Adult substance use as a function of growth in peer use across adolescence and young adulthood in the context of ADHD: Findings from the MTA

EEG Connectivity as Predictor of ICAN ADHD Children's Improvement After Completion of Theta Beta Ratio Neurofeedback: Machine Learning Analyses

Attention deficit hyperactivity disorder is a prevalent syndrome that costs billions of dollars annually. Finding meaningful interventions based upon predictive baseline EEG values can reduce uncertainty in symptom remediation. This study aims to deepen the understanding of ADHD neurophysiology and contribute to the development of personalized approaches in its treatment. This study retrospectively assessed EEG connectivity of participants in the International Collaborative ADHD Neurofeedback (ICAN) randomized controlled trial (7-10YO, N = 83) of theta/beta ratio neurofeedback (TBR-NFB). Using machine learning, it examined the relationship between inattention improvement on the Conners' Teacher and Parent Rating Scales (CTPRS) and specific baseline frequency connections within networks relevant to ADHD to find predictors of clinical improvement. Analyses were also performed considering specific comorbidities, slow cognitive tempo, ADHD presentation, pre-to-post network changes, and treatment group. Dysregulation in the ventral and dorsal attention networks, and delta and hibeta frequency bands throughout all networks were the strongest baseline connectivity predictors of clinical improvement on the CTPRS. The connectivity patterns predicting improvement differed significantly between active NFB and control. Other findings included predictors of improvements in EEG connectivity dysregulations, demographics, and connectivity patterns of comorbidity. Machine learning algorithms identified EEG features in connectivity, network, and frequency to assess when considering ADHD interventions. There was evidence, albeit weak, that the EEG features we studied predicted improvement with the ICAN TBR-NFB protocol. When considering interventions for ADHD symptoms, a multi-channel EEG evaluation that focuses on specific brain connectivity patterns may offer insight into treatment choice.

Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment

OBJECTIVE

Among untreated adults, functional impairments associated with ADHD are widespread and cumulative, and can include social, educational, and professional impairments, increased risk of accidents and mortality, and reduced quality of life. Here, we review the most prominent functional impairments in adults with ADHD and summarize evidence describing the potential role of medication in improving outcomes.

METHOD

Articles related to the search terms "ADHD," "adult," and functional impairments were identified through Google Scholar and PubMed and selected for inclusion based on four criteria: strength of evidence, relevance to current challenges in adult ADHD, impact on the field, and recency of the results.

RESULTS

We identified 179 papers to support the conclusions on the relationship between ADHD and functional impairments, and the impact of pharmacological therapy on functional impairments.

CONCLUSION

This narrative review provides evidence that pharmacological treatment can be effective in minimizing not only the symptoms of ADHD, but its functional consequences as well.

Development of individuals' own and perceptions of peers' substance use from early adolescence to adulthood

This study evaluated how individuals' own substance use and their perception of peers' substance use predict each other across development from early adolescence to middle adulthood. Participants were from two longitudinal studies: Fast Track (FT; N = 463) and Child Development Project (CDP; N = 585). Participants reported on their own and peers' substance use during early and middle adolescence and early adulthood, and their own substance use in middle adulthood. From adolescence to early adulthood, individuals' reports of their own substance use in a given developmental period predicted reports of their peers' substance use in the next developmental period more than peers' substance use in a given developmental period predicted individuals' own substance use in the next. In the higher-risk FT sample, individuals' own substance use in early adulthood predicted alcohol, cannabis, and other substance use in middle adulthood, and peers' substance use in early adulthood predicted cannabis use in middle adulthood. In the lower-risk CDP sample, participants' own substance use in early adulthood predicted only their own cannabis use in middle adulthood, whereas peers' substance use in early adulthood predicted participants' alcohol, cannabis, opioid, and other substance use in middle adulthood. The findings suggest that peer substance use in early adulthood may indicate a greater propensity for subsequent substance use in lower-risk groups, whereas those in higher-risk groups may remain more stable in substance use, with less variability explained by peer contexts.

Perceived friendship and binge drinking in young adults: A study of the Human Connectome Project data

BACKGROUND

Peer influences figure prominently in young adult binge drinking. Women have trended to show a level of alcohol use on par with men during the last decades. It would be of interest to investigate the neural processes of social cognition that may underlie binge drinking and the potential sex differences.

METHODS

Here, we examined the data of the Human Connectome Project where we identified a total of 175 binge drinkers (125 men) and 285 non-binge drinkers (97 men) performing a social cognition task during brain imaging. We analyzed the imaging data with published routines and evaluated the results at a corrected threshold.

RESULTS

Both male and female binge relative to non-binge drinkers showed higher perceived friendship. Binge relative to non-binge drinkers demonstrated diminished activations in the anterior medial orbitofrontal cortex (amOFC) during perception of social vs. random interaction, with a more prominent effect size in women. Further, whole-brain regression identified activity of the right posterior insula (rPI) in negative correlation with perceived friendship score in non-binge drinking women. Post-hoc analyses showed significant correlation of rPI activity with perceived friendship, amOFC activity, and a summary measure of alcohol use severity identified by principal component analysis, across all subjects. Mediation and path analysis demonstrated a significant model: amOFC activity → rPI activity → perceived friendship → severity of alcohol use.

CONCLUSIONS

These findings support peer influences on binge drinking and suggest neural correlates that may relate altered social cognitive processing to alcohol misuse in young adults.

Neurodevelopmental Effects of Cannabis Use in Adolescents and Emerging Adults with ADHD: A Systematic Review

OBJECTIVE

Systematically review the scientific literature to characterize the effects of cannabis use on brain structure, function, and neurodevelopmental outcomes in adolescents and young adults with ADHD.

METHOD

Systematic review following PRISMA guidelines utilizing PubMed, Embase, PsycINFO, and Cochrane CENTRAL trials register from inception until 1 January 2020. Articles that examined the impact of cannabis use on youth with ADHD were included.

RESULTS

Eleven studies were identified that compared outcomes for individuals with ADHD who used cannabis or synthetic cannabinoids against those with ADHD who did not. Seven of these studies used neuroimaging techniques, including fMRI, structural MRI, and SPECT. Differential regions of activation were identified, including the right hippocampus and cerebellar vermis, and bilateral temporal lobes. Morphological differences were identified in the right precentral and postcentral gyri, left nucleus accumbens, right superior frontal and postcentral gyri. No study identified any additive or ADHD × cannabis use interaction on neuropsychological tasks of executive function. Two studies found adverse differential impacts of early-onset cannabis use in this population.

CONCLUSION

A dearth of evidence is available on the impact of cannabis use on the developing brain and functioning for individuals with ADHD, despite the elevated risk for substance use in this population. The limited, potentially underpowered evidence does not support the hypothesis that cannabis use has a deleterious impact on neuropsychological tasks in transitional age youth with ADHD. Larger and longer-term studies are needed, however, to better inform clinicians and patients as to the impacts of cannabis use in youth with ADHD.

Beers with Peers: Childhood ADHD and Risk for Correlated Change in Perceived Peer and Personal Alcohol Use Across Young Adulthood

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.