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

Annual research review: conceptualising functional impairment in children and adolescents

Functional impairment is a key factor in the clinical importance of mental health problems in children. Yet, the nature of impairment and criteria for defining and assessing impairment in childhood disorders has been surprisingly overlooked in much of the literature. The current article examines the extant literature on the conceptualisation, nature and assessment of impairment in childhood disorders. Relations between diagnostic symptoms and functional impairment are discussed together with the influence of impairment on diagnostic decisions and prevalence rates. Several factors influencing impairment in childhood such as culture, development and gender are considered. This article concludes with a discussion of the utility of separating judgements of impairment from specific diagnoses, which is proposed for consideration in the forthcoming DSM-5.

Bullying and peer victimisation in adolescent girls with Attention-Deficit/Hyperactivity Disorder

Emerging evidence suggests that adolescent girls with Attention-Deficit/Hyperactivity Disorder (ADHD) are more socially impaired compared with their peers; however, research has yet to elucidate the nature of this impairment. We investigated overt (e.g., physical, such as hitting or kicking or verbal, such as teasing and taunting) and relational (e.g., social manipulation, such as social exclusion) bullying and victimisation in adolescent girls with and without ADHD. Adolescent girls (mean age = 15.11) with (n = 22) and without (n = 20) ADHD and their primary caregivers completed measures of overt/relational bullying and victimisation and social impairment. Adolescent girls with ADHD experienced more social problems and more relational and overt victimisation than adolescent girls without ADHD. Although adolescent girls with ADHD engaged in more overt and relational bullying than adolescent girls without ADHD, this difference was not statistically significant. Oppositional Defiant Disorder symptoms appeared to be more strongly related to bullying behaviour, while victimisation appeared to be more strongly related to ADHD.

Training the brain: fact and fad in cognitive and behavioral remediation

Putatively safe and effective for improving cognitive performance in both health and disease, products purported to train the brain appeal to consumers and healthcare practitioners. In an increasingly health-centered society, these applications constitute a burgeoning commercial market. Sparse evidence coupled with lack of scientific rigor, however, leaves claims concerning the impact and duration of such brain training largely unsubstantiated. On the other hand, at least some scientific findings seem to support the effectiveness and sustainability of training for higher brain functions such as attention and working memory. In the present paper we provide a tectonic integration and synthesis of cognitive training approaches. Specifically, we sketch the relative merits and shortcomings of these programs, which often appeal to parents who must choose between side-effect-laden medication and other less conventional options. Here we examine how neuroplasticity allows the healthy as well the impaired to benefit from cognitive training programs. We evaluate the evidence and consider whether brain training can be a stand-alone treatment or an adjunct to pharmacotherapy, outline promising future prospects, and highlight what training outcomes are plausible in line with available data. Future research would determine whether the field of brain training realizes its potential to revolutionize education and rehabilitation or withers away engulfed in controversy.

Why More Boys Than Girls With ADHD Receive Treatment: A Study of Dutch Twins

More boys than girls with attention deficit hyperactivity disorder (ADHD) receive treatment. One explanation for this bias may be that boys score higher on disruptive behavior scales than girls. Although this was supported by findings in clinical samples, recent studies in nonreferred samples showed that boys and girls with ADHD are similar with respect to their levels of disruptive behavior as reported by their mother. In this report, we investigate whether the difference in treatment rate is associated with higher teacher problem scores in boys with ADHD than in girls with ADHD. Data were obtained from mothers and teachers in a nonreferred sample of 283 boys and 291 girls with and without ADHD. Children were selected when they scored either low (controls) or high (probands) on attention problems. Mothers completed DSM-IV interviews, Child Behavior Checklists (CBCL) and the Conners Rating Scale (CRS). Teachers filled in the Teacher Report Form (TRF), and the CRS. Boys and girls with ADHD had similar levels of psychiatric illness and school impairment (such as being held back, special class placement and learning problems) by mother report. Mothers reported similar levels of aggression and attention problems in boys and girls with ADHD. In contrast, teachers consistently rated boys with ADHD as having higher scores on reports of attention problems and aggression than girls with ADHD. Gender differences vary across settings: boys and girls with ADHD are rated as behaving differently at school, but not at home. The higher level of teacher reported problem behavior at school may explain the high male–female ratio for ADHD in clinical settings. These findings have implications for the results of genetic studies that rely on referred samples, as these studies may give a distorted view of sex differences in the population.

Gender and conduct problems predict peer functioning among children with attention-deficit/hyperactivity disorder

Children with attention-deficit/hyperactivity disorder (ADHD) often have poor relationships with peers. However, research on this topic has predominantly focused on boys. This study considered child gender, ADHD status, and dimensionally assessed conduct problems as predictors of peer relationship difficulties. Participants were 125 children (ages 6-10; 67% male), 63 with clinical diagnoses of ADHD and 62 non-ADHD comparison youth. Conduct problems were reported by teachers and observed in a lab playgroup. Peer relationships were assessed by parent report, teacher report, and peer sociometric nominations in the playgroup. Results suggested that children with ADHD, as well as those with high conduct problems, displayed more impaired peer relationships than did comparison children and those with low conduct problems, but overall there were no gender differences in social functioning. However, statistical interactions appeared such that the negative impact of conduct problems on peer relationships was stronger for girls than for boys.

Prevalence of the ADHD phenotype in 7- to 9-year-old children: effects of informant, gender and non-participation

PURPOSE

To estimate the prevalence of the ADHD phenotype based on parent and teacher reports in a general population sample of 7- to 9-year-old Norwegian children and evaluate the effect of parent attrition, gender and informant on the prevalence estimate.

METHODS

The population consisted of all children (N = 9,430) attending 2nd-4th grade in the City of Bergen, Norway. The 18 symptoms of ADHD corresponding to the SNAP-IV and DSM-IV were included in the Bergen Child Study questionnaire to teachers and parents. Teacher information was available for 9,137 children (97%) and information from both informants was available for the 6,237 children (66%) whose parents agreed to participate in the study.

RESULTS

The prevalence of the ADHD phenotype based on the combination of parent and teacher reports was 5.2% among participants. Teacher ratings of non-participants had a doubled rate of ADHD high scorers with an OR of 2.1 (95% CI, 1.9-2.4). The non-participant ADHD high scorers had more inattentive and fewer hyperactive/impulsive symptoms as compared to participating ADHD high scorers. Teachers reported high scores of hyperactivity/impulsivity and the combined symptom constellation much more frequently in boys than girls, while the difference between genders was less marked according to parent reports.

CONCLUSIONS

The ADHD phenotype was twice as prevalent among non-participants as among participants. Reported prevalences in population studies are therefore likely to be underestimates, if such attrition bias is not accounted for. Choice of informant, criteria for symptom count, definitions of subtypes and gender differences influence the prevalence estimates of the ADHD phenotype.

Sustained attention and behavioral characteristics associated with ADHD in adults

The goal of the current study was to investigate whether two cognitive functions (i.e., sustained attention and response inhibition) were related to a general model of personality traits and behavioral characteristics associated with attention-deficit hyperactivity disorder (ADHD). To examine these relations, the Conjunctive Continuous Performance Test was used to measure the two cognitive functions, the Mini-Marker was used to measure the Big Five domains of personality, and the Wender Utah Rating Scale (WURS) was used to index ADHD symptoms. Correlations and multiple regression analyses showed that difficulties in sustained attention were associated with the WURS behavioral symptoms of inattention, oppositional/defiant behavior, impulsivity, and Big Five low conscientiousness, but were not associated with emotional problems such as neuroticism or low agreeableness (Big Five). Difficulties in response inhibition were marginally correlated with behavioral symptoms of inattention and low conscientiousness. Surprisingly, response inhibition was also highly correlated with sustained attention. In addition, neuroticism independently was highly associated with the WURS emotional and oppositional/defiant behavior symptoms. The findings suggest that deficient sustained attention relates specifically to the main ADHD behaviors but not to the emotional problems typically associated with the disorder.

Oppositional defiant disorder-gender differences in co-occurring symptoms of mental health problems in a general population of children

Informant- and gender-specific characteristics of Oppositional Defiant Disorder (ODD) and how these might relate to patterns of comorbidity need to be further clarified. We collected data from 7,007 children (aged 7-9) who participated in the Bergen Child Study (BCS), an ongoing population-based study of children's development and mental health. A questionnaire containing the DSM-IV behavioral descriptions of ODD was distributed to parents and teachers. Co-occurring symptoms of mental health problems were measured by the Strengths and Difficulties Questionnaire (SDQ). The boys (n = 122) and girls (n = 41) with symptomatic ODD had an increased risk of co-occurring emotional symptoms, hyperactivity or inattention and peer problems, as compared to their peers without symptomatic ODD. The impact of symptomatic ODD was higher for boys than girls in teacher reported SDQ ratings, except for emotional symptoms. There were no significant interaction effects of gender in parent SDQ ratings. Our results are contrary to the gender paradox hypothesis, which states that co-occurring symptoms of mental health problems are more frequent among girls with ODD as compared to boys with ODD.

Family routine moderates the relation between child impulsivity and oppositional defiant disorder symptoms

Although child impulsivity is associated with oppositional defiant disorder (ODD) symptoms, few studies have examined whether family processes moderate this association. To address this gap, we tested whether child-reported family routine moderated the relation between child hyperactivity/impulsivity (HI) and ODD symptoms among a sample of low-income, urban, ethnic-minority children (N = 87, 51% male). Child HI and ODD symptoms were assessed using parent and teacher reports. HI also was indexed by a laboratory task. Family routine was assessed using child self-report. Hierarchical regression analyses indicated that family routine moderated child HI. Among children with higher levels of teacher-reported HI symptoms, lower levels of family routine were associated with higher levels of teacher-reported ODD symptoms compared to children with lower levels of teacher-reported HI symptoms. Children who self-reported higher levels of family routine were rated as low on teacher-reported ODD symptoms, regardless of teacher-reported HI levels. Parent report and laboratory measures of child HI did not produce significant interactions. Lower levels of family routine may confer risk for ODD symptoms among low-income, urban, ethnic-minority children experiencing higher levels of HI.

Social adjustment among Taiwanese children with symptoms of ADHD, ODD, and ADHD comorbid with ODD

This study examined social problems at school and relationships with peers, siblings, mothers, and fathers among children with ADHD only (n = 41), ODD only (n = 14), ADHD + ODD (n = 47), and normal controls (n = 204) from a school-based sample of 2,463 first to ninth graders in Taiwan. ADHD and ODD symptoms were determined by teacher and mother reports on the Conners' Rating Scales and social adjustment problems were assessed by mother reports on the Social Adjustment Inventory for Children and Adolescents. Results indicated that relative to normal controls, children with ADHD + ODD displayed greater levels of social adjustment problems across domains (i.e., school, peers, siblings, and parents) while children with ADHD were significantly more impaired only in social adjustment at schools and children with ODD were more impaired only in social adjustment at home. Some similarities and differences in our findings, in relation to the Western literature, were discussed.

Sex difference in the rates and co-occurring conditions of psychiatric symptoms in incoming college students in Taiwan

OBJECTIVE

The authors investigated the sex difference in the rates and co-occurring patterns in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-referenced psychiatric symptoms among incoming first-year college students in Taiwan.

METHODS

This was a college-based questionnaire survey. The participants included 2731 incoming first-year college students (male, 52.4%; mean age, 19.3 ± 2.6 years). The participants completed the Chinese version of the Adult Self Report Inventory-4 for the assessment of a wide range of psychiatric symptoms according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition symptom criteria. The participant rate was 74.1%.

RESULTS

There were 55% of the participants having at least one psychiatric symptom. Symptoms of agoraphobia, body dysmorphic, and gender identity disorder were more prevalent in women; those of obsession-compulsion, tics, conduct problems, schizoid personality, and kleptomania were more prevalent in men. The magnitude of symptom correlations between compulsion and gender identity disorder, dysthymia, and antisocial personality, and between gender identity disorder and schizophrenia was significantly greater in male participants, whereas that between conduct problems and obsession and motor tics was significantly greater in female participants.

CONCLUSIONS

The Chinese version of the Adult Self Report Inventory-4 identified similar sex difference in psychiatric symptoms as Western studies. The sex difference in co-occurring psychiatric conditions warrants further investigation.

Gender differences in quality of schoolwork task performance among typically developing students and students at risk of or with mild disabilities

AIM

As no studies have examined for gender differences in quality of schoolwork task performance, the purpose of this study was to examine whether there is a gender difference in quality of schoolwork task performance among students at risk of or with mild disabilities, and to compare any identified differences to those that might exist among their typically developing peers.

METHODS

The participants were 2510 students (typically developing = 412 girls, 422 boys; at risk = 147 girls, 379 boys; mild = 242 girls, 901 boys), 4-10 years of age. Schoolwork task performance was measured using the School Version of the Assessment of Motor and Process Skills (School AMPS).

RESULTS

Regression analyses revealed no significant gender or age-by-gender interaction effects for any of the three groups (typically developing, at risk, mild).

INTERPRETATION

The results, focused on occupational performance, complement prior research that has focused on examining for gender differences in behaviour, academic achievement, and coordination among students with mild disabilities. These results also suggest that current School AMPS normative values, based on combined gender means, are valid.

Potential impact of ADHD with stimulant medication label on teacher expectations

OBJECTIVE

The present study investigated how teachers rated children's Behavior, IQ, and Personality contingent on the presence or absence of an Attention Deficit Hyperactivity Disorder (ADHD) label.

METHOD

Teachers from K-12 read a hypothetical description of either a male or female child with no label, an ADHD label, or an ADHD with stimulant treatment label. Teachers responded to 30, 7-point Likert rating scales anchored with descriptors related to Behavior, IQ, and Personality.

RESULTS

Teachers rated the child with an ADHD label and ADHD with stimulant treatment label significantly less favorably than the child with no label. Results partially supported that teachers rated the child with an ADHD label significantly less favorably than the child with an ADHD with stimulant treatment label.

CONCLUSION

Teachers rated the children with ADHD and ADHD with stimulant treatment label less favorably than the child with no label. Implications for educators and future research are discussed.

Are children with ADHD predominantly inattentive and combined subtypes different in terms of aspects of everyday attention?

The validity of the DSM-IV subtypes is a recurring diagnostic debate in attention deficit/hyperactivity disorder (ADHD). Laboratory measures, such as the test of everyday attention for children (TEA-Ch) can help us address this question. TEA-Ch is a test battery covering different aspects of everyday attention relating to selective and sustained attention and attentional control. The aim of the current study was to investigate whether this instrument can differentiate between combined (ADHD-C) and inattentive subtype (ADHD-I) of ADHD. Subjects were recruited from a multidisciplinary ADHD outpatient unit and tested free of medication. Sixty-four children with a diagnosis of ADHD were included (38 with ADHD-C; 26 with ADHD-I). The control group was 76 children recruited from primary and secondary schools. Children with ADHD performed worse than controls on 6 out of 9 TEA-Ch subtests. However a regression analysis revealed that TEA-Ch subtests made only a marginal contribution to the correct classification of ADHD, once the effects of IQ and age are controlled. Confirmatory factor analysis in our ADHD group demonstrated that the three factor structure achieved a poor fit. More detailed analysis suggested that inferior performance on the tasks designed to test vigilance was not the result of deficient-sustained attention. ADHD-C and ADHD-I showed very few differences across tasks. In conclusion, our results provided not much support for the value of the ADHD-C and ADHD-I distinction in predicting difficulties in everyday attention.

Sex differences in attentional performance and their modulation by methylphenidate in children with attention-deficit/hyperactivity disorder

BACKGROUND

Still little is known about neuropsychological differences between boys and girls with attention-deficit/hyperactivity disorder (ADHD) and whether there are sex-specific differences in the modulation of attentional performance by methylphenidate (MPH).

METHOD

In this study, 27 males and 27 females between 8-12 years old and with ADHD were investigated in a double-blind, placebo-controlled trial on five computerized attention tests (0.25 vs. 0.5 mg/kg MPH as a single dose, versus placebo).

RESULTS

Boys and girls with ADHD did not differ with respect to age, intelligence quotient (IQ), symptom severity, co-morbidity patterns, and ADHD subtype. However, ADHD boys were more impulsive on a sustained attention task, whereas girls with ADHD had more deficits on tasks measuring selective attention. Attentional performance increased differentially as a function of MPH dose, with some tasks showing linear improvement with higher dosage whereas more complex tasks in particular showed inverse U-shaped patterns of MPH effects. However, these effects were comparable between girls and boys.

CONCLUSIONS

Our data suggest that there are some gender differences in attentional performance in subjects with ADHD in a clinical sample, even if symptom severity and co-morbidity are controlled; however, modulation of attention by MPH does not seem to differ between sexes.

Gender differences in attention-deficit/hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is recognized to exist in males and females although the literature supports a higher prevalence in males. However, when girls are diagnosed with ADHD, they are more often diagnosed as predominantly inattentive than boys with ADHD. This article provides a review of gender differences noted across the lifespan. Males and females with ADHD are more similar than different, and generally ADHD profiles are not sex specific. Small gender differences have been found: adolescent girls with ADHD have lower self-efficacy and poorer coping strategies than adolescent boys with ADHD; rates of depression and anxiety may be higher, and physical aggression and other externalizing behaviors lower in girls and women with ADHD. Men with ADHD seem to be incarcerated more often than women with ADHD. However, many studies suffer from small sample sizes, referral biases, differences in diagnostic procedures, and possible rater influences. Treatments are reviewed and discussed with reference to the reported gender differences in functioning and the global deficits noted in all samples. The data available so far suggest that treatments are likely to be equally effective in males and females. However, referral bias is a problem, in that females with ADHD are less likely to be referred for treatment than males with ADHD. Future research should include equal representation of both sexes in samples such that sex by treatment analyses can be routinely conducted.

Hyperactivity, shyness, and sex: development and socio-emotional functioning

Based on formulations about the possible consequences for adaptation of gender nonnormative behaviour, we investigated predictive and concurrent relations of hyperactivity and shyness to various aspects of adaptation focusing on possible effects of sex. At ages 5-6, parents and preschool teachers rated hyperactivity and shyness for 151 children (50% boys). At age 9, we obtained teacher ratings of hyperactivity, internalizing and externalizing problems, self-ratings of trait anxiety, and peer nominations of shyness, social preference, and aggression. Several effects of sex were found. Hyperactivity ratings were more strongly related across time and raters for boys than for girls. In the predictive analyses, boys' hyperactivity was more strongly related to aggression than was girls' hyperactivity, and in concurrent analyses, girls' hyperactivity was more strongly associated with low social preference than was boys' hyperactivity. There was a protective effect of shyness with regard to aggression that applied only to boys, that is, at high hyperactivity levels, boys with high shyness levels were less aggressive than boys with low shyness levels. There were also main effects of hyperactivity and shyness. In predictive and concurrent analyses, hyperactivity was associated with low social preference, high levels of externalizing problems and with aggression, whereas shyness was associated with high levels of internalizing problems. Finally, there was an interactive effect of hyperactivity and shyness. In the concurrent analyses, an exacerbating effect was demonstrated insofar as high shyness was associated with low social preference at high, but not at low levels of hyperactivity. The different developmental risks of hyperactivity and shyness were discussed.

Differential effects of atomoxetine on executive functioning and lexical decision in attention-deficit/hyperactivity disorder and reading disorder

OBJECTIVE

The effects of a promising pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD), atomoxetine, were studied on executive functions in both ADHD and reading disorder (RD) because earlier research demonstrated an overlap in executive functioning deficits in both disorders. In addition, the effects of atomoxetine were explored on lexical decision.

METHODS

Sixteen children with ADHD, 20 children with ADHD + RD, 21 children with RD, and 26 normal controls were enrolled in a randomized placebo-controlled crossover study. Children were measured on visuospatial working memory, inhibition, and lexical decision on the day of randomization and following two 28-day medication periods.

RESULTS

Children with ADHD + RD showed improved visuospatial working memory performance and, to a lesser extent, improved inhibition following atomoxetine treatment compared to placebo. No differential effects of atomoxetine were found for lexical decision in comparison to placebo. In addition, no effects of atomoxetine were demonstrated in the ADHD and RD groups.

CONCLUSION

Atomoxetine improved visuospatial working memory and to a lesser degree inhibition in children with ADHD + RD, which suggests differential developmental pathways for co-morbid ADHD + RD as compared to ADHD and RD alone.

CLINICAL TRIAL REGISTRY

B4Z-MC-LYCK, NCT00191906; http://clinicaltrials.gov/ct2/show/NCT00191906.

Adolescent female rats are more resistant than males to the effects of early stress on prefrontal cortex and impulsive behavior

We tested the hypothesis that adolescent Sprague-Dawley females may be more resistant than males to display impulsive behavior and lower prefrontal cortex thickness after mother-infant separation (MS). Starting at postnatal day 2 (P2), the MS group was separated 6 hr/day and the early handled (EH) group 15 min/day for 10 days, and another group was standard facility reared (SFR). Subjects were examined for novel open-field activity (P28), light-dark apparatus (P29), familiar open-field (P30) and frontal cortical thickness. This protocol resulted in impulsive behavior in MS rats relative to EH and SFR, but this effect was less pronounced in females than males. MS affected the two sexes differently in terms of decreased prefrontal cortex dorsoventral thickness, with this effect being significant in males but not females. Neuroanatomical and behavioral documentation that adolescent females are more resistant than males to ADHD-like effects of maternal separation have not been previously reported.

The relationship between attention deficit hyperactivity disorder, conduct disorder, and psychopathy in adolescent male and female detainees

Although ADHD and CD are apparent risk factors for adult psychopathy, there are three distinct perspectives regarding their relationships to psychopathy: (1) ADHD may contribute uniquely to the development of psychopathy or (2) its contribution may reflect its high comorbidity with CD. Alternatively, (3) the comorbid presence of ADHD and CD may confer unique risk for the development of psychopathy. Although prior adult studies have yielded conflicting findings, no prior studies of adolescents address this issue. We examined these three hypotheses and the possibility of sex differences using cross-sectional analyses in 90 male and 123 female incarcerated adolescents. Among males the influence of ADHD was largely attributable to the overlap between ADHD and CD, whereas among females ADHD contributed independently to psychopathy scores and to scores on several dimensions of psychopathy. In addition, among females, the ADHD x CD interaction was significant for the total score and the antisocial component of psychopathy and in a direction opposite to that predicted by the comorbid subtype hypothesis. These findings indicate that there may be sex-specific pathways to elevations in psychopathic traits and suggest that the comorbid subtype hypothesis is probably not correct for either boys or girls.

Effects of comorbid ADHD with learning disabilities on anxiety, depression, and aggression in adults

OBJECTIVE

ADHD and learning disabilities (LD) frequently coexist and there are indications that comorbidity may increase the risk of psychopathology.

METHOD

The current study examined the gender distribution and frequency of comorbidity and its impact on the prevalence of symptoms of anxiety, depression, and aggression in a clinic sample of 80 adults with ADHD, aged 18 to 58 years. More individuals were diagnosed with ADHD+LD than ADHD only, with no difference in this distribution according to gender.

RESULTS

A factorial multivariate analysis of variance indicated that females with ADHD+LD displayed more cognitive depression than females with ADHD only and than males with ADHD+LD and ADHD only. However,individuals with ADHD only and individuals with ADHD+LD did not differ on overall anxiety, depression or aggression. Likewise, males and females did not differ on measures of psychopathology.

CONCLUSION

This study lays the foundation for continued research into the characteristics and comorbidities of adults with ADHD.

Prevalence rates of attention deficit/hyperactivity disorder in a school sample of Venezuelan children

A total of 1,535 4-12 year-old children were screened with the Conners' rating scales, followed by diagnostic confirmation by the diagnostic interview schedule for children-IV-parent version. The prevalence of ADHD was estimated to be 10.03%, and only 3.9% of children had received medication for the treatment of ADHD symptoms. Prevalence rates and demographic profile of Venezuelan children with ADHD are very similar to those found in samples from other countries. Authorities need to develop public health policies to correctly identify and treat affected subjects. Furthermore, clinicians must actively search for children with ADHD in order to provide the best-available treatment.

ADHD symptoms and associated psychopathology in a community sample of adolescents from the European north of Russia

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.

Co-occurrence of motor problems and autistic symptoms in attention-deficit/hyperactivity disorder

OBJECTIVE

To investigate the relation between parent reports of motor problems and clinically significant autistic symptoms in children with and without attention-deficit/hyperactivity disorder (ADHD).

METHOD

Subjects were male (n = 521) and female (n = 330) twins from an epidemiological study of ADHD, ages 7 to 19 years at assessment using the Child Behavior Checklist and semistructured psychiatric diagnostic interviews. Parent-rated Social Responsiveness Scale questionnaires were returned for 62% of 1,647 individuals who participated in interviews. After exclusion of subjects with incomplete data or evidence of mental retardation, 851 subjects (52%) were available for the present study analysis. Each subject was classified by DSM-IV ADHD subtype and assigned to one of seven population-defined ADHD subtypes based on latent class analysis of DSM-IV ADHD symptoms. Within each ADHD subtype, we examined the relation between Child Behavior Checklist motor problem endorsement and elevated autistic symptoms on the Social Responsiveness Scale.

RESULTS

Motor problems and high levels of autistic traits were most common in individuals with combined-type ADHD. Within each of the clinically relevant DSM-IV and latent class ADHD subtypes, individuals with the combination of motor problems and ADHD were more likely to have high levels of autistic traits than those with ADHD alone.

CONCLUSIONS

Children with the combination of ADHD and parent-reported motor coordination deficits have elevated levels of autistic symptoms. Targeted treatment and prevention interventions may be warranted. The exclusion criteria for DSM-IV ADHD should be revised to reflect these population-based findings.

Gender differences in ADHD: implications for psychosocial treatments

Attention-deficit/hyperactivity disorder (ADHD) has now been recognized to exist in both males and females, albeit the literature supports a higher prevalence in males. However, when girls are diagnosed with ADHD, they are more often diagnosed as predominantly inattentive than boys with ADHD. This paper provides a review of gender differences noted across the lifespan in terms of psychosocial functioning, cognitive abilities and psychiatric comorbidities. Males and females with ADHD are more similar than different, and generally symptoms of ADHD are not sex specific. Small gender differences have been found: adolescent girls with ADHD have lower self-efficacy and poorer coping strategies than adolescent boys with ADHD, but these differences tend to disappear by adulthood; rates of depression and anxiety may be higher (especially in adolescence) while physical aggression and other externalizing behaviors may be lower in girls and women with ADHD, although not all studies support these findings (e.g., non-referred samples show similar rates of coexisting psychiatric disorders between boys and girls with ADHD). However, many studies suffer from small sample sizes, referral biases, differences in diagnostic procedures and possible rater influences. Psychosocial treatments are reviewed and discussed with reference to the reported gender differences in functioning as well as the global deficits noted in all samples. Although the data available so far suggest that psychosocial treatments are likely to be equally effective in males and females, this conclusion is based more on the small number of gender differences noted in overall functioning and less on empirical research on treatment by sex effects and the moderating role of sex, an effect only investigated by the Multi-modal Treatment Study of ADHD group, to date. Future research should include equal representation of both sexes in samples such that treatment analyses by gender can be routinely conducted.

Epidemiologic considerations in attention deficit hyperactivity disorder: a review and update

Epidemiologic data on attention deficit hyperactivity disorder (ADHD) are essential for planning health services and implementing strategies of detection and early intervention, with possible substantial benefits on public health. This article addresses methodological aspects of prevalence studies, recent findings on the prevalence of ADHD in childhood and adolescence based on a systematic review, current findings on the persistence of the disorder over time and prevalence in adulthood, and factors associated with ADHD. Evidence from the reviewed literature indicates the importance of methodological aspects in the understanding of epidemiologic findings and the necessity of large-scale cross-national studies. Moreover, governments clearly must direct attention to childhood mental disorders to guarantee a healthy future for their countries.

The shifting subtypes of ADHD: classification depends on how symptom reports are combined

Research on the correlates of ADHD subtypes has yielded inconsistent findings, perhaps because the procedures used to define subtypes vary across studies. We examined this possibility by investigating whether the ADHD subtype distribution in a community sample was sensitive to different methods for combining informant data. We conducted a study to screen all children in grades 1-5 (N = 7847) in a North Carolina County for ADHD. Teachers completed a DSM-IV behavior rating scale and parents completed a structured telephone interview. We found substantial differences in the distribution of ADHD subtypes depending on whether one or both sources were used to define the subtypes. When parent and teacher data were combined, the procedures used substantially influenced subtype distribution. We conclude the ADHD subtype distribution is sensitive to how symptom information is combined and that standardization of the subtyping process is required to advance our understanding of the correlates of different ADHD subtypes.

Affective decision-making and externalizing behaviors: the role of autonomic activity

We tested a conceptual model involving the inter-relations among affective decision-making (indexed by a gambling task), autonomic nervous system (ANS) activity, and attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms in a largely impoverished, inner city sample of first through third grade children (N=63, 54% male). The present study hypothesized that impaired affective decision-making and decreased sympathetic and parasympathetic activation would be associated with higher levels of ADHD and ODD symptoms, and that low sympathetic and parasympathetic activation during an emotion-inducing task would mediate the relation between affective decision-making and child externalizing symptoms. In support of our model, disadvantageous decision-making on a gambling task was associated with ADHD hyperactivity/impulsivity symptoms among boys, and attenuated sympathetic activation during an emotion-inducing task mediated this relation. Support for the model was not found among girls.

Oppositional defiant disorder as a clinical phenotype in children with autism spectrum disorder

To examine the validity of oppositional defiant disorder (ODD) as a clinical phenotype distinct from attention-deficit hyperactivity disorder (ADHD), parents and teachers completed a DSM-IV-referenced rating scale and a background questionnaire for 608 children (ages 3-12 years) with autism spectrum disorder (ASD). The ASD sample was separated into four groups: ODD, ADHD, ODD + ADHD, and neither (NONE). Comparison samples were non-ASD clinic (n = 326) and community (n > 800) controls. In the ASD sample, all three ODD/ADHD groups were clearly differentiated from the NONE group, and the ODD + ADHD group had the most severe co-occurring symptoms, medication use, and environmental disadvantage. There were few differences between ASD + ODD and ASD + ADHD groups. Findings for ASD and control samples were similar, supporting overlapping mechanisms in the pathogenesis of ODD.

The neurobiological profile of girls with ADHD

Since boys are more commonly diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) than girls, the majority of theories and published research studies of ADHD have been based on samples comprised primarily (or exclusively) of boys. While psychosocial impairment in girls with ADHD is well established, the neuropsychological and neurobiological basis of these deficits is less consistently observed. There is growing evidence that boys' and girls' brains develop and mature at different rates, suggesting that the trajectory of early anomalous brain development in ADHD may also be sex-specific. It remains unclear, however, whether earlier brain maturation observed in girls with ADHD is protective. In this review, we outline the current theory and research findings that seek to establish a unique neurobiological profile of girls with ADHD, highlighting sex differences in typical brain development and among children with ADHD. The review highlights findings from neurological, neurocognitive, and behavioral studies. Future research directions are suggested, including the need for longitudinal neuroimaging and neurobehavioral investigation beginning as early as the preschool years, and continuing through adolescence and adulthood, with consideration of identified sex differences in the development of ADHD.

Comorbidity of internalizing disorders in children with oppositional defiant disorder

Oppositional defiant disorder (ODD) is often comorbid with other psychiatric disorders in childhood. Its association with attention deficit hyperactivity disorder and conduct disorder has been well studied. Recent studies suggest that children with ODD have substantial comorbidity with anxiety and depressive (internalizing) disorders, as well. Identifying the pattern of internalizing comorbidity with ODD in childhood and adolescence and how this varies across age and gender may help to identify mechanisms of such comorbidity. This systematic review presents evidence on the association of internalizing disorders with ODD across childhood and adolescence. Data from cross-sectional and longitudinal studies in clinic, community and epidemiologic samples are considered separately. Findings suggest that while internalizing comorbidity with ODD is present at all ages, the degree of comorbidity may vary over time in particular groups of children. Girls and boys appear to have different patterns of ODD comorbidity with either anxiety or depression, as well as ages of onset of ODD, however more large studies are required. Children with ODD in early life require further study as they may be a subgroup at increased risk for anxiety and affective disorders. This could have important implications for the treatment of these ODD children and the prevention of sequential comorbidity.

Do inattention and hyperactivity symptoms equal scholastic impairment? Evidence from three European cohorts

Background

Attention Deficit/Hyperactivity Disorder (ADHD) affects many children, adolescents, and adults and is associated with a number of impairments. Poor academic performance is related to ADHD in clinical samples. However, it is unclear to what extent core ADHD symptoms and scholastic impairment are related in non-referred school-aged children.

Methods

Data come from three population-based cohorts from Sweden, Denmark, and Finland, which are part of the Nordic Network on ADHD. The combined sample size was 13,087 children who were studied at ages 7–8 or 10–12 years. Teachers rated children on inattention and hyperactivity symptoms and reported children's scholastic performance on basic skills.

Results

There was a significant association in all cohorts between core ADHD symptoms and scholastic impairment in reading, writing, and mathematics. Particularly, inattention was related to a two to tenfold increase in scholastic impairment. Prevalence of hyperactivity symptoms was similar across the three cohorts, but inattention was lowest among children from the Finnish cohort, after stratification on living conditions.

Conclusion

These results extend previous reports of scholastic impairment among children with clinically diagnosed ADHD to non-referred population samples from three European countries. Surveillance policies should be implemented in school systems to catch children in need of behavioral or scholastic support early.

ODD, ADHD, versus ODD+ADHD in clinic and community adults

OBJECTIVE

To seek evidence for the validity of oppositional defiant disorder (ODD) as a behavioral syndrome in adults.

METHOD

Two samples of adults, mental health outpatient clinic referrals (N = 490) and community controls (N = 900), completed a Diagnostic and Statistic Manual of Mental Disorders-referenced rating scale and a brief questionnaire (social, educational, occupational, and treatment variables). Participants were separated into four groups: ODD-only, ADHD-only, ODD+ADHD, and NONE.

RESULTS

In general, the three symptom groups were more severe than the NONE group; the ODD+ADHD and NONE groups were the most and least severe, respectively; and there were clear differences between the ODD-only and ADHD-only groups. The pattern of group differences was generally similar in both samples.

CONCLUSION

Findings support the distinction between ADHD and ODD symptom presentations in adults, and the notion that the comorbid condition is a unique clinical entity, both of which are consistent with the child literature. Nevertheless, additional research with larger samples of patients will be necessary to establish ODD as a potential behavioral syndrome in adults.

Attention-deficit/hyperactivity disorder and social dysfunctioning

Attention-deficit/hyperactivity disorder (ADHD) is associated with functional impairments in different areas of daily life. One such area is social functioning. The purpose of this paper is to critically review research on social dysfunctioning in children with ADHD. Children with ADHD often have conflicts with adults and peers, and suffer from unpopularity, rejection by peers, and a lack of friendships, in part as a consequence of their ADHD symptoms. Comorbid oppositional defiant or conduct disorder aggravates these impairments. In some cases the inadequate social behavior of children with ADHD may be phenomenologically and etiologically related to pervasive developmental disorders (PDD). However, the causes and consequences of PDD symptoms in ADHD are understudied. Also, the relative contributions of ADHD, on the one hand, and comorbid disorders, on the other, to the course of social impairments are unknown. Social dysfunctioning in children with ADHD appears to increase their risk of later psychopathology other than ADHD. Thus far effective treatment for social dysfunctioning is lacking. Future research should address the exact nature and long-term consequences of social dysfunctioning in children with ADHD, and focus on development of effective treatment strategies.

Evaluating the evidence for and against the overdiagnosis of ADHD

OBJECTIVE

According to the DSM-IV TR, approximately 3 to 7% of school-age children meet the criteria for ADHD. However, there is a common conception that ADHD is overdiagnosed. The purpose of this article is to evaluate the evidence for and against overdiagnosis.

METHOD

Recent prevalence studies and research on factors affecting diagnostic accuracy were reviewed. For ADHD to be overdiagnosed, the rate of false positives (i.e., children inappropriately diagnosed with ADHD) must substantially exceed the number of false negatives (children with ADHD who are not identified or diagnosed).

RESULTS AND CONCLUSION

Based on the review of prevalence studies and research on the diagnostic process, there does not appear to be sufficient justification for the conclusion that ADHD is systematically overdiagnosed. Yet, this conclusion is generally not reflected in public perceptions or media coverage of ADHD. Potential explanations for the persistence of the belief in the overdiagnosis of ADHD are offered.

Attention-deficit/hyperactivity disorder: a neuropsychological perspective towards DSM-V

Neuropsychological methods and techniques have much to offer in the evaluation of the individual suspected as having Attention-Deficit/Hyperactivity Disorder (ADHD). After a review of the historical evolution of the ADHD concept, incidence and prevalence, and DSM-IV criteria for diagnosis, especially as regards omission related to gender differences, and other associated cultural, familial, socioenvironmental, and subject influences, this paper describes a number of dilemmas and obstacles encountered in clinical practice. Included are the confounds associated with the wide range of possible comorbidities, the insufficiency of current DSM-IV criteria, the emergence of subtype differentiation and its impact on diagnosis and treatment. The complex relationship between neuropsychological constructs and ADHD, and obstacles to valid assessment are also addressed. The complexities associated with a thorough ADHD evaluation are viewed within an impressive and expansive existing scientific framework and recommendations are made for future directions.

Is OPTAx useful for monitoring the effect of stimulants on hyperactivity and inattention? A brief report

PURPOSE

The purpose of this study was to investigate whether OPTAx, an objective measurement of hyperactivity, impulsivity and inattention can be used to measure the positive clinical effect of stimulants found in children with hyperkinetic disorder (HKD) or attention deficit disorder without hyperactivity.

METHOD

A total of 22 boys and one girl, with ages ranging between 7-12 years, diagnosed with HKD or attention deficit disorder without hyperactivity and receiving treatment with stimulants were tested with OPTAx, with and without stimulants. The main parameters investigated were: displacement, area, accuracy, variability, errors of commission and errors of omission.

RESULTS

OPTAx showed a significant improvement on all parameters during stimulant treatment compared with no treatment. The improvement measured by OPTAx was supported by clinical assessment, which found that 95% of the children improved much or very much on the Clinical Global Assessment Scale during stimulant treatment.

CONCLUSIONS

The objective parameters of the OPTAx reflected the clinical improvement found in children with HKD or attention deficit disorder without hyperactivity during stimulant treatment. This suggests a greater role for objective measurements such as OPTAx in daily clinical practise.

Special considerations in diagnosing and treating attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent chronic condition that affects people of all ages, including young children, school-aged children, adolescents, and adults. Symptoms can be noted as early as preschool age, tend to progress into functional impairment and behavioral problems in later childhood, and typically persist into adulthood. Contrary to previous belief, the disorder does not resolve with puberty for the majority of children; rather, the symptoms are manifested differently throughout the lifecycle. Presentation in adults is heavily biased toward inattentive symptoms, which are less likely to draw notice than hyperactive or impulsive symptoms and may contribute to the underrecognition of ADHD in this patient population. Diagnosis is particularly difficult due in large part to the pronounced comorbidity of psychiatric disorders in this patient population. Identification may be even more difficult in adults than children as the diagnostic criteria are not as clear, adults have difficulty remembering symptoms prior to 7 years of age, and there is a high prevalence of comorbid psychiatric disorders in adults. Early identification and treatment of symptoms of ADHD in preschool-age children is essential to effective long-term management of the disorder. Both medication and behavioral treatments appear to alleviate the symptoms of ADHD, and evidence suggests that discontinuation of treatment leads to the reemergence of the condition. Efforts are currently continuing toward understanding the genetic underpinnings of ADHD. This expert review supplement will address the prevalence, comorbidity, treatment issues, and special considerations surrounding ADHD management throughout each stage of the lifecycle beginning with ADHD in preschool-aged children, continuing with school-aged children and adolescents, and ending with adulthood.

Associations between obesity and developmental functioning in pre-school children: a population-based study

OBJECTIVE

To examine associations between obesity and impairment in developmental functioning in a general population sample of pre-school children.

METHOD

Standardized medical examinations were conducted in nine consecutive cohorts of male and female children (n=9415) aged between 4.4 and 8.6 years (mean=6.0, s.d.=0.37) residing in the Lower Bavaria region of Germany. Tests designed to assess performance in subdivisions representing four broad developmental domains, namely, motor development, speech development, cognitive development and psycho-social development, were completed by all participants.

RESULTS

Boys had significantly higher rates of impairment than girls. The prevalence of obesity in boys was 2.4%, whereas in girls it was 4.3% (chi (2)=21.51, P< 0.01). After controlling for age, gender, year of recruitment and other potential covariates, the prevalence of impairment in gross motor skills was higher among obese male children than normal-weight male children (adjusted odds ratio=1.76, 95% confidence interval (CI)=1.02, 3.01, P< 0.05), whereas the prevalence of impairment in the ability to focus attention was higher in obese female children than normal-weight female children (adjusted odds ratio=1.86, 95% CI=1.00, 3.44, P< 0.05).

CONCLUSIONS

The findings suggest that gender-specific associations between obesity and impairment in specific aspects of developmental functioning may be evident in younger children.

Resilient adolescent adjustment among girls: buffers of childhood peer rejection and attention-deficit/hyperactivity disorder

Examined a risk-resilience model of peer rejection and attention-deficit/hyperactivity disorder (ADHD) in a 5-year longitudinal study of 209 ethnically and socioeconomically diverse girls aged 6-13 at baseline and 11-18 at follow-up. Risk factors were childhood ADHD diagnosis and peer rejection; hypothesized protective factors were childhood measures of self-perceived scholastic competence, engagement in goal-directed play when alone, and popularity with adults. Adolescent criterion measures were multi-informant composites of externalizing and internalizing behavior plus indicators of academic achievement, eating pathology, and substance use. ADHD and peer rejection predicted risk for all criterion measures except for substance use, which was predicted by ADHD only. ADHD and peer rejection predicted lower adolescent academic achievement controlling for childhood achievement, but they did not predict adolescent externalizing and internalizing behavior after controlling for baseline levels of these constructs. Regarding buffers, self-perceived scholastic competence in childhood (with control of academic achievement) predicted resilient adolescent functioning. Contrary to hypothesis, goal-directed play in childhood was associated with poor adolescent outcomes. Buffers were not found to have differential effectiveness among girls with ADHD relative to comparison girls.

Transtorno de oposição e desafio e transtorno de conduta: os desfechos no TDAH em adultos

Os autores examinam a influência dos transtornos de oposição e desafio (TOD), de conduta (TC) e de personalidade anti-social (TPAS) ao longo da vida do indivíduo com TDAH. Os principais achados mostram que o TDAH é modulado por essas comorbidades e que seu prognóstico é modificado dependendo da presença ou não desses transtornos. O transtorno de oposição e desafio intensificaria as características de impulsividade e isolacionismo do TDAH, porém não acarretaria em um aumento na incidência de TPAS na vida adulta. Já o TC associado ao TDAH implica um aumento significativo na impulsividade e agressividade, estando associado significativamente a TPAS e um pior prognóstico. A diferenciação entre os diferentes transtornos e seu correto diagnóstico é essencial para o tratamento adequado do TDAH. Futuros estudos precisam determinar se o tratamento do TDAH produziria uma mudança significativa no prognóstico desse grupo de pacientes.

What is the Social Impact of ADHD in Girls? A Multi-Method Assessment

This study explores the social impact of ADHD, with and without opposition-defiant behaviour (ADHD+ODD (n= 22) and ADHD-only (n= 18)), in 9- to 12- year old girls compared to girls without ADHD (n= 40). Girls played a computer game involving simulated players, and mothers and teachers completed rating scales. In general, mothers and teachers saw girls with ADHD+ODD as more overtly and relationally aggressive and less prosocial than girls with ADHD-only, who were seen as more overtly and relationally aggressive and less prosocial than control girls. On the computer game, girls with ADHD+ODD were more overtly aggressive, more directly relationally aggressive, and showed less skilled behaviour than the other groups. Girls with ADHD-only showed less covert, indirect relational aggression and more socially awkward interactions than girls in the control group on the computer game. In all, the results indicate that girls with ADHD, with and without ODD behaviour, engage in socially detrimental behaviours.

Are ADHD gender patterns moderated by sample source?

OBJECTIVE

To examine whether ADHD gender patterns with respect to social-demographic characteristics, comorbidity, and impairment vary as a function of service use for emotional or behavioral problems.

METHOD

Two hundred and seventy-nine males and 119 females meeting ADHD symptom criteria identified in a nationally representative sample of Australian youth ages 6 to 17 are stratified according to whether they had attended a service in the previous 6 months.

RESULTS

ADHD gender patterns vary across service use on only 2 of the 31 comparisons made. The two exceptions were child's age at interview (females were older than males among service attendees but younger among nonattendees) and depressive disorders (females had higher rates than males among service attendees but lower rates among nonattendees).

CONCLUSION

Systematic differences in methods of case identification rather than sample source may be responsible for the discrepant ADHD patterns found between clinic and community-based studies.

A post hoc subgroup analysis of an 18-day randomized controlled trial comparing the tolerability and efficacy of mixed amphetamine salts extended release and atomoxetine in school-age girls with attention-deficit/hyperactivity disorder

BACKGROUND

Because the scientific literature on the pharmacotherapy of attention-deficit/hyperactivity disorder (ADHD) is almost entirely based on the results of studies in samples consisting primarily of boys, much is unknown about the treatment response in girls.

OBJECTIVE

This post hoc analysis compared the efficacy, tolerability, and time course of the effect of mixed amphetamine salts extended release (MAS XR) and atomoxetine in school-age girls with ADHD.

METHODS

This was an intent-to-treat subanalysis of the data from girls enrolled in a multicenter, 18-day, randomized, double-blind, parallel-group, forced dose-titration, laboratory school study enrolling boys and girls aged 6 to 12 years with ADHD. The study compared the efficacy, tolerability, and time course of the effect of increasing doses of MAS XR (10, 20, and 30 mg/d) and atomoxetine (0.5 and 1.2 mg/kg per day). The laboratory school sessions were organized in cycles to include 12 hours of observation. Efficacy measures included the SKAMP (Swanson, Kotkin, Agler, M-Flynn, and Pelham) deportment rating subscale, the SKAMP attention rating subscale, and academic testing (number of math problems attempted and answered correctly). Adverse events were assessed throughout the study period. Tolerability and efficacy measures were assessed during laboratory school visits on days 7, 14, and 21.

RESULTS

This subanalysis included 57 girls (median age, 9 years; 49.1% white, 22.8% black, 17.5% Hispanic) with a diagnosis of ADHD, combined subtype. Twenty-six girls were randomized to receive MAS XR and 31 were randomized to receive atomoxetine. Mean SKAMP deportment and attention subscale scores in the 2 groups were similar at baseline. Mean changes from baseline were significantly greater for MAS XR compared with atomoxetine on the SKAMP deportment score (-0.48 vs -0.04, respectively; P<0.001) and SKAMP attention score (-0.45 vs -0.05; P<0.001). The time course of medication effect, based on change from baseline in SKAMP deportment scores, indicated 12-hour efficacy for MAS XR at hours 2, 4.5, 7, 9.5, and 12 (all time points, P<0.01 vs baseline) but not for atomoxetine. At the end of the study, both treatment groups had a significant increase from baseline in the mean number of math problems attempted and answered correctly (P<0.001). Girls who received MAS XR attempted significantly greater numbers of problems compared with those who received atomoxetine (P=0.04). Both MAS XR and atomoxetine were well tolerated. The most frequently occurring treatment-related adverse events in girls receiving MAS XR were decreased appetite (40.7%), upper abdominal pain (29.6%), insomnia (25.9%), and headache (14.8%). The most frequently occurring treatment-related adverse events in girls receiving atomoxetine were somnolence (28.1%), upper abdominal pain (15.6%), vomiting (15.6%), nausea (12.5%), and decreased appetite (12.5%).

CONCLUSION

This post hoc analysis in a subpopulation of girls with ADHD, combined subtype, found that 18-day treatment with MAS XR was significantly more effective than atomoxetine in terms of ratings of classroom behavior, attention, and academic productivity.

ADHD in adults: a study of clinical characteristics, impairment and comorbidity

In this study, we explored the clinical characteristics, impairment and comorbidity in a sample of 45 adult patients with attention-deficit/hyperactivity disorder (ADHD). The collection of data is based on a naturalistic, retrospective approach using medical records documenting a comprehensive assessment of the patients. The sample was severely impaired in terms of academic achievement, employment and criminality, and had very high levels of comorbidity, especially alcohol and drug abuse, antisocial personality disorder and depression. Despite a high degree of contact with child psychiatric services in childhood, very few were diagnosed with ADHD, and many had a long period of psychiatric treatment as adults before the ADHD diagnosis was made. ADHD is in this sample of adults associated with severe impairment and comorbidity, and the connection between impairment and lack of proper diagnosis and treatment is discussed.

Evaluation and assessment issues in the diagnosis of attention deficit hyperactivity disorder

This article discusses the availability and appropriateness of various assessment techniques for diagnosing ADHD. In terms of the interview/history, the necessity and viability of using formal structured, semi structured, computerized and informal interviews for making an ADHD diagnosis are critiqued. The pros and cons of the various questionnaires frequently used to diagnose ADHD are addressed. The conundrum raised by multiple informants who often disagree is discussed, as are the effects of age and gender. The contributions of the medical and neurological examinations to the diagnosis of ADHD are considered. The utility of a neuropsychological assessment and of continuous performance testing to diagnosis is critiqued. Finally the lack of need for laboratory tests and the lack of necessity of neurological workup, specifically EEG and imaging, are argued.