Journal of Attention Disorders recent issues

ADHD Psychosocial Treatments: Generalization Reconsidered

Abikoff, H. — Thu, 15 Oct 2009 17:29:39 PDT

ADHD in the Arab World: A Review of Epidemiologic Studies

Thu, 15 Oct 2009 17:29:39 PDT

Objective: Epidemiological studies on psychiatric disorders are quite rare in the Arab World. This article reviews epidemiological studies on ADHD in all the Arab countries. Method: All epidemiological studies on ADHD conducted from 1966 through th present were reviewed. Samples were drawn from the general community, primary care clinical settings, and populations of traumatized children. Data on prevalence, gender differences, risk factors, comorbidity, and burden of ADHD were reviewed. Results: ADHD rates in Arab populations were similar to those in other cultures. Comparisons within Arab studies were difficult given the variability of methodology and instruments used. Conclusion: There is an important need for research on ADHD in the Arab World, not only to assess the national prevalence in children and adolescents, but also to look at the differential burden and treatment of this disorder, which has high levels of mental comorbidities and high impact across the life span. (J. of Att. Dis. 2009; 13(3) 211-222)

Editor's Note

Goldstein, S. — Thu, 15 Oct 2009 17:29:39 PDT

Hyper-activity in Children Having Behavior Disorders

Childers, A.T. — Thu, 15 Oct 2009 17:29:39 PDT

Commentary on Hyper-activity in Children Having Behavior Disorders (Childers, 1935)

Barkley, R. A. — Thu, 15 Oct 2009 17:29:39 PDT

Introduction to Special Series on College Students With ADHD

DuPaul, G. J., Weyandt, L. L. — Thu, 15 Oct 2009 17:29:39 PDT

College Students With ADHD: Current Status and Future Directions

DuPaul, G. J., Weyandt, L. L., O'Dell, S. M., Varejao, M. — Thu, 15 Oct 2009 17:29:39 PDT

Approximately 2 to 8% of the college population reports clinically significant levels of ADHD symptomatology and at least 25% of college students with disabilities are diagnosed with ADHD. A comprehensive review of the literature was conducted with findings consistently indicating academic deficits associated with ADHD in college students. It is less clear whether this disorder significantly impacts social, psychological, and neuropsychological functioning. Although several self- and parent-report measures have been developed for this population, very few studies of assessment methods have been conducted. Similarly, no controlled studies of psychopharmacological, psychosocial, or educational interventions have been completed in samples of college students with ADHD. Non-prescribed use (i.e., diversion) of stimulant medication is a growing problem with approximately 7% of college students reporting this behavior. Studies, to date, are limited by lack of controlled investigations, use of small samples, and lack of confirmation of diagnostic status. Comprehensive and methodologically sound investigations are needed, especially regarding treatment, to promote the success of students with ADHD in higher education settings. (J. of Att. Dis. 2008; 13(3) 234-250)

ADHD Symptomatology and Its Relationship to Factors Associated With College Adjustment

Norwalk, K., Norvilitis, J. M., MacLean, M. G. — Thu, 15 Oct 2009 17:29:39 PDT

Objective: The present study assessed the relationship between self-reported ADHD symptomatology in college students and various factors that are associated with persistence in college. Method: A total of 321 students completed questionnaires examining ADHD symptoms, academic and social adjustment to college, career decision-making self-efficacy, study skills, and GPA. Results: Analyses indicated that higher levels of ADHD symptoms were significantly related to lower levels of career decision-making self-efficacy, academic adjustment, study skills, and GPA. Regression analyses revealed that only the inattentive cluster of symptoms was a significant predictor of career decision-making self-efficacy, study skills, and academic adjustment. Conclusion: These results suggest that the inattentive symptoms of ADHD may have a particularly negative effect on success in college. (J. of Att. Dis. 2009; 13(3) 251-258)

Motives and Perceived Consequences of Nonmedical ADHD Medication Use by College Students: Are Students Treating Themselves for Attention Problems?

Thu, 15 Oct 2009 17:29:39 PDT

Objective: This study examines why college students without a prescription take ADHD medication, what they perceive the consequences of this to be, and whether attention problems are associated with this behavior. Method: More than 3,400 undergraduates attending one public and one private university in the southeastern United States completed a Web-based survey. Results: Nonmedical ADHD medication use in the prior 6 months was reported by 5.4% of respondents and was positively associated with self-reported attention difficulties. Enhancing the ability to study was the most frequent motive reported; nonacademic motives were less common. Students perceived nonmedical use to be beneficial despite frequent reports of adverse reactions. Conclusion: Students without prescriptions use ADHD medication primarily to enhance academic performance and may do so to ameliorate attention problems that they experience as undermining their academic success. The academic, social, and biomedical consequences of illicit ADHD medication use among college students should be researched further. (J. of Att. Dis. 2009; 13(3) 259-270)

College Students' Attitudes Toward Their ADHD Peers

Chew, B. L., Jensen, S. A., Rosen, L. A. — Thu, 15 Oct 2009 17:29:39 PDT

Objective: The attitudes of college students with and without ADHD toward peers with ADHD were examined. Method: A total of 196 college students (30 diagnosed with ADHD) anonymously completed four attitude measures. General analyses of attitudes toward peers with ADHD as well as comparisons between those with and without ADHD are made. Results: For all participants, but especially for those with ADHD, more frequent contact with peers with ADHD was associated with more positive attitudes toward individuals with ADHD. Only half of individuals with ADHD report receiving adequate accommodations, and only half of those report actually using the available accommodations. Overall, more negative than positive adjectives were endorsed as describing individuals with ADHD, and this was especially true for individuals with ADHD in comparison to those without ADHD. Conclusion: Contact with other individuals with ADHD may be especially important for college students with ADHD. (J. of Att. Dis. 2009; 13(3) 271-276)

Diagnosing Attention-Deficit Hyperactivity Disorder in College Students: An Investigation of the Impact of Informant Ratings on Diagnosis and Subjective Impairment

Katz, N., Petscher, Y., Welles, T. — Thu, 15 Oct 2009 17:29:39 PDT

Objective: Formal criteria for the use informant-ratings of adult ADHD symptoms have not been established yet they are commonplace in standard assessment batteries. Method: The current study explores the relationship between self- and informant-ratings and the impact of requiring interrater agreement in a sample comprised of 190 self-referred college students. Results: Participants self-reported higher childhood and current symptoms scores and current impairment scores than informants. Similarities were evident between diagnostic groups who met ADHD criteria by self-report only and by both sources when considering the number of self-reported settings of impairment. Diagnostic groups who met criteria by informant-report only and by both sources were similar when considering informant-reported settings of impairment. Conclusion: Participants who meet criteria for ADHD based on one source endorse a similar number of settings of impairment as participants who meet criteria for ADHD by both sources. The implications for the use of informant-ratings are presented. (J. of Att. Dis. 2009; 13(3) 277-283)

Nonmedical Prescription Stimulant Use Among a Sample of College Students: Relationship With Psychological Variables

Thu, 15 Oct 2009 17:29:39 PDT

Objective: To further investigate use and potential misuse of prescription stimulants (e.g., Ritalin, Adderall, Concerta) among a sample of college students and to explore the relationship between psychological variables and nonmedical stimulant use. Method: The sample consisted of 390 college students (71.6% female, 28.4% male). Participants were asked to complete five questionnaires concerning demographic information, prescription stimulant use, internal restlessness, sensation seeking, and psychological distress. Results: The study findings revealed that, regarding nonprescribed stimulants, 7.5% reported use within the past 30 days; 60% reported knowing students who misused stimulants; and 50% agreed or strongly agreed that prescription stimulants were "easy to get on this campus." Findings further revealed a relationship between stimulant use and degree of psychological distress and internal restlessness. Conclusions: Continued research regarding psychological variables, specific group membership (e.g., fraternity, sorority, athletics), and stimulant acquisition is suggested. Effective prevention and education efforts are needed to help address the nonmedical use of prescription stimulants on college campuses. (J. of Att. Dis. 2009; 13(3) 284-296)

Self-Reported ADHD and Adjustment in College: Cross-sectional and Longitudinal Findings

Thu, 15 Oct 2009 17:29:39 PDT

Objective: To examine the association between self-reported ADHD and college adjustment. Participants: Study 1 included nearly 3400 undergraduates attending a public and private university. Study 2 included 846 students who participated during freshman and sophomore year. Method: Students completed a web-based survey that assessed diagnostic status and adjustment in multiple domains. Results: Relative to other students, those with self-reported ADHD had lower GPAs and reported more academic concerns, depressive symptoms, social concerns, emotional instability, and substance use. Overall, however, most were making satisfactory adjustments in these domains. Benefits of medication treatment were not found. Freshman year ADHD predicted lower GPA, increased academic concerns and alcohol use, and smoking initiation. Conclusion: Students with ADHD struggled relative to peers but most were adjusting reasonably well across multiple domains. Future research should move beyond the use of self-reported diagnosis and more carefully examine the impact of medication treatment in this population. (J. of Att. Dis. 2009; 13(3) 297-309)

Test and Product Review: Pediatric Attention Disorders Diagnostic Screener

Huang, L. V. — Thu, 15 Oct 2009 17:29:39 PDT

Current Literature in ADHD

Goldstein, S. — Thu, 15 Oct 2009 17:29:39 PDT

Reliability of DSM-IV Symptom Ratings of ADHD: Implications for DSM-V

Solanto, M. V., Alvir, J. — Tue, 18 Aug 2009 11:48:01 PDT

Objective: The objective of this study was to examine the intrarater reliability of DSM-IV ADHD symptoms. Method: Two-hundred-two children referred for attention problems and 49 comparison children (all 7-12 years) were rated by parents and teachers on the identical DSM-IV items presented in two different formats, the SNAP-IV and Conners’ Revised Questionnaires, at two closely spaced points in time. Results: For the combined sample, weighted kappa scores for intrarater agreement ranged from .30 ("fair") to .77 ("good") across symptoms. Kappa scores were good with respect to agreement on the DSM-IV criterion of endorsement of at least six symptoms in a given cluster for Inattention (.60 and .76, for parents and teachers, respectively) and Hyperactivity-Impulsivity (.72 and .75, respectively). Kappas for identification of cases as AD/HD or not AD/HD were good to excellent (.67 and .79 for parents and teachers, respectively). Classification as AD/HD or not AD/HD changed from the first to the second rating in 12% and 10% of cases rated parents and teachers, respectively. Conclusion: Reliability of individual ADHD symptoms appears to be suboptimal for clinical and research use and is improved, although less than ideal, at the levels of cluster endorsement and case classification. (J. of Att. Dis. 2009; 13(2) 107-116)

Attention Deficit/Hyperactivity Disorder in Children and Adolescents With Autism Spectrum Disorder: Symptom or Syndrome?

Sinzig, J., Walter, D., Doepfner, M. — Tue, 18 Aug 2009 11:48:01 PDT

Objective: This study aims to evaluate ADHD-like symptoms in children with autism spectrum disorder (ASD) based on single-item analysis, as well as the comparison of two ASD subsamples of children with ADHD (ASD+) and without ADHD (ASD-). Methods: Participants are 83 children with ASD. Dimensional and categorical aspects of ADHD are evaluated using a diagnostic symptom checklist according to DSM-IV. Results: Of the sample, 53% fulfill DSM-IV criteria for ADHD. The comparison of the ASD+ and the ASD- samples reveals differences in age and IQ. Correlations of ADHD and PDD show significant results for symptoms of hyperactivity with impairment in communication and for inattention with stereotyped behavior. Item profiles of ADHD symptoms in the ASD+ sample are similar to those in a pure ADHD sample. Conclusion: The results of our study reveal a high phenotypical overlap between ASD and ADHD. The two identified subtypes, inattentive-stereotyped and hyperactive-communication impaired, reflect the DSM classification and may theoretically be a sign of two different neurochemical pathways, a dopaminergic and a serotonergic. (J. of Att. Dis. 2009; 13(2) 117-126)

The Impact of Childhood ADHD on Dropping Out of High School in Urban Adolescents/ Young Adults

Trampush, J. W., Miller, C. J., Newcorn, J. H., Halperin, J. M. — Tue, 18 Aug 2009 11:48:01 PDT

Objective: To examine cognitive and psychosocial factors associated with high school dropout in urban adolescents with and without childhood ADHD. Method: In a longitudinal study, 49 adolescents/young adults with childhood ADHD and 44 controls who either dropped out or graduated from high school are included. Risk factors examined as potential correlates of dropout were intelligence, reading skills, socioeconomic status, marijuana use, and paternal contact. Results: Lower IQ, reading ability, socioeconomic status, frequent marijuana use, and limited paternal contact significantly differentiated dropouts from graduates, irrespective of childhood ADHD. Follow-up analyses determined that IQ, marijuana use, and paternal contact independently contribute to the likelihood of dropout. Conclusion: Selected cognitive and psychosocial factors appear independently associated with the likelihood of high school dropout irrespective of ADHD. Notably, childhood ADHD did not increase this risk, suggesting that previous reports of increased dropout because of ADHD may become negated in urban areas when matched with similar community controls. (J. of Att. Dis. 2009; 13(2) 127-136)

Stop Signal and Conners' Continuous Performance Tasks: Test--Retest Reliability of Two Inhibition Measures in ADHD Children

Soreni, N., Crosbie, J., Ickowicz, A., Schachar, R. — Tue, 18 Aug 2009 11:48:01 PDT

Objective: To measure test -retest reliability of the Stop-Signal Task (SST) and the Conners’ Continuous Performance Test (CPT) in children with ADHD. Methods: 12 children with ADHD (age 11.46 ±1.66) participated in the study. Primary outcome measures were stop-signal reaction time (SSRT) for the SST and CPT’s commission errors (%FP). For each participant, we acquired three morning (8:00am) measurements and behavioral observations, separated by two 7-day intervals. Reliability of cognitive measures and behavioral observations was measured using the Intraclass-correlation coefficient (ICC). Results: ICC values for SSRT and %FP were 0.72. Consistency of behavioral observations was much lower (ICC =0.41). Conclusion: Both the SST and the CPT yielded reliable measurements in ADHD children. Our findings lend further support to using these measures in the study of ADHD. (J. of Att. Dis. 2009; 13(2) 137-143)

The Misuse and Diversion of Prescribed ADHD Medications by College Students

Tue, 18 Aug 2009 11:48:01 PDT

Objective: This study assesses the misuse and diversion of prescribed attention-deficit/hyperactivity disorder (ADHD) medications. Method: One hundred fifteen students, attending two universities, with prescriptions for ADHD medications completed a Web survey in spring 2007. Results: Eighty-nine of 115 students (69%) used their ADHD medications as prescribed, whereas 36 (31%) had misused during college by taking larger or more frequent doses than prescribed or by using someone else’s medication. Nine students (8%) reported intranasal use during the previous 6 months, and 30 (26%) had diverted medications to peers. Misuse was associated with impulsivity and with other substance use. Enhancing the ability to study outside of class was students’ primary motive for misuse, but nonacademic reasons were also reported. Students who misused ADHD medications generally felt that doing so was helpful. Conclusions: Although most students use their ADHD medication as prescribed, misuse and diversion is not uncommon. Because enhancing academic performance was the primary motive for misuse, the results raise questions about whether undergraduates with ADHD perceive their treatment as adequate and the extent to which physicians and students communicate about issues related to medication adjustments. (J. of Att. Dis. 2009; 13(2) 144-153)

Self-Reported ADHD Symptoms Among College Students: Item Positioning Affects Symptom Endorsement Rates

Mitchell, J. T., Knouse, L. E., Nelson-Gray, R. O., Kwapil, T. R. — Tue, 18 Aug 2009 11:48:01 PDT

Objective: The effect of manipulating item positioning on self-reported ADHD symptoms was examined. We assessed whether listing DSM-IV ADHD symptoms serially or interspersed affected (a) the correlation between ADHD symptoms and (b) the rate of symptom endorsement. Method: In Study 1, an undergraduate sample (n = 102) completed a measure that listed DSM-IV ADHD symptoms serially and a measure that interspersed DSM-IV ADHD items among non-ADHD symptoms. In Study 2, a separate undergraduate sample (n = 240) completed a measure that listed DSM-IV ADHD symptoms serially and another ADHD measure that interspersed DSM-IV ADHD items among non-DSM-IV ADHD items. Results: Item positioning did not affect the correlation between symptoms, but did reveal a significant bias in the rate of symptom endorsements. Conclusion: These findings suggest that there is significant variability in ADHD symptom endorsements resulting from item positioning. This effect has implications for clinical assessment and epidemiological research of ADHD among college students. (J. of Att. Dis. 2009; 13(2) 154-160)

Executive Function Impairments in High IQ Adults With ADHD

Brown, T. E., Reichel, P. C., Quinlan, D. M. — Tue, 18 Aug 2009 11:48:01 PDT

Objectives: To demonstrate that high IQ adults diagnosed with ADHD suffer from executive function (EF) impairments that: a) can be identified with a combination of standardized measures and self-report data; and b) occur more commonly in this group than in the general population. Method: 157 ADHD adults with IQ ≥ 120 were assessed with 8 normed measures of EF— 3 index scores from standardized tests of memory and cognitive abilities, and 5 subscales of a normed self-report measure of EF impairments in daily life. Results: 73% of subjects were significantly impaired on ≥ 5 of these 8 EF markers. On all 8 measures, incidence of these impairments was significantly greater than in the general population. Conclusion: High IQ adults with ADHD tend to suffer EF impairments that can be assessed with these measures; incidence of such impairments in this group is significantly higher than in the general population. (J. of Att. Dis. 2009; 13(2) 161-167)

Are Patient-Administered Attention Deficit Hyperactivity Disorder Scales Suitable for Adults?

Rogers, E. S., Spalding, S. L., Eckard, A. A., Wallace, L. S. — Tue, 18 Aug 2009 11:48:01 PDT

Objective: This primary purpose of this study was to examine cognitive complexity and readability of patient-administered ADHD scales. The secondary purpose was to estimate variation in readability of individual ADHD scale items. Method: Using comprehensive search strategies, we identified eight English-language ADHD scales for inclusion in our study. A complete copy of each ADHD scale was obtained from the most current publication. Cognitive complexity of individual ADHD scale items were assessed using three techniques (number of items, number of words, and linguistic problems), while readability was calculated using the Flesch-Kinkaid formula. Results: Total number of ADHD scale items ranged from 6 to 66. The ADHD scale items averaged from a low of 4.4±2.9 to a high of 18.7±4.4 words. Most individual ADHD scale items had between 1 to 3 linguistic problems. Although readability of ADHD scales ranged from approximately 5th to 8th grade, there was notable variation in readability across individual statements and questions. Conclusion: Formatting characteristics, including linguistic problems and high readability, may interfere with patients’ ability to accurately complete ADHD scales. (J. of Att. Dis. 2009; 13(2) 168-174)

Occupational Outcome in Adult ADHD: Impact of Symptom Profile, Comorbid Psychiatric Problems, and Treatment: A Cross-Sectional Study of 414 Clinically Diagnosed Adult ADHD Patients

Halmoy, A., Fasmer, O. B., Gillberg, C., Haavik, J. — Tue, 18 Aug 2009 11:48:02 PDT

Objective: To determine the effects of symptom profile, comorbid psychiatric problems, and treatment on occupational outcome in adult ADHD patients. Method: Adult ADHD patients (N = 414) responded to questionnaires rating past and present symptoms of ADHD, comorbid conditions, treatment history, and work status. Results: Of the patients, 24% reported being in work, compared to 79% in a population-based control group (N = 359). Combined subtype of ADHD, substance abuse, and a reported history of depression or anxiety were correlated with being out of work. Current and past medical treatment of ADHD was correlated with being in work. Logistic regression analyses showed that stimulant therapy during childhood was the strongest predictor for being in work as adults (odds ratio = 3.2, p = .014). Conclusion: Early recognition and treatment of ADHD is a strong predictor of being in work as an adult, independently of comorbidity, substance abuse, and current treatment. (J. of Att. Dis. 2009; 13(2) 175-187)

Comorbidity/Overlapping Between ADHD and PTSD in Relation to IQ Among Children of Traumatized/Non-Traumatized Parents

Daud, A., Rydelius, P.-A. — Tue, 18 Aug 2009 11:48:02 PDT

Objective: This study explores the comorbidity between symptoms of ADHD and PTSD in relation to IQ among refugee children of traumatized parents (TP) and non-traumatized parents (NTP). Method: The study compares 80 refugee children, 40 with TP with 40 with NTP. ADHD and PTSD are assessed using DICA. Children’s cognitive functions are measured by WISC. Teacher ratings of YCI and SDQ are performed. Results: Overlapping between ADHD and PTSD symptoms are represented among children with TP. Cognitive functions, related to ADHD and PTSD, reveal associations between low IQ (<84) and having both ADHD and PTSD among children with TP. Conclusions: Concerns are raised about how ADHD and PTSD symptoms in a child are to be interpreted. Some overlapping exists between the two syndromes, but further studies should determine whether true comorbidity exists between ADHD and PTSD symptoms to better understand how to correctly diagnose and treat refugee children with TP. (J. of Att. Dis. 2009; 13(2) 188-196)

Attention Deficit Hyperactivity Disorder Erroneously Diagnosed and Treated as Bipolar Disorder

Atmaca, M., Ozler, S., Topuz, M., Goldstein, S. — Tue, 18 Aug 2009 11:48:02 PDT

Objective: There is a dearth of literature on patients erroneously diagnosed and treated for bipolar disorder. Method: The authors report a case of an adult with attention deficit hyperactivity disorder erroneously diagnosed and treated for bipolar disorder for 6 years. At that point, methylphenidate was initiated. The patient was judged to be a good treatment responder with improvements noted in the clinical global impressions severity scale. It was seen that the improvement was maintained at a 6-month follow-up. Conclusion: The present case reflects the importance of careful differential diagnosis when evaluating for bipolar disorder. (J. of Att. Dis. 2009;13(2) 197-198)

Book Review: Wilens, T. E. (2009). Straight Talk About Psychiatric Medications for Kids (3rd ed.). New York: Guilford, 324 pp, $17.95 paper, $38.00 cloth

Margulies, D. M., Carlson, G. A. — Tue, 18 Aug 2009 11:48:02 PDT

Summarized by Sam Goldstein

Tue, 18 Aug 2009 11:48:02 PDT

2008 JAD Awards

Tue, 18 Aug 2009 11:48:02 PDT

Rethinking a Right Hemisphere Deficit in ADHD

Sigi Hale, T., Loo, S. K., Zaidel, E., Hanada, G., Macion, J., Smalley, S. L. — Thu, 11 Jun 2009 13:59:32 PDT

Introduction: Early observations from lesion studies suggested right hemisphere (RH) dysfunction in ADHD. However, a strictly right-lateralized deficit has not been well supported. An alternatively view suggests increased R > L asymmetry of brain function and abnormal interhemispheric interaction. If true, RH pathology in ADHD should reflect interhemispherically networked and overactivated functioning. The authors evaluated these assertions. Method: Four elements of lateralized brain function were measured: LH specialized, RH specialized, LH with interhemispheric processing (LH/IH), and RH with interhemispheric processing (RH/IH). Next, the authors tested their association with cognitive ability, psychiatric comorbidity, and sibling correlations in 79 children with ADHD. Results: RH/IH processing was uniquely associated with other outcome measures. There were no associations for independent RH or LH function alone. Conclusion: Interhemispherically networked RH processing is critical in ADHD. In addition, lack of association between LH specialized processing and cognitive ability (especially for verbal cognitive tasks) supports increased RH mediation of task processing.

Sleep Problems in Chinese School-Aged Children with a Parent-Reported History of ADHD

Thu, 11 Jun 2009 13:59:32 PDT

Objective: The objective was to survey the prevalence of parent-reported ADHD diagnosis and to assess its associations with sleep problems among urban school-aged children in China. Method: A random sample of 20,152 school-aged children participated in a cross-sectional survey in eight cities of China. A parent-administered questionnaire and the Children's Sleep Habits Questionnaire were completed to quantify history of ADHD diagnosis and sleep problems, respectively. Results: Slightly more than 4% of Chinese school-aged children were reported to have a history of ADHD diagnosis. The multivariate regression models revealed that, after controlling for some confounders—such as gender, parents' educational level, family income, family structure, and stimulant medication—there was a higher prevalence of sleep problems, especially parasomnias, sleep-disordered breathing, and daytime sleepiness, in children with a history of ADHD diagnosis. Conclusion: The results emphasized the importance of incorporating screens of sleep problems into the evaluation of ADHD.

Social Functioning in Predominantly Inattentive and Combined Subtypes of Children With ADHD

Solanto, M. V., Pope-Boyd, S. A., Tryon, W. W., Stepak, B. — Thu, 11 Jun 2009 13:59:32 PDT

Objective: The objective of this study was to compare the social functioning of children with the Combined (CB) and Predominantly Inattentive (PI) subtypes of Attention Deficit/Hyperactivity Disorder (ADHD), controlling for comorbidity and medication-status, which may have confounded the results of previous research. Method: Parents and teachers of rigorously diagnosed unmedicated children with PI or CB subtypes of ADHD, and typical comparison children, rated them on the multidimensional Social Skills Rating Scale (SSRS). Results: After co-varying for oppositionality and anxiety, social impairment was substantial and equivalent in both ADHD groups whether rated by parent or teacher. In addition, when rated by teacher, the nature of the deficits varied by subtype: Children with PI were impaired in assertiveness, whereas children with CB were deficient in self-control. These findings indicate that AD/HD subtypes differ in the nature of their social dysfunction independent of comorbidity and highlight the need for interventions to target their divergent needs.

Inattentive Symptoms of ADHD Are Related to Evening Orientation

Caci, H., Bouchez, J., Bayle, F. J. — Thu, 11 Jun 2009 13:59:32 PDT

Objective: Morningness is a stable characteristic of individuals, related to impulsivity and novelty seeking. The evening orientation is a risk factor for psychiatric conditions such as depression and personality disorders. The authors hypothesized that adults suspected of having ADHD are more evening oriented than adults without ADHD. Method: Exploratory factor analyses were performed on the polychoric correlation matrices of the full Adult Self-Report Scale for ADHD (ASRS) and the Composite Scale of Morningness (CSM). Results: As expected, two factors for the ASRS—Inattention and Impulsivity— Hyperactivity—and three factors for the CSM were retrieved. All three CSM factors correlated negatively with ASRS Inattention, none with ASRS Impulsivity—Hyperactivity. Conclusion: Inattention is more strongly related to eveningness than is Impulsivity—Hyperactivity, and therefore eveningness may constitute an endophenotype of the predominantly inattentive subtype of ADHD. These findings need to be replicated in a patient population with a standardized assessment of sleep quality.

The Disruptive Behavior Rating Scale--Parent Version (DBRS-PV): Factor Analytic Structure and Validity Among Young Preschool Children

Friedman-Weieneth, J. L., Doctoroff, G. L., Harvey, E. A., Goldstein, L. H. — Thu, 11 Jun 2009 13:59:32 PDT

Objective: Despite recognition that disruptive behavior disorders often begin early in development, existing assessment tools are largely based on research with school-aged children. Further empirical work is needed to evaluate the utility of these tools in younger children. Methods: The present study investigated the factor structure, internal consistency, and validity of the Disruptive Behavior Rating Scale -Parent Version (DBRS-PV) in a sample of preschoolers. Participants included mothers and fathers of 261 three- to four-year-old children with and without behavior problems. Results: Findings provide support for the use of the DBRS-PV as a measure of disruptive behavior disorder symptoms in this age group, with strong internal consistency and evidence of convergent/divergent and discriminative validity. Conclusions: Results provide evidence in favor of a two-factor (a. inattention/hyperactivity -impulsivity and b. oppositional defiant behaviors) and moderate support for a three-factor (a. inattention, b. hyperactivity -impulsivity, and c. oppositional defiant behaviors) conceptualization of attention and disruptive behavior disorder symptoms among preschool children.

Sensitivity and Specificity of Long Wave Infrared Imaging for Attention-Deficit/Hyperactivity Disorder

Coben, R., Myers, T. E. — Thu, 11 Jun 2009 13:59:32 PDT

Objective: This study was the first to investigate the efficacy of long wave infrared (LWIR) imaging as a diagnostic tool for ADHD. Method: This study was conducted to assess the sensitivity and specificity of LWIR imaging as a method of diagnosis among 190 patients (ages 4.4-57 years) with various diagnoses, including ADHD, who came into our office for neuropsychological evaluation. Results: LWIR imaging demonstrated a moderate level of sensitivity (65.71%) in identifying patients with ADHD and a high level of specificity (94%) in discriminating those with ADHD from those with other diagnoses. The overall classification rate was 73.16%. This was indicative of a high level of discriminant validity in distinguishing between patients with and without ADHD. There was a moderate level of agreement between LWIR imaging and multiple other diagnostic tests for ADHD. Conclusions: LWIR imaging demonstrated high sensitivity and specificity as a diagnostic tool for ADHD. These results provide evidence for the efficacy of a novel, quick, and effective way to investigate the physiological basis of one of the most prevalent childhood psychiatric disorders.

Distinct Response Time Distributions in Attention Deficit Hyperactivity Disorder Subtypes

Querne, L., Berquin, P. — Thu, 11 Jun 2009 13:59:32 PDT

Objective: To address the issue of response time (RT) profiles in hyperactive-impulsive (ADHD-HI), inattentive (ADHD-IA), and combined (ADHD-C) subtypes of ADHD. We hypothesized that children with ADHD-HI should respond more rapidly than children without ADHD and children with ADHD-IA and ADHD-C should respond more slowly than children without ADHD. Method: Four groups (3 ADHD groups and 1 non-ADHD group) each composed of 16 children (7-13 years old) performed a visuospatial choice task. Results: ANOVA indicated very variable RTs for each ADHD subtype when controlling for individual RT. ANOVA performed on RT distribution showed significant differences between the ADHD and non-ADHD groups: biased to fast responses in ADHD-HI and biased to slow responses in ADHD-IA and ADHD-C. Conclusion: The results suggest that response time profiles were abnormal in all ADHD subtypes and were markedly different between children meeting criteria for ADHD-HI and those meeting criteria for ADHD-IA or ADHD-C.

A Linguistic Analysis of In-Office Dialogue Among Psychiatrists, Parents, and Child and Adolescent Patients With ADHD

Findling, R. L., Connor, D. F., Wigal, T., Eagan, C., Onofrey, M. N. — Thu, 11 Jun 2009 13:59:32 PDT

Objective: The aim was to evaluate in-office discussions of ADHD and psychiatric comorbidities. Method: Naturally occurring interactions among 11 psychiatrists, 32 patients and their parents were recorded, with a focus on "complicated" patients (i.e., having or suspected to have ≥ 1 psychiatric comorbidities and/or learning disabilities in addition to ADHD). Participants were interviewed separately post visit. Transcripts were analyzed using validated sociolinguistic methodologies. Results: Some 62% of patients were male, with an average age of 12.5 years, and 79% had a family history of ADHD. Visits were psychiatrist-driven, focusing on medication management and school performance, leaving management of comorbidities largely unaddressed. Post visit, 78% of parents and psychiatrists disagreed on patients' "most concerning behavior." Parents most often reported concern about aggression and oppositionality. Psychiatrists and parents emphasized different aspects of patients' personality, using deficit- and strength-based models, respectively. Conclusion: Psychiatrists and parents interpreted the relationship between ADHD and comorbidities differently. The significant incidence of misalignment regarding worrisome behaviors warrants further exploration.

The Wender Utah Rating Scale: Adult ADHD Diagnostic Tool or Personality Index?

Hill, B.D., Pella, R. D., Singh, A. N., Jones, G. N., Gouvier, Wm. D. — Thu, 11 Jun 2009 13:59:32 PDT

Objective: The Wender Utah Rating Scale (WURS) is used to retroactively assess ADHD symptoms. This study sought to determine whether the WURS actually functions as an index of dysfunctional personality traits. Method: Five hundred twenty-two adult participants completed the WURS and at least one of the following measures: Wechsler Adult Intelligence Scale—III (WAIS-III), Trails Making Test (Forms A and B), Conners' Continuous Performance Test, d2 Test of Attention, and the Personality Assessment Inventory (PAI). Results: The WURS correlated significantly with all PAI clinical and treatment scales; however, of the neuropsychological measures, only the CPT significantly correlated with the WURS score. Multiple regression analyses revealed a significant model that included clinical and treatment scales from the PAI as well as working memory and processing speed indexes from the WAIS-III that accounted for 39% of the variance in WURS scores. Conclusion: Performance on the WURS was more related to dysfunctional personality traits than to actual attentional performance in this young adult sample. (J. of Att. Dis. 2009; 13(1) 87-94)

Improvement with Duloxetine in an Adult ADHD Patient

Tourjman, S. V., Bilodeau, M. — Thu, 11 Jun 2009 13:59:32 PDT

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a common and disabling disorder among adults and is treated with stimulant and non stimulant medication. Objective: To report the case of a patient with ADHD showing good clinical response to duloxetine, a selective serotonin and norepinephrine reuptake inhibitor (SSNRI). Case presentation: A 53 year-old man with a recently diagnosed ADHD was successfully treated with duloxetine 60 mg and showed reduced scores on the Conners' Adult ADHD Rating Scales — Self-Report Scale: Short Version (CAARS-S:S). Conclusion: Duloxetine could be an option for patients who either do not tolerate or show resistance to more common pharmacological choices. Randomized controlled trials are needed to assess the efficacy of duloxetine in treating ADHD symptoms.

Book Review: Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in Adults: What the Science Says. New York: Guilford

Jensen, P. S. — Thu, 11 Jun 2009 13:59:32 PDT

Current Literature in ADHD

Goldstein, S. — Thu, 11 Jun 2009 13:59:32 PDT

What Exactly Are the Benefits of Stimulants for ADHD?

Advokat, C. — Mon, 20 Apr 2009 17:10:06 PDT

Sport Participation and Anxiety in Children with ADHD

Kiluk, B. D., Weden, S., Culotta, V. P. — Mon, 20 Apr 2009 17:10:06 PDT

Objective: Few studies have examined the psychological benefits of physical activity in children with ADHD who may be at higher risk for mood and anxiety problems. This study explores the relationship between participation in physical activity and emotional functioning in children with ADHD. Method: Scores on parent-reported measures of mood and behavior were retrospectively compared among a group of 65 children (ages 6 to 14) diagnosed with ADHD based on their amount of sport participation. A total of 32 children diagnosed with a learning disorder (LD) were used as a comparison group. Results: Children with ADHD who participated in three or more sports displayed significantly fewer anxiety or depression symptoms than did those who participated in fewer than three sports. These differences were not evident among children with LDs. Conclusion: Results suggest that active sport participation may be associated with a reduced expression of anxiety or depression symptoms in children with ADHD. (J. of Att. Dis. 2009; 12(6) 499-506)

The Relationship Between Satisfaction with Life, ADHD Symptoms, and Associated Problems Among University Students

Gudjonsson, G. H., Sigurdsson, J. F., Smari, J., Susan Young, — Mon, 20 Apr 2009 17:10:06 PDT

Objective: To ascertain whether ADHD symptoms, and associated problems, are negatively related to subjective well-being. Method: The Satisfaction With Life Scale (SWLS) was completed by 369 university students, along with the Reasoning & Rehabilitation (R&R) ADHD Training Evaluation (RATE), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Scale for current ADHD symptoms, and the Depression Anxiety Stress Scales (DASS). Results: The SWLS was negatively correlated with all the other measures, and the strongest correlations were with the Total RATE score. A multiple regression analysis showed that the variables in the study accounted for 22% and 25% of the variance of the SWLS among males and females, respectively. Among males poor social functioning was the best predictor of dissatisfaction with life, whereas among females it was poor emotional control. Conclusion: Both ADHD symptoms and associated problems are significantly related to poorer satisfaction with life. (J. of Att. Dis. 2009; 12(6) 507-515 )

Changes in Caregiver Strain Over Time in Young Adolescents With ADHD: The Role of Oppositional and Delinquent Behavior

Evans, S. W., Sibley, M., Serpell, Z. N. — Mon, 20 Apr 2009 17:10:06 PDT

Objective: The objectives of this study were to identify the relationships between caregiver strain among parents of young adolescents with ADHD and child characteristics during a 1-year period. Method: Parents of 52 middle-school-aged youth with ADHD participated in this study and completed two evaluations 1 year apart. Results: Ratings of oppositional and delinquent behavior best predicted levels of caregiver strain, and change over time did not significantly add to the equation. Patterns of change in caregiver strain indicated important individual differences. Conclusion: Oppositional, delinquent behavior was the best predictor of caregiver strain and suggests that preventing and treating these child behavior problems should be a high priority when working with young adolescents with ADHD. Given the variability in parent responses to changes in oppositional and delinquent behavior, it may also be important to address personal coping strategies for parents of youth exhibiting high rates of these behaviors. (J. of Att. Dis. 2009; 12(6) 516-524)

Effects of Comorbid ADHD with Learning Disabilities on Anxiety, Depression, and Aggression in Adults

McGillivray, J.A., Baker, K.L. — Mon, 20 Apr 2009 17:10:06 PDT

Objective: ADHD and learning disabilities (LD) frequently coexist and there are indications that comorbidity may increase the risk of psychopathology. Method: The current study examined the gender distribution and frequency of comorbidity and its impact on the prevalence of symptoms of anxiety, depression, and aggression in a clinic sample of 80 adults with ADHD, aged 18 to 58 years. More individuals were diagnosed with ADHD+LD than ADHD only, with no difference in this distribution according to gender. Results: A factorial multivariate analysis of variance indicated that females with ADHD+LD displayed more cognitive depression than females with ADHD only and than males with ADHD+LD and ADHD only. However,individuals with ADHD only and individuals with ADHD+LD did not differ on overall anxiety, depression or aggression. Likewise, males and females did not differ on measures of psychopathology. Conclusion: This study lays the foundation for continued research into the characteristics and comorbidities of adults with ADHD. (J. of Att. Dis. 2009; 12(6) 525-531 )

Two New Rating Scales for Assessment of ADHD Symptoms in Italian Preschool Children: A Comparison Between Parent and Teacher Ratings

Re, A. M., Cornoldi, C. — Mon, 20 Apr 2009 17:10:06 PDT

Objective: Two new rating scales are presented for the assessment of ADHD symptoms in Italian preschool children, and the agreement between parents and teachers on the presence of an ADHD profile is examined. Method: The scales were administered to parents and teachers of 180 children with a mean age of 5 years and 9 months, attending final year of the Italian preschool system (kindergarten). Results: Despite the good psychometric properties of the scales, parent and teacher agreement was poor and parents endorsed more symptomatic behaviors in their children than the teachers, especially for the hyperactive dimension, although they did not necessarily associate these with the presence of a potential problem. Conclusions: The low correspondence between teachers and parents shows that ADHD rating scales, although useful screening instruments, are not sufficient for diagnosis and must be combined with other tools. ( J. of Att. Dis. 2009; 12(6) 532-539)

ADHD Subtypes and Co-Occurring Anxiety, Depression, and Oppositional-Defiant Disorder: Differences in Gordon Diagnostic System and Wechsler Working Memory and Processing Speed Index Scores

Mayes, S. D., Calhoun, S. L., Chase, G. A., Mink, D. M., Stagg, R. E. — Mon, 20 Apr 2009 17:10:06 PDT

Objective: Wechsler Intelligence Scale for Children Freedom-from-Distractibility/Working Memory Index (FDI/WMI), Processing Speed Index (PSI), and Gordon Diagnostic System (GDS) scores in ADHD children were examined as a function of subtype and coexisting anxiety, depression, and oppositional-defiant disorder. Method: Participants were 587 children with ADHD combined type (alone, with oppositional-defiant disorder, and with anxiety or depression) and ADHD inattentive type (alone and with anxiety or depression). Results: Attention scores (FDI/WMI and GDS Vigilance and Distractibility) were similar and low for all groups. ADHD combined groups had greater impulsivity (GDS Delay) than ADHD inattentive groups, and ADHD inattentive groups had slower processing speed (PSI) than ADHD combined groups. Comorbidity did not affect test performance. Scores differentiated ADHD subtypes with 72% accuracy. Conclusion: Findings support the validity of DSM-IV ADHD combined and inattentive subtypes and the validity of the GDS, FDI/WMI, and PSI in assessing attention, impulsivity, and processing speed in children with ADHD. (J. of Att. Dis. 2009; 12(6) 540-550)

Do Attention Deficits Influence IQ Assessment in Children and Adolescents With ADHD?

Jepsen, J. R. M., Fagerlund, B., Mortensen, E. L. — Mon, 20 Apr 2009 17:10:06 PDT

Objective: To characterize the relationship between IQ and attention deficits in children with ADHD and to estimate the inattention-related mean influence on IQ when children are tested before stimulant drug treatment has been initiated. Method: Studies of various methodologies are reviewed. Results: Correlation studies show mostly weak associations between IQ scores and attention deficits. Meta-analyses report the average short-term stimulant treatment effect on IQ in children with ADHD to be 2 to 7 IQ points. Conclusion: The associations between IQ and attention deficits in ADHD are generally modest, with the mean influence on IQ probably amounting to 2 to 5 IQ points. This may serve as a benchmark when clinicians interpret the validity of IQ in this clinical population. (J. of Att. Dis. 2009; 12(6) 551-562)

Variability of Attention Processes in ADHD: Observations From the Classroom

Rapport, M. D., Kofler, M. J., Alderson, R. M., Timko, T. M., DuPaul, G. J. — Mon, 20 Apr 2009 17:10:06 PDT

Objective: Classroom- and laboratory-based efforts to study the attentional problems of children with ADHD are incongruent in elucidating attentional deficits; however, none have explored within- or between-minute variability in the classroom attentional processing in children with ADHD. Method: High and low attention groups of ADHD children defined via cluster analysis, and 36 typically developing children, were observed while completing academic assignments in their general education classrooms. Results: All children oscillated between attentive and inattentive states; however, children in both ADHD groups switched states more frequently and remained attentive for shorter durations relative to typically developing children. Conclusion: Overall differences in attention and optimal ability to maintain attention among the groups are consistent with laboratory studies of increased ADHD-related interindividual and intergroup variability but inconsistent with laboratory results of increased intra-individual variability and attention decrements over time. (J. of Att. Dis. 2009; 12(6) 563-573)

A Pilot Study of Working Memory and Academic Achievement in College Students With ADHD

Gropper, R. J., Tannock, R. — Mon, 20 Apr 2009 17:10:06 PDT

Objective: To investigate working memory (WM), academic achievement, and their relationship in university students with attention-deficit/hyperactivity disorder (ADHD). Method: Participants were university students with previously confirmed diagnoses of ADHD (n = 16) and normal control (NC) students (n = 30). Participants completed 3 auditory—verbal WM measures, 2 visual—spatial WM measures, and 1 control executive function task. Also, they self-reported grade point averages (GPAs) based on university courses. Results: The ADHD group displayed significant weaknesses on auditory—verbal WM tasks and 1 visual—spatial task. They also showed a nonsignificant trend for lower GPAs. Within the entire sample, there was a significant relationship between GPA and auditory—verbal WM. Conclusion: WM impairments are evident in a subgroup of the ADHD population attending university. WM abilities are linked with, and thus may compromise, academic attainment. Parents and physicians are advised to counsel university-bound students with ADHD to contact the university accessibility services to provide them with academic guidance. (J. of Att. Dis. 2008; 12(6) 574-581)

Current Literature in ADHD: 2008 CHADD Poster Session Abstracts

Goldstein, S. — Mon, 20 Apr 2009 17:10:06 PDT