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PubMed2001

Actigraphy and parental ratings of sleep in children with attention-deficit/hyperactivity disorder (ADHD).

STUDY OBJECTIVES: To assess various sleep parameters in latency-aged children with ADHD and their normally developing peers through the use of multiple sleep measures. DESIGN: Six sleep parameters were evaluated for two groups of children, ADHD and normal comparison. Each group consisted of 25 children (20 males, 5 females) who ranged in age from 7 to 11 years. All children underwent rigorous diagnostic procedures and the ADHD subjects were selected only if they displayed pervasiveness in their symptomatology and were medication naive. Parents completed a retrospective questionnaire which evaluated sleep problems over the past six months. Additionally, each child wore an actigraph for seven consecutive nights, and the child's parents completed a sleep diary during this time period. SETTING: N/A. PATIENTS OR PARTICIPANTS: N/A. INTERVENTIONS: N/A. RESULTS: Based on the findings from the questionnaire, parents of children with ADHD reported significantly more sleep problems than parents of normally developing children. However, the majority of these sleep differences were not verified through actigraphy or sleep diary data, with the exception of longer sleep duration for children with ADHD and parent reports that describe increased bedtime resistence. It was also found that child-parent interactions during bedtime routines were more challenging in the ADHD group. CONCLUSIONS: Despite the possibility of intrinsic sleep problems such as longer sleep duration, results indicate that many of the sleep problems of children with ADHD may be due to challenging behaviours during bedtime routines. The reason for discrepancies among sleep studies employing objective measures as well as between retrospective and prospective measures are discussed.

Attention Deficit Disorder with Hyperactivity↗

PubMed1996

Child Behavior Checklist findings further support comorbidity between ADHD and major depression in a referred sample.

OBJECTIVE: To examine the convergence of categorical and empirical diagnostic systems to evaluate whether psychiatric comorbidity of juvenile major depression with attention-deficit hyperactivity disorder (ADHD) is due to assessment bias. METHOD: Using total predictive value and the odds ratio, the authors evaluated the convergence of Child Behavior Checklist (CBCL) scales with structured interview-derived diagnoses in 94 children with major depression, 97 with ADHD, and 115 normal control children with neither diagnosis. RESULTS: The CBCL Anxious/Depressed scale discriminated depressed from nondepressed children irrespective of comorbidity with ADHD, and the Attention Problems scale discriminated ADHD from non-ADHD children irrespective of comorbidity with major depression. Children with major depression comorbid with ADHD had CBCL correlates of both syndromes. CONCLUSIONS: Since the CBCL is an empirically derived taxonomic system, the correspondence between the content-congruent CBCL scales and DSM-III-R categorical diagnoses of major depression and of ADHD indicates that previously reported findings of high overlap between these two disorders using structured diagnostic interview methodology and trained raters were not due to rater biases.

Adolescent↗

PubMed1996

Growth deficits in ADHD children revisited: evidence for disorder-associated growth delays?

OBJECTIVE: To reevaluate the hypothesis that stimulants cause growth deficits in children with attention-deficit hyperactivity disorder (ADHD). METHOD: Growth deficits in height and weight were examined in 124 children and adolescents with ADHD and 109 controls, using appropriate correction by age and parental height measures and attending to issues of pubertal stage, treatment, and psychiatric comorbidity. RESULTS: Small but significant differences in height were identified between ADHD children and controls. However, height deficits were evident in early but not late adolescent ADHD children and were unrelated to use of psychotropic medications. There was no evidence of weight deficits in ADHD children relative to controls, and no relationship between measures of malnutrition and short stature was identified. CONCLUSIONS: ADHD may be associated with temporary deficits in growth in height through mid-adolescence that may normalize by late adolescence. This effect appears to be mediated by ADHD and not its treatment.

Adolescent↗

PubMed1997

Noradrenergic mechanisms in ADHD children with and without reading disabilities: a replication and extension.

OBJECTIVE: To examine noradrenergic (NA) function in children with attention-deficit hyperactivity disorder (ADHD) by replicating and expanding upon a previous finding that ADHD children with and without reading disabilities (RD) differ in plasma levels of the NA metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG). METHOD: Plasma levels of MHPG were compared in ADHD children who were subdivided on the basis of the presence or absence of RD. Subsequently, this replication sample was combined with a previously studied sample to further explore the relationship between plasma MHPG levels and measures of cognitive function in children with ADHD. RESULTS: Plasma levels of MHPG were significantly lower in ADHD children without RD, compared with those with RD, replicating a published finding. Analyses in the combined sample indicated that, among children with ADHD, plasma MHPG levels were inversely associated with measures of academic achievement and verbal processing, but not parent or teacher ratings of behavior or continuous performance test measures of attention and impulsivity. CONCLUSIONS: These data indicate that children with ADHD are not homogeneous with regard to NA function and that neurochemical variation is closely associated with differences in clinical characteristics of the children.

Achievement↗

PubMed1997

Gender differences in children with ADHD, ODD, and co-occurring ADHD/ODD identified in a school population.

OBJECTIVE: To examine gender differences among children with disruptive behavior disorders (DBDs) from an ethnically diverse school sample. METHOD: From 2,984 children, children with attention-deficit/hyperactivity disorder, combined type (ADHD-C) (46 boys, 11 girls), oppositional defiant disorder (ODD) (59 boys, 35 girls), and co-occurring ADHD-C/ODD (76 boys, 27 girls), diagnosed by teacher-rated DSM-IV symptoms, were compared with each other and with 254 controls on teacher ratings of symptoms, social functioning and Achenbach Teacher's Report Form scales. RESULTS: Children with ADHD-C/ODD received the poorest ratings on all variables. In "pure" groups, children with ODD were rated as learning more, working harder, and being less inattentive than children with ADHD-C; only the ODD group showed more internalizing problems than controls. For ADHD-C and ODD groups, ratings of aggression and some individual symptoms were higher in boys than girls. Girls with ODD were rated as more appropriate and less inattentive, but unhappier and more socially impaired than boys with ODD. Overall, girls received higher peer dislike scores than boys. CONCLUSIONS: Comorbidity and gender issues affect the correlates of DBDs, with learning problems higher in ADHD-C, internalizing problems associated only with ODD, and greatest impairment for ADHD-C/ODD groups. Despite having similar or less behavioral dysfunction, girls with DBDs may have more social problems than boys with DBDs.

Adolescent↗

PubMed1999

ADHD in girls: clinical comparability of a research sample.

OBJECTIVE: The investigation of attention-deficit/hyperactivity disorder (ADHD) in girls raises complex questions of referral bias and selection criteria. The authors sought to determine whether they could recruit a research sample of comparably affected girls using a combination of sex-independent diagnostic criteria and sex-normed cutoffs on teacher ratings. They also report on the largest placebo-controlled crossover comparison of methylphenidate and dextroamphetamine in girls with ADHD. METHOD: Subjects were 42 girls with DSM-III-R/DSM-IV ADHD (combined type) contrasted to 56 previously studied boys with ADHD on comorbid diagnoses, behavioral ratings, psychological measures, psychiatric family history, and stimulant drug response. RESULTS: Girls with ADHD were statistically indistinguishable from comparison boys on nearly all measures. Girls exhibited robust beneficial effects on both stimulants, with nearly all (95%) responding favorably to one or both drugs in this short-term trial. Dextroamphetamine produced significantly greater weight loss than methylphenidate. CONCLUSIONS: This highly selected group of ADHD girls was strikingly comparable with comparison boys on a wide range of measures. The results confirm that girls with ADHD do not differ from boys in response to methylphenidate and dextroamphetamine and that both stimulants should be tried when response to the first is not optimal.

Analysis of Variance↗

PubMed1999

Antecedents and complications of trauma in boys with ADHD: findings from a longitudinal study.

OBJECTIVE: To examine the relationship between trauma and attention-deficit hyperactivity disorder (ADHD), evaluating whether ADHD increases the risk for trauma, the risk for posttraumatic stress disorder (PTSD), or the risk for trauma-associated psychopathology. METHOD: Data from a longitudinal sample of 260 children and adolescents with and without ADHD were examined. All were evaluated comprehensively with assessments in multiple domains of functioning including systematic assessments of trauma and PTSD. Comparisons were made between traumatized and nontraumatized youths with and without ADHD. RESULTS: No meaningful differences were detected in comparisons between ADHD and control children, either in the rate of trauma exposure or in the development of PTSD. Although trauma was associated with the development of major depression, this effect was independent of ADHD status. In contrast, bipolar disorder at baseline assessment was a significant risk factor for subsequent trauma exposure. CONCLUSIONS: ADHD was not found to be a risk factor for either trauma exposure or PTSD, but childhood mania was. If confirmed, this finding stresses the potential severe clinical sequelae of childhood mania in children.

Adolescent↗

PubMed1999

Clinical correlates of ADHD in females: findings from a large group of girls ascertained from pediatric and psychiatric referral sources.

OBJECTIVE: The scientific literature about attention-deficit hyperactivity disorder (ADHD) is based almost exclusively on male subjects, and girls with ADHD may be underidentified and undertreated. The aim of this study was to examine clinical correlates of ADHD in females using comprehensive assessments in multiple domains of functioning. METHOD: Subjects were 140 girls with ADHD and 122 comparison girls without ADHD ascertained from pediatric and psychiatric referral sources of the same age and social class. Subjects were assessed with structured diagnostic interviews, psychometric tests assessing intellectual functioning and academic achievement, as well as standardized assessments of interpersonal, school, and family functioning by raters who were blind to clinical diagnosis. RESULTS: Compared with female controls, girls with ADHD were more likely to have conduct, mood, and anxiety disorders; lower IQ and achievement scores; and more impairment on measures of social, school, and family functioning. CONCLUSIONS: These results extend to girls previous findings in boys indicating that ADHD is characterized by prototypical core symptoms of the disorder, high levels of comorbid psychopathology, and dysfunction in multiple domains. These results not only support findings documenting phenotypic similarities between the genders but also stress the severity of the disorder in females.

Adolescent↗

PubMed1999

Atypical frontal brain activation in ADHD: preschool and elementary school boys and girls.

OBJECTIVE: To investigate patterns of frontal brain activation in unmedicated preschool and school boys and girls with attention-deficit/hyperactivity disorder (ADHD). METHOD: Baseline electroencephalographic activity of 117 children (66 aged 4 years, 51 aged 8 years) was subjected to power spectral analysis, and laterality scores were determined. RESULTS: Boys with ADHD exhibited a less right-lateralized frontal activation pattern than normal control boys. Girls with ADHD displayed a more right-lateralized frontal activation pattern than normal control girls. This finding applied to children at both 4 1/2 and 8 years of age. There was no difference between children with ADHD and children with ADHD plus oppositional defiant disorder. CONCLUSIONS: This pattern of frontal brain activation is in line with magnetic resonance imaging studies of ADHD. It could be demonstrated in children as young as 4 1/2 years, as well as in school-age children. The opposite direction of asymmetry in boys and girls stresses the importance of gender-specific analyses in ADHD.

Attention↗

PubMed2001

Teacher reports of DSM-IV ADHD, ODD, and CD symptoms in schoolchildren.

OBJECTIVE: To examine the prevalence of DSM-IV symptoms of attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder and age, gender, and comorbidity differences between ADHD subtypes. METHOD: Teachers completed a DSM-IV-referenced symptom inventory for 3,006 schoolchildren aged between 3 and 18 years. RESULTS: The screening prevalence rate of ADHD behaviors was 15.8%; rates for individual subtypes were 9.9% for inattentive, 2.4% for hyperactive-impulsive, and 3.6% for combined. The inattentive type was relatively uncommon in preschool children (3.9%), whereas the hyperactive-impulsive type was least common in teenagers (0.8%). Screening prevalence rates were higher for African-American (39.5%) than white (14.2%) students, but did not vary significantly (p < .05) as a function of geographic region or socioeconomic status. ADHD subtypes were rated as more impaired than the non-ADHD group on most measures and were easily differentiated on the basis of comorbid symptoms, social skills impairment, and special education services. CONCLUSIONS: The findings of this and similar studies show relatively high convergence for the prevalence of ADHD behaviors and differences between ADHD subtypes.

Adolescent↗

PubMed2001

Motivational effects on inhibitory control in children with ADHD.

OBJECTIVE: The problems children with attention-deficit/hyperactivity disorder (ADHD) encounter in tasks measuring inhibitory control are often theoretically related to deficits in cognitive processes. This study investigated the effects of different motivational incentives on the ability of children to inhibit intended or ongoing actions. METHOD: In a large German industrial town, 33 children with ADHD were compared with 33 members of a combined group of children with major depressive disorder, anxiety disorders, oppositional defiant disorder, or conduct disorder, and 33 children without any psychiatric disorder with respect to their performances in a stop-signal task. The children received continuous feedback under high- or low-incentive conditions. The children's performance was compared in terms of qualitative (inhibition rate) and quantitative (reaction time) measures. RESULTS: There were no indications of deficits in sustained attention in children with ADHD. Under conditions of low incentives, children with ADHD were less able to inhibit their reactions and had longer stop-signal reaction times. But when given high incentives, children with ADHD performed the task as well as both other groups. CONCLUSIONS: Supposed deficits in children with ADHD should be regarded from a perspective that differentiates performance from ability. Furthermore, the findings support a motivational explanation of the origins of lowered inhibitory control in children with ADHD.

Adolescent↗

PubMed2006

Relationship of family environment and parental psychiatric diagnosis to impairment in ADHD.

OBJECTIVE: Family environmental factors as well as parental attention-deficit/hyperactivity disorder (ADHD) status have shown associations with variability in ADHD. The purpose of the present study was to examine the links among family environment, parental psychiatric diagnosis, and child impairment within a sample of ADHD-affected sibling pairs (ASPs) ages 5 to 18 years. METHOD: Parents in 220 ASP families completed a measure of family functioning, the Family Environment Scale. Children's impairment was measured by clinical ratings of global functioning and by maternal ratings of behavior. RESULTS: Parents of children with ADHD rate their families as higher in conflict and lower in achievement and organization than normative samples. High family conflict is significantly associated with impairment in ADHD ASPs accounting for approximately 40% of the sibling similarity in impairment. Parental psychiatric diagnosis revealed no significant direct link to sibling impairment, but rather a significant indirect link to impairment mediated by family conflict. Direct associations with parental diagnosis depend on birth order of the ASP members despite the comparable mean impairment scores for older and younger ADHD siblings. CONCLUSIONS: There are strong links between impairment in children with ADHD and family environment. Different processes and mechanisms may contribute to impairment in different children in the same family.

Adolescent↗

PubMed2001

Latent class analysis of ADHD and comorbid symptoms in a population sample of adolescent female twins.

Attention-deficit/hyperactivity disorder (ADHD) is a phenotypically heterogeneous and highly heritable syndrome. which commonly co-occurs with other psychiatry disorders. To assess the role of genetic influences in ADHD, we used latent class analysis (LCA) to identify subtypes of ADHD taking into account its comorbidity with separation anxiety, oppositional defiant disorder (ODD), and three major depression symptoms. A structured interview was used to collect diagnostic data from a population sample of 2,904 adolescent female twins and their parents. LCA was applied to ADHD. separation anxiety. ODD symptom profiles obtained from the twins' parents, and major depression symptom profiles obtained from the twins' self-report. Odds ratios were used to test for familiality of class membership by examining the effect of zygosity on twin concordance within and between latent classes. Structural equation modeling was used to compute heritabilities for latent class membership. LCA revealed three ADHD categories of clinical interest: an inattentive subtype without comorbidity, a second inattentive subtype with increased number of ODD symptoms. and a combined inattentive/hyperactive-impulsive type with elevated levels of ODD, separation anxiety, and depressive symptoms. LCA also distinguished an ODD class and a separation anxiety class, each without increased levels of other comorbid symptoms; a second ODD class co-occurring with increased separation anxiety and depression symptoms; and a pure depression class. Odds ratios for MZ contrasted with DZ twin concordance for individual latent class membership ranged from 2.5 to 19.4. Overall, 66% of MZ pairs, but only 36% of DZ pairs, were assigned to the same latent class, consistent with a genetic hypothesis for latent class membership. Individual class membership was shown to have high heritability ranging from .34-.85. The pattern of latent classes suggested that in the general female adolescent population, there are three highly heritable ADHD subtypes, two of which are comorbid with other disorders. These classes were consistent with a genetic hypothesis for ADHD, with each class potentially reflecting a unique genetic subtype.

Adolescent↗

PubMed2005

Towards an understanding of unique and shared pathways in the psychopathophysiology of ADHD.

Most attention deficit hyperactivity disorder (ADHD) research has compared cases with unaffected controls. This has led to many associations, but uncertainties about their specificity to ADHD in contrast with other disorders. We present a selective review of research, comparing ADHD with other disorders in neuropsychological, neurobiological and genetic correlates. So far, a specific pathophysiological pathway has not been identified. ADHD is probably not specifically associated with executive function deficits. It is possible, but not yet established, that ADHD symptoms may be more specifically associated with motivational abnormalities, motor organization and time perception. Recent findings indicating common genetic liabilities of ADHD and other conditions raise questions about diagnostic boundaries. In future research, the delineation of the pathophysiological mechanisms of ADHD needs to match cognitive, imaging and genetic techniques to the challenge of defining more homogenous clinical groups; multi-site collaborative projects are needed.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Are endophenotypes based on measures of executive functions useful for molecular genetic studies of ADHD?

BACKGROUND: Behavioral genetic studies provide strong evidence that attention-deficit/hyperactivity disorder (ADHD) has a substantial genetic component. Yet, due to the complexity of the ADHD phenotype, questions remain as to the specific genes that contribute to this condition as well as the pathways from genes to behavior. Endophenotypes, or phenotypes that are more closely linked to the neurobiological substrate of a disorder, offer the potential to address these two issues simultaneously (Freedman, Adler, & Leonard, 1999). Thus far, potential endophenotypes for ADHD have not been systematically studied. METHOD: The current paper reviews evidence supporting the use of deficits on neurocognitive measures of executive functions for this purpose. RESULTS: Such deficits are a correlate of ADHD and show preliminary evidence of heritability and association with relevant candidate genes. Nonetheless, studies that have assessed the familial and genetic overlap of neurocognitive impairments with ADHD have yielded inconsistent results. CONCLUSIONS: In order for executive function deficits to be used as an endophenotype for ADHD, we recommend greater attention to the neurocognitive heterogeneity of this disorder and to the precision of measurement of the neuropsychological tests employed. We also discuss empirical strategies that may be necessary to allow such research to progress prior to full resolution of the pathophysiological basis of ADHD.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

Co-occurrence of conduct disorder and depression in a clinic-based sample of boys with ADHD.

BACKGROUND: Children with attention-deficit/hyperactivity disorder (ADHD) are at risk for the development of comorbid conduct disorder (CD) and depression. The current study examined potential psychosocial risk factors for CD and depression in a clinic-based sample of 203 boys (aged 6-10 years) with ADHD. METHODS: The boys and their mothers participated in an evaluation that involved assessments of cognitive, behavioral, academic, and family functioning. Potential predictors of CD and depression involved four domains: parenting behaviors, family environment, academic/cognitive functioning, and peer relations. ADHD groups were defined using mother- and teacher-report of DSM-IV symptoms. Mother-ratings of DSM-IV symptoms were obtained for a subsample of 91 boys approximately 5 years after the initial assessment. RESULTS: For both mother- and teacher-defined ADHD groups, social problems were related to depression symptoms; hostile, inconsistent, and detached parenting behaviors were related to CD symptoms; and family environment characterized by low cohesion, high conflict, and low marital satisfaction was related to CD and depression symptoms. For the teacher-defined ADHD group, parenting variables also predicted depression symptoms. Academic and cognitive variables did not predict CD or depression symptoms when parenting, family, and peer relationship variables were taken into account. Depression prospectively predicted CD, but not the reverse, and parental hostile control and familial conflict prospectively predicted CD for the teacher-defined ADHD group only. CONCLUSIONS: Source-specificity is a useful consideration when describing the relation of parenting and home environment with CD and depression symptoms in boys with ADHD. Intervention efforts that address these parenting, family, and peer relationship variables may aid in preventing the development of comorbid conditions.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

Child ADHD and personality/temperament traits of reactive and effortful control, resiliency, and emotionality.

BACKGROUND: Models of attention-deficit/hyperactivity disorder (ADHD) suggest developmental influences may feed into components of the disorder separately from associated disruptive behavior problems. We investigated this in terms of key personality/temperament traits of Reactive and Effortful Control, Resiliency, and Emotionality. METHODS: A sample of 179 children (age 6-12, 63% boys), of whom 92 had ADHD, 52 were Controls, and 35 were borderline or not otherwise specified cases of ADHD, were examined. Dispositional trait scores were derived from parent-completed California Q-sort and the Early Adolescent Temperament Questionnaire. Child ADHD symptoms were evaluated using maternal structured diagnostic interview and teacher-completed symptom ratings. RESULTS: Traits were differentially associated with symptoms. Reactive Control was related to hyperactivity-impulsivity as rated by both parents and teachers. Negative Emotionality was related to oppositional-defiance. Resiliency was primarily related to inattention-disorganization as rated by both parents and teachers; Effortful Control was related uniquely to inattention in parent but not teacher data. A moderation effect emerged; the relationship between parent-rated Negative Emotionality and teacher-rated ADHD symptoms was stronger for children with high levels of both Reactive and Effortful Control. CONCLUSIONS: Results are interpreted in relation to a two-pathway model of ADHD; regulation problems contribute to the emergence of symptoms of inattention-disorganization, reactive or motivational control problems to the emergence of hyperactivity-impulsivity, and these are distinct from negative affectivity. Children with regulation deficits and a reactive motivational style are especially at risk for the development of ADHD.

Adaptation, Psychological↗

PubMedDate not supplied

Descriptions of self: an exploratory study of adolescents with ADHD.

PROBLEM: How do adolescents experience attention deficit hyperactivity disorder (ADHD), and how are those experiences shaped and managed? METHODS: A qualitative exploratory design to investigate how adolescents with ADHD (N = 11; 8 males, 3 females) experience, perceive, and manage ADHD. Findings are based on a subset of data from a large grounded theory study of the experiences of living in a family when a child or adolescent has ADHD. The constant comparative method was used to analyze both individual and focus group interview data. FINDINGS: The primary finding, presented as a hypothesis, suggests that an ADHD adolescent's sense of self is distorted and that the development of self has been disrupted due to the neurobiology of ADHD and environmental factors associated with the difficulties of parenting a difficult child, social role expectations, and modeling. CONCLUSIONS: Therapeutic attention to how the self functions is important in stabilizing and ordering an adolescent's sense of self. Intrapsychic psychotherapy may be an important therapeutic approach in helping adolescents with ADHD develop personal responsibility and increased capacity for empathy.

Adolescent↗