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PubMed2005

Are maternal smoking and stress during pregnancy related to ADHD symptoms in children?

BACKGROUND: There are some indications that maternal lifestyle during pregnancy (smoking and stress) contributes to symptoms of ADHD in children. We prospectively studied whether prenatal exposure to maternal smoking and/or stress is associated with ADHD symptoms and diagnostic criteria (according to DSM-IV) in 7-year-olds. METHODS: Nulliparous Scandinavian women were consecutively recruited at their first prenatal health care visit and assessments of smoking and stress were collected at gestational weeks 10, 12, 20, 28, 32, and 36. Children were followed up at 7 years old. We obtained full data for 72% of the sample: ADHD symptoms were rated by 74% of mothers (n=290) and 96% of eligible teachers (n=208). Attrition analyses showed no differences on key variables between participants and non-participants at follow-up. RESULTS: Results of multiple regression analyses showed prenatal exposure to smoking (beta=.16, p<.01) and stress (beta=.18, p<.01) were independently associated with later symptoms of ADHD. Results of logistic regression analyses showed that fulfillment of the diagnostic criteria for ADHD was related to exposure to prenatal stress (beta=.68, p<.01) especially in boys. The results were not confounded by sociodemographic factors or birth outcomes. CONCLUSIONS: This study provides evidence that prenatal exposure to stress and smoking is independently associated with later symptoms of ADHD in human children, particularly for boys. Because stress and smoking are relatively common during pregnancy, and yet preventable, these results are of public health significance.

Adult↗

PubMed1999

Components of attention in children with complex partial seizures with and without ADHD.

PURPOSE: To evaluate attentional difficulties in children with complex partial seizures, we reviewed the records of 12 children with complex partial seizures with attention deficient hyperactivity disorder (CPS/ADHD); 21 children with CPS without ADHD (CPS); 22 children with ADHD; and 15 control children. METHODS: Each child completed a computerized performance test (CPT), which evaluated sustained attention, inhibition of response, response time, and consistency of response. The ADHD groups also completed the CPT after a dose of methylphenidate. RESULTS: The results found poorest performance on the CPT by the CPS/ADHD group. Particular difficulty in attention was found for children with epilepsy regardless of the ADHD diagnosis. When methylphenidate was administered to the ADHD groups, both groups improved in performance on the CPT. CONCLUSIONS: Epilepsy may predispose children to attention problems that can significantly interfere with learning. Similar improvement for children with CPS/ADHD was found with methylphenidate compared with baseline as for children with ADHD but without CPS.

Adolescent↗

PubMed2026

Psychiatric and neurological predictors of early ADHD medication discontinuation across the lifespan: a multinational study.

BACKGROUND: Early discontinuation of attention-deficit/hyperactivity disorder (ADHD) medication is common and linked to worse outcomes. Identifying clinical predictors could aid personalised treatment yet evidence is inconsistent across ages and countries/regions. OBJECTIVE: Investigate psychiatric and neurological comorbidity as predictors of early ADHD medication discontinuation in new ADHD medication users across age groups, sex and countries/regions. METHODS: Using health records from eight countries/regions, we identified 1 000 411 (44% female) new ADHD medication users (2011-2020). Discontinuation was defined as a ≥180 day gap between dispensations. We examined 23 indicators of psychiatric or neurological comorbidity, severity and psychotropic medication use. Associations were estimated using Cox regression, pooled with random-effects meta-analyses and stratified by age-at-initiation and sex. FINDINGS: Discontinuation rates varied widely (children 19%-61%, adolescents 37%-68%, young adults 52-67%, adults 38%-68%). In pooled analyses, earlier discontinuation in children was predicted by intellectual disability, autism and use of psychotropic medications (HR range 1.32-1.51), while conduct/oppositional defiant disorder (CD/ODD) was protective (HR 0.83, 95% CI 0.73 to 0.94). In adolescents, no indicators remained statistically significant after multiple-testing control. In young adults, CD/ODD (HR 1.42, 95% CI 1.30 to 1.55), and in adults, schizophrenia (HR 1.25, 95% CI 1.09 to 1.44) and tic disorders (HR 1.27, 95% CI 1.11 to 1.46) predicted earlier discontinuation. Statistical heterogeneity was substantial, largely driven by US estimates. In meta-analyses excluding the USA, additional associations emerged. For example, in children, OCD and anxiety disorders predicted earlier discontinuation, while eating disorders and antidepressants/anxiolytics were protective in adults. Associations with schizophrenia, tic disorders and CD/ODD were no longer significant. Country-specific analyses showed similar association patterns, except in the USA, Hong Kong and the UK. Sex differences were limited. CONCLUSIONS: Children with neuropsychiatric comorbidity and related comedication are more likely to discontinue ADHD medication early, whereas few consistent predictors were seen from adolescence onwards. Marked cross-country variation, particularly in the USA, points to system-level influences on treatment patterns. CLINICAL IMPLICATIONS: Improving ADHD medication persistence will require consideration of healthcare context and age-specific strategies, including close monitoring for children with complex neuropsychiatric profiles, and consideration of broader factors in adolescents and adults, where clinical predictors were limited.

Humans↗

PubMed2005

Abnormal brain activation during inhibition and error detection in medication-naive adolescents with ADHD.

OBJECTIVE: Patients with attention deficit hyperactivity disorder (ADHD) and a medication history have shown abnormal brain activation in prefrontal and striatal brain regions during cognitive challenge. Previous findings have been confounded, however, by potential long-term effects of stimulant medication exposure and group discrepancies in task performance. The aim of this study was to investigate whether medication-naive adolescents with ADHD would still show abnormal brain activation in prefrontal brain regions during motor response inhibition in a task designed to control for intergroup performance discrepancies. METHOD: Rapid, event-related functional magnetic resonance imaging was used to compare brain activation in 16 medication-naive ADHD adolescents and 21 IQ-, age-, and sex-matched healthy comparison volunteers during a challenging, idiosyncratically adjusted task that required withholding of a triggered motor response. The design, which manipulated task parameters to force each subject to fail on 50% of trials, ensured that subjects worked at the edge of their own inhibitory performance, thereby controlling for intersubject and intergroup performance discrepancies and furthermore allowing for investigation of differences in brain activation related to inhibition and inhibition failure. RESULTS: Medication-naive adolescents with ADHD showed significantly reduced brain activation in the right inferior prefrontal cortex during successful motor response inhibition and in the precuneus and posterior cingulate gyrus during inhibition failure, both of which correlated with behavioral scores of ADHD. CONCLUSIONS: The study shows that abnormal brain activation during inhibitory challenge in ADHD is specific to the disorder, since it persists when medication history and performance discrepancies are excluded.

Adolescent↗

PubMed2002

Correlates of ADHD among children in pediatric and psychiatric clinics.

OBJECTIVE: Conventional wisdom among pediatricians has been that children with attention-deficit hyperactivity disorder (ADHD) who receive their diagnosis and are managed in the primary care setting have fewer comorbid psychiatric disorders and milder impairments than those seen in psychiatric clinics. The authors sought to determine whether comorbidity and clinical correlates of ADHD differ among children in these two settings. METHODS: A case-control study design was used. Participants were 522 children and adolescents of both sexes, six to 18 years of age, with (N=280) and without (N=242) ADHD. Participants were drawn from pediatric and psychiatric clinics in a tertiary care hospital and a health maintenance organization in a large metropolitan area. Assessments were conducted with standardized measures of psychiatric, cognitive, social, academic, and family function. RESULTS: The number, type, clusters, and age at onset of ADHD symptoms were nearly identical for youths at pediatric and psychiatric ascertainment sources. Regardless of source, participants with ADHD were significantly more likely than controls to have a higher prevalence of mood disorders, other disruptive behavior, anxiety disorders, and substance use disorders. Significant impairments of intellectual, academic, interpersonal, and family functioning did not differ between ascertainment sources. CONCLUSIONS: Children with ADHD from both psychiatric and pediatric practices have prototypical symptoms of the disorder; high levels of comorbidity with mood, anxiety, and disruptive behavior disorders; and impairments in cognitive, interpersonal, and academic function that do not differ by ascertainment source. These findings suggest that children cared for in pediatric practice have similar levels of comorbidity and dysfunction as psychiatrically referred youth.

Adolescent↗

PubMedDate not supplied

Learning disabilities and ADHD: overlapping spectrumn disorders.

Clinical and psychoeducational data were analyzed for 119 children ages 8 to 16 years who were evaluated in a child diagnostic clinic. A learning disability (LD) was present in 70% of the children with attention-deficit/hyperactivity disorder (ADHD), with a learning disability in written expression two times more common (65%) than a learning disability in reading, math, or spelling. Children with LD and ADHD had more severe learning problems than children who had LD but no ADHD, and the former also had more severe attention problems than children who had ADHD but no LD. Further, children with ADHD but no LD had some degree of learning problem, and children with LD but no ADHD had some degree of attention problem. Results suggest that learning and attention problems are on a continuum, are interrelated, and usually coexist.

Adolescent↗

PubMedDate not supplied

ADHD and reading disability in male adults: is there a connection?

The present study examined the comorbidity between attention-deficit/hyperactivity disorder (ADHD) and reading disability (RD) in male adults. Participants were 120 men, of whom 24 were classified as having ADHD. The basis for the diagnosis was two self-report scales validated by interviews and background data. An extensive battery was used to assess phonological abilities and various aspects of reading skills. No differences were obtained between adults with and without ADHD on measures of either phonological processing skills or word decoding, indicating a low comorbidity with RD. This finding was valid even when different criteria were used to diagnose RD. However, the two groups differed in reading comprehension, with individuals with ADHD performing poorly in tests of reading comprehension. These results are compatible with the view that reading comprehension involves many of the higher cognitive control functions assumed to be impaired in ADHD. However, these attentional control functions are not critical to word recognition, which is determined by a more encapsulated phonological processing module. The pattern of associations between ADHD and RD observed in the present study is explained with reference to the differential attentional demands of the two aspects of reading.

Adult↗

PubMedDate not supplied

ADHD and dyscalculia: Evidence for independent familial transmission.

The familial relationship between dyscalculia and attention-deficit/hyperactivity disorder (ADHD) was assessed. We conducted a familial risk analysis using probands with and without ADHD of both genders and their first-degree relatives. Participants were assessed with structured diagnostic interviews and a cognitive test battery. We found elevated rates of ADHD in relatives of both ADHD proband groups, regardless of dyscalculia status, and elevated rates of dyscalculia in relatives of probands with dyscalculia, irrespective of ADHD status. There was no evidence for cosegregation or assortative mating. Our findings support the hypothesis that ADHD and dyscalculia are independently transmitted in families and are etiologically distinct. These results reinforce the current nosological approach to these disorders and underscore the need for separate identification and treatment strategies for children with both conditions.

Adolescent↗

PubMedDate not supplied

Utility of the PASS theory and cognitive assessment system for Dutch children with and without ADHD.

This study examined the utility of the Planning, Attention, Simultaneous, Successive (PASS) theory of intelligence as measured by the Cognitive Assessment System (CAS) for evaluation of children with attention-deficit/hyperactivity disorder (ADHD). The CAS scores of 51 Dutch children without ADHD were compared to the scores of a group of 20 Dutch children with ADHD. The scores of the Dutch children were also compared to American standardization samples of children with and without ADHD. The findings showed that children with ADHD in both countries demonstrated relatively low scores on the Planning and Attention scales of the CAS, but average scores on the Simultaneous and Successive scales. These findings are similar to previously published research suggesting that the PASS theory, as operationalized by the CAS, has sensitivity to the cognitive processing difficulties found in some children with ADHD.

Attention Deficit Disorder with Hyperactivity↗

PubMed1996

The effects of auditory stimulation on the arithmetic performance of children with ADHD and nondisabled children.

This study evaluated the impact of extra-task stimulation on the academic task performance of children with attention-deficit/hyperactivity disorder (ADHD). Twenty boys with ADHD and 20 nondisabled boys worked on an arithmetic task during high stimulation (music), low stimulation (speech), and no stimulation (silence). The music "distractors" were individualized for each child, and the arithmetic problems were at each child's ability level. A significant Group x Condition interaction was found for number of correct answers. Specifically, the nondisabled youngsters performed similarly under all three auditory conditions. In contrast, the children with ADHD did significantly better under the music condition than speech or silence conditions. However, a significant Group x Order interaction indicated that arithmetic performance was enhanced only for those children with ADHD who received music as the first condition. The facilitative effects of salient auditory stimulation on the arithmetic performance of the children with ADHD provide some support for the underarousal/optimal stimulation theory of ADHD.

Acoustic Stimulation↗

PubMedDate not supplied

Neuropsychological and behavioral assessment of ADHD in seven- to twelve-year-old children: a discriminant analysis.

We hypothesized that children with attention-deficit/hyperactivity disorder (ADHD) would underperform on neuropsychological tests that are sensitive to executive function impairments. We further proposed that a linear discriminant analysis using behavioral and neuropsychological variables as dependent variables would pinpoint the capability of behavioral questionnaires and neuropsychological tests to predict the correct classification of ADHD and control children. We designed a transversal study with 62 seven- to twelve-year-old children with ADHD and 62 Full Scale IQ-matched controls using two behavioral scales and 13 neuropsychological tests. Using analysis of variance and covariance with age and school achievement and multifactor analysis of variance, we found that behavioral variables established robust, statistically significant differences between groups (p < .001). Children with ADHD scored worse than controls on 31 out of 61 neuropsychological variables. Children with ADHD, however, obtained better scores that were statistically significant on WISC-R Comprehension and Picture completion. A linear discriminant analysis with nine behavioral variables correctly classified 100% of the participants in both groups. Another linear discriminant analysis using 10 neuropsychological variables correctly classified 85.48% of the participants in both groups. We propose a core battery of selected tests for assessing children with ADHD. The significance of cross-cultural analyses of different developmental disturbances is emphasized.

Child↗

PubMed2004

The validity of the ADHD section of the Diagnostic Interview Schedule for Children.

The purpose of this study was to assess the concurrent criterion validity of the attention-deficit/hyperactivity disorder (ADHD) portion of the National Institute of Mental Health Diagnostic Interview Schedule for Children-IV (NIMHDISC-IV). Fifty-seven adolescent participants were divided into three groups on the basis of whether participants met criteria for ADHD on caretaker and adolescent responses on the DISC: (a) 18 participants for whom both the caretakers and adolescents endorsed ADHD, (b) 17 participants for whom the caretakers but not the youth endorsed ADHD, and (c) a clinical control group with no ADHD diagnosis (n = 22). These three groups were compared across parent, teacher, and adolescent checklists; clinician diagnosis; and three objective measures of behavior (continuous performance task, actigraphy monitoring, and a structured observation). Findings lend partial support to the concurrent criterion validity of the ADHD section of DISC.

Adolescent↗

PubMed2004

Technetium 99m ethylcysteinate dimer single-photon emission computed tomography (SPECT) during intellectual stress test in children and adolescents with pure versus comorbid attention-deficit hyperactivity disorder (ADHD).

Children and adolescents with the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnosis of attention-deficit hyperactivity disorder (ADHD) can have comorbid conditions such as conduct disorder, oppositional defiant disorder, and obsessive-compulsive disorder (comorbid type). The purpose of our study was to compare the pattern of regional cerebral perfusion in these two groups of children with ADHD during a computerized performance test. Nineteen children and adolescents were enrolled in the study. Seven boys and one girl with pure ADHD (group 1: mean age 12 years, range 9-16 years) and nine boys and two girls with comorbid ADHD (group 2: mean age 11 years, range 8-16 years) were studied by single-photon emission computed tomography (SPECT). The patients were not receiving any medication for at least 48 hours prior to the study. All patients were injected with 99mTc-ethylcysteinate dimer while doing a computerized performance test. Nine age-matched control children (five boys and four girls, mean age 12 years, range 9-17 years) with a normal brain SPECT served as controls. All patients in group 2 showed significantly decreased perfusion in the temporal lobes (P < .005). Five patients had decreased frontal lobe perfusion. Additionally, two patients in group 2 had decreased perfusion in the basal ganglia (not significant). Four of eight patients in group 1 had decreased frontal lobe perfusion (not significant). In addition, two patients had bilateral temporal lobe abnormalities, whereas two patients had a normal SPECT. Three patients in group 1 also had decreased basal ganglia perfusion. In contrast to previous studies of brain perfusion in ADHD that focused mainly on frontal and prefrontal cortical abnormalities, our study demonstrates that temporal lobe perfusion abnormalities are more common in patients with the comorbid type of ADHD. We postulate that these findings can have therapeutic implications and explain the decreased response to stimulants in this group of patients.

Adolescent↗

PubMed2002

A meta-analytic review of gender differences in ADHD.

The present study examined gender differences in ADHD through a meta-analysis. Effect size estimates for the primary symptoms and correlates of ADHD were calculated in an attempt to replicate and extend a previous meta-analysis on gender differences in the disorder. Relatively lenient inclusion criteria were used in order to maximize the number of studies included in the effect sizes. The results indicated that in comparison to ADHD boys, ADHD girls had lower ratings on hyperactivity, inattention, impulsivity, and externalizing problems. In addition, ADHD girls had greater intellectual impairments and more internalizing problems than ADHD boys. Overall, the results of the current meta-analysis indicated general agreement with the previous meta-analysis. The clinical implications of these gender differences and future research considerations are discussed.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

Differences in heterosocial behavior and outcomes of ADHD-symptomatic subtypes in a college sample.

The purpose of this study was to explore heterosocial relational outcomes in a college-aged sample showing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). Using questionnaires and a behavioral observation task, dating, sexual, and social outcomes were examined in three groups: 24 non-ADHD controls, 27 ADHD-Combined (ADHD/C) Type, and 13 ADHD-Primarily Inattentive (ADHD/IA) Type. The ADHD/IA group showed a consistent pattern of passivity and inexperience and was perceived relatively negatively by female confederates, whereas the ADHD/C group reported increased sexual drive and early dating experience. The effects of externalizing comorbidity differed by DSM-IV ADHD subtype. These findings indicate that ADHD-symptomatic adults differ by DSM-IV subtype in the manifestation of heterosocial deficits. Results suggest specific and divergent types of psychosocial intervention with ADHD/C versus ADHD/IA clients.

Adolescent↗

PubMed2004

Knowledge and attitudes about attention-deficit hyperactivity disorder (ADHD): a comparison between practicing teachers and undergraduate education students.

The knowledge and attitudes of practicing teachers regarding ADHD were compared with those of undergraduate education students. Key elements of studies of American and Canadian teachers by Jerome, Gordon, and Hustler (1994) and Jerome, Washington, Laine, and Segal (1999) were replicated. Information was gathered about participants' demographic background (training in ADHD), attitudes towards ADHD, and knowledge about its diagnosis and treatment. Results confirmed the existence of some knowledge gaps, although both practicing teachers and undergraduate education students possessed sound information about ADHD. Misconceptions about ADHD primarily concerned dietary treatment. Attitudes and knowledge were significantly correlated and most participants regarded ADHD as a valid diagnosis with implications for the school setting, and expressed a desire for comprehensive training. Despite similar results for both samples, teachers achieved higher accuracy on knowledge-based questions. These results are discrepant from those of Jerome et al. (1999) who found teachers and students to be similar in factual knowledge. Implications of these findings for curriculum development in academia and in-service teacher training are highlighted.

Adult↗

PubMed2005

Applying a psychoeducational perspective to ADHD.

This article examines whether various cognitive abilities are associated with symptoms of ADHD. Cognitive ability is conceptualized using Cattell-Horn-Carroll (CHC) theory as measured using the Woodcock-Johnson Tests of Cognitive Ability (3rd ed.). This article also examines whether test session behavior mediates the association between cognitive ability and ADHD. Participants are children ages 6 to 12 with (n= 33) and without (n= 19) ADHD. Results show that inattentive symptoms of ADHD are significantly related to the CHC ability of processing speed above and beyond the effect of test session behavior. Symptoms of ADHD (both inattention and hyperactivity/impulsivity) are also significantly associated with visual spatial processing, but this is completely mediated by test session behavior. It is concluded that inattentive symptoms of ADHD are associated with slower processing speed and that this relationship is not explained by test session behavior.

Achievement↗

PubMed2005

Accuracy of self-evaluation in adults with ADHD: evidence from a driving study.

Research on children with ADHD indicates an association with inaccuracy of self-appraisal. This study examines the accuracy of self-evaluations in clinic-referred adults diagnosed with ADHD. Self-assessments and performance measures of driving in naturalistic settings and on a virtual-reality driving simulator are used to assess accuracy of self-evaluations. The group diagnosed with ADHD (n= 44) has a higher rate of collisions, speeding tickets, and total driving citations in their driving history; report less use of safe driving behaviors in naturalistic settings; and use fewer safe driving behaviors in the simulator than the community comparison group (n= 44). Despite poorer performance, adults with ADHD provide similar driving self-assessments, thereby overestimating in naturalistic settings to a greater degree than the comparison group. These findings extend research in children with ADHD to an adult sample in an important domain of functioning and may relate to findings of executive deficits associated with ADHD.

Adult↗