A Survey on Prevalence Rate Among Male Subjects in Elementary School (7 to 9 Years Old) in Iran

Talaei, A., Mokhber, N., Abdollahian, E., Bordbar, M. R. F., Salari, E. — Mon, 13 Apr 2009 15:18:30 PDT

Objective: Because there have been a few studies on the prevalence of ADHD in Iran, assessment of its prevalence seems to have a great impact on the physicians approach toward its diagnosis and management. Method: This study listed all the schools in Mashhad and chose 12, including 24 classes and 714 students by stratified cluster sampling. A total of 72 children were selected randomly for pilot study. Their parents and teachers filled the 10-item Conners’ questionnaire for ADHD separately. Clinical interview was based on DSM-IV criteria. Students with the total scores higher than the cut-off point 23 were selected for interview. Results: A total of 109 students out of 714 schoolboys had ADHD (15.27% ± 2.64%). The subgroups’ prevalence rates were as follows: attention deficit (AD) = 4.62%, hyperactive impulsive (HI) = 5.32%, and combined type (CT) = 5.32%. Conclusion: Frequency of ADHD among Iranian schoolboys is more than that in many countries.

Cognitive-Behaviorally-Oriented Group Rehabilitation of Adults With ADHD: Results of a 6-Month Follow-Up

Fri, 03 Apr 2009 12:04:38 PDT

Objective: Recently, novel psychological treatments for adult ADHD have been reported with promising results. However, studies about long-term treatment effects are scanty. The authors study effects of cognitive-behaviorally-oriented group rehabilitation during a 6-month follow-up. Method: Participating in the rehabilitation were 29 adults, of whom 25 were reached 3 and 6 months later. ADHD and other psychiatric symptoms were assessed with self-ratings (Brown ADD Scale for Adults, Symptom Check List–90 [SCL-90], 16 ADHD-related items of SCL-90, Beck Depression Inventory). Participants from the pretreatment period served as their own controls. Results: Participants having improvement in ADHD symptoms during treatment (n = 11) maintained most of the benefit during follow-up. They also had a decrease in other psychiatric symptoms, but this did not fully persist through the follow-up. Of all participants, 72% found their overall situation improved as compared to the pretreatment situation. Conclusion: Results suggest that cognitive-behaviorally-oriented group rehabilitation of ADHD adults might have long-term benefits. (J. of Att. Dis. XXXX; XX(X) xx-xx)

Negative Priming Within a Stroop Task in Children and Adolescents With Attention-Deficit Hyperactivity Disorder, Their Siblings, and Independent Controls

Christiansen, H., Oades, R. D. — Wed, 11 Mar 2009 14:31:06 PDT

Objective: Negative priming (NP) is the slowed response to a stimulus that was previously ignored. Response times in NP task conditions were compared with the interference provided by congruent/incongruent stimuli in a Stroop condition in the same task in children diagnosed with attention-deficit hyperactivity disorder (ADHD), their unaffected siblings, and independent controls. Method: Speed, accuracy, and variability of responses were compared using a computerized NP Stroop test for 35 children with ADHD, 24 siblings without diagnosis, and 37 independent healthy controls aged 6 to 17 years. Results: NP was evident at test onset for congruent trials in children without a diagnosis and was reduced initially in those with ADHD occurring in the absence of a significant Stroop interference effect and independently of age or symptom severity. Incongruency masked NP effects. Cases showed more intraindividual response-time variability. Conclusions: Both NP in normal children and its reduction in ADHD cases attenuated across trials reflecting the increased facilitation from previous stimulation.

Efficacy of ADHD Coaching for Adults With ADHD

Kubik, J. A. — Tue, 10 Mar 2009 09:11:17 PDT

Objective: This is perhaps the first outcome study on the efficacy of ADHD coaching for adults with ADHD and its long-term effect. Method: Forty-five adults (30 women, 15 men) rated 22 areas of concern before and after the coaching experience. Factor analysis of the 22 areas of concern revealed five factors. Descriptive statistics and intercorrelations were analyzed on the five factors. Results: Test–retest reliabilities for each factor ranged from .44 to .61, all statistically significant at p < .01. In addition, there are many significant correlations between factors at similar times and factors at different time periods that provide preliminary research support for the efficacy of ADHD coaching. Repeated measures two-way analysis of variance was used to determine the effects of ADHD coaching alone as well as the combined effect with therapy or stimulants. Conclusions: Results indicate that ADHD coaching is having the desired effect on the five factors. (J. of Att. Dis. IN PRESS)

Speed of Language Comprehension is Impaired in ADHD

Wed, 29 Oct 2008 14:49:38 PDT

Objective: Children with ADHD have an increased risk of poor academic performance. It is important to identify cognitive processes that may be related to this academic failure. In Western schooling systems, especially language processing skills may be of relevance. The present study, therefore, compares the ability to comprehend complex sentences of individuals with and without ADHD. Method: Fifteen children (aged 8-11) and 15 adolescents (aged 12-16) with ADHD combined subtype are matched for age, gender, and parental level of education to 30 control subjects. Language comprehension is measured using the neuropsychological procedure proposed by Luria and an adapted version of the Token Test. Results: Compared with the control group, children and adolescents with ADHD perform significantly slower on language comprehension tasks. Differences in accuracy are limited. No interaction between age and ADHD is found. Conclusions: Children and adolescents with ADHD are slower and less efficient than matched control subjects with regard to complex sentence comprehension. J. of Att. Dis. 2008; XX(X)xx-xx

Measuring Several Aspects of Attention in One Test: The Factor Structure of Conners's Continuous Performance Test

Egeland, J., Kovalik-Gran, I. — Tue, 26 Aug 2008 11:17:39 PDT

Objective: Continuous performance tests are known to typically measure sustained attention but usually also yield parameters that potentially measure other subprocesses of attention. The aim of the present study was to test the factor structure of the Conners’s Continuous Performance Test (CCPT) in a heterogeneous clinical sample consisting of subjects considered to fail in different subfunctions of attention. Method and Results: CCPT records from 376 patients were factor analyzed, yielding five factors indicating a differentiation between focused attention, hyperactivity–impulsivity, sustained attention, vigilance, and change in control. Conclusion: The study warns against reducing CCPT performance to one overall score of attention. The study further emphasizes the need to reserve the concept of sustained attention for measures of change as a function of time on task. The differentiation between sustained attention and vigilance and the concept of change in mental control during the test are possible methodological contributions of the study.