Journal of Attention Disorders recent issues

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

Report From the National Survey on Drug Use and Health: Nonmedical Stimulant Use, Other Drug Use, Delinquent Behaviors, and Depression Among Adolescents

Goldstein, S. — 2008-06-23

Evidence, Interpretation, and Qualification From Multiple Reports of Long-Term Outcomes in the Multimodal Treatment Study of Children With ADHD (MTA): Part I: Executive Summary

2008-06-23

Objective: To review the primary and secondary findings from the Multimodal Treatment study of ADHD (MTA) published over the past decade as three sets of articles. Method: In a two-part article—Part I: Executive Summary (without distracting details) and Part II: Supporting Details (with additional background and detail required by the complexity of the MTA)—we address confusion and controversy about the findings. Results: We discuss the basic features of the gold standard used to produce scientific evidence, the randomized clinical trial, for which was used to contrast four treatment conditions: medication management alone (MedMgt), behavior therapy alone (Beh), the combination of these two (Comb), and a community comparison of treatment "as usual" (CC). For each of the three assessment points we review three areas that we believe are important for appreciation of the findings: definition of evidence from the MTA, interpretation of the serial presentations of findings at each assessment point with a different definition of long-term, and qualification of the interim conclusions about long-term effects of treatments for ADHD. Conclusion: We discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families, clinicians, and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD. (J. of Att. Dis. 2008; 12(1) 4-14)

Evidence, Interpretation, and Qualification From Multiple Reports of Long-Term Outcomes in the Multimodal Treatment Study of Children With ADHD (MTA): Part II: Supporting Details

2008-06-23

Objective: To review and provide details about the primary and secondary findings from the Multimodal Treatment study of ADHD (MTA) published during the past decade as three sets of articles. Method: In the second of a two part article, we provide additional background and detail required by the complexity of the MTA to address confusion and controversy about the findings outlined in part I (the Executive Summary). Results: We present details about the gold standard used to produce scientific evidence, the randomized clinical trial (RCT), which we applied to evaluate the long-term effects of two well-established unimodal treatments, Medication Management (MedMGT) and behavior therapy (Beh), the multimodal combination (Comb), and treatment "as usual" in the community (CC). For each of the first three assessment points defined by RCT methods and included in intent-to-treat analyses, we discuss our definition of evidence from the MTA, interpretation of the serial presentations of findings at each assessment point with a different definition of long-term varying from weeks to years, and qualification of the interim conclusions about long-term effects of treatments for ADHD based on many exploratory analyses described in additional published articles. Conclusions: Using a question and answer format, we discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families, clinicians, and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD. (J. of Att. Dis. 2008; 12(1) 15-43)

Literature Review: Visual Search by Children With and Without ADHD

Mullane, J. C., Klein, R. M. — 2008-06-23

Objective: To summarize the literature that has employed visual search tasks to assess automatic and effortful selective visual attention in children with and without ADHD. Method: Seven studies with a combined sample of 180 children with ADHD (M age = 10.9) and 193 normally developing children (M age = 10.8) are located. Results: Using a qualitative approach, the authors find no group difference in automatic search, but results are variable for effortful serial search. Using a novel, graphical approach, the authors find that the ADHD group demonstrated less efficient serial search. This overall effect is explored as a function of search display complexity. Children with ADHD search less efficiently at the lowest and highest levels of display complexity. Conclusion: Children with ADHD show impairments in aspects of their effortful visual selective attention, as measured by visual search. (J. of Att. Dis. 2008; 12(1) 44-53)

ADHD Symptoms and Associated Psychopathology in a Community Sample of Adolescents From the European North of Russia

Ruchkin, V., Lorberg, B., Koposov, R., Schwab-Stone, M., Sukhodolsky, D. G. — 2008-06-23

Objective: To assess the prevalence of ADHD symptoms and their relationship to psychopathology in adolescents from the European North of Russia. Method: The prevalence of ADHD symptoms is assessed by teacher reports in 536 adolescents. Internalizing and externalizing problems are assessed by teacher ratings and student self-reports. Results: Prevalence of individual ADHD symptoms ranges between 3.3% and 35%. Only 8.9% of boys and 3.6% of girls have positive ratings on six items in either inattention or hyperactivity subtype. These adolescents fare significantly worse regarding externalizing but not internalizing problems. Compared to girls with ADHD, boys with ADHD report higher levels of violent and nonviolent delinquency and are described by teachers as having more conduct problems. Possible ADHD status is associated with depressive symptoms in boys but not in girls. Conclusion: The estimates of ADHD prevalence rates obtained in this study are similar to those of other countries, suggesting the need for identification and treatment of the disorder. Evaluation of associated disruptive behavior disorders and depression, particularly in boys, is warranted. (J. of Att. Dis. 2008; 12(1) 54-63)

Injury Among Stimulant-Treated Youth With ADHD

Marcus, S. C., Wan, G. J., Zhang, H. F., Olfson, M. — 2008-06-23

Objective: To assess risk factors for injury among children and adolescents treated with stimulants for ADHD. Method: An analysis was performed of pharmacy and service claims data from 2000-2003 California Medicaid (Medi-Cal) focusing on children and adolescents ages 6 to 17 years who initiated stimulant therapy for ADHD. Bivariate and multivariate analyses were performed to examine associations of demographic and clinical characteristics with injury. Results: In a Cox proportional hazard model that controlled for background patient characteristics, patients ages 13 to 17 years, male gender, prescription of anxiolytic/hypnotic medications, and diagnosis of a mood disorder were each independently associated with increased risk of injury, whereas African American ancestry and other minority racial/ethnic ancestry were associated with lower risk. Youth with high stimulant medication possession ratios (MPR) had a nonsignificantly lower risk of injury as compared to those with a low stimulant MPR. Conclusion: These findings reveal several patient characteristics that may be associated with increased risk of injury among children and adolescents treated for ADHD. (J. of Att. Dis. 2008; 12(1) 64-69)

Agreement Rates Between Parent and Self-Report on Past ADHD Symptoms in an Adult Clinical Sample

Dias, G., Mattos, P., Coutinho, G., Segenreich, D., Saboya, E., Ayrao, V. — 2008-06-23

Objective: To investigate agreement rates between parent and self-report on childhood symptoms of ADHD. Method: Sixty-eight self-referred treatment-naïve adults (33 men, 35 women) were interviewed with a modified version of the Kiddie Schedule for Affective Disorders and Schizophrenia—Epidemiological Version (K-SADS-E) and asked about past ADHD symptoms, using modified Diagnostic and Statistical Manual of Mental Disorders (4th edition; DSM-IV) criteria (at least six symptoms in either domain for present and past symptoms). Parents were given a questionnaire with DSM-IV symptoms list. Results: Forty-six patients (67.6%) agreed on the presence of past ADHD diagnosis with their parents; there was agreement on subtype in more than half of cases (58.7%). Fifty patients (73.5%) reported positive past inattention symptomatology, and 31 of them (62.0%) agreed with their parents on their presence in childhood. Thirty-six patients (52.9%) reported positive hyperactivity—impulsivity symptomatology, and 20 of them (55.6%) agreed with their parents' reports. Conclusions: Results suggest retrospective information provided by adults with ADHD has moderate agreement rates with parents' reports for both domains. (J. of Att. Dis. 2008; 12(1) 70-75)

CBCL Clinical Scales Discriminate ADHD Youth With Structured-Interview Derived Diagnosis of Oppositional Defiant Disorder (ODD)

Biederman, J., Ball, S. W., Monuteaux, M. C., Kaiser, R., Faraone, S. V. — 2008-06-23

Objective: To evaluate the association between the clinical scales of the child behavior checklist (CBCL) and the comorbid diagnosis of oppositional defiant disorder (ODD) in a large sample of youth with attention deficit hyperactivity disorder (ADHD). Method: The sample consisted of 101 girls and 106 boys ages 6 to17 with ADHD. Conditional probability analysis was used to examine the correspondence between CBCL Clinical Scales with the structured-interview derived diagnosis of ODD. Results: Conditional probability analysis showed that the CBCL Aggression Scale best predicted a structured-interview derived diagnosis of ODD in boys and girls with ADHD. Conclusion: These findings suggest that the CBCL Aggression Scale could serve as a rapid and cost-effective screening instrument to help identify cases likely to meet clinical criteria for ODD in the context of ADHD (J. of Att. Dis. 2008; 12(1) 76-82)

Treatment of ADHD With Amphetamine: Short-Term Effects on Family Interaction

Gustafsson, P., Hansson, K., Eidevall, L., Thernlund, G., Svedin, C. G. — 2008-06-23

Objective: This research seeks to study the impact on family function after 3 months of treatment with amphetamine. Method: A total of 43 children, 6 to 11 years of age, with ADHD were treated with amphetamine for 3 months. Family function was studied before and after treatment by parent self-rating and independent observer ratings of videotaped parent—child interactions. Results: The families with a child with ADHD were found to be more dysfunctional than control families. Families with children with severe ADHD behavior showed evidence of more family dysfunction compared to families with children with less severe ADHD behavior. After 3 months of treatment with amphetamine, the children's behavior and the mother's well-being and some aspects of parent-reported and observer-rated family functioning improved. Conclusion: This study gives support to the notion that some aspects of family dysfunction may be related to the child's ADHD behavior. (J. of Att. Dis. 2008; 12(1) 83-91)

Discordance Between Psychometric Testing and Questionnaire-Based Definitions of Executive Function Deficits in Individuals With ADHD

2008-06-23

Objective: One suspected source of negative outcomes associated with ADHD has been deficits in executive functions. Although both psychometrically defined and self-reported executive function deficits (EFDs) have been shown to be associated with poor academic and occupational outcomes, whether these two approaches define the same individuals remains unknown. Method: Participants were 194 adults with ADHD from a case-control study of ADHD. Empirically based cutoffs were ascertained for an EFD diagnosis on both psychometric tests and scores on the Current Behavior Scale. Results: Results showed a modest overlap between the psychometric and self-reported definitions of EFDs. Whereas neuropsychological testing largely identified individuals with lower IQ and achievement testing, the behavioral questionnaire largely identified individuals with higher levels of ADHD symptoms, psychiatric comorbidity, and interpersonal deficits. Conclusion: Results indicate that behavioral questionnaires cannot be used interchangeably with neuropsychological testing for the assessment of EFDs in adults with ADHD. (J. of Att. Dis. 2008; 12(1) 92-102)

A Case of ADHD and a Major Y Chromosome Abnormality

Mulligan, A., Gill, M., Fitzgerald, M. — 2008-06-23

Background: ADHD is a common, heritable disorder of childhood. Sex chromosome abnormalities are relatively rare conditions that are sometimes associated with behavioral disorders. Method: The authors present a male child with ADHD and a major de-novo Y chromosome abnormality consisting of deletion of the long arm and duplication of the short arm. It is possible that the Y chromosomal abnormality is causing the ADHD syndrome in this boy. Conclusion: Considering this case and considering that (a) ADHD is more common in boys than in girls, (b) the transmission of some genes associated with ADHD may occur preferentially from fathers rather than from mothers, and (c) ADHD is more common in children with XYY syndrome and Turner's syndrome than in other children, the authors propose that the sex chromosomes may contain risk genes for ADHD. (J. of Att. Dis. 2008; 12(1) 103-105)

Book Review: Elliot, G. R., & Kelly, K. (2006). Medicating young minds: How to know if psychiatric drugs will help or hurt your child. New York: STC Healthy Living

Diller, L. — 2008-06-23

Current Literature in ADHD: Summarized by Sam Goldstein

2008-06-23

Award Announcements

2008-06-23

Introduction to the Special Issue on ADHD in Adults: Overcoming Resistance While Avoiding Zealotry

Reynolds, C. R. — 2008-04-16

Letter to the Editor

da Silva, M. A., Louza, M. — 2008-04-16

Adult ADHD Research: Current Status and Future Directions

Ramsay, J. R., Rostain, A. L. — 2008-04-16

Literature Review: ADHD in Adults: A Review of the Literature

Davidson, M. A. — 2008-04-16

Objective: ADHD presents significant challenges to adults. The current review's goals are (a) to critically examine the current state of knowledge regarding ADHD in adults and (b) to provide clinicians with practice-friendly information regarding assessment, diagnosis, and treatment. Method: Searches of PsycINFO and Medline were conducted, and reference lists from articles and books were searched for additional relevant references. Results/Conclusion: A valid and reliable assessment should be comprehensive and include the use of symptom rating scales, a clinical interview, neuropsychological testing, and the corroboration of patient reports. Specific diagnostic criteria that are more sensitive and specific to adult functioning are needed. In treatment, pharmacological interventions have the most empirical support, with the stimulants methylphenidate and amphetamine and the antidepressants desipramine and atomoxetine having the highest efficacy rates. Scientific research on psychosocial treatments is lacking, with preliminary evidence supporting the combination of cognitive behavioral therapy and medication. (J. of Att. Dis. 2008; 11(6) 628-641)

Research Forum on Psychological Treatment of Adults With ADHD

2008-04-16

Background: A literature search found five empirical studies of psychological treatment for adults with ADHD, out of 1,419 articles on ADHD in adults. Practice guidelines to date all recommend multimodal intervention, given that a significant number of patients cannot tolerate, do not respond to, or fail to reach optimal outcomes with medication alone. Method: This article provides a literature review and the recommendations of a forum of experts in the psychological treatment of adults with ADHD. Results: Empirical studies of brief, structured, and short-term psychological interventions for adults with ADHD to date demonstrate moderate to large effect sizes. Methodological challenges include selection of control groups, broad-based measures of outcome, and the need for larger samples. Conclusion: Psychological treatment may play a critical role in the management of adults with ADHD who are motivated and developmentally ready to acquire new skills as symptoms remit. (J. of Att. Dis. 2008; 11(6) 642-651)

The Expression of Adult ADHD Symptoms in Daily Life: An Application of Experience Sampling Methodology

2008-04-16

Objective: To use experience sampling method (ESM) to examine the impact of inattentive and hyperactive-impulsive ADHD symptoms on emotional well-being, activities and distress, cognitive impairment, and social functioning assessed in the daily lives of young adults. The impact of subjective appraisals on their experiences is also examined. Method: Participants (n = 206) complete up to 56 in-the-moment assessments of mood and current activities using Personal Digital Assistants for 1 week. Results: Multilevel modeling techniques reveal that ADHD inattentive and hyperactive-impulsive symptoms differentially relate to daily experiences. Higher inattentive symptoms are associated with indices of general distress, including less positive and more negative mood as well as more concentration problems. Higher hyperactive-impulsive symptoms are associated with reduced sensitivity to contextual factors in perceptions of situations. Conclusion: These findings demonstrate predictive validity for adult self-report of ADHD symptoms in a general population sample and suggest future research directions using ESM. (J. of Att. Dis. 2008; 11(6) 652-663)

Sustained and Focused Attention Deficits in Adult ADHD

2008-04-16

Objective: To examine the specificity of deficits in focused attention and sustained attention in adults with ADHD and to evaluate the effect of comorbidity. Method: Twenty-eight adults with ADHD without comorbidity were compared with 28 ADHD outpatients with comorbidity. Two control groups were used: 68 adults referred for ADHD but with another psychopathology rather than ADHD (non-ADHD) and 28 healthy controls. All participants completed attention tests of the Amsterdam Neuropsychological Tasks program. Results: Both ADHD groups demonstrated a sustained attention deficit relative to the control groups, as indicated by a disproportionate deterioration of speed fluctuation with time-on-task reflecting temporal lapses in attention. Only the ADHD⁺ group showed focused attention deficits in that they were less able to ignore irrelevant information. Conclusion: These findings show that adults with ADHD have specific deficits in sustained attention. Additional deficits in focused attention are confined to outpatients with ADHD and comorbidity. (J. of Att. Dis. 2008; 11(6) 664-676)

Comparison of a Norm-Based Versus Criterion-Based Approach to Measuring ADHD Symptomatology in College Students

McKee, T. E. — 2008-04-16

Objective: The prevalence of ADHD symptomatology in college students is unclear because rates can vary depending on the methodology that is employed. Gender differences in college prevalence have also remained unexplored. Method: Self-reported ADHD symptomatology was assessed in 1,096 college students using the College ADHD Response Evaluation, a measure that has been normed on college students and that also contains the 18 criteria currently used for diagnosis. Results : Almost 20% met the threshold for a modified diagnosis if the 97th percentile was used, whereas 7.48% reported the number of symptoms required for current diagnostic criteria. Few women reported extreme levels of impulsivity, whereas both men and women reported excessive inattention. However, men exceeded women in number and severity of inattentive symptoms. Conclusion: These findings suggest that rates of ADHD symptomatology are higher when college students are compared to their peers, which has implications for using current diagnostic criteria with this population. (J. of Att. Dis. 2008; 11(6), 677-688)

Adjustment to College in Students With ADHD

2008-04-16

Objective: To examine college adjustment in students reporting an ADHD diagnosis and the effect of medication treatment on students' adjustment. Method: 1,648 first-semester freshmen attending a public and a private university completed a Web-based survey to examine their adjustment to college. Results: Compared with 200 randomly selected control students, 68 students with ADHD reported more academic concerns and depressive symptoms. This was explained by higher rates of inattentive symptoms among students with ADHD and was unrelated to hyperactive-impulsive symptoms. Among students with ADHD, medication treatment was not related to better adjustment or diminished ADHD symptoms. The contribution of inattention to academic concerns and depressive symptoms remained significant when controlling for personality traits. Conclusion: Students with ADHD experience greater academic performance concerns and depressive symptoms during the transition to college. Medication treatment did not appear to diminish ADHD symptoms nor enhance students' adjustment. (J. of Att. Dis. 2008; 11(6) 689-699)

Social Appraisal of Adult ADHD: Stigma and Influences of the Beholder's Big Five Personality Traits

Canu, W. H., Newman, M. L., Morrow, T. L., Pope, D. L. W. — 2008-04-16

Objective: This study investigates social stigma associated with a diagnosis of ADHD in adulthood and whether Big Five personality traits predict appraisals of affected individuals. Method: A sample of 257 undergraduates rate the desirability of targets with ADHD, minor medical problems, and with no appreciable weakness, across several social engagement contexts. Results: Participants exhibit significantly less desire to engage with those with ADHD (as compared to both controls). Agreeableness, Extraversion, and Conscientiousness are found to predict appraisals of targets with and without ADHD, moderated by sex of the target and the beholder. Conclusion: It is suggested that fairly subtle, negative bias toward ADHD contributes to rejection of individuals with the disorder, particularly in academic and work settings. Findings also suggest peers' personalities do have some effect on appraisals of targets with ADHD ( J. of Att. Dis. 2008; 11(6) 700-710).

The Reliability and Validity of Self- and Investigator Ratings of ADHD in Adults

2008-04-16

Objective: Little information is available comparing self- versus investigator ratings of symptoms in adult ADHD. The authors compared the reliability, validity, and utility in a sample of adults with ADHD and also as an index of clinical improvement during treatment of self- and investigator ratings of ADHD symptoms via the Conners Adult ADHD Rating Scale (CAARS). Method: We analyzed data from two double-blind, parallel-design studies of 536 adult ADHD patients, randomized to 10-week treatment with atomoxetine or placebo. Outcome variables included ADHD symptom severity (CAARS self- and investigator ratings), psychiatric symptom comorbidity, and functioning. Results: All five CAARS subscales showed good internal consistency at each time point. Similarly, interrater reliability was acceptable for each subscale. Following treatment, CAARS total scores and subscale scores improved significantly from baseline. CAARS subscales also predicted changes in other psychiatric symptoms and functioning. Overall, baseline investigator ratings were stronger predictors of treatment outcome than baseline self-report scores. Conclusions: The CAARS demonstrated good internal consistency and inter-rater reliability, as well as sensitivity to treatment outcome. The finding of greater predictive power of investigator-rated baseline scores merits further investigation. (J. of Att. Dis. 2008; 11(6) 711-719)

Functional Outcomes in the Treatment of Adults With ADHD

2008-04-16

Objective: ADHD is associated with significant functional impairment in adults. The present study examined functional outcomes following 6-month double-blind treatment with either atomoxetine or placebo. Method: Patients were 410 adults (58.5% male) with DSM-IV—defined ADHD. They were randomly assigned to receive either atomoxetine 40 mg/day to 80 mg/day (n = 271) or placebo (n = 139). The primary functional outcome measure was the Endicott Work Productivity Scale (EWPS), and the secondary measure was the Adult ADHD Quality of Life (AAQoL). Patients were seen for four visits in 6 months. Results: At 6 months, both groups had nonsignificantly different improvements in EWPS total scores. Atomoxetine-treated patients showed significantly greater improvement than placebo-treated patients on the AAQoL after controlling for baseline severity of ADHD. Both treatment groups had low 6-month study completion rates. Conclusion: Following 6-month treatment with atomoxetine, adults with ADHD showed significantly greater improvement in functioning on disease-specific measures of quality of life than patients treated with placebo. (J. of Att. Dis. 2008; 11(6) 720-727)

Development of a New Psychosocial Treatment for Adult ADHD

Solanto, M. V., Marks, D. J., Mitchell, K. J., Wasserstein, J., Kofman, M. D. — 2008-04-16

Objective: The purpose of this study was to assess the effectiveness of a new manualized group Meta-Cognitive Therapy (MCT) for adults with ADHD that extends the principles and practices of cognitive-behavioral therapy to the development of executive self-management skills. Method: Thirty adults diagnosed with ADHD completed an 8- or 12-week program designed to target impairments in time management, organization, and planning skills. Treatment efficacy was measured using pre- and posttreatment self-report standardized measures (CAARS-S:L & Brown ADD Scales). Results: General linear modeling revealed a robust significant posttreatment decline on the CAARS DSM-IV Inattentive symptom scale (p < .001) as well as improvement on the Brown ADD Scales (p < .001). Conclusion: The findings indicate that participants in the MCT program showed marked improvement with respect to core ADHD symptoms of inattention, as well as executive functioning skills, suggesting that this program has promise as a treatment for meta-cognitive deficits in adults with ADHD. (J. of Att. Dis. 2008; 11(6) 728-736)

Mindfulness Meditation Training in Adults and Adolescents With ADHD: A Feasibility Study

2008-04-16

Objective: ADHD is a childhood-onset psychiatric condition that often continues into adulthood. Stimulant medications are the mainstay of treatment; however, additional approaches are frequently desired. In recent years, mindfulness meditation has been proposed to improve attention, reduce stress, and improve mood. This study tests the feasibility of an 8-week mindfulness training program for adults and adolescents with ADHD. Method: Twenty-four adults and eight adolescents with ADHD enrolled in a feasibility study of an 8-week mindfulness training program. Results: The majority of participants completed the training and reported high satisfaction with the training. Pre—post improvements in self-reported ADHD symptoms and test performance on tasks measuring attention and cognitive inhibition were noted. Improvements in anxiety and depressive symptoms were also observed. Conclusion: Mindfulness training is a feasible intervention in a subset of ADHD adults and adolescents and may improve behavioral and neurocognitive impairments. A controlled clinical study is warranted. (J. of Att. Dis. 2008; 11(6) 737-746)

Book Review: Ramsay, J. R., & Rostain, A. L. (2008). Cognitive--Behavioral Therapy for Adult ADHD: An Integrative Psychosocial and Medical Approach. New York: Taylor & Francis Group

Jansen, J. C. — 2008-04-16

Current Literature in ADHD: Special Section on Adults

Goldstein, S. — 2008-04-16

Improving School Outcomes for Students With ADHD: Using the Right Strategies in the Context of the Right Relationships

DuPaul, G., Power, T. J. — 2008-02-07

Identifying, Evaluating, Diagnosing, and Treating ADHD in Minority Youth

Hervey-Jumper, H., Douyon, K., Falcone, T., Franco, K. N. — 2008-02-07

Objective: This literature review describes evaluation and treatment of minority youth with ADHD. Method: A search of databases for reports of ADHD in minority children was conducted. Results: Interpretation of behavior varies among parents, as does their trust in health care providers and school personnel. Parents desire to avoid stigmatization of their children from diagnostic labels and medications. They may not understand the sequelae of inadequate treatment or fear side effects of treatment. Children respond to stimulant medication but fare better when it is combined with regularly scheduled psychosocial treatment, including education and support for parents. Financial struggles affect access, evaluation, and treatment. Community support is desperately needed to gain parental trust. Creative planning allows health care providers and neighborhood leaders to join in, benefiting the children. Conclusion: Quality evaluation by a competent provider, careful choice of assessment tools, clear communication with parents, and close follow-up of progress are all needed. (J. of Att. Dis. 2008; 11(5) 522-528)

The Role of Impairment in the Diagnosis of ADHD

Gathje, R. A., Lewandowski, L. J., Gordon, M. — 2008-02-07

Objective: Current diagnostic criteria for ADHD require the consideration of impairment in making a diagnosis, although clinical and research definitions of ADHD rely more heavily on reported symptoms. This study explored the relationship between impairment and symptoms, variables predictive of impairment, and variation in ADHD identification when impairment criteria are added to symptom criteria. Method: ADHD symptoms and impairment were assessed using archival parent and teacher rating scale data. Results: The results indicated that (a) single impairment measures alone and a global impairment index were, at best, only moderately correlated with symptom reports; (b) predictor variables accounted for a small percentage of the variance in impairment; and (c) the number of children meeting criteria for ADHD diagnosis varied dramatically when impairment measures were considered. Conclusion: Symptoms and impairment are related yet distinct constructs that should be measured independently to determine the presence of ADHD. (J. of Att. Dis. 2008; 11(5) 529-537)

Epidemiology of Attention Problems Among Turkish Children and Adolescents: A National Study

Erol, N., Simsek, Z., Oner, O., Munir, K. — 2008-02-07

Objective: To evaluate the epidemiology of attention problems using parent, teacher, and youth informants among a nationally representative Turkish sample. Method: The children and adolescents, 4 to 18 years old, were selected from a random household survey. Attention problems derived from the Child Behavior Checklist (CBCL) (N = 4,488), Teacher Report Form (TRF) (N = 2,360), and the Youth Self Report (YSR) (N = 2,206) were examined. Results: The CBCL and TRF attention problems scores were higher among young male children, whereas the YSR reported scores were higher among older adolescents without a gender effect. The CBCL and YSR scores were also higher by urban residence. Conclusion: Compared with other European samples, our national sample had higher mean attention problems scores than the Scandinavian but lower mean scores than the former Soviet Union samples. In addition to elucidating the profile of attention problems in Turkey, our results also contribute to understanding the comparative global epidemiology of attention problems. (J. of Att. Dis. 2008; 11(5) 538-545)

Anxiety, Methylphenidate Response, and Working Memory in Children With ADHD

Bedard, A.-C., Tannock, R. — 2008-02-07

Objective: To investigate the effects of methylphenidate (MPH) on components of working memory (WM) in children with ADHD and determine whether MPH produces differential effects on WM in children with comorbid anxiety (ANX). Method: Participants were a clinical sample of 130 children with ADHD, aged 6 to 12 years old (32% comorbid ANX). Each child participated in an acute randomized, double-blind, placebo-controlled, crossover trial with single challenges of three MPH doses. Four WM measures were used that varied in processing demands (storage versus manipulation of information) and modality (auditory—verbal; visual—spatial). Results: MPH improved auditory—verbal manipulation but only in the non-ANX children with ADHD. It had no effect on auditory—verbal storage of information. Also, MPH improved the ability to manipulate visual—spatial information in both ADHD groups, but beneficial effects on visual—spatial storage were evident only in children without comorbid ANX. Conclusions: Findings provide insight into potential mechanisms underlying individual differences in treatment response in ADHD, which may facilitate more targeted treatments. (J. of Att. Dis. 2008; 11(5) 546-557)

Self-Reported Symptoms of ADHD Among College Students in China and the United States

Norvilitis, J. M., Ingersoll, T., Jie Zhang, , Shuhua Jia, — 2008-02-07

Objective: The present study examined ADHD symptoms among college students in China and the United States. Method: A total of 283 (45%) American and 343 (55%) Chinese students completed the Wender Utah Rating Scale (WURS) and the Current Symptoms Scale (CSS), in addition to other measures. Results: Both of the ADHD measures appear to be reliable and valid, with good internal consistency, similar factor structures, and predicted relationships with other variables, such as depression and self-esteem. However, differences exist between the cultures in gender and overall reported symptom severity. Conclusion: ADHD symptomatology is present among college students in China in a pattern similar to that found in American college students. The WURS and the CSS appear to be effective screening measures for the disorder in China, although further research on gender and cultural differences is necessary. (J. of Att. Dis. 2008; 11(5) 558-567)

Emotional Expression in Children Treated With ADHD Medication: Development of a New Measure

2008-02-07

Objective: Although existing instruments contain items addressing the effect of ADHD medications on emotional expression, a review of measures did not yield any instruments that thoroughly evaluated positive and negative aspects of emotional expression. Method: The Expression and Emotion Scale for Children (EESC), a parent-report measure, was developed from an analysis of qualitative data from parent focus groups and expert opinion. Data from 179 parents and children treated with stimulants or atomoxetine are used to examine the psychometric properties of the EESC. Results: The EESC demonstrates good internal consistency and test-retest reliability. A factor analysis yields three factors (positive, flat, and emotional lability) that were consistent with the predicted structure of the measure. Small to moderate correlations between the EESC and psychological symptom measures are found, with the strength of the relationships varying by symptom measure. Conclusion: The EESC shows appropriate psychometric properties and is appropriate for use in clinical and research settings. (J. of Att. Dis. 2008; 11(5) 568-579)

Emotional Symptoms in Inattentive Primary School Children: A Population-Based Study

Sorensen, L., Hugdahl, K., Lundervold, A. J. — 2008-02-07

Objective: The present study investigates teacher and parent reports of inattention and emotional symptoms in 6,229 primary school children. Method: The assessment included the Emotional Symptoms subscale and the Impact scale from the Strengths and Difficulties Questionnaire and the inattention items from the Swanson, Nolan, and Pelham IV Questionnaire. Results: Children defined as inattentive showed a high risk of being defined as high scorers on the Emotional Symptoms subscale. A high score on both the Inattention and Emotional Symptoms subscales was associated with a high impact score. Teachers but not parents reported a higher risk of such co-occurrence of symptoms in girls than in boys. Conclusion: Inattentive children should be screened for emotional problems by use of the multi-informants method. (J. of Att. Dis. 2008; 11(5) 580-587 )

A Comparative Study of Performance in the Conners' Continuous Performance Test Between Brazilian and North American Children

Miranda, M. C., Elaine Girao Sinnes, , Pompeia, S., Francisco Amodeo Bueno, O. — 2008-02-07

Objective: The present study investigated the performance of Brazilian children in the Continuous Performance Test, CPT-II, and compared results to those of the norms obtained in the United States. Method: The U.S. norms were compared to those of a Brazilian sample composed of 6- to 11-year-olds separated into 4 age-groups (half boys) that represented the socioeconomic class distribution of São Paulo City. The children were prescreened for attention deficit disorders (ADHD). Results: Age and gender effects in the Brazilian sample were similar to those previously described. However, the Brazilian sample showed better performance in almost all measures in all age-groups compared to that of the United States. Conclusion: It is discussed that differences between samples probably reflect lack of ADHD screening of the U.S. children. More studies are necessary to determine if the CPT-II is a cross-cultural test with participants from different samples matched for age, gender, and socioeconomic status screened for ADHD. (J. of Att. Dis. 2008; 11(5) 588-598)

Vestibular Stimulation for ADHD: Randomized Controlled Trial of Comprehensive Motion Apparatus

2008-02-07

Objective: This research evaluates effects of vestibular stimulation by Comprehensive Motion Apparatus (CMA) in ADHD. Method: Children ages 6 to 12 (48 boys, 5 girls) with ADHD were randomized to thrice-weekly 30-min treatments for 12 weeks with CMA, stimulating otoliths and semicircular canals, or a single-blind control of equal duration and intensity, each treatment followed by a 20-min typing tutorial. Results: In intent-to-treat analysis (n = 50), primary outcome improved significantly in both groups (p = .0001, d = 1.09 to 1.30), but treatment difference not significant (p = .7). Control children regressed by follow-up (difference p = .034, d = 0.65), but overall difference was not significant (p = .13, d = .47). No measure showed significant treatment differences at treatment end, but one did at follow-up. Children with IQ-achievement discrepancy ≥ 1 SD showed significantly more CMA advantage on three measures. Conclusion: This study illustrates the importance of a credible control condition of equal duration and intensity in trials of novel treatments. CMA treatment cannot be recommended for combined-type ADHD without learning disorder. (J. of Att. Dis. 2008; 11(5) 599-611)

Book Review: Lewis, B. (2006). Moving Beyond Prozac, DSM, and the New Psychiatry: The Birth of Postpsychiatry. Ann Arbor: University of Michigan Press

Diller, L. — 2008-02-07

Current Literature in ADHD

Goldstein, S. — 2008-02-07