Journal of Attention Disorders current issue

ADHD, Substance Use Disorders, and Psychostimulant Treatment: Current Literature and Treatment Guidelines

Kollins, S. H. — 2008-08-13

Objective: This review explores the relationship between ADHD and substance use disorder (SUD), factors that determine the abuse potential of psychostimulants, and strategies for identifying and treating at-risk ADHD patients. Method: This study uses a Medline review of literature. Results: Psychostimulants, such as methylphenidate and amphetamines, are effective first-line pharmacotherapy for ADHD and when used appropriately in individuals with ADHD do not appear to be frequently abused by patients. Diversion and misuse of prescription stimulants are growing concerns, especially among young adults and college students. Short-acting psychostimulant formulations may have higher potential for abuse, misuse, and diversion, but more data are needed to substantiate this observation. Nonstimulant treatments for ADHD may be considered for patients at particularly high risk for substance use, misuse, or diversion of stimulants. Conclusion: In treating patients with ADHD and comorbid substance use, psychostimulants may be a useful pharmacologic alternative. However, the risks of such treatment with high-risk populations must be considered alongside potential benefits. (J. of Att. Dis. 2008; 12(2) 115-125)

ADHD With Comorbid Oppositional Defiant Disorder or Conduct Disorder: Discrete or Nondistinct Disruptive Behavior Disorders?

Connor, D. F., Doerfler, L. A. — 2008-08-13

Objective: In children with ADHD who have comorbid disruptive behavior diagnoses distinctions between oppositional defiant disorder (ODD) and conduct disorder (CD) remain unclear. The authors investigate differences between ODD and CD in a large clinical sample of children with ADHD. Method: Consecutively referred and systematically assessed male children and adolescents with either ADHD (n = 65), ADHD with ODD (n = 85), or ADHD with CD (n = 50) were compared using structured diagnostic interviews and parent, teacher, and clinician rating scales. Results: In children with ADHD, significant differences emerged between ODD and CD in the domains of delinquency, overt aggression, and ADHD symptom severity; ADHD with CD was most severe, followed by ADHD with ODD, and ADHD had the least severe symptoms. Distinctions between ADHD with CD and the other two groups were found for parenting, treatment history, and school variables. Conclusion: Within the limits of a cross-sectional methodology, results support clinically meaningful distinctions between ODD and CD in children with ADHD. (J. of Att. Dis. 2008; 12(2) 126-134)

Inattention, Hyperactivity, and Oppositional- Defiant Symptoms in Brazilian Adolescents: Gender Prevalence and Agreement Between Teachers and Parents in a Non-English Speaking Population

Serra-Pinheiro, M. A., Mattos, P., Angelica Regalla, M. — 2008-08-13

Objective: To assess hyperactivity (H/I), inattention (IN), and oppositional—defiant (OP) symptoms in a nonclinical Brazilian sample of adolescents, and to investigate the association between scoring profiles of teachers and parents, symptom levels, and gender. Method: Symptoms were assessed through the Swanson, Nolan, and Pelhman (SNAP-IV) Questionnaires distributed for teachers and parents to fill out. Score means and prevalence rates based on Criterion A of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) for ADHD or oppositional—defiant disorder were estimated. Agreement rates between teachers and parents were calculated for each group of symptoms. Mean scores were compared by gender. Results: Between 7% and 33% of students were rated as having high scores of symptoms. Boys and girls had the same level of symptoms, when scored by parents. Teachers rated boys as having more H/I and OP symptoms. Parents gave scores significantly higher for H/I and OP symptoms, and teachers rated more students as inattentive. Conclusions: H/I, IN, and OP symptoms were highly prevalent in this nonclinical sample. Few differences between boys and girls were observed in symptom levels. Teachers and parents have different scoring profiles for the different SNAP subscales and are probably influenced by cultural aspects. (J. of Att. Dis. 2008; 12(2) 135-140)

Long-Term Psychosocial and Health Economy Consequences of ADHD, Autism, and Reading-Writing Disorder: A Prospective Service Evaluation Project

Nyden, A., Myren, K.-J., Gillberg, C. — 2008-08-13

Objective: The study aims to evaluate psychosocial, societal, and family cost consequences of a psychoeducational intervention program. Methods: Sixty boys with ADHD, Asperger syndrome/high-functioning autism (AS/HFA), and reading and writing disorder (RD/WD) were allocated to participate in a service evaluation project. Every other boy in each diagnostic group was randomly allocated to receive either (a) a special education program (clinical index group) or (b) follow-up without the special education program (clinical comparison group). Nine years after initial assessments the stability of the psychosocial and economic resource consequences over time was studied. Results: ADHD, AS/HFA, and RD/WD all had severe impact on family life quality. The societal costs were high, but no significant differences in resource use or in total costs were found between the clinical index and the comparison groups. Conclusions: The results underscore the very long-term need for support including individually tailored reevaluations and carefully monitored intervention programs adapted to family needs and severity of child disorder. (J. of Att. Dis. 2008; 12(2) 141-148)

Comorbidity of Psychiatric Disorders and Parental Psychiatric Disorders in a Sample of Iranian Children With ADHD

Ghanizadeh, A., Mohammadi, M. R., Moini, R. — 2008-08-13

Objective: To study the psychiatric comorbidity of a clinical sample of children with ADHD and the psychiatric disorders in their parents. Method: Structured psychiatric interviews assessing lifetime psychiatric disorders by DSM-IV criteria, using the Farsi version of the Schedule for Affective Disorders and Schizophrenia. Results: The mean age of the children was 8.7, mothers, 40.1, and fathers, 34.6 years. Only 7.6% of the boys and 21.7% of the girls manifested ADHD without any other psychiatric comorbidity. The most common comorbid disorders were disruptive behavior disorders and anxiety disorders. The prevalence of lifetime ADHD in the parents was 45.8% and 17.7%, respectively. The rate for major depressive disorder in mothers and fathers was 48.1% and 43.0%, respectively. Discussion: The clinical sample of ADHD children typically had at least one other psychiatric disorder, usually oppositional defiant disorder in boys and anxiety disorders in girls. The most common psychiatric disorder in the parents was mood disorder. (J. of Att. Dis. 2008; 12(2) 149-155)

Symptoms of ADHD and Academic Concerns in College Students With and Without ADHD Diagnoses

Lewandowski, L. J., Lovett, B. J., Codding, R. S., Gordon, M. — 2008-08-13

Objective: Previous research has found ADHD symptoms to be common in the general population but has not compared endorsement of symptoms between ADHD and non-ADHD groups. This study examines self-reported ADHD symptoms and academic complaints in college students. Method: Students without (n = 496) and with ADHD (n = 38) completed a questionnaire covering the 18 ADHD symptoms in the Diagnostic and Statistical Manual of Mental Disorders and academic and test-taking concerns. Results and Conclusion: Students with ADHD diagnoses reported significantly more ADHD symptoms and academic concerns, but none of the 18 symptoms or 6 concerns proved to be both sensitive and specific to ADHD. Poor specificity of symptoms and academic complaints casts doubt on the utility of this self-reported information in diagnosis, particularly if used alone and without regard to severity or extent of impairment. (J. of Att. Dis. 2008; 12(2) 156-161)

Growing Out of ADHD: The Relationship Between Functioning and Symptoms

Young, S., Gudjonsson, G. H. — 2008-08-13

Objective: The objective is to ascertain whether people in partial remission (IPR) or in full remission (IR) of their ADHD symptoms continue to have neuropsychological deficits and clinical and psychosocial problems. Method: IPR and IR groups are compared with fully symptomatic ADHD patients and normal controls. Results: The results show a decline across the patient groups indicating that symptom remission is associated with improvement in neuropsychological, clinical, and psychosocial problems. The two symptomatic (ADHD and IPR) groups have the most marked psychosocial and drug-related problems, and they seem to continue to attempt to access help by presenting to adult psychiatric services. However, the IR group continues to have neuropsychological problems in comparison to the normal controls. Conclusion: Neuropsychological functioning, clinical, and psychosocial problems seem to be closely associated with ADHD symptoms and improve steadily with remission. However, some residual problems persist for which the patients seek psychiatric help. (J. of Att. Dis. 2008; 12(3) 162-169)

Exercise Responses in Boys With Attention Deficit/Hyperactivity Disorder: Effects of Stimulant Medication

Mahon, A. D., Stephens, B. R., Cole, A. S. — 2008-08-13

Objective: The effect of stimulant medication on exercise responses was studied in 14 boys (10.9 ± 1.1 years) with attention deficit/hyperactivity disorder (ADHD). Method: Exercise, with and without medication, was performed at 25 W, 50 W, and 75 W, followed by a peak exercise test. Result: Submaximal heart rate (HR) was significantly higher by ~8 to 13 b·min^—1 across the three intensities during the medication trial, but oxygen uptake (VO₂), respiratory exchange ratio (RER), and perceived exertion were similar (p > .05). At peak exercise, VO₂, HR, and work rate were attenuated (p ≤ .05) in the absence of medication but not RER or perceived exertion. The decreased peak exercise responses were apparent in 6 of 13 participants. Conclusion: Stimulant medication raises submaximal HR but does not affect other cardiorespiratory measures or perceived exertion. Without medication physiological responses at peak exercise are attenuated in some but not all boys with ADHD. (J. of Att. Dis. 2008; 12(2) 170-176)

Neuropsychological Functioning in Subgroups of Children With and Without Social Perception Deficits and/or Hyperactivity--Impulsivity

Schafer, V., Semrud-Clikeman, M. — 2008-08-13

Objective: The purpose of this study is to ascertain whether there are differences among groups of children based on their social perception skills in visual perception and fluid reasoning to assist in more effective intervention planning. Method: A total of 80 children were grouped on the basis of their performance on a social perception measure (Child and Adolescent Social Perception) and the presence or absence of hyperactive—impulsive behaviors. They were administered a battery of tests to determine whether the groups differed in their visual perceptual skills and fluid reasoning abilities. Results: The groups with poor social perception significantly differed from groups with intact social perception on the Rey-O and Fluid Reasoning but not on the Judgment of Line Orientation or the Developmental Test of Visual Motor Integration. Conclusion: A subgroup of children with ADHD demonstrates poor social perception skills and accompanying deficits in complex visual perception and fluid reasoning. (J. of Att. Dis. 2008; 12(2) 177-190)

Test and Product Review: Freer, P. (2003). Play Attention Interactive Learning Tool. Asheville, NC: Unique Logic and Technology Inc

Walker, J. M., Bardos, A. N. — 2008-08-13

Current Literature in ADHD

Goldstein, S. — 2008-08-13