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Ulusoy V, Bilican I, Gormez A. Effectiveness of an online dialectical behavior therapy skills training in adults with attention-deficit/hyperactivity disorder: A randomized controlled trial. Psychother Res 2024:1-17. [PMID: 38359387 DOI: 10.1080/10503307.2024.2311773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE The current study aims to examine the efficacy of an add-on dialectical behavior therapy skills training (DBT-ST) on adult attention-deficit/hyperactivity disorder (ADHD). The DBT-ST was applied online under the pandemic conditions that occurred after the study had started. METHODS The current randomized controlled trial consists of an intervention group to whom the DBT-ST was applied in online setting and a waitlist control group who received treatment as usual (TAU). Data were collected pre-, post-, and mid-treatment. ADHD symptoms (with the sub-dimensions of inattention and hyperactivity), impulsivity, mindfulness, difficulty with emotion regulation, interpersonal effectiveness, distress tolerance, life satisfaction, functionality in daily life, and general psychological symptom levels were measured with self-report scales. The data were analyzed using mixed-design ANOVA. RESULTS The global ADHD, inattention, and hyperactivity symptoms of the DBT-ST group significantly decreased more than those in the TAU control group. The DBT-ST group also showed a significant decrease regarding difficulty with emotion regulation and increases in life satisfaction and functionality, though the group × time effect was not significant. CONCLUSION DBT-ST was found effective against the participants' ADHD symptoms. The treatment was additionally found to improve their emotion regulation and quality of life. Further investigation is needed to investigate DBT-ST in an online setting.
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Affiliation(s)
- Vahide Ulusoy
- Department of Psychology, Fatih Sultan Mehmet Vakıf University, Istanbul, Turkiye
| | - Işıl Bilican
- Department of Psychology, Istanbul Medeniyet University, Istanbul, Turkiye
| | - Aynur Gormez
- Department of Psychiatry, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkiye
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Anderson LG, Vogiatzoglou E, Tang S, Luiz S, Duque T, Ghaly JP, Schwartzer JJ, Hales JB, Sabariego M. Memory deficits and hippocampal cytokine expression in a rat model of ADHD. Brain Behav Immun Health 2024; 35:100700. [PMID: 38107021 PMCID: PMC10724493 DOI: 10.1016/j.bbih.2023.100700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 12/19/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a complex behavioral disorder characterized by hyperactivity, impulsivity, inattention, and deficits in working memory and time perception. While animal models have advanced our neurobiological understanding of this condition, there are limited and inconsistent data on working and elapsed time memory function. Inflammatory signaling has been identified as a key factor in memory and cognitive impairments, but its role in ADHD remains unclear. Additionally, the disproportionate investigation of male subjects in ADHD research has contributed to a poor understanding of the disorder in females. This study sought to investigate the potential connections between memory, neuroimmunology, and ADHD in both male and female animals. Specifically, we utilized the spontaneously hypertensive rat (SHR), one of the most extensively studied animal models of ADHD. Compared to their control, the Wistar-Kyoto (WKY) rat, male SHR are reported to exhibit several behavioral phenotypes associated with ADHD, including hyperactivity, impulsivity, and poor sustained attention, along with impairments in learning and memory. As the hippocampus is a key brain region for learning and memory, we examined the behavior of male and female SHR and WKY rats in two hippocampal-dependent memory tasks. Our findings revealed that SHR have delay-dependent working memory deficits that were similar to, albeit less severe than, those seen in hippocampal-lesioned rats. We also observed impairments in elapsed time processing in female SHR, particularly in the discrimination of longer time durations. To investigate the impact of inflammatory signaling on memory in these rats, we analyzed the levels of several cytokines in the dorsal and ventral hippocampus of SHR and WKY. Although we found some sex and genotype differences, concentrations were generally similar between groups. Taken together, our results indicate that SHR exhibit deficits in spatial working memory and memory for elapsed time, as well as some differences in hippocampal cytokine concentrations. These findings contribute to a better understanding of the neurobiological basis of ADHD in both sexes and may inform future research aimed at developing effective treatments for the disorder. Nonetheless, the potential mediating role of neuroinflammation in the memory symptomatology of SHR requires further investigation.
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Affiliation(s)
- Lucy G. Anderson
- Program in Neuroscience and Behavior, Mount Holyoke College, South Hadley, MA, 01075, USA
| | | | - Shi Tang
- Program in Neuroscience and Behavior, Mount Holyoke College, South Hadley, MA, 01075, USA
| | - Sarah Luiz
- Program in Neuroscience and Behavior, Mount Holyoke College, South Hadley, MA, 01075, USA
| | - Turley Duque
- Department of Psychological Sciences, University of San Diego, San Diego, CA, 92110, USA
| | - James P. Ghaly
- Department of Psychological Sciences, University of San Diego, San Diego, CA, 92110, USA
| | - Jared J. Schwartzer
- Program in Neuroscience and Behavior, Mount Holyoke College, South Hadley, MA, 01075, USA
| | - Jena B. Hales
- Department of Psychological Sciences, University of San Diego, San Diego, CA, 92110, USA
| | - Marta Sabariego
- Program in Neuroscience and Behavior, Mount Holyoke College, South Hadley, MA, 01075, USA
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3
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Chutko LS, Surushkina SY, Yakovenko EA, Cherednichenko DV. [Attention deficit hyperactivity disorder in adults]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:97-102. [PMID: 38465816 DOI: 10.17116/jnevro202412402197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
The article presents a review of scientific publications devoted to the study of the characteristics of the clinical picture and the dynamics of the main symptoms in adult patients with attention deficit hyperactivity disorder (ADHD). The authors present current data on the prevalence of this disease, leading clinical manifestations and the most common comorbid pathology. Research data on the impact of ADHD in adulthood on educational and professional activities are presented, and the economic and criminological aspects of ADHD are considered. The main methods of psychotherapeutic correction and pharmacological therapy are presented.
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Affiliation(s)
- L S Chutko
- N.P. Bechtereva Institute of Human BraIn Russian Academy of Sciences, St. Petersburg, Russia
| | - S Yu Surushkina
- N.P. Bechtereva Institute of Human BraIn Russian Academy of Sciences, St. Petersburg, Russia
| | - E A Yakovenko
- N.P. Bechtereva Institute of Human BraIn Russian Academy of Sciences, St. Petersburg, Russia
| | - D V Cherednichenko
- N.P. Bechtereva Institute of Human BraIn Russian Academy of Sciences, St. Petersburg, Russia
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Federico A, Zgodic A, Flory K, Hantman RM, Eberth JM, Mclain AC, Bradshaw J. Predictors of Autism Spectrum Disorder and ADHD: Results from the National Survey of Children's Health. Disabil Health J 2024; 17:101512. [PMID: 37838574 DOI: 10.1016/j.dhjo.2023.101512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/19/2023] [Accepted: 07/30/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common neurodevelopmental disorders with comorbidity rates of up to 70%. Population-based studies show differential rates of ADHD and ASD diagnosis based on sociodemographic variables. However, no studies to date have examined the role of sociodemographic factors on the likelihood of receiving an ADHD, ASD, or comorbid ASD + ADHD diagnosis in a large, nationally representative sample. OBJECTIVE This study aims to examine the impact of sociodemographic factors on the odds of experiencing ASD-only, ADHD-only, or both diagnoses for children in the United States. METHODS Using a mixed effects multinomial logistic modeling approach and data from the 2016-2018 National Survey of Children's Health, we estimated the association between sociodemographic variables and the log odds of being in each diagnostic group. RESULTS Sociodemographic variables were differentially related to the three diagnostic groups: ASD-only, ADHD-only, and ASD + ADHD. Compared to girls, boys experienced higher odds of all three diagnosis categories. White children had higher odds of having an ADHD-only or ASD + ADHD diagnosis compared to non-Hispanic (NH) Black, NH multiple/other race, and Hispanic children. Odds ratios for levels of parent education, household income, and birth characteristics showed varying trends across diagnostic groups. CONCLUSIONS Overall, our findings point to unique sets of risk factors differentially associated ASD and ADHD, with lower income standing out as an important factor associated with receiving a diagnosis of ASD + ADHD.
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Affiliation(s)
- Alexis Federico
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Anja Zgodic
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA
| | - Kate Flory
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Rachel M Hantman
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA; Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA; Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Alexander C Mclain
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA
| | - Jessica Bradshaw
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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5
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Sanguineti C, Nisticò V, Folatti I, Santangelo G, Faggioli R, Bertani A, Gambini O, Demartini B. Toward an Increased Attention on ADHD Symptoms and Traits in Young Adults: Prevalence Data From Screening Tools in a Psychiatric Outpatient Clinic. J Atten Disord 2024; 28:151-160. [PMID: 37919945 DOI: 10.1177/10870547231201954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE to analyze the prevalence of ADHD symptoms and traits in a heterogeneous clinical psychiatric sample of young adults (aged 18-24 years old), who referred to a specialized outpatient clinic for various psychiatric and psychological disturbances. METHOD 259 participants completed three validated self-report screening questionnaires for ADHD: the Wender Utah Rating Scale (WURS), the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 (ASRS-5), and the Conners' adult ADHD rating scale (CAARS). RESULTS 12.4% of our sample scored above the cut-off at both the WURS and the ASRS-5 and was considered at risk of ADHD. CONCLUSION the prevalence rate in our sample is higher than the one found in the adult general population (6.76%), and in the lower range of the one found in the adult clinical population (6.9%-38.8%). The potential role of sociodemographic (age, sex, gender identity, and employment) and comorbidity factors is discussed.
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Affiliation(s)
- Claudio Sanguineti
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
- Dipartimento di Psicologia, Università degli Studi di Milano-Bicocca, Italy
- Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy
| | - Irene Folatti
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Giulia Santangelo
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Raffaella Faggioli
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Angelo Bertani
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Orsola Gambini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
- Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Benedetta Demartini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
- Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
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Abarca-Castro EA, Talavera-Peña AK, Reyes-Lagos JJ, Becerril-Villanueva E, Pérez-Sanchez G, de la Peña FR, Maldonado-García JL, Pavón L. Modulation of vagal activity may help reduce neurodevelopmental damage in the offspring of mothers with pre-eclampsia. Front Immunol 2023; 14:1280334. [PMID: 38022681 PMCID: PMC10653300 DOI: 10.3389/fimmu.2023.1280334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Maternal Immune Activation (MIA) has been linked to the pathogenesis of pre-eclampsia and adverse neurodevelopmental outcomes in the offspring, such as cognitive deficits, behavioral abnormalities, and mental disorders. Pre-eclampsia is associated with an activation of the immune system characterized by persistently elevated levels of proinflammatory cytokines, as well as a decrease in immunoregulatory factors. The Cholinergic Anti-inflammatory Pathway (CAP) may play a relevant role in regulating the maternal inflammatory response during pre-eclampsia and protecting the developing fetus from inflammation-induced damage. Dysregulation in the CAP has been associated with the clinical evolution of pre-eclampsia. Some studies suggest that therapeutic stimulation of this pathway may improve maternal and fetal outcomes in preclinical models of pre-eclampsia. Modulation of vagal activity influences the CAP, improving maternal hemodynamics, limiting the inflammatory response, and promoting the growth of new neurons, which enhances synaptic plasticity and improves fetal neurodevelopment. Therefore, we postulate that modulation of vagal activity may improve maternal and fetal outcomes in pre-eclampsia by targeting underlying immune dysregulation and promoting better fetal neurodevelopment. In this perspective, we explore the clinical and experimental evidence of electrical, pharmacological, physical, and biological stimulation mechanisms capable of inducing therapeutical CAP, which may be applied in pre-eclampsia to improve the mother's and offspring's quality of life.
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Affiliation(s)
- Eric Alonso Abarca-Castro
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Lerma (UAM-L), Lerma, Mexico
| | - Ana Karen Talavera-Peña
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Lerma (UAM-L), Lerma, Mexico
| | - José Javier Reyes-Lagos
- Facultad de Medicina, Universidad Autónoma del Estado de México (UAEMéx), Toluca de Lerdo, Mexico
| | - Enrique Becerril-Villanueva
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Gilberto Pérez-Sanchez
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Francisco R. de la Peña
- Unidad de Fomento a la Investigación, Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - José Luis Maldonado-García
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Lenin Pavón
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
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Fraiman YS, Guyol G, Acevedo-Garcia D, Beck AF, Burris H, Coker TR, Tiemeier H. A Narrative Review of the Association between Prematurity and Attention-Deficit/Hyperactivity Disorder and Accompanying Inequities across the Life-Course. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1637. [PMID: 37892300 PMCID: PMC10605109 DOI: 10.3390/children10101637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Preterm birth is associated with an increased risk of neurodevelopmental and neurobehavioral impairments including attention-deficit/hyperactivity disorder (ADHD), the most common neurobehavioral disorder of childhood. In this narrative review, we examine the known associations between prematurity and ADHD and highlight the impact of both prematurity and ADHD on multiple domains across the pediatric life-course. We develop a framework for understanding the health services journey of individuals with ADHD to access appropriate services and treatments for ADHD, the "ADHD Care Cascade". We then discuss the many racial and ethnic inequities that affect the risk of preterm birth as well as the steps along the "ADHD Care Cascade". By using a life-course approach, we highlight the ways in which inequities are layered over time to magnify the neurodevelopmental impact of preterm birth on the most vulnerable children across the life-course.
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Affiliation(s)
- Yarden S. Fraiman
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Genevieve Guyol
- Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02218, USA
| | - Dolores Acevedo-Garcia
- Heller School of Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
| | - Andrew F. Beck
- Cincinnati Children’s, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Heather Burris
- Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tumaini R. Coker
- Seattle Children’s, University of Washington School of Medicine, Seattle, WA 98105, USA
| | - Henning Tiemeier
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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8
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Ruf A, Neubauer AB, Koch ED, Ebner-Priemer U, Reif A, Matura S. Microtemporal Dynamics of Dietary Intake, Physical Activity, and Impulsivity in Adult Attention-Deficit/Hyperactivity Disorder: Ecological Momentary Assessment Study Within Nutritional Psychiatry. JMIR Ment Health 2023; 10:e46550. [PMID: 37590053 PMCID: PMC10472180 DOI: 10.2196/46550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/24/2023] [Accepted: 06/17/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Increasing attention is being paid to lifestyle factors, such as nutrition and physical activity (PA), as potential complementary treatment options in attention-deficit/hyperactivity disorder (ADHD). Previous research indicates that sugar and saturated fat intake may be linked to increased impulsivity, a core symptom of ADHD, whereas protein intake and PA may be related to reduced impulsivity. However, most studies rely on cross-sectional data that lack microtemporal resolution and ecological validity, wherefore questions of microtemporal dynamics (eg, is the consumption of foods high in sugar associated with increased impulsivity within minutes or hours?) remain largely unanswered. Ecological momentary assessment (EMA) has the potential to bridge this gap. OBJECTIVE This study is the first to apply EMA to assess microtemporal associations among macronutrient intake, PA, and state impulsivity in the daily life of adults with and without ADHD. METHODS Over a 3-day period, participants reported state impulsivity 8 times per day (signal-contingent), recorded food and drink intake (event-contingent), and wore an accelerometer. Multilevel 2-part models were used to study the association among macronutrient intake, PA, and the probability to be impulsive as well as the intensity of impulsivity (ADHD: n=36; control: n=137). RESULTS No association between macronutrient intake and state impulsivity was found. PA was not related to the intensity of impulsivity but to a higher probability to be impulsive (ADHD: β=-.09, 95% CI -0.14 to -0.04; control: β=-.03, 95% CI -0.05 to -0.01). No evidence was found that the combined intake of saturated fat and sugar amplified the increase in state impulsivity and that PA alleviated the positive association between sugar or fat intake and state impulsivity. CONCLUSIONS Important methodological considerations are discussed that can contribute to the optimization of future EMA protocols. EMA research in the emerging field of nutritional psychiatry is still in its infancy; however, EMA is a highly promising and innovative approach as it offers insights into the microtemporal dynamics of psychiatric symptomology, dietary intake, and PA in daily life.
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Affiliation(s)
- Alea Ruf
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Andreas B Neubauer
- DIPF | Leibniz Institute for Research and Information in Education, Frankfurt, Germany
- Center for Research on Individual Development and Adaptive Education of Children at Risk (IDeA), Frankfurt, Germany
| | - Elena D Koch
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Ulrich Ebner-Priemer
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Silke Matura
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
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9
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Sibley MH, Bruton AM, Zhao X, Johnstone JM, Mitchell J, Hatsu I, Arnold LE, Basu HH, Levy L, Vyas P, Macphee F, Gonzalez ES, Kelley M, Jusko ML, Bolden CR, Zulauf-McCurdy C, Manzano M, Torres G. Non-pharmacological interventions for attention-deficit hyperactivity disorder in children and adolescents. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:415-428. [PMID: 36907194 PMCID: PMC10370370 DOI: 10.1016/s2352-4642(22)00381-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/26/2022] [Accepted: 12/19/2022] [Indexed: 03/11/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) affects approximately 5% of children and adolescents globally and is associated with negative life outcomes and socioeconomic costs. First-generation ADHD treatments were predominantly pharmacological; however, increased understanding of biological, psychological, and environmental factors contributing to ADHD has expanded non-pharmacological treatment possibilities. This Review provides an updated evaluation of the efficacy and safety of non-pharmacological treatments for paediatric ADHD, discussing the quality and level of evidence for nine intervention categories. Unlike medication, no non-pharmacological treatments showed a consistent strong effect on ADHD symptoms. When considering broad outcomes (eg, impairment, caregiver stress, and behavioural improvement), multicomponent (cognitive) behaviour therapy joined medication as a primary ADHD treatment. With respect to secondary treatments, polyunsaturated fatty acids showed a consistent modest effect on ADHD symptoms when taken for at least 3 months. Additionally, mindfulness and multinutrient supplementation with four or more ingredients showed modest efficacy on non-symptom outcomes. All other non-pharmacological treatments were safe; clinicians might tolerate their use but should educate families of childrenand adolescents with ADHD on the disadvantages, including costs, burden to the service user, absence of proven efficacy relative to other treatments, and delay of proven treatment.
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Alisha M Bruton
- Department of Psychiatry, Oregon Health Sciences University, Portland, OR, USA
| | - Xin Zhao
- Department of Medicine, University of California-Irvine, Irvine, CA, USA
| | | | - John Mitchell
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Irene Hatsu
- Department of Human Sciences, Ohio State University, Columbus, OH, USA
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
| | - Hana H Basu
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Laura Levy
- Department of Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Pooja Vyas
- Department of Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Fiona Macphee
- Division of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Erin Schoenfelder Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA
| | - Megan Kelley
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Morgan L Jusko
- Department of Psychology, Florida International University, Miami, FL, USA
| | - China R Bolden
- Division of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Courtney Zulauf-McCurdy
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA
| | - Maychelle Manzano
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Gabriela Torres
- Department of Psychology, Florida International University, Miami, FL, USA
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10
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Koerts J, Bangma DF, Mette C, Tucha L, Tucha O. Strengths and Weaknesses of Everyday Financial Knowledge and Judgment Skills of Adults with ADHD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4656. [PMID: 36901665 PMCID: PMC10001631 DOI: 10.3390/ijerph20054656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
Adequate financial capability is crucial in everyday life. This capability might, however, not be given to adults with ADHD. The present study aims to determine strengths and weaknesses regarding everyday financial knowledge and judgment skills in adults with ADHD. In addition, the impact of income is explored. Forty-five adults with ADHD (Mage = 36.6, SDage = 10.2) and 47 adults without ADHD (Mage = 38.5, SDage = 13.0) were included and were assessed with the Financial Competence Assessment Inventory. Adults with ADHD showed decreased scores regarding awareness of the arrival of bills, knowledge of own income, having a reserve fund for unexpected expenses, the ability to state long-term financial goals, own preferences for estate management, understanding of assets, legal action for debt, access to financial advice/counseling, and the ability to compare medical insurance plans as compared with adults without ADHD (all p < 0.001). However, no effect of income was found. In conclusion, adults with ADHD have difficulties with many aspects of everyday financial knowledge and skills, which might result in a plethora of personal and legal consequences. It is, therefore, of the utmost importance that professionals who support adults with ADHD proactively ask about everyday financial functioning so that assessment, financial support, and coaching can be provided.
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Affiliation(s)
- Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, 9712 TS Groningen, The Netherlands
| | - Dorien F. Bangma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, 9712 TS Groningen, The Netherlands
- Novicare, 3542 AB Utrecht, The Netherlands
| | - Christian Mette
- Department of Social Work and Education, Protestant University of Applied Sciences Bochum, 44803 Bochum, Germany
- LVR Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, 45147 Essen, Germany
| | - Lara Tucha
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, 18147 Rostock, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, 9712 TS Groningen, The Netherlands
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, 18147 Rostock, Germany
- Department of Psychology, Maynooth University, National University of Ireland, W23 F2K8 Maynooth, Ireland
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11
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Girela-Serrano B, Miguélez C, Porras-Segovia AA, Díaz C, Moreno M, Peñuelas-Calvo I, Roselló R, Baca-García E, Carballo JJ. Predictors of mental health service utilization as adolescents with attention deficit hyperactivity disorder transition into adulthood. Early Interv Psychiatry 2023; 17:252-262. [PMID: 35706409 DOI: 10.1111/eip.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/01/2022] [Accepted: 05/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) symptoms may persist into adulthood and are likely to cause great problems in young adults. To date, few studies have explored the characteristics of patients diagnosed with ADHD that might influence the utilization of adult mental health services (AMHS). We aimed to examine and identify predictive symptoms of AMHS. METHODS We analysed data from 114 participants diagnosed with ADHD from a cohort of adolescents recruited at the age of 12-17 years, who, at the time of data analysis, were over 18 years old. RESULTS Among AMHS users, hyperactivity/impulsivity measures were significantly more severe (t = 2.668, df = 112, p < .001), ADHD combined subtype diagnosis (χ2 = 4.66, df = 1, p = .031) was more frequent and dysregulation profile in the SDQ-P was also significantly higher (t = -2.497, df = 109, p = .014). However, the dysregulation profile did not remain statistically significant after controlling for type of AMHS contact. CONCLUSIONS Our findings suggest that adolescents with ADHD are more likely continue their care under AMHS if they present more severe symptoms of hyperactivity/impulsivity and emotional dysregulation. The better characterization of the patient profile will help clinicians to early identify groups at-risk and to tailor interventions and prevention strategies.
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Affiliation(s)
- Braulio Girela-Serrano
- Westminster Child & Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, UK
- Division of Psychiatry, Imperial College, London, UK
| | - Carolina Miguélez
- Department of Child and Adolescent Psychiatry, Hospital Niño Jesús, Madrid, Spain
| | - Alejandro Albán Porras-Segovia
- Division of Psychiatry, Imperial College, London, UK
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | | | - Manon Moreno
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | | | - Rocio Roselló
- Division of Psychiatry, Imperial College, London, UK
- Department of Psychiatry, University Hospital Doctor Peset of Valencia & University of Valencia, Valencia, Spain
| | - Enrique Baca-García
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Infanta Elena, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Central de Villalba, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Universidad Católica del Maule, Talca, Chile
- Université de Nîmes, Nîmes, France
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12
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Kulzer J, Beck KB, Trabert C, Meyer EC, Colacci J, Pramuka M, McCue M. A vocational rehabilitation partnership to provide transition services to young adults with neurodevelopmental disabilities: The cognitive skills enhancement program. JOURNAL OF VOCATIONAL REHABILITATION 2023; 58:155-164. [DOI: 10.3233/jvr-230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND: There is an urgent need for services that support a successful transition to postsecondary education and employment for young adults with neurodevelopmental and cognitive disabilities (e.g. autism spectrum disorder, attention-deficit/hyperactivity disorder, traumatic brain injury). OBJECTIVE: The purpose of this expository article is to describe the Cognitive Skills Enhancement Program (CSEP), a comprehensive clinical program designed for young adults with neurodevelopmental and cognitive disabilities transitioning to postsecondary education. METHODS: CSEP was developed through a community-academic partnership between a university and a state vocational rehabilitation program. Young adult participants complete programming that addresses four primary clinical targets: (1) emotion regulation, (2) social skills, (3) work readiness, and (4) community participation with the overall goal to increase awareness and promote successful employment outcomes while they transition to post-secondary education. RESULTS: To date, CSEP has supported 18 years of sustained programming and clinical services to 621 young adults with neurodevelopmental and cognitive disabilities. CONCLUSION: This partnership model allows for flexible responses to participant needs, implementation barriers, and advances in evidence-based practices. CSEP meets the needs of diverse stakeholders (e.g. state vocational rehabilitation, post-secondary training facilities, participants, universities) while providing high-quality and sustainable programming. Future directions include examining the clinical efficacy of current CSEP programming.
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Affiliation(s)
- Jamie Kulzer
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kelly B. Beck
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Caitlin Trabert
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric C. Meyer
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jenna Colacci
- Monte Nido & Affiliates, The Clementine Program, New York, NY, USA
| | - Michael Pramuka
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael McCue
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Piscitello J, Altszuler AR, Mazzant JR, Babinski DE, Gnagy EM, Page TF, Molina BSG, Pelham WE. The Impact of ADHD on Maternal Quality of Life. Res Child Adolesc Psychopathol 2022; 50:1275-1288. [PMID: 35648330 PMCID: PMC9613519 DOI: 10.1007/s10802-022-00935-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/24/2022]
Abstract
Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with substantial burden to caregiver quality of life (QoL). However, a paucity of work has focused on quantifying QoL among caregivers of adolescents with a history of ADHD. The purpose of the current study was (1) to quantify maternal QoL in a sample of mothers of adolescents with and without childhood ADHD; and (2) to examine predictors (i.e., parent and child characteristics and behavior) associated with maternal QoL. Participants included mothers of adolescents with (N = 110) and without ADHD (N = 90) ranging in age from 13 to 18 (M = 16.09, 92% male). The Quality Adjusted Life-Year (QALY) was used to calculate maternal QoL using two health domains (i.e., anxiety/depression and disruption in daily activities) commonly impacted by raising youth with ADHD. QALYs are valued monetarily to estimate disease burden. Mothers of adolescents with childhood ADHD experienced significantly worse QoL relative to mothers in the comparison group. Maternal depression, as well as adolescent age, ADHD status, and discipline problems significantly predicted lower levels of maternal QALY health status index, with ADHD being the strongest predictor. This is equal to a reduction in 1.96 QALYs when summed over the course of a child's lifetime and is associated with a loss of $98,000 to $196,000. Results of the investigation help to further elucidate the health impacts incurred by families of adolescents with ADHD and have important public health implications. Further, parental QoL should be considered when conceptualizing the financial and negative health impact of ADHD.
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Affiliation(s)
- Jennifer Piscitello
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US.
| | - Amy R Altszuler
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Jessica Robb Mazzant
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Dara E Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, US
| | - Elizabeth M Gnagy
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Timothy F Page
- Department of Management, H. Wayne Huizenga College of College of Business and Entrepreneurship, Nova Southeastern University, Davie, FL, US
| | - Brooke S G Molina
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, US
| | - William E Pelham
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
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14
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Sex differences in ADHD symptoms, problematic gaming, and impairment in college students. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Lu W, Oursler J, Herrick S, Gao N, Beninato J, Minor T, Franco S, Santiago G, Mihana T, Hauck E. Interview skills training for people with neurodevelopmental disorders receiving vocational services: A pilot study. JOURNAL OF VOCATIONAL REHABILITATION 2022. [DOI: 10.3233/jvr-221210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: People with neurodevelopmental disorders often face significant challenges to finding and keeping employment including engaging in a job interview. Successfully navigating a job interview is a complex and essential stage to finding employment and requires skillful behaviors. OBJECTIVE: The study aimed to determine the feasibility of the Presenting Qualifications intervention for people with neurodevelopmental disorders. METHODS: Direct skills teaching (DST) is a researched method that can be utilized to help people learn a new skill. The current study implemented a multi-session, group based work-related soft skills intervention (“Presenting Qualifications”) for 76 people with various neurodevelopmental disorders via a DST approach. RESULTS: Participants reported increased perceived interview preparedness from pre to post intervention. Participants also reported satisfaction with the intervention. CONCLUSIONS: This suggests soft skills interventions delivered in group settings can be successfully implemented among people with neurodevelopmental disabilities. Implications of the findings and future research directions are discussed.
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Affiliation(s)
| | | | - Samantha Herrick
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Ni Gao
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - John Beninato
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Tameika Minor
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Samantha Franco
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Gabriela Santiago
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Tatiana Mihana
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Emmaleigh Hauck
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
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16
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Fabiano GA, Tower D, Valente M, Rejman E, Rodriguez Z. An Observational Study of the Morning and Evening Behavior of Individuals With and Without Attention-Deficit/Hyperactivity Disorder. J Atten Disord 2022; 26:1199-1211. [PMID: 34911376 DOI: 10.1177/10870547211063644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Evidence of ADHD symptoms and impairments were documented in the morning and evening hours for individuals diagnosed with ADHD. These results illustrate additional areas in need of attention in the refinement of treatments for adults with ADHD.
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Affiliation(s)
| | - Devon Tower
- Florida International University, Buffalo, NY, USA
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17
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Di Lonardo Burr SM, LeFevre JA, Arnold LE, Epstein JN, Hinshaw SP, Molina BSG, Hechtman L, Hoza B, Jensen PS, Vitiello B, Pelham WE, Howard AL. Paths to postsecondary education enrollment among adolescents with and without childhood attention-deficit/hyperactivity disorder (ADHD): A longitudinal analysis of symptom and academic trajectories. Child Dev 2022; 93:e563-e580. [PMID: 35635061 DOI: 10.1111/cdev.13807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We examined developmental trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary education (PSE; N = 749; 79% boys; 63% White, 17% non-Hispanic Black, 10% Hispanic, and 10% other ethnicities). In a multisite study (recruitment based in New York, North Carolina, Pennsylvania, California, and Quebec), participants were originally enrolled between 1994 and 1998 at ages 7 to 9.9 and followed up through 2012 (Mage = 25 at final follow-up). Adolescents who eventually enrolled in PSE had less severe symptoms, but differences were modest and trajectories were similar over time. For all adolescents, standardized achievement trajectories declined up to two thirds of a standard deviation from ages 9 to 17. By the end of high school, the average GPA of adolescents with ADHD was three quarters of a point higher for those who eventually enrolled in PSE compared to those who did not. Overall, school performance mattered more than academic achievement for understanding eventual enrollment of adolescents with ADHD.
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Affiliation(s)
- Sabrina M Di Lonardo Burr
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Cognitive Science, Carleton University, Ottawa, Ontario, Canada
| | - Jo-Anne LeFevre
- Department of Cognitive Science, Carleton University, Ottawa, Ontario, Canada.,Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio, USA
| | - Jeffrey N Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, California, USA
| | - Brooke S G Molina
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lily Hechtman
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Betsy Hoza
- Department of Psychological Science, University of Vermont, Burlington, Vermont, USA
| | - Peter S Jensen
- The REACH Institute, New York, New York, USA.,Department of Psychiatry, University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA
| | - Benedetto Vitiello
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - William E Pelham
- College of Arts, Sciences, and Education, Florida International University, Miami, Florida, USA
| | - Andrea L Howard
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
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18
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Barney S, Sibley MH, Coxe SJ, Meinzer MC, Pelham WE. High Versus Low Intensity Summer Adolescent ADHD Treatment Effects on Internalizing, Social, and Self-Esteem Problems. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022:1-8. [PMID: 35617099 DOI: 10.1080/15374416.2022.2062761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The current study aims to evaluate the effectiveness of a high-intensity (HI) versus a low-intensity (LI) skills-based summer intervention delivered to adolescents with ADHD by school staff in improving depressive symptoms, anxiety symptoms, social problems, and self-esteem. Participants were 325 ethnically diverse rising sixth and ninth graders with ADHD randomized to an HI versus an LI intervention (n = 218) or recruited into an untreated comparison group (n = 107). Group x time and group x grade x time one-year outcome trajectories were compared using linear mixed models. Across the transitional year (sixth or ninth grade), adolescents in the HI group were found to experience significantly greater decreases in depressive symptoms (p = .022, d = .25) compared to the LI group. There was no significant impact of the HI intervention (vs. LI) on anxiety symptoms (p = .070, d = .29), social problems (p = .054, d = .34), or self-esteem (p = .837, d = 0.21); however, secondary analyses of the non-randomized untreated comparison group indicated a significant effect of HI versus the untreated comparison group on social problems (p = .009, d = 43). These significant treatment effects suggest that comprehensive academic and organizational skills interventions for adolescents with ADHD may have a secondary impact of relieving adolescent depression for teens with this comorbidity. Given mixed evidence for the efficacy of the HI intervention on social skills, future work should further evaluate this effect.
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Affiliation(s)
| | - Margaret H Sibley
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Stefany J Coxe
- Department of Psychology, Florida International University
| | | | - William E Pelham
- Center for Children and Families, Florida International University
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19
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Cherkasova MV, Roy A, Molina BSG, Scott G, Weiss G, Barkley RA, Biederman J, Uchida M, Hinshaw SP, Owens EB, Hechtman L. Review: Adult Outcome as Seen Through Controlled Prospective Follow-up Studies of Children With Attention-Deficit/Hyperactivity Disorder Followed Into Adulthood. J Am Acad Child Adolesc Psychiatry 2022; 61:378-391. [PMID: 34116167 DOI: 10.1016/j.jaac.2021.05.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/28/2021] [Accepted: 06/01/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To describe adult outcome of people with attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood and its several key predictors via a review of 7 North American controlled prospective follow-up studies: Montreal, New York, Milwaukee, Pittsburgh, Massachusetts General Hospital (MGH), Berkeley, and 7-site Multimodal Treatment Study of Children With ADHD (MTA). METHOD All studies were prospective and followed children with a diagnosis of ADHD and an age- and gender-matched control group at regular intervals from childhood (6-12 years of age) through adolescence into adulthood (20-40 years of age), evaluating symptom and syndrome persistence, functional outcomes, and predictors of these outcomes. RESULTS The rates of ADHD syndrome persistence ranged from 5.7% to 77%, likely owing to varying diagnostic criteria and the source of information (self-report vs informant report) across the studies. However, all studies observed high rates of symptomatic persistence ranging from 60% to 86%. The 7 studies were largely consistent in finding that relative to control groups, research participants with childhood-diagnosed ADHD had significant impairments in the areas of educational functioning, occupational functioning, mental health, and physical health as well as higher rates of substance misuse, antisocial behavior, and unsafe driving. The most consistently observed predictors of functional outcomes included ADHD persistence and comorbidity, especially with disruptive behavior disorders. CONCLUSION Childhood ADHD has high rates of symptomatic persistence, which is associated with negative functional outcomes. Characteristics that predict these negative outcomes, such as comorbid disruptive behavior disorders, may be important targets for intervention.
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Affiliation(s)
| | | | | | | | - Gabrielle Weiss
- McGill University, Montreal, and the University of British Columbia, Vancouver, Canada
| | | | | | - Mai Uchida
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Stephen P Hinshaw
- University of California Berkeley and the University of California San Francisco, California
| | | | - Lily Hechtman
- McGill University Health Center, Montreal, Quebec, Canada; Division of Child Psychiatry, McGill University, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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20
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Rhodes JD, Kennedy TM, Walther CA, Gnagy EM, Pelham WE, Molina BS. Smoking-Specific Risk Factors in Early Adulthood That Mediate Risk of Daily Smoking by Age 29 for Children with ADHD. J Atten Disord 2022; 26:525-536. [PMID: 33769107 PMCID: PMC9747070 DOI: 10.1177/10870547211003664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test whether smoking-specific risk factors in early adulthood mediate prediction to daily smoking from childhood ADHD. METHODS Participants were 237 with and 164 without childhood ADHD. A smoking risk profile score comprising smoking-specific factors measured between ages 18 to 25 (e.g., craving severity) and age of initiation was tested as mediator of the association between childhood ADHD and age 29 daily smoking. RESULTS Childhood ADHD predicted age 29 smoking (β = -.15, p = .019), 35% of ADHD versus 17% of nonADHD, and the profile score (β = -.07, p = .004), which in turn mediated prediction to age 29 daily smoking (β = -.03; p = .007). When tested individually, three profile variables (# cigarettes/day, difficulty concentrating during abstinence, and nicotine dependence) were significant mediators (ps = 0.005-0.038), above and beyond early adult smoking, ADHD persistence, and delinquency. CONCLUSIONS These behavioral smoking characteristics help explain later daily cigarette smoking for adults with ADHD histories and may need to be targeted in intervention.
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21
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Are There Long-Term Effects of Behavior Therapy for Adolescent ADHD? A Qualitative Study. Child Psychiatry Hum Dev 2022:10.1007/s10578-021-01294-4. [PMID: 35039978 DOI: 10.1007/s10578-021-01294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/03/2022]
Abstract
We utilized qualitative methodology to characterize potential long-term effects (therapeutic and iatrogenic) of behavior therapy for adolescents with ADHD. Forty-two in-depth interviews were conducted with adolescents with ADHD and parents, 4 years post-treatment. Grounded theory methods identified and reported prevalence of themes. All reported long-term effects were classified as benefits; no iatrogenic effects were noted. Long-term impact themes reported for a majority of participants included: development of organization skills (81.0%), enhanced motivation (57.1%), improved self-awareness (57.1%), improved parental knowledge of ADHD (76.2%), increased parent autonomy granting (61.9%), enhanced parental engagement with the youth (52.4%), and improved parent-teen relationships (52.4%). Fourteen themes were present for smaller subsamples, including reduced need for medication (3 of 9 medicated participants). Experimental studies of behavior therapy for adolescent ADHD should measure themes detected herein and directly test the possibility of long-term treatment effects.
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22
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Steele CM, Wymbs BT, Capps RE. Birds of a Feather: An Examination of ADHD Symptoms and Associated Concerns in Partners of Adults with ADHD. J Atten Disord 2022; 26:296-306. [PMID: 33322995 DOI: 10.1177/1087054720978553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Adults often select romantic partners who behave like they do (i.e. assortative mating). However, little is known about whether assortative mating is common among adults with attention-deficit/hyperactivity disorder (ADHD) and whether it is related to associated problems. METHOD About 94 adults without ADHD, 43 adults with childhood ADHD histories but without current symptoms or impairment (ADHD-Desist), 27 adults with childhood ADHD histories and elevated current symptoms and impairment (ADHD-Persist) rated their partners' ADHD symptoms and their own associated problems (e.g., intimate partner violence, financial difficulties). RESULTS The ADHD-Persist group reported that their partners exhibited more ADHD symptoms than the ADHD-Desist group and those without ADHD. Adults in the ADHD-Persist group who had partners with elevated ADHD symptoms endorsed high intimate partner violence and financial difficulties. CONCLUSION Assortative mating appears to be common among adults with ADHD, especially those with persistent symptoms, and to increase risk of additional problems.
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23
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Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent neuropsychiatric disorder associated with significant impairment and distress throughout the lifespan. Recent investigations have shed light on different aspects regarding the trajectory of ADHD, including reports on risk factors in childhood, that are associated with remission or persistence in adulthood. Despite significant advances in our understanding of the pathophysiology of the disorder, the diagnosis of ADHD remains strictly clinical and is based on behavioral symptoms of inattention, impulsivity, and hyperactivity. In this chapter we review the diagnostic process of ADHD, discuss the clinical presentation of the disorder across the lifespan, and examine patterns of comorbidity and longitudinal predictor of outcomes.
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Affiliation(s)
- Douglas Teixeira Leffa
- ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Arthur Caye
- ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luis Augusto Rohde
- ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
- National Institute of Developmental Psychiatry, São Paulo, Brazil.
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24
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Investigating the Clinical Utility of the Combined Use of Objective and Subjective Measures of ADHD During Treatment Optimization. J Clin Psychopharmacol 2022; 42:146-153. [PMID: 33605643 PMCID: PMC8884177 DOI: 10.1097/jcp.0000000000001350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study investigated the clinical utility of the combined use of objective and subjective measures of attention-deficit/hyperactivity disorder (ADHD) prepharmacological and postpharmacological treatment. METHODS Adults with ADHD (N = 77) completed the Quantified Behavioral Test, self-ratings of ADHD-related symptoms, and quality of life measures pretreatment and posttreatment. RESULTS The use of objective and subjective measures of ADHD-related symptoms during initiation and follow-up of pharmacological treatment resulted in significant improvements in quality of life after 6 months. Both objective and subjective measures captured changes in ADHD-related symptoms, with more patients showing clinically relevant treatment effects on objective measures. Convergence rates between objective and subjective measures were low to moderate, and improvements on these measures correlated with increased quality of life. CONCLUSIONS Objective and subjective measures of ADHD capture important components of the condition. The findings from this study have important implications for clinical practice.
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25
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Babinski DE, Sibley MH. Family-based treatments for attention-deficit/hyperactivity disorder: A review of family functioning outcomes in randomized controlled trials from 2010 to 2019. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:83-106. [PMID: 34779516 DOI: 10.1111/jmft.12572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/31/2021] [Indexed: 06/13/2023]
Abstract
This review details advances in randomized controlled trials of family-based treatments for attention-deficit/hyperactivity disorder (ADHD) conducted in the United States from 2010 to 2019, and the impact of these treatments on the domain of family functioning. Twenty-two studies were included in the review and three types of family treatments, integrated parent-child treatments, parent-directed treatments, and youth treatments with adjunctive parent involvement, were identified for children and adolescents. Studies point to considerable advancements in consideration of understudied and diverse populations, and results of the review show all three types of family interventions for ADHD should be considered well-established interventions addressing family functioning. Practical guidelines are offered, and future directions for research are discussed.
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Affiliation(s)
- Dara E Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Margaret H Sibley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, Washington, USA
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26
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Zhao X, Kennedy TM, Hayes T, Gnagy EM, Pelham WE, Molina BSG. A measure of functioning in adults With ADHD: Psychometric properties of the general life functioning scale-parent version. J Clin Psychol 2021; 77:2894-2914. [PMID: 34862602 PMCID: PMC8767958 DOI: 10.1002/jclp.23285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 10/10/2021] [Accepted: 11/12/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The General Life Functioning Scale (GLF) was developed to provide a complementary alternative to existing measures of impairment. We examined the psychometric properties of the GLF-Parent version (GLF-P), given the known value of informant ratings. METHODS The GLF-P was administered to parents of adults with attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood and a nonADHD comparison group in the Pittsburgh ADHD Longitudinal Study. GLF-P ratings described 334 participants (ADHD = 186; comparison = 148) rated at age 25 (Mage = 24.80 years, SDage = 0.46, range = 24-26) and 401 participants (ADHD = 237; comparison = 164) rated at age 30 (Mage = 29.30, SDage = 0.64, range = 28-33). Exploratory (EFA) and confirmatory (CFA) factor analyses were used. RESULTS EFAs suggested and CFAs confirmed a five-factor solution. We found measurement invariance across diagnostic and age groups, satisfactory internal consistency, construct validity, and known-group validity. CONCLUSION Psychometric results suggest the GLF-P as a helpful adjunctive measure of functioning. Further research is needed to determine the utility of the GLF across diverse settings.
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Affiliation(s)
- Xin Zhao
- Center for Children and Families, Florida International University, Miami, Florida, USA
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Traci M. Kennedy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Timothy Hayes
- Center for Children and Families, Florida International University, Miami, Florida, USA
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Elizabeth M. Gnagy
- Center for Children and Families, Florida International University, Miami, Florida, USA
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - William E. Pelham
- Center for Children and Families, Florida International University, Miami, Florida, USA
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Brooke S. G. Molina
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Psychology, Pediatrics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Glasofer A, Dingley C. Diagnostic and Medication Treatment Disparities in African American Children with ADHD: a Literature Review. J Racial Ethn Health Disparities 2021; 9:2027-2048. [PMID: 34520001 DOI: 10.1007/s40615-021-01142-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite a national focus on achieving health equity, limited attention has been paid to behavioral and pediatric health disparities. As the most common pediatric neurobehavioral disorder, attention-deficit/hyperactivity disorder (ADHD) provides an opportunity to assess the status of pediatric behavior health disparities. The purpose of this literature review is to provide a synthesis of existing research on ADHD diagnostic and treatment disparities between African American and White children. METHODS Studies were systematically identified through searches in PubMed, CINAHL, and APA PsycInfo using the terms attention-deficit/hyperactivity disorder, disparity, race, ethnicity, diagnosis, medication, and treatment. Summary calculations were conducted to report the proportions of studies with statistically significant differences in ADHD diagnosis and treatment between White and African American children, and to describe trends in disparities over time. RESULTS Forty-one studies were included in this review. The majority of studies identified significant disparities in ADHD diagnosis and medication treatment between African American and White children. While diagnostic disparities show a trend toward reduction over time, a similar trend was not observed in medication treatment disparities. This synthesis provides a critique of the existing literature and recommendations for practice and future research.
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Affiliation(s)
- Amy Glasofer
- School of Nursing, University of Nevada, Las Vegas, NV, USA.
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Leveraging Machine Learning to Identify Predictors of Receiving Psychosocial Treatment for Attention Deficit/Hyperactivity Disorder. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:680-692. [PMID: 32405822 DOI: 10.1007/s10488-020-01045-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aimed to identify factors associated with receiving psychosocial treatment for ADHD in a nationally representative sample. Participants were 6630 youth with a parent-reported diagnosis of ADHD from the 2016-2017 National Survey of Children's Health. Machine learning analyses were performed to identify factors associated with receipt of psychosocial treatment for ADHD. We examined potentially associated factors in the broad categories of variables hypothesized to affect problem recognition (e.g., severity, mental health comorbidities); the decision to seek treatment; service selection (e.g., insurance coverage) and service use. We found that three machine learning models unanimously identified parent-reported ADHD severity (mild vs. moderate/severe) as the factor that best distinguishes between children who receive psychosocial treatment for ADHD and those who do not. Receive operating characteristic curve analysis revealed the following model performance: classification and regression tree analysis (area under the curve; AUC = .68); an ensemble model (AUC = .71); and a deep, multi-layer neural network (AUC = .72), as well as comparison to a logistic regression model (AUC = .69). Further, insurance coverage of mental/behavioral health needs emerged as a salient factor associated with the receipt of psychosocial treatment. Machine learning models identified risk and protective factors that predicted the receipt of psychosocial treatment for ADHD, such as ADHD severity and health insurance coverage.
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Norvilitis JM, Linn BK, Merwin MM. The Relationship Between ADHD Symptomatology and Financial Well-Being Among College Students. J Atten Disord 2021; 25:1051-1057. [PMID: 31707903 DOI: 10.1177/1087054719887446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Although there is research that indicates financial difficulties among adults with ADHD, little research has examined financial well-being among college students with ADHD. Method: The present study explored the relationships between symptoms of ADHD and credit card and student loan debt, expected student loan debt, perceived financial well-being, worries about student loans, and financial strain behaviors among 612 college students at two public universities in different states. Results: Results indicated that students with more symptoms of ADHD reported lower perceived financial well-being, but there was no relationship between symptomatology and credit card and student loan debt or expected student loan debt. Conclusion: These results highlight the opportunity for interventions to address current perceived financial well-being and to prevent future financial concerns.
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Abstract
INTRODUCTION Adult Attention Deficit/Hyperactivity Disorder (ADHD) is prone to misdiagnosis because its symptoms are subjective, share features with a broad range of mental, behavioral and physical disorders, and express themselves heterogeneously. Furthermore, Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for adult ADHD diagnosis remain underdeveloped, prompting a need for systematic and empirically-informed guidelines. METHOD This article presents a brief history of research on adult ADHD and reviews common sources of false positive and false negative diagnoses. A systematic, stepped diagnostic procedure is described that adheres to DSM guidelines and integrates the latest science on adult ADHD assessment and diagnosis. RESULTS Seven steps are recommended: a structured diagnostic interview with the patient, collection of informant ratings, casting a wide net on symptoms using "or rule" to integrate informant reports, providing checks and balances on the "or rule" by enforcing the impairment criterion, chronicling a symptom timeline, ruling out alternative explanations for symptoms, and finalizing the diagnosis. CONCLUSIONS Based on the extant research, it is expected that the stepped diagnostic procedure will increase detection of malingering, improve diagnostic accuracy, and detect non-ADHD cases with subclinical difficulties or non-ADHD pathologies.
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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Koerts J, Bangma DF, Fuermaier ABM, Mette C, Tucha L, Tucha O. Financial judgment determination in adults with ADHD. J Neural Transm (Vienna) 2021; 128:969-979. [PMID: 33709182 PMCID: PMC8295146 DOI: 10.1007/s00702-021-02323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/01/2021] [Indexed: 11/27/2022]
Abstract
ADHD has a debilitating influence on everyday functioning, including the capability to make financial decisions. The capability to make financial decisions is a multidimensional construct that includes financial knowledge, financial judgment, financial performance and related contextual factors. So far, the majority of studies in adults with ADHD focused on financial performance, while the other aspects of financial capability were less explored. The current study aims to partly bridge this gap by examining the ability of financial judgment in adults with ADHD. Thirty-nine adults with ADHD and 83 adults without ADHD were included. All participants were assessed with the Financial Competence Assessment Inventory (FCAI) and Financial Decision-Making Interview (FDMI) which both assess the four abilities of financial judgment, i.e., understanding, appreciation, reasoning and communication. The results show that adults with ADHD, compared to adults without ADHD, obtained significantly lower scores on understanding (according to the FCAI and FDMI). Furthermore, adults with ADHD showed a significantly lower appreciation, reasoning and communication (according to the FCAI) than adults without ADHD. In conclusion, adults with ADHD have difficulties with financial judgment especially with the ability to understand information that is relevant for a financial situation or transaction. Furthermore, adults with ADHD were found to have problems with appreciating, reasoning and communicating about practical information that partly relates to their own financial situation (as assessed with the FCAI). A careful assessment of financial capability in adults with ADHD, therefore, appears warranted in clinical practice.
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Affiliation(s)
- Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
| | - Dorien F Bangma
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Christian Mette
- Department of Social Work and Education, Protestant University of Applied Sciences Bochum, Bochum, Germany
- LVR Hospital Essen, Essen, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Lara Tucha
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
- Department of Psychology, Maynooth University, National University of Ireland, Maynooth, Ireland
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Triece PA, Oddo LE, Hill RM, Pettit JW, Meinzer MC. Investigation of the interpersonal theory of suicide in the context of attention-deficit/hyperactivity disorder symptomatology and suicide ideation. Suicide Life Threat Behav 2020; 50:1198-1204. [PMID: 32770790 DOI: 10.1111/sltb.12683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/05/2020] [Accepted: 06/01/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The current study examines components of the Interpersonal Theory of Suicide as mediators of the association between attention-deficit/hyperactivity disorder (ADHD) symptoms and suicide ideation in college students with elevated depressive symptoms. Specifically, indirect effects of perceived burdensomeness and thwarted belongingness were simultaneously evaluated on the association between self-reported ADHD symptoms and suicide ideation, controlling for gender and levels of depression. METHOD Participants were 217 college students with elevated depressive symptoms (Mage = 20.72 years old; SD = 3.74) who participated in a larger study on mood and well-being. The sample was predominantly female (77.9% female) and Hispanic (72.7%). RESULTS In a multivariate mediation model controlling for gender and depressive symptoms, there were significant indirect effects of perceived burdensomeness and thwarted belongingness on the association between self-reported ADHD symptoms and suicide ideation. CONCLUSION Perceived burdensomeness and thwarted belongingness may represent promising targets for preventing suicide ideation in individuals with elevated ADHD symptoms.
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Affiliation(s)
| | - Lauren E Oddo
- University of Maryland at College Park, College Park, MD, USA
| | - Ryan M Hill
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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Sibley MH, Coxe SJ, Page TF, Pelham WE, Yeguez CE, LaCount PA, Barney S. Four-Year Follow-Up of High versus Low Intensity Summer Treatment for Adolescents with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 51:750-763. [PMID: 33210938 DOI: 10.1080/15374416.2020.1833734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Despite an emergence of psychosocial treatments for adolescent ADHD, their long-term effects are unknown. METHOD We examine four-year outcomes of a randomized controlled trial (N = 218) comparing high-intensity (HI; 412 h, $4,373 per participant) versus low-intensity (LI; 24 h, $97 per participant) skills-based summer intervention delivered to adolescents with ADHD at two secondary school transitions (6th/9th grade). Quantitative and qualitative analyses evaluated group×time and group×grade×time effects on 4-year outcomes. RESULTS Relative to LI, a single dose of HI had modest but lasting effects on teen organization skills (d =.40) and ADHD symptoms (9th grade only: d =.27 to.31) at 4-year follow-up. There was no long-term incremental effect of HI (vs. LI) for parent-teen conflict, GPA, or parent use of contingency management. Treatment appeared most effective when delivered to older adolescents (i.e., 9th versus 6th grade), suggesting the long-term impact of ADHD treatment may increase with age. Qualitative data corroborated that the primary long-term benefit of HI (vs. LI) treatment was to organization skills; many of the remaining perceived benefits were to parent and teen psychological variables (i.e., increased self-esteem, self-awareness, parental optimism). HI offered no incremental benefit to long-term educational or clinical service utilization or costs. CONCLUSIONS Modest therapeutic benefits of adolescent ADHD treatment are maintained long term. However, HI treatment did not impact outcomes that could defray the intervention's high costs ($4,373) compared to LI treatment ($97).
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
| | - Stefany J Coxe
- Department of Psychology, Florida International University
| | - Timothy F Page
- Department of Psychology, Florida International University
| | | | | | - Patrick A LaCount
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
| | - Samantha Barney
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
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Kennedy TM, Walther CAP, Pedersen SL, McKone KMP, Gnagy EM, Pelham WE, Molina BSG. Beers with Peers: Childhood ADHD and Risk for Correlated Change in Perceived Peer and Personal Alcohol Use Across Young Adulthood. Alcohol Clin Exp Res 2020; 44:2350-2360. [PMID: 32966613 PMCID: PMC7680395 DOI: 10.1111/acer.14467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND ADHD poses risk for problematic alcohol use through adulthood. Perceived peer alcohol use, one of the strongest correlates of individuals' own alcohol use, is especially salient for adolescents with ADHD. The extent to which this risk extends into young adulthood is unknown, as well as how change in these constructs is associated throughout young adulthood. METHODS In the Pittsburgh ADHD Longitudinal Study, 358 individuals with childhood-diagnosed ADHD and 239 without were prospectively followed from ages 18 to 29. Piecewise, bivariate longitudinal growth modeling was used to examine the change in both peer alcohol use and individuals' heavy drinking (binge-drinking frequency), their between-person associations, and differences by ADHD group. The addition of structured residuals probed within-person year-to-year change in peer and personal alcohol use and their prospective associations. RESULTS Perceived peer alcohol use and individuals' heavy drinking frequencies changed together over time concurrently-from ages 18 to 21 (piece 1) and 21 to 29 (piece 2). Prospectively, individuals who increased the most in heavy drinking from ages 18 to 21 reported more friends using alcohol at age 29, regardless of ADHD history. Within-person increases in personal alcohol use likewise predicted increased perceived peer use the subsequent year within each age group (piece), regardless of ADHD history. However, while decreasing perceived peer use from ages 21 to 29 was related to more frequent heavy drinking at age 29 for those without ADHD, increasing perceived peer use from ages 18 to 21 predicted more frequent heavy drinking at age 29 for those with ADHD. CONCLUSIONS Young adult heavy drinking changes in tandem with perceived peer alcohol use across individuals and predicts selection of alcohol-using peers from year to year within individuals, further into adulthood than previously documented. Findings suggest the centrality of relationships with alcohol-consuming friends in relation to one's heavy drinking, especially for young adults with ADHD histories, through the twenties.
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Affiliation(s)
- Traci M Kennedy
- From the, University of Pittsburgh, (TMK, SLP, KMPM, BSGM), Pittsburgh, Pennsylvania, USA
| | | | - Sarah L Pedersen
- From the, University of Pittsburgh, (TMK, SLP, KMPM, BSGM), Pittsburgh, Pennsylvania, USA
| | - Kirsten M P McKone
- From the, University of Pittsburgh, (TMK, SLP, KMPM, BSGM), Pittsburgh, Pennsylvania, USA
| | | | - William E Pelham
- Florida International University, (EMG, WEP), Miami, Florida, USA
| | - Brooke S G Molina
- From the, University of Pittsburgh, (TMK, SLP, KMPM, BSGM), Pittsburgh, Pennsylvania, USA
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Bangma DF, Tucha L, Fuermaier ABM, Tucha O, Koerts J. Financial decision-making in a community sample of adults with and without current symptoms of ADHD. PLoS One 2020; 15:e0239343. [PMID: 33044961 PMCID: PMC7549773 DOI: 10.1371/journal.pone.0239343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022] Open
Abstract
Research found that adults with attention deficit hyperactivity disorder (ADHD) have more problems with financial decision-making than healthy controls. The present study investigates the impact of symptoms of ADHD on impulsive buying and the use of financial decision styles. Furthermore, the influence of personality, symptoms of depression and demographics on the association between ADHD and these aspects of financial decision-making is evaluated. A community sample of 1292 participants (age range 18–93 years, 45.4% male) completed questionnaires related to ADHD, impulsive buying, financial decision styles, personal financial situation, depression and personality. Four groups were formed based on self-reported ADHD symptoms: an ‘ADHD’ group (n = 45), an ‘Adult-only ADHD’ group (n = 57), a ‘Subthreshold ADHD’ group (n = 162) and a ‘No ADHD’ group (n = 265). Groups were compared using ANOVA and chi-square tests. Furthermore, multiple regression analyses in the complete sample were employed to examine the association between ADHD and financial decision-making. The ADHD and Adult-only ADHD groups reported significantly more impulsive buying, used more often an avoidant or spontaneous decision style and less often saved money compared to the No ADHD group. Regression analyses revealed that impulsive buying and financial decision styles were not significantly associated with ADHD symptoms when controlling for personality, symptoms of depression and demographics. The present study confirms previous research on adults with ADHD by indicating more impulsive buying and a more frequent use of disadvantageous financial decision styles (i.e., avoidant and spontaneous styles) in individuals with an elevated number of current symptoms of ADHD compared to individuals without symptoms of ADHD. Personality and demographic variables were found to be related to both impulsive buying and the use of specific financial decision styles and might be of influence on the association between impulsive buying, the use of financial decision styles and ADHD.
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Affiliation(s)
- Dorien F Bangma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Lara Tucha
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands.,Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
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Abstract
The purpose of the study was to estimate the burden to families of raising a child with attention-deficit/hyperactivity disorder (ADHD). Data were drawn from a longitudinal sample recruited in western Pennsylvania. When participants were between 14 and 17 years old, parents completed a questionnaire assessing economic burden over the course of raising their children. Domains of economic burden to families included direct costs related to child's behaviors (excluding treatment expenses) and indirect costs related to caregiver strain. On average, participants with ADHD incurred a total economic burden over the course of child development that was more than five times greater compared to youths without ADHD (ADHD = $15,036 per child, Control = $2,848 per child), and this difference remained significant after controlling for intellectual functioning, oppositional defiant symptoms, or conduct problems. Parents of participants with ADHD were more likely to have changed their job responsibilities or been fired and reported lower work efficiency. The current evaluation of economic burden to individual families extends previous estimates of annual societal cost of illness (COI) of ADHD. Our rough annual estimate of COI for ADHD in children and adolescents is $124.5 billion (2017 US Dollars). Findings underscore the need for interventions to reduce the costly dysfunctional outcomes in families of children with ADHD.
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Campez M, Raiker JS, Sarver DE, Friedman LM, Orban SA, Rapport MD. Working Memory Capacity and ADHD Symptoms in Boys: Examining the Heterogeneity of Working Memory Functioning Using Latent Profile Analysis. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020; 42:450-463. [PMID: 33343079 PMCID: PMC7747754 DOI: 10.1007/s10862-019-09762-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recent studies demonstrate that working memory (WM) is integral to etiological models of ADHD; however, significant questions persist regarding the relation between WM performance across tasks with varying cognitive demands and ADHD symptoms. The current study incorporates an individual differences approach to WM heterogeneity (i.e., latent profile analysis) to (a) identify differential profiles of WM across the phonological and visuospatial WM subsystems; and (b) characterize differences in symptom presentation among WM profiles. Parent and teacher ratings of child behavior, obtained for boys with (n=51) and without (n=38) a diagnosis of ADHD, were compared across latent classes of visuospatial and phonological WM performance. Latent profile analysis identified three classes of WM functioning: Low WM, Moderate WM, and High WM. Membership in the Low and Moderate WM classes was associated with greater levels of parent- and teacher-rated inattentive and hyperactive symptoms. While 84% of the ADHD group were assigned to the Low and Moderate WM classes, more than a quarter of children without ADHD exhibited Moderate WM limitations. Collectively, these findings extend prior work suggesting that there is substantial heterogeneity in WM functioning in children with and without ADHD and that these differences contribute to the expression of symptoms of inattention and hyperactivity.
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Affiliation(s)
- Mileini Campez
- Department of Psychology, Center for Children &
Families, Florida International University, 11200 SW 8 Street AHC1 140,
Miami, FL 33199 USA
| | - Joseph S. Raiker
- Department of Psychology, Center for Children &
Families, Florida International University, 11200 SW 8 Street AHC1 140,
Miami, FL 33199 USA
| | - Dustin E. Sarver
- Department of Pediatrics, Department of Psychiatry and
Human Behavior, Center for Advancement of Youth, University of Mississippi Medical
Center, 2500 North State Street, Jackson, MS, 39216 USA
| | - Lauren M. Friedman
- Department of Psychiatry, University of California–
San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Sarah A. Orban
- Department of Psychology, University of Tampa, 401 W.
Kennedy Boulevard, Tampa, FL 33606 USA
| | - Mark D. Rapport
- Department of Psychology, University of Central Florida,
4111 Pictor Lane, Psychology Bldg 99, Orlando, FL 32816 USA
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Beauchaine TP, Ben-David I, Bos M. ADHD, financial distress, and suicide in adulthood: A population study. SCIENCE ADVANCES 2020; 6:6/40/eaba1551. [PMID: 32998893 PMCID: PMC7527218 DOI: 10.1126/sciadv.aba1551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 07/24/2020] [Indexed: 05/20/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) exerts lifelong impairment, including difficulty sustaining employment, poor credit, and suicide risk. To date, however, studies have assessed selected samples, often via self-report. Using mental health data from the entire Swedish population (N = 11.55 million) and a random sample of credit data (N = 189,267), we provide the first study of objective financial outcomes among adults with ADHD, including associations with suicide. Controlling for psychiatric comorbidities, substance use, education, and income, those with ADHD start adulthood with normal credit demand and default rates. However, in middle age, their default rates grow exponentially, yielding poor credit scores and diminished credit access despite high demand. Sympathomimetic prescriptions are unassociated with improved financial behaviors. Last, financial distress is associated with fourfold higher risk of suicide among those with ADHD. For men but not women with ADHD who suicide, outstanding debt increases in the 3 years prior. No such pattern exists for others who suicide.
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Affiliation(s)
- Theodore P Beauchaine
- Department of Psychology, College of Arts and Sciences, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA.
- Nisonger Center for Excellence in Developmental Disabilities, The Ohio State University, 1581 Dodd Drive, Columbus, OH 43210-1257, USA
| | - Itzhak Ben-David
- Department of Finance, Fisher College of Business, The Ohio State University, 606A Fisher Hall, 2100 Neil Avenue, Columbus, OH 43210, USA.
- National Bureau of Economic Research, 1050 Massachusetts Ave., Cambridge, MA 02138, USA
| | - Marieke Bos
- The Swedish House of Finance at the Stockholm School of Economics, Drottninggatan 98, 111 60 Stockholm, Sweden.
- The Federal Reserve Bank of Philadelphia, 10 N Independence Mall W, Philadelphia, PA 19106, USA
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Heterogeneous Trajectories of Problematic Alcohol Use, Depressive Symptoms, and their Co-Occurrence in Young Adults with and without Childhood ADHD. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1265-1277. [PMID: 32648044 DOI: 10.1007/s10802-020-00675-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The literature is inconsistent regarding whether childhood ADHD confers risk for adulthood problematic alcohol use, depressive symptoms, and their co-occurrence. These inconsistencies could be due to meaningful heterogeneity in the adulthood outcomes of children with ADHD that were obscured in traditional group-based analyses. The current study tested this possibility, as well as the contribution of adulthood ADHD symptom persistence, in order to clarify long-term risk in this population. Children diagnosed with ADHD and demographically-similar children without ADHD were followed longitudinally into adulthood and repeatedly assessed on heavy drinking, alcohol problems, and depressive symptoms from ages 21-29 (84.1% White (not Hispanic); 86.9% male; 51.2% childhood ADHD; 14.7% adulthood-persistent ADHD; N = 320). Group-based multi-trajectory modeling identified six groups with different combinations of trajectories across these variables. Heterogeneous longitudinal outcomes for those with ADHD were found. Some children with ADHD showed increased risk as typically predicted, with a higher likelihood of membership in a group with stable-moderate alcohol outcomes and stable-severe depression (adulthood persistent ADHD also predicted this group), whereas some children with ADHD were more likely to belong to a group with virtually no alcohol outcomes and low depression. Additionally, adulthood persistent ADHD predicted membership in a group with stable-severe alcohol outcomes and stable-moderate depression. Given the severity associated with co-occurring alcohol and depressive disorders, studies of early risk and protective factors and long-term outcomes for these disparate trajectory patterns are needed, particularly for those with childhood and persisting ADHD.
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The Transition of Youth with ADHD into the Workforce: Review and Future Directions. Clin Child Fam Psychol Rev 2020; 22:316-347. [PMID: 30725305 DOI: 10.1007/s10567-019-00274-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Previous research suggests that a majority of children with attention-deficit/hyperactivity disorder (ADHD) continue to experience increased impairment across multiple life domains into adulthood. A systematic review of the occupational impairments, and associated educational and financial difficulties, faced by individuals with childhood ADHD was conducted. Systematic searches from PsycINFO and PubMed databases and other sources (i.e., books and consultants with experts) yielded 35 relevant articles that described 19 longitudinal studies on adults with a history of ADHD or related symptoms. Multiple studies indicated that those with a history of ADHD had more educational impairment and were less likely to graduate from high school and college than their peers without a history of ADHD. Subsequently, they faced lower occupational attainment, had more job instability, and demonstrated more impaired job performance, and these outcomes were largely consistent regardless of sex, medication history, or symptom persistence. Similar results were found in clinical and representative national studies in both U.S. and abroad, although older studies tended to indicate less occupational impairment. In addition, ADHD was associated with a number of financial challenges, including lower annual income, more reliance on public aid, and increased risk for homelessness. Future research should use more varied informant sources and utilize innovative measures of occupational impairment at both a macro- and micro-level of analyses. In addition, studies of effective supports and interventions in occupational settings for individuals with ADHD are needed.
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Affiliation(s)
- Russell A. Barkley
- Editor of The ADHD Report and a Clinical professor of Psychiatry at the Virginia Commonwealth University Medical Center in Richmond, VA. He can be contacted by email at:
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Beauchaine TP, Hinshaw SP. RDoC and Psychopathology among Youth: Misplaced Assumptions and an Agenda for Future Research. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:322-340. [PMID: 32525746 PMCID: PMC7495028 DOI: 10.1080/15374416.2020.1750022] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Now over 10 years old, the Research Domain Criteria (RDoC) has gained impressive traction in the adult psychopathology literature, but enthusiasm among child and adolescent psychopathologists lags somewhat behind. We consider possible reasons why RDoC has not been embraced fully in the child and adolescent literatures. We emphasize common, interrelated, and sometimes outdated assumptions that impede scientific progress that RDoC could facilitate. Traditionally, child and adolescent psychopathologists have used behavioral syndromes as gold standards against which biological markers are validated, even though behavioral syndromes are often measured with less precision; sought to identify large main effects of single biological functions on single behavioral syndromes, thereby ignoring (even if implicitly) the overwhelming etiological complexity of psychopathology; expected 1:1 correspondencies between biological functions and behaviors, despite evidence that core biological systems subserving behavior are functionally interdependent (i.e., modulate one another); and failed to consider neurobiological mechanisms of homotypic and heterotypic comorbidity and continuity. Using examples from our work, we show how a developmental, RDoC-informed approach to externalizing behavior enriches our understanding of psychopathology. We also provide an agenda for future research, which includes calls to (1) adopt neural-systems-first approaches over disorder-first approaches when studying psychopathology, (2) eschew biological reductionism by integrating environmental risk mediators into our etiopathophysiological models, (3) integrate neural vulnerabilities into the empirical latent structure of psychopathology, and (4) replace null hypothesis significance testing with computational approaches that accommodate etiological complexity by evaluating functional dependencies among RDoC constructs, including positive valence systems (approach), negative valence systems (avoidance), and arousal/regulatory systems (self-regulation).
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Affiliation(s)
| | - Stephen P Hinshaw
- University of California Berkeley
- University of California San Francisco
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Babinski DE, Mazzant JR, Merrill BM, Waschbusch DA, Sibley MH, Gnagy EM, Molina BSG, Pelham WE. Lifetime caregiver strain among mothers of adolescents and young adults with attention-deficit/hyperactivity disorder. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2020; 34:342-352. [PMID: 31750692 PMCID: PMC7102920 DOI: 10.1037/fam0000609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The lifetime maternal caregiver strain (CS) associated with raising a child with attention-deficit/hyperactivity disorder (ADHD) into adolescence and young adulthood was examined in the Pittsburgh ADHD Longitudinal Study (PALS), a longitudinal study of individuals diagnosed with ADHD in childhood and recontacted in adolescence and young adulthood for yearly follow-up. Mothers of adolescents/young adults with (n = 364, 89.6% male; Mage = 19.79) and without childhood ADHD (n = 240, 88.8% male; Mage = 18.97) rated their lifetime maternal CS at Wave 3. Adolescent/young adult (AYA) ADHD and ODD severity measured at Wave 1, AYA delinquency measured at Wave 2, and school disciplinary actions combined from Waves 1 and 2 were explored as mediators of the association between childhood ADHD and lifetime maternal CS at Wave 3 using path analysis. AYA gender and age, parental marital status, maternal depression and ADHD, and highest parental education were included as covariates. Greater lifetime CS was reported among mothers of adolescents/young adults with versus without childhood ADHD. In the mediation model, direct effects of childhood ADHD on AYA ADHD and ODD severity, delinquency, and school discipline problems emerged, and direct effects of AYA ODD severity, delinquency, and school discipline problems on lifetime CS emerged. AYA ODD, delinquency, and school discipline mediated the association between childhood ADHD and lifetime maternal CS. These findings extend research on childhood ADHD to identify AYA sequelae contributing to maternal CS. Future research on the transaction between AYA functional impairment and maternal CS across the transition from adolescence into adulthood is needed to clarify opportunities for intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Pelham WE, Page TF, Altszuler AR, Gnagy EM, Molina BSG, Pelham WE. The long-term financial outcome of children diagnosed with ADHD. J Consult Clin Psychol 2020; 88:160-171. [PMID: 31789549 PMCID: PMC6940517 DOI: 10.1037/ccp0000461] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Characterize the early trajectories of financial functioning in adults with history of childhood ADHD and use these trajectories to project earnings and savings over the lifetime. METHOD Data were drawn from a prospective case-control study (PALS) following participants with a rigorous diagnosis of ADHD during childhood (N = 364) and demographically matched controls (N = 240) for nearly 20 years. Participants and their parents reported on an array of financial outcomes when participants were 25 and 30 years old. RESULTS At age 30, adults with a history of ADHD exhibited substantially worse outcomes than controls on most financial indicators, even when they and their parents no longer endorsed any DSM symptoms of ADHD. Between ages 25 and 30, probands had exhibited considerably slower growth than controls in positive financial indicators (e.g., monthly income) and substantially less reduction than controls in indicators of financial dependence (e.g., living with parents), indicating worsening or sustained deficits on nearly all measures. When earnings trajectories from age 25 to age 30 were extrapolated using matched census data, male probands were projected to earn $1.27 million less than controls over their working lifetime, reaching retirement with up to 75% lower net worth. CONCLUSION The financial deficit of adults with history of childhood ADHD grows across early adulthood. Projections based on early financial trajectories suggest very large cumulative differences in earnings and savings. With or without persistence of the DSM symptoms, the adult sequela of childhood ADHD can be conceptualized as a chronic condition often requiring considerable support from others during adulthood. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Timothy F. Page
- Health Policy and Management, Florida International University, Miami, FL 33199
- Center for Children and Families, Florida International University, Miami, FL 33199
| | - Amy R. Altszuler
- Center for Children and Families, Florida International University, Miami, FL 33199
| | - Elizabeth M. Gnagy
- Center for Children and Families, Florida International University, Miami, FL 33199
| | | | - William E. Pelham
- Department of Psychology, Florida International University, Miami, FL 33199
- Center for Children and Families, Florida International University, Miami, FL 33199
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Butterbaugh SM, Ross DB, Campbell A. My Money and Me: Attaining Financial Independence in Emerging Adulthood Through a Conceptual Model of Identity Capital Theory. CONTEMPORARY FAMILY THERAPY 2019. [DOI: 10.1007/s10591-019-09515-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sibley MH, Coxe SJ, Campez M, Morley C, Olson S, Hidalgo-Gato N, Gnagy E, Greiner A, Coles EK, Page T, Pelham WE. High versus Low Intensity Summer Treatment for ADHD Delivered at Secondary School Transitions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 47:248-265. [PMID: 29498550 DOI: 10.1080/15374416.2018.1426005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Spikes in symptom severity are noted for adolescents with attention deficit/hyperactivity disorder (ADHD) at the transitions to middle and high school that are attributed to developmental maladjustment. This study evaluated the effectiveness of high-intensity (HI; 412 hr, $4,373 per participant) versus low-intensity (LI; 24 hr, $97 per participant) skills-based summer intervention delivered to adolescents with ADHD by local school district staff. Participants were 325 ethnically diverse rising sixth and ninth graders with ADHD randomized to HI versus LI (n = 218) or recruited into an untreated comparison group (n = 107). Group × Time 1-year outcome trajectories were compared using linear mixed models. Both interventions possessed high fidelity and were viewed by families as enjoyable and beneficial. Youth attendance was higher for HI (~80%) versus LI (~45%). Parent training attendance was uniform across groups (~50%). Parent and student attendance did not impact trajectories. Primary benefits of HI over LI were to note taking (d = .50), parent contingency management (d = .43), and parent-rated ADHD symptoms (d = .40-.46; ninth grade only). Secondary analyses suggested that HI may produce additional benefits compared to no treatment for home organization skills (HI vs. untreated d = .54), parent-teen conflict (HI vs. untreated d = .39), and grade point average (HI vs. untreated d = .47, ninth grade only). Summer HI treatment was superior to LI in engagement and uptake of certain skills. However, the extent to which these medium benefits on a limited number of outcomes justify high costs compared to LI remains an open question. Delivering treatment during the summer instead of school year may limit generalizability.
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Affiliation(s)
- Margaret H Sibley
- a Department of Psychiatry & Behavioral Health , Florida International University
| | - Stefany J Coxe
- b Department of Psychology, Florida International University
| | - Mileini Campez
- b Department of Psychology, Florida International University
| | - Candance Morley
- c Center for Children and Families, Florida International University
| | - Sandra Olson
- c Center for Children and Families, Florida International University
| | - Nick Hidalgo-Gato
- c Center for Children and Families, Florida International University
| | - Elizabeth Gnagy
- c Center for Children and Families, Florida International University
| | - Andrew Greiner
- c Center for Children and Families, Florida International University
| | - Erika K Coles
- b Department of Psychology, Florida International University
| | - Timothy Page
- d Department of Health Policy and Management, Florida International University
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Wang FL, Pedersen SL, Joseph H, Gnagy EM, Curran P, Pelham WE, Molina BS. Role of ADHD in the Co-Occurrence Between Heavy Alcohol Use and Depression Trajectories in Adulthood. Alcohol Clin Exp Res 2019; 43:342-352. [PMID: 30537147 PMCID: PMC6370516 DOI: 10.1111/acer.13934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is associated with greater heavy alcohol use and depressive symptoms in adulthood. Yet, few studies have investigated whether childhood ADHD predicts an increased association between heavy drinking and depression in adulthood when this co-occurrence becomes more common. We examined associations among heavy alcohol use and depression longitudinally from ages 21 to 29 and whether these associations differed for those with or without childhood ADHD, as well as for those with or without persistent ADHD in adulthood. METHODS Data were from the Pittsburgh ADHD Longitudinal Study, a prospective cohort of children diagnosed with ADHD and demographically similar individuals without ADHD histories. ADHD symptoms in adulthood were self- and parent reported; depressive symptoms and frequency of drinking 5 or more drinks in a single drinking occasion were self-reported and measured at 5 time-points from ages 21 to 29. Depression and alcohol use were modeled in a multiple-group, parallel process longitudinal growth model. RESULTS The slopes of heavy alcohol use and depression were significantly and positively associated from ages 25 to 29 but not at the younger ages. Although the strength of these associations did not differ by group (with or without ADHD, childhood or adulthood), the slopes of depression and heavy drinking at the older ages were highly variable and individuals with ADHD showed significantly faster growth in depression from ages 25 to 29. CONCLUSIONS Due to the strengthening association between heavy drinking and depression for adults in their late 20s, and increasing depression for adults with ADHD histories, individuals with ADHD may be at greater risk for co-occurring depression and binge drinking. Negative reinforcement-related alcohol use may strengthen as these individuals age toward the fourth decade of life. More rigorous testing of this possibility is warranted.
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Affiliation(s)
- Frances L. Wang
- Department of Psychiatry University of Pittsburgh Medical Center
| | | | - Heather Joseph
- Department of Psychiatry University of Pittsburgh Medical Center
| | | | - Patrick Curran
- Department of Psychology University of North Carolina, Chapel Hill
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Merrill BM, Molina BSG, Coxe S, Gnagy EM, Altszuler AR, Macphee FL, Morrow AS, Trucco EM, Pelham WE. Functional Outcomes of Young Adults with Childhood ADHD: A Latent Profile Analysis. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:215-228. [PMID: 30689405 DOI: 10.1080/15374416.2018.1547968] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Adults with childhood attention-deficit hyperactivity disorder (ADHD) experience impairment in core functional domains (e.g., educational attainment, occupational status, social relationships, substance abuse, and criminal behavior), but it is currently unclear which impairments co-occur and whether subgroups experience differentiable patterns, none, or all aforementioned functional domains. Latent profile analysis (LPA) was used to characterize patterns of impairment. Data from the Pittsburgh ADHD Longitudinal Study were used. The 317 participants were 25 years old and had childhood ADHD. LPA characterized the variability across substance use (alcohol consumption, cigarette smoking, marijuana use), criminal behavior, peer impairment, educational attainment, maternal relationship, financial dependence, and sexual activity among young adults with childhood ADHD. Childhood predictors of profiles were examined, and ADHD profiles were compared to a matched comparison group without ADHD also followed longitudinally (n = 217). Five profiles were found: prototypic impairment group (54%), high binge-drinking group (17%), high marijuana use group (10%), high criminal activity group (3%), and high cross-domain impairment group (17%). All profiles were impaired compared to non-ADHD young adults. Childhood variables rarely significantly predicted profiles. Young adults with childhood ADHD have differentiable impairment patterns that vary based on substance use, criminal behavior, and number of clinically impaired domains. Nearly all young adult ADHD profiles were impaired in peer, educational, and financial domains, and there was not a nonimpaired ADHD profile. Use of specific substances was elevated among subgroups of, but not all, young adults with ADHD histories. Finally, the high cross-domain impairment profile was impaired in all domains.
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Affiliation(s)
| | | | - Stefany Coxe
- Department of Psychology, Florida International University
| | | | | | | | - Anne S Morrow
- Department of Psychology, Florida International University
| | - Elisa M Trucco
- Department of Psychology, Florida International University
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Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry 2018; 56:14-34. [DOI: 10.1016/j.eurpsy.2018.11.001] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/02/2018] [Accepted: 11/03/2018] [Indexed: 12/17/2022] Open
Abstract
AbstractBackground Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.
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Childress AC, Stark JG. Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Preschool-Aged Children. J Child Adolesc Psychopharmacol 2018; 28:606-614. [PMID: 30388032 DOI: 10.1089/cap.2018.0057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder defined as a persistent pattern of inactivity and/or hyperactivity that interferes with behavioral function or development. Diagnosis and treatment of ADHD in the preschool-aged population (children 3-5 years old) is more complicated compared with older children because of developmental and physiological differences. This article reviews the available literature regarding the challenges associated with ADHD diagnosis and treatment in preschool-aged children, as well as the unmet needs of preschool-aged children with ADHD. METHODS Key considerations for ADHD diagnosis and treatment patterns in preschool-aged children are summarized in this review, including the need for early intervention, the association with comorbidities, and the differences in pharmacokinetic profiles between preschool-aged children and older children. RESULTS Efficacy and safety data are lacking, as clinical trial design and execution pose unique challenges in this population. Preschool-aged children often have difficulty with pill swallowing and tolerating phlebotomy necessary for the collection of pharmacokinetic and safety data. However, early diagnosis and treatment are essential to mitigate ADHD symptoms and comorbidities that may develop during childhood and adolescence in patients with persistent ADHD. CONCLUSION This review describes the established diagnostic and treatment modalities, along with the unmet needs of preschool-aged children with ADHD.
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Affiliation(s)
- Ann C Childress
- 1 Center for Psychiatry and Behavioral Medicine, Inc. , Las Vegas, Nevada
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