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PubMed2004

Gender differences in the effects of oppositional behavior on teacher ratings of ADHD symptoms.

H. Abikoff, M. Courtney, W. E. Pelham, and H. S. Koplewicz (1993) presented elementary school teachers with a videotape of a 4th-grade male child exhibiting behavior associated with either Attention Deficit Hyperactivity Disorder (ADHD) or Oppositional Defiant Disorder (ODD). Comparisons with ratings generated from a control tape (same child exhibiting unremarkable behavior) suggested that oppositional tendencies inflated teacher ratings of ADHD for boys. The term "halo effect" has been used in the literature to refer to the impact of one class of behavior on the perception of another. This study replicated this procedure using identical scripts with both male and female child models. Oppositional behavior was associated with higher teacher ratings of hyperactivity and inattentiveness. Portrayals of behavior associated with ADHD generated higher teacher ratings of oppositional conduct. This bidirectional effect differed in magnitude as a function of child gender. The boy actor exhibiting oppositional behavior received teacher ratings of hyperactivity and inattention that were roughly half of those elicited by his portrayal of ADHD itself. The girl actor portraying ADHD generated oppositional defiant ratings that were roughly two thirds of those elicited from her performance as a child with ODD. These teacher rating tendencies could contribute to higher diagnostic rates of ADHD among boys and ODD among girls. Available epidemiologic data indicate a much higher rate of ADHD among boys and prevalence differentials for ODD (girls initially lower) that disappear by adolescence. Future research will be required to determine the extent to which these teacher response sets generalize to other evaluators such as parents, physicians and mental health professionals.

Attention Deficit Disorder with Hyperactivity↗

PubMed2004

Significance of childhood conduct problems to later development of conduct disorder among children with ADHD: a prospective follow-up study.

This study investigates whether low to moderate levels of childhood oppositional defiant disorder (ODD) and conduct disorder (CD) behaviors contribute to the development of clinically diagnosed CD in adolescence, in children with attention deficit hyperactivity disorder (ADHD). Participants were 207 White boys (ages 6-12) with ADHD free of conduct disorder diagnoses. Parent and teacher ratings were obtained. Participants were assessed at mean age 18 by clinicians blind to childhood status. A non-ADHD group (recruited in adolescence) was also studied. ODD behavior ratings did not predict CD in adolescence, whereas CD behavior ratings did. No single ODD or CD behavior predicted adolescent outcome. ADHD probands with very low ratings (Not at all, Just a little) by parents and teachers on all CD behaviors were still at significantly increased risk for CD in adolescence, compared to non-ADHD controls. The same relationships were found between childhood ODD and CD behaviors, and antisocial personality disorder in adulthood (mean age, 25). We conclude that childhood ADHD is a developmental precursor of later antisocial disorder, even in the absence of comorbid ODD or CD in childhood. However, low levels of CD-type problems are not innocuous, because they predict later CD among children with ADHD without comorbid CD.

Adolescent↗

PubMed2002

Attention-deficit/hyperactivity disorder (ADHD): feasibility of linkage analysis in a genetic isolate using extended and multigenerational pedigrees.

Segregation analyses converge in explaining the predisposition to attention-deficit/hyperactivity disorder (ADHD) as the consequence of a major gene and exclude purely environmental or cultural transmission. As a result of the ADHD phenotype restrictions, collection of extended families or design of linkage studies using families has been extremely difficult and thus currently linkage studies have been performed using only concordant or discordant sib-pairs rather than large families. On the other hand, intergenerational studies are represented by the transmission disequilibrium test (TDT) using trios. We collected pedigree data on ADHD from the Paisa community from Antioquia, Colombia, a genetic isolate. The goal of this study was to genetically map a putative gene predisposing to ADHD in a set of 27 multigenerational Paisa families. Here we present the results of a power simulation using SIMLINK to detect linkage of ADHD. ADHD was assumed to be a dichotomous trait with incomplete penetrance and a phenocopy rate of 3% in males and 0.2% in females. We simulated cosegregation of the trait and a marker locus in our pedigrees. We assumed Hardy-Weinberg and linkage equilibrium, equally frequent marker alleles and evaluated power at several recombination fractions between the trait and marker loci. Also, the ADHD trait was assumed to be genetically heterogeneous and different functions of age-dependent penetrance were simulated. We found exceptionally good power to detect linkage (expected LOD > 14 if theta is 0.1 or less), and that the presence of heterogeneity up to 50% does not affect substantially the projected LOD scores even for a theta recombination value of 0.05 (eLOD > 5.87). Having now obtained blood samples and confirmatory interviews in five families (representing 20% of the projected number of families), we performed a new analysis. The expected mean LOD in these five families reached values close to 10 and remained invariant when heterogeneity and different penetrance models were considered. We discuss the relative benefits of using extended and multigenerational families for genetic mapping studies as opposed to using nuclear families, affected sib pairs or sporadic cases which require the collection of over 1000 analytical units to get the same power exhibited by the small number of pedigrees described here.

Adult↗

PubMed2004

Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children.

The association between executive function deficits (EFDs) and functional outcomes were examined among children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Participants were children and adolescents with (n = 259) and without (n = 222) ADHD, as ascertained from pediatric and psychiatric clinics. The authors defined EFD as at least 2 executive function measures impaired. Significantly more children and adolescents with ADHD had EFDs than did control participants. ADHD with EFDs was associated with an increased risk for grade retention and a decrease in academic achievement relative to (a) ADHD alone, (b) controlled socioeconomic status, (c) learning disabilities, and (d) IQ. No differences were noted in social functioning or psychiatric comorbidity. Children and adolescents with ADHD and EFDs were found to be at high risk for significant impairments in academic functioning. These results support screening children with ADHD for EFDs to prevent academic failure.

Achievement↗

PubMed2003

Childhood ADHD and adolescent substance use: an examination of deviant peer group affiliation as a risk factor.

Deviant peer group affiliation was evaluated as a risk factor for substance use in adolescents with childhood attention-deficit/hyperactivity disorder (ADHD). Results showed that deviant peer affiliation mediated the relationship between ADHD and substance use, suggesting that children with ADHD are more likely than children without ADHD to become involved with deviant peers and, as a result, more likely to use substances. Moreover, the relationship between deviant peer affiliation and substance use was stronger for adolescents with ADHD, suggesting that once they are immersed in a deviant peer group, adolescents with ADHD are more vulnerable to the negative social influences of that group. This study is the first step in identifying high-risk pathways from childhood ADHD to substance use in adolescence.

Adolescent↗

PubMed1998

Association of the dopamine receptor D4 (DRD4) gene with a refined phenotype of attention deficit hyperactivity disorder (ADHD): a family-based approach.

Previously in this journal, we reported an association of the dopamine D4 receptor gene (DRD4) and attention deficit hyperactivity disorder (ADHD). In a population-association (case-control) study of 39 children with a refined phenotype of ADHD and 39 ethnically matched controls, we observed an increased percentage of the 7 repeat allele (29% vs 12%) and the 7+ genotype (49% vs 21%) in the ADHD group compared to the control group. In a replication and an extension of our initial study, we recruited another sample of ADHD subjects and found percentages of the 7 repeat allele (28%) and the 7+ genotype (48%) consistent with our previous findings. We used a family-based approach to evaluate a predicted association of DRD4 and ADHD based on a test of allele transmission focused on the 7 repeat allele. We identified 52 families based on the diagnosis of the refined phenotype of ADHD in the proband and the availability of DNA from both biological parents as well as the proband. Haplotype relative risk (HRR) analysis was performed to test our a priori hypothesis and produced significant results (chi-square = 4.65, P < 0.035). This provides additional evidence that the DRD4 gene is associated with a refined phenotype of ADHD.

Alleles↗

PubMed2002

Synaptosomal-associated protein 25 (SNAP-25) and attention deficit hyperactivity disorder (ADHD): evidence of linkage and association in the Irish population.

Several lines of evidence have suggested that ADHD is a polygenic disorder produced by the interaction of several genes each of a minor effect. Synaptosomal-associated protein 25 (SNAP-25) is a presynaptic plasma membrane protein which is expressed highly and specifically in the nerve cells. The gene encodes a protein essential for synaptic vesicle fusion and neurotransmitter release. Animal model studies showed that the coloboma mouse mutant has a hyperactive phenotype similar to that of ADHD. The hyperactive phenotype of this model has been shown to be the result of a deletion of the SNAP-25 gene. DNA variations within or closely mapped to the SNAP-25 gene may alter the level of expression and hence may have an effect on the function of synaptic vesicle fusion and neurotransmitter release. Using HHRR and TDT we analysed 93 ADHD nuclear families from Ireland and found increased preferential transmission of SNAP-25/DdeI allelel to ADHD cases; HHRR (chi(2) = 6.55, P = 0.01) and linkage (TDT) (chi(2) = 6.5, P = 0.015). In contrast to our findings, Barr et al(1) reported an increased transmission of allele 2 of the DdeI polymorphism though this was not statistically significant. However, they also reported a significantly increased transmission of a haplotype (made of allele 1 of MnlI and allele 2 of the DdeI) in their Canadian ADHD sample. It is not clear what the role of SNAP-25 in ADHD is until these findings are either confirmed or refuted in other ADHD samples.

Adolescent↗

PubMed1998

The striatum in a putative cerebral network activated by verbal awareness in normals and in ADHD children.

The aim of the present study was to evaluate the striatum's involvement in verbal awareness (semantic processing and supra-modal attention) in normals and children with attention deficit hyperactivity disorder (ADHD). Our previous finding of striatal hypoperfusion in ADHD at rest, supports our prediction that the striatum will also show reduced activation in response to tasks requiring verbal awareness. Regional cerebral blood flow (rCBF) was studied with the Xenon133 SPECT method in 12 boys with ADHD and six normal controls. The experimental controls included: (1) White Noise, (2) Passive Listening to a series of animal names, and (3) Detection of Targets ("dangerous animals") from the same series of animal names. The conditions were selected to isolate the semantic processing (Passive Listening - White Noise) and supra-modal attention components (Detection of Targets - Passive Listening of verbal awareness). ADHD children had decreased rCBF in the right striatum when compared to normals (mean difference from grand mean of each subject 8.06 ml/100 g/min vs 14.16 ml/100 g/min, p < 0.05). Factor analysis of the rCBF data revealed high factor I loadings for the frontal and striatal regions, which, in conjunction with the nature of the experimental conditions supported the inference that factor I mediated verbal awareness. Factor scores, which summarized the activity of all of the regions of interest (ROI's) on factor I, were differentially affected by the language component of the experimental tasks. Function scores were derived from factor I for the anterior cingulum and infero-frontal regions to evaluate their respective involvement in supra-modal attention and semantic processing. Function scores were also developed for the striatum, because of its central location and potential role in ADHD. The anterior cingulum was activated by supra-modal attention. The infero-frontal and the striatal regions were both activated by the language demands of the tasks. However, the striatum demonstrated reduced function scores (p < 0.05) in ADHD for all tasks. Our finding that the anterior gyrus cinguli were activated by supramodal attention and that the infero-frontal and striatal regions were activated by semantic processing supports the involvement of these ROI's in verbal awareness. Furthermore, the depressed functional contribution of the striatum to verbal awareness in ADHD children is consistent with and helps to explain their reduced cognitive control over behaviour and mental function.

Journal Article↗

PubMedDate not supplied

Time perception differences in children with and without ADHD.

INTRODUCTION: The purpose of this study was to compare time perception in children with and without attention deficit hyperactivity disorder (ADHD) with use of a time reproduction task. METHODS: The sample consisted of 60 children (30 with ADHD and 30 without ADHD) ranging in age from 9 to 12 years. Children were asked to watch a light, verbally estimate how long the light was illuminated, and hold a lever in a depressed position for the same amount of time they thought the light was on. Each child participated in 16 trials of 3, 6, 12, or 24 seconds for a total of 64 trials. RESULTS: Children with ADHD had significantly greater absolute discrepancy scores on the time reproduction task (F(1,58) = 10.878; P <.01) than did children in the control group. In addition, children with ADHD had greater increases in absolute discrepancy scores across time intervals (F(3,174) = 82.08; P <.01). DISCUSSION: Poor time perception affects the performance of social skills and other adaptive behaviors such as health consciousness and concerns for safety. The findings of this study indicate that children with ADHD have impaired time perception compared with children who do not have ADHD.

Adaptation, Psychological↗

PubMed2002

Effects of IQ on executive function measures in children with ADHD.

The present study compared children with Attention-Deficit Hyperactivity Disorder (ADHD) and controls on a selected set of clinical measures of executive function (EF). A total of 92 children (51 ADHD, 41 control), ages 6-16, completed measures chosen from a larger neuropsychological battery to illustrate diverse components of the EF construct (planning, inhibitory control, response preparation, memory search). The selected measures were moderately correlated with one another, and moderately correlated with IQ. After controlling for age, sex, presence of learning disability (LD), ADHD, and IQ test version, Full Scale IQ was significantly related to four of the five selected EF measures. A second analysis showed group differences on the EF measures at different IQ levels. After covarying for age, there was a significant multivariate effect for IQ level (average, high average, superior) and a significant multivariate interaction between group (ADHD vs. control) and IQ level. Three of the five selected EF measures showed significant univariate group effects (controls performing better than ADHD) at the average IQ level; however, there were no significant group differences between children with ADHD and controls at high average or superior IQ levels. These results suggest that clinical measures of EF may differ among children with ADHD and controls at average IQ levels, but there is poorer discriminatory power for these measures among children with above average IQ.

Adolescent↗

PubMed2003

Relations between inhibition, executive functioning, and ADHD symptoms: a longitudinal study from age 5 to 8(1/2) years.

The present study examined whether inhibition measured as early as preschool can predict more general executive functioning and ADHD symptoms at school age. In contrast to previous studies, the present study focused specifically on ADHD symptoms rather than general disruptive behavior problems, and boys and girls were studied separately. The main result was that inhibition was strongly related to ADHD symptoms both in school and at home for boys, but only in the school context for girls. Early inhibition was also significantly related to later executive functioning, and concurrent relations were found between executive functioning and ADHD symptoms, although in both cases only for boys. Besides this, inhibition added significantly to the variance, beyond that of executive functioning, which meant that for boys, inhibition and the other executive functioning explained about half the variance in inattention problems. The stronger relation between inhibition, executive functioning and ADHD symptoms for boys compared to girls could suggests that either the predictors of ADHD are different for the two sexes, or girls are more often equipped with some factor that protects them from developing ADHD symptoms, despite poor executive functioning. However, it is also possible that relations are just harder to demonstrate for girls due to their lower incidence of disruptive problem behaviors.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

The prevalence of ADHD in children with enuresis: comparison between a tertiary and non-tertiary care sample.

OBJECTIVE: The main aim of the current study was to determine reliable comorbidity rates of ADHD for enuretic children admitted either to non-tertiary care or to a specialized paediatric clinic, i.e. tertiary care, since previous research has failed to incorporate a possible setting effect in this comorbidity; and to use a multi-method multi-informant assessment of ADHD. MATERIAL AND METHODS: Eighty children, aged between 6 and 12 y, admitted to non-tertiary care with enuresis and 120 children referred to tertiary care were screened for the presence of ADHD using a multi-method (diagnostic interview, questionnaires) multi-informant (parents, teachers) assessment. RESULTS: Enuretic children from the tertiary care sample have a 3.4 times increased chance of having comorbid ADHD when compared to children with enuresis admitted to non-tertiary care, corresponding to a prevalence rate of 28% and 10%, respectively. Overall, the tertiary care sample was older, showed more daytime incontinence and revealed an increasing prevalence of ADHD with older age when compared with the non-tertiary care group. CONCLUSION: The prevalence rate of ADHD is increased in an enuretic population compared to community samples (3-5%). Moreover, enuretic children admitted to tertiary care show significantly higher comorbidity than non-tertiary care patients. The ADHD prevalence in the former group increases with older age, suggesting therapy resistance and a negative prognosis for enuresis in the case of comorbidity.

Academic Medical Centers↗

PubMed2003

Inhibition and executive functioning in Type A and ADHD boys.

The present study was aimed at clarifying the standing of Type A behavior, as measured by behavioral observations, relative to Attention Deficit Hyperactivity Disorder (ADHD), using measures of inhibitory control and executive functioning. The study sample included 20 boys exhibiting Type A behavior, 21 boys exhibiting Type B behavior and 14 boys diagnosed with ADHD, ranging in age from 7 to 12 years. The results of the present study showed that the Type A children differed from Type B children on two time-related variables, response latency and reaction time, in accordance with the view of Type As as time-urgent and impatient. Furthermore, in comparisons with the ADHD group, the Type A boys were found to be superior on several performance tasks, such as Go/no-go omissions, time reproduction, story recall and memory for sequences of hand movements, although similarities between Type A and ADHD boys were evidenced in terms of response latency and reaction time. In other words, although Type A boys were similar to ADHD boys in terms of overt displays of time-urgency and impatience, Type As do not display deficits with regard to executive functioning, of the kind often found when ADHD children are compared with normal controls. It may thereby be concluded that Type A behavior and hyperactivity/ADHD appear to be well differentiated except with regard to what may be interpreted as impatience. Speculations concerning differing origins of overtly similar characteristics of Type A behavior and ADHD should be considered in future research.

Analysis of Variance↗

PubMed2005

Latent inhibition and asymmetrical visual-spatial attention in children with ADHD.

The research was designed to determine whether the purported hemispheric asymmetries that are associated with attention deficit/hyperactivity disorder (ADHD) affect performance on a selective attention visual search task, and whether any obtained asymmetry will be modulated by methylphenidate. Two groups of children (8-15 years) with ADHD, one with methylphenidate treatment (ADHD+) and one without (ADHD+), were compared to matched controls on a two-stage visual search task. The task assessed right-left visual field asymmetries and the effects of changing a previous distractor into a target. Such a procedure, related to latent inhibition (LI; poorer performance to a previously irrelevant stimulus than to a novel one), can provide evidence for dysfunctional processing of irrelevant stimuli. All three groups exhibited the LI effect. The ADHD group, however, exhibited less LI for left- than right-side targets, an effect absent in the control and ADHD+ groups, suggesting a lateralized attentional deficit for ADHD+ that was normalized by methylphenidate.

Attention↗

PubMed2006

Cognitive remediation in ADHD: effects of periodic non-contingent alerts on sustained attention to response.

Few studies have attempted direct cognitive remediation of attention deficits in attention-deficit hyperactivity disorder (ADHD). The present study investigated the efficacy of periodic non-informative alerting cues for improving sustaining attention in ADHD. This technique is known to improve sustained attention in right frontal injury patients and may be effective in ADHD, given that this disorder has also been linked with right frontal dysfunction. Fifteen children with ADHD and 15 matched controls completed four blocks of a modified version of the Sustained Attention to Response Task (SART). Eight random non-contingent alerts were introduced on two of these blocks as a cue for participants to adopt a more supervisory stance to their performance. While the alerting cues did not alter the total number of commission errors committed by ADHD children over a task block, they did produce a significant short-term reduction in commission errors in the period immediately following an alerting cue. Our data demonstrate that sustained attention performance can be enhanced in children with ADHD using a simple cognitive training strategy. Methods from the field of cognitive rehabilitation may be viably applied to the remediation of attention deficits in ADHD.

Adolescent↗

PubMed2007

A clinical construct validity study of a novel computerized battery for the diagnosis of ADHD in young adults.

The cognitive profile of adult attention deficit hyperactivity disorder (ADHD) remains understudied despite difficulty in diagnosis. Further, no battery of neuropsychological tests has been shown valid in adult ADHD. Continuous performance tests are widely used for ADHD but provide limited information on cognitive functioning in general. The present study evaluated the construct and discriminant validity of Mindstreams (NeuroTrax Corp., NY), a computerized battery assessing multiple cognitive domains. Twenty-nine young male adults with ADHD diagnosis completed a Mindstreams battery, including a multi-stage continuous performance ('Expanded Go-NoGo') test, and the Conners' CPT-II (Multi-Health Systems Inc., NY). Discriminant validity was assessed by comparisons with cognitively healthy controls of comparable age and education. Expanded Go-NoGo and corresponding CPT-II outcomes were significantly correlated in ADHD participants, and the Expanded Go-NoGo test exhibited excellent discriminant validity, with ADHD participants performing more poorly than controls. ADHD participants also performed more poorly on Stroop and Staged Information Processing Speed tests.

Adult↗

PubMed1996

Urinary catecholamine excretion and behavioral differences in ADHD and normal boys.

Urinary catecholamine excretion was assessed in 15 boys with attention-deficit/hyperactivity disorder (ADHD) and 16 normal controls during a defined physical and mental task. Dihydroxyphenylalanine, dopamine, norepinephrine (NE), epinephrine (EPI), 3,4-dihydroxyphenylacetic acid, and 3,4-dihydroxyphenylglycol (DOPEG) concentrations were assayed by high-pressure liquid chromatography with electrochemical detection. The urinary concentration of DOPEG, an NE metabolite that has not been previously measured in ADHD, was significantly lower in the ADHD subjects than in the normal controls. There was also a trend for lower urinary EPI levels in the hyperactive boys. Stepwise multiple regression analyses demonstrated that DOPEG and EPI each contributed significantly to the variance in the behavioral symptoms within the full sample. The results are consistent with previous reports of abnormal metabolism of norepinephrine and epinephrine in ADHD. These neurochemical findings may be due to differences between ADHD and normal boys in neuronal (central or peripheral) or nonneuronal (e.g., adrenal, renal) activity. The results are also consistent with prior findings in normal children of an inverse relationship between EPI excretion and inattentive, restless behaviors. Together, these findings suggest caution in ascribing metabolite changes to ADHD or to ADHD-like behaviors that may be seen in normal children.

3,4-Dihydroxyphenylacetic Acid↗

PubMed2003

A survey of music therapy methods and their role in the treatment of early elementary school children with ADHD.

Attention-Deficit Hyperactivity Disorder (ADHD) has recently been receiving more frequent attention in professional circles and in the press, and some sources would assert that its occurrence in the general population is consistently growing. Because music therapists often work with preschool and school-age children, it is likely that they will increasingly be treating children with a diagnosis of ADHD. However, there is little in the music therapy literature about music therapy treatment for ADHD. The purpose of this survey was to ascertain what music therapy methods are being used for children with an ADHD diagnosis, how effective this treatment is perceived to be, and the role that music therapy treatment plays in relation to other forms of treatment. Results of the survey indicated that music therapists often utilize a number of music therapy methods in the treatment of children with ADHD. They often address multiple types of goals, and treatment outcome is generally perceived to be favorable. Referrals for music therapy services are received from a number of different sources, although parents and teachers were indicated to be the most frequent referral sources. Most children with ADHD receiving music therapy services also receive other forms of treatment, with an overwhelming majority receiving medication. The implications of these results are discussed, and areas for continuing research into the use of music therapy with ADHD are identified.

Attention Deficit Disorder with Hyperactivity↗