Familial aggregation of ADHD characteristics

Is Parents' ADHD Symptomatology Associated With the Clinical Feasibility or Effectiveness of a Psychoeducational Program Targeting Their Children's ADHD?

OBJECTIVE

To examine if the clinical feasibility and effectiveness of a psychoeducational program targeting children's ADHD differ between parents with varying ADHD symptom severities.

METHOD

An open trial analyzed data from 549 parents of children with ADHD aged 3 to 17 years, who participated in psychoeducation at an outpatient habilitation/disability clinic. In all analyses, parents were stratified into three symptom severity groups (low/middle/high) based on scores on an ADHD screening scale.

RESULTS

Parental ADHD symptom severity was not associated with results on any outcome, although the odds of having incomplete data were higher in parents reporting higher symptom severity. Across the entire sample, we observed high program completion rates, positive acceptability ratings and large increases in parental knowledge.

CONCLUSIONS

Psychoeducation may be beneficial regardless of the participating parent's ADHD symptomatology. Further research is needed to examine whether these results are generalizable to parents diagnosed with ADHD, an underrepresented group in our study.

Personality disorders, depression and anxiety in mothers of children with ADHD and anxiety disorders in Iran

BACKGROUND/AIM

This study aims to assess and compare personality disorders and psychiatric disorders (depression and anxiety) in mothers of children with ADHD and anxiety disorders aged 2-16 years living in Iran.

MATERIAL AND METHODS

This is a descriptive cross-sectional study. Participants were 168 mothers (100 with children having ADHD and 68 with children having anxiety disorders). The Millon Clinical Multiaxial Inventory-III, the Depression Anxiety Stress Scale (DASS-21) and the Symptom Checklist-90-Revised (SCL-90-R) were used for assessing personality disorders, depression and anxiety in mothers. Collected data were analysed in SPSS software.

RESULTS

Of 168 mothers, only 100 completed the questionnaires completely (68 having children with ADHD and 32 with anxious children). Of 100 mothers, 61 had personality disorders, where 21 had children with anxiety disorders and 40 had children with ADHD. The most common personality disorder was depressive personality disorder (n = 27) followed by compulsive personality disorder (n = 15). No antisocial, borderline and paranoid personality disorders were observed in mothers. Based on DASS-21, 72 mothers had depression, and 84 had anxiety. Based on the SCL-90-R, 86 had depression, and 81 had anxiety. We found no statistically significant difference between the two groups of mothers in terms of personality disorders, depression and anxiety.

CONCLUSION

Prevalence of depression, anxiety and personality disorders in mothers of children with anxiety disorders and ADHD in Iran is high, and there is no difference between them. It is recommended that psychiatric and psychological counseling be provided for these mothers.

Increased Risk of Traumatic Injuries Among Parents of Children with Attention Deficit/Hyperactivity Disorder: A Nationwide Population-Based Study

Children with attention deficit/hyperactivity disorder (ADHD) are vulnerable to traumatic injuries. Parents of children with ADHD experience undesirable impacts more frequently than parents of children without ADHD. The aim of this study was to evaluate whether traumatic injuries are more prevalent in parents of children with ADHD than in parents of children without ADHD. We compared the prevalence of traumatic injuries between parents of children with and without ADHD by using data from the Taiwan Maternal and Child Health Database from 2004 to 2017. The Cox proportional-hazards regression model was used to examine differences in burn injury, fracture, and traumatic brain injury between parents of children with and without ADHD after adjustment for age, urbanicity, and income level. In total, 81,401 fathers and 87,549 mothers who had at least one offspring with ADHD and 1,646,100 fathers and 1,730,941 mothers with no offspring with ADHD were included in the analysis. The results indicated that both fathers and mothers of children with ADHD had higher risks of burn injury, fracture, and traumatic brain injury than fathers and mothers of children without ADHD. Mothers of children with ADHD had higher risks for all kinds of traumatic events than fathers of children with ADHD.

Comorbidity and patterns of familial aggregation in attention-deficit/hyperactivity disorder and bipolar disorder in a family study of affective and anxiety spectrum disorders

The aim of this study is to examine the familial aggregation of Attention-deficit/hyperactivity disorder (ADHD) and its cross-transmission with bipolar disorder (BD) in a community-based family study of mood spectrum disorders. A clinically-enriched community sample of 562 probands recruited from the greater Washington, DC metropolitan area and their 698 directly interviewed relatives were included in analyses. Inclusion criteria were English speaking and consent to contact at least two first-degree relatives. Standard family study methodology was used and DSM-IV classified mental disorders were ascertained through a best-estimate procedure based on direct semi-structured interviews and multiple family history reports. There was specificity of familial aggregation of both bipolar I disorder (BD I) and bipolar II disorder (BD II) (i.e., BD I OR = 6.08 [1.66, 22.3]; BD II OR = 2.98 [1.11, 7.96]) and ADHD (ADHD OR = 2.13 [1.16, 3.95]). However, there was no evidence for cross-transmission of BD and ADHD in first degree relatives (i.e., did not observe increased rates of BD in relatives of those with ADHD and vice versa; all ps > 0.05). The specificity of familial aggregation of ADHD and BD alongside the absence of shared familial risk are consistent with the notion that the comorbidity between ADHD and BD may be attributable to diagnostic artifact, could represent a distinct BD suptype characterized by childhood-onset symptoms, or the possibility that attention problems serve as a precursor or consequence of BD.

The effects of atomoxetine on emotional control in adults with ADHD: An integrated analysis of multicenter studies

Purpose:

To investigate the effects of atomoxetine on emotional control in adults with ADHD.

Methods:

We performed an integrated analysis using individual patient data pooled from three Eli Lilly-sponsored studies. An integrated analysis can be viewed as a meta-analysis of individual patient-level data, rather than study-level summary data.

Results:

Two populations were identified: a large sample of patients with pre-treatment baseline data (the “overall population”; n = 2846); and a subset of these patients with placebo-controlled efficacy data from baseline to 10 or 12 weeks after initiating treatment (the “placebo-controlled population”; n = 829). At baseline, in the overall population, ∼50% of ADHD patients had BRIEF-AS (Behavior Rating Inventory of Executive Function-Adult Version Self-Report) Emotional control subscores between 21 and 30, compared with ∼10% of normative subjects in the BRIEF-A manual. At endpoint, in the placebo-controlled population, atomoxetine led to a small (effect size 0.19) but significant (P = 0.013) treatment effect for emotional control. The effect size was 0.32 in patients with BRIEF-AS Emotional control scores > 20 at baseline. Improvements in emotional control correlated with improvements in the core ADHD symptoms and quality-of-life.

Discussion:

As deficient emotional control is associated with impaired social, educational and occupational functioning over and above that explained by core ADHD symptoms alone, improvements in emotional control may be clinically relevant.

Conclusion:

At baseline, adults with ADHD were more likely to have impaired emotional control than normative subjects. In the adult ADHD patients, atomoxetine treatment was associated with improvements in emotional control, as well as in core ADHD symptoms and quality-of-life.

Evaluation of Risk Factors for ADHD and Co-Morbid Psychiatric Disorders Among the Parents of Children With ADHD

OBJECTIVE

The aim of this study is to investigate the presence of ADHD and other psychiatric disorders among parents with at least one child with ADHD relative to parents with children who do not have ADHD.

METHOD

Eighty five parents of children with ADHD with 68 control parents who had healthy children without ADHD were interviewed for participation in present study. Each parent was evaluated for co-existing psychiatric disorders using the Structured Clinical Interview for the DSM IV Axis I Disorders (SCID I).

RESULTS

We found that ADHD and co-morbid psychiatric symptoms were increased in the parents of children with ADHD in comparison with the healthy control group.

CONCLUSION

Psychiatric co-morbidity was more common among the parents of patients with inattentive and combined presentations. Adult ADHD is associated with psychiatric co-morbidities including anxiety disorders, mood disorders, and somatoform disorders as well as substantial role impairment.

Maternal Executive Functioning and Scaffolding in Families of Children with and without Parent-Reported ADHD

Parental scaffolding robustly predicts child developmental outcomes, including improved self-regulation and peer relationships and fewer externalizing behaviors. However, few studies have examined parental characteristics associated with a parent's ability to scaffold. Executive functioning (EF) may be an important individual difference factor associated with maternal scaffolding that has yet to be examined empirically. Scaffolding may be particularly important for children with attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorder (DBD) symptoms due to their core difficulties with inattention, disorganization, EF, and self-regulation, their need for greater parental structure, and higher-than-average rates of parental EF deficits. Yet, little research has examined child ADHD in relation to parental scaffolding. This cross-sectional study examined: (1) the association between maternal EF (as measured by the Hotel Test, Barkley's Deficits in Executive Functioning Scale, and Digit Span) and observed scaffolding, (2) the association between parent-reported child ADHD/DBD symptoms and scaffolding, and (3) the interaction between child ADHD/DBD symptoms and maternal EF in predicting scaffolding. In a sample of 84 mothers and their 5-10 year-old biological children (62% male) with and without parent-reported ADHD, we found that maternal EF, as measured by Digit Span and the Hotel Test, predicted observed maternal scaffolding. However, child ADHD/DBD symptoms did not significantly predict maternal scaffolding controlling for child age, maternal education, and maternal EF, nor did the interaction of maternal EF and parent-reported child ADHD/DBD symptoms. Working memory and task shifting may be key components of parental EF that could be targeted in interventions to improve parental scaffolding.

Attention deficit/hyperactivity disorder and future expectations in Russian adolescents

In recent years, there has been an increasing focus on the role of future expectations-the extent to which a future outcome is deemed likely-in the health and well-being of adolescents, with research linking future expectations to outcomes such as an increased likelihood of engaging in risky health behaviors. As yet, however, there has been no research on future expectations and attention deficit/hyperactivity disorder (ADHD) in adolescence. To address this research gap, the current study examined the association between ADHD symptoms/possible ADHD status and future expectations in a school-based sample of adolescents. Data were analyzed from 537 Russian adolescents (aged 12-17) with teacher-reported ADHD symptoms and self-reported future expectations. Logistic regression analysis was used to examine associations. In fully adjusted analyses, inattention symptoms/possible ADHD inattentive status was associated with lower future educational expectations, while a possible ADHD hyperactivity status was associated with increased odds for negative future expectations relating to work, family and succeeding in what is most important. The findings of this study suggest that greater ADHD symptoms/possible ADHD status in adolescence may be linked to an increased risk for negative future expectations across a variety of different life domains.

The effect of having a child with ADHD or ASD on family separation

PURPOSE

The primary aim of this study was to estimate the risk of parental separation associated with having a child with ADHD or ASD when controlling for a large range of known risk factors for parental separation using Danish registries.

METHODS

The study included all children with ADHD or ASD born between 1990 and 1998 in Denmark and a sex and age matched random sample of children from the background population. We followed these children and their parents from birth until the child's 25th birthday, parental separation or December 31, 2015, whichever came first. Data were analyzed using Cox Proportional Hazard models by estimating hazard ratios (HR) and 95% confidence intervals. Models were adjusted for a range of child, parental, and family variables.

RESULTS

The study included the parents of 12,916 children with ADHD, 7496 children with ASD and 18,423 controls. The study found that, even after controlling for a range of potential risk factors, having a child with either ADHD (HR = 1.8, 95% CI 1.6-2.0) or ASD (HR = 1.2, 95% CI 1.1-1.3) significantly increased parents' risk of separating compared with non-affected families. Other factors associated with parental separation were parental imprisonment, parental psychopathology, low parental education level, low household income and living in a larger city.

CONCLUSION

Parents of children diagnosed with ADHD or ASD were more likely to separate than control parents. It is important to improve our knowledge about the particular characteristics of families at risk of separating to prevent distress for the families and their child.

Maternal ADHD Symptoms, Personality, and Parenting Stress: Differences Between Mothers of Children With ADHD and Mothers of Comparison Children

OBJECTIVE

Mothers raising a child with ADHD can experience high parenting stress. We evaluated if mothers' personality traits and own ADHD symptoms could also affect parenting stress.

METHOD

430 biological mothers from the Multimodal Treatment Study of Children with ADHD (MTA mothers) and 237 of a local normative comparison group (LNCG mothers) were evaluated at baseline. Interactions were tested between mothers' group and maternal personality/ADHD symptoms related to parenting stress.

RESULTS

Compared to LNCG, MTA mothers had higher parenting stress, self-reported ADHD, neuroticism, and lower conscientiousness and agreeableness. When personality and ADHD were evaluated together, ADHD symptoms interacted with mothers' group: high maternal ADHD was positively associated with parenting stress for LNCG but not MTA mothers.

CONCLUSION

Personality traits or ADHD characteristics do not appear operative for the high parenting stress of mothers of a child with ADHD. However, high maternal ADHD or low conscientiousness are associated with stress levels similar to raising a child with ADHD.

Maternal ADHD symptoms, child ADHD symptoms and broader child outcomes

OBJECTIVE

This study investigated the associations between maternal symptoms of attention deficit hyperactivity disorder (ADHD) and child functional outcomes in a community-based sample of children with and without ADHD.

DESIGN AND SETTING

In this cohort study, children with ADHD and healthy controls were recruited through schools in Melbourne, Australia, using a combined screening (Conners 3 ADHD Index) and case confirmation (Diagnostic Interview Schedule for Children Version IV) procedure.

PATIENTS

117 children with ADHD and 149 control children were included in the analyses.

MAIN OUTCOME MEASURES

Maternal ADHD symptoms (Conners Adult ADHD Rating Scale) and child outcomes (ADHD severity, quality of life (QoL), academic competence, social-emotional functioning) were measured at a mean child age of 8.9 years.

RESULTS

Mothers of children with ADHD had clinically elevated ADHD symptoms compared with mothers of control children (adjusted analysis: 18.0% vs 2.0%, P<0.001). Elevated maternal ADHD symptoms were associated with greater child ADHD symptom severity and lower QoL by maternal report for children with (severity P=0.01; QoL P=0.003) and without (severity P=0.003; QoL P=0.003) ADHD. Elevated maternal ADHD symptoms were additionally associated with increased parent-rated emotional problems, peer problems and total impairment scores in children without ADHD (all P<0.01).

CONCLUSIONS

Maternal ADHD symptoms are associated with increased ADHD symptom severity and reduced QoL by maternal report in offspring with or without ADHD, and have broader negative associations with emotional and social functioning in children without ADHD. In the evaluation of the referred children, maternal ADHD symptoms should be considered and referral made to adult services where indicated.

Emotion dysregulation in attention-deficit/hyperactivity disorder and borderline personality disorder

There is ongoing debate on the overlap between Attention-Deficit/Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD), particularly regarding emotion dysregulation (ED). In this paper, we present a narrative review of the available evidence on the association of these two disorders from several standpoints. First, we discuss the unique and shared diagnostic criteria for ADHD and BPD, focusing particularly on ED. We consider the methodology of ecological momentary assessment and discuss why this approach could be an alternative and more accurate way to qualitatively distinguish between ADHD and BPD. We summarise key findings on the genetic and environmental risk factors for ADHD and BPD and the extent to which there are shared or unique aetiological and neurobiological risk factors. Finally, we discuss the clinical relevance of considering both disorders in the assessment of patients presenting with trait-like behavioural syndromes, distinguishing the two conditions and implications for treatment.

Investigating the genetic underpinnings of early-life irritability

Severe irritability is one of the commonest reasons prompting referral to mental health services. It is frequently seen in neurodevelopmental disorders that manifest early in development, especially attention-deficit/hyperactivity disorder (ADHD). However, irritability can also be conceptualized as a mood problem because of its links with anxiety/depressive disorders; notably DSM-5 currently classifies severe, childhood-onset irritability as a mood disorder. Investigations into the genetic nature of irritability are lacking although twin studies suggest it shares genetic risks with both ADHD and depression. We investigated the genetic underpinnings of irritability using a molecular genetic approach, testing the hypothesis that early irritability (in childhood/adolescence) is associated with genetic risk for ADHD, as indexed by polygenic risk scores (PRS). As a secondary aim we investigated associations between irritability and PRS for major depressive disorder (MDD). Three UK samples were utilized: two longitudinal population-based cohorts with irritability data from childhood (7 years) to adolescence (15-16 years), and one ADHD patient sample (6-18 years). Irritability was defined using parent reports. PRS were derived from large genome-wide association meta-analyses. We observed associations between ADHD PRS and early irritability in our clinical ADHD sample and one of the population samples. This suggests that early irritability traits share genetic risk with ADHD in the general population and are a marker of higher genetic loading in individuals with an ADHD diagnosis. Associations with MDD PRS were not observed. This suggests that early-onset irritability could be conceptualized as a neurodevelopmental difficulty, behaving more like disorders such as ADHD than mood disorders.

Examining the validity of the adapted Alabama Parenting Questionnaire-Parent Global Report Version

The purpose of the present study was to comprehensively examine the validity of an adapted version of the parent global report form of the Alabama Parenting Questionnaire (APQ) with respect to its factor structure, relationships with demographic and response style covariates, and differential item functioning (DIF). The APQ was adapted by omitting the corporal punishment and the other discipline items. The sample consisted of 674 Canadian and United States families having a 9- to 12-year-old child and at least 1 parent figure who had received treatment within the past 5 years for alcohol problems or met criteria for alcohol abuse or dependence. The primary parent in each family completed the APQ. The 4-factor CFA model of the 4 published scales used and the 3-factor CFA model of those scales from prior research were rejected. Exploratory structural equation modeling was then used. The final 3-factor model combined the author-defined Involvement and Positive Parenting scales and retained the original Poor Monitoring/Supervision and Inconsistent Discipline scales. However, there were substantial numbers of moderate magnitude cross-loadings and large magnitude residual covariances. Differential item functioning (DIF) was observed for a number of APQ items. Controlling for DIF, response style and demographic variables were related significantly to the factors. (PsycINFO Database Record

Individual-level predictors of inpatient childhood burn injuries: a case-control study

Background

Burn injuries are considered one of the most preventable public health issue among children; however, are a cause of significant morbidity and mortality in Iran. The aim of this study was to assess individual-level predictors of severe burn injuries among children leading to hospitalization, in East Azerbaijan Province, in North-West of Iran.

Methods

The study was conducted through a hospital based case–control design involving 281 burn victims and 273 hospital-based controls who were frequency matched on age, gender and urbanity. Both bivariate and multivariate methods were used to analyze the data.

Results

Mean age of the participants was 40.5 months (95 % CI: 37–44) with the majority of burns occurring at ages between 2 months-13.9 years. It was demonstrated that with increase in the caregiver’s age there was a decrease in the odds of burn injuries (OR = 0.94, 95 % CI: 0.92-0.97). According to the multivariate logistic regression there were independent factors associated with burn injuries including childhood ADHD (OR = 2.82, 95 % CI: 1.68 - 4.76), child’s age (OR = 0.73, 95%CI: 0.67 - 0.80), flammability of clothing (OR = 1.60, 95 % CI: 1.12 - 2.28), daily length of watching television (OR = 1.31, 95 % CI: 1.06 - 1.61), playing outdoors (OR = 1.32, 95 % CI: 1.16 - 1.50) and increment in the economic status (OR = 1.37, 95 % CI: 1.18 - 1.60).

Conclusion

Major risk predictors of burn injuries among the Iranian population included childhood ADHD, child’s age, watching television, playing outdoors, high economic status and flammable clothing.

Self-Rated ADHD Symptoms Among Biological Mothers or Fathers of Children with Confirmed ADHD in a French Population

Parents of children with ADHD are more likely to present the disorder, which can affect quality of life and parenting strategies. Few studies have examined parental ADHD to date, none in France. Prevalence of self-rated ADHD symptoms in adulthood and childhood was estimated among 60 biological mothers or fathers of children with confirmed ADHD in France. Cutoffs were total score ≥46 on the Wender Utah Rating Scale and ≥4 on the Adult ADHD Self-Report Scale Screener. Results indicated possible child and adult ADHD in 12.5% of mothers and 10.0% of fathers. As these percentages exceed reported prevalence rates for the French population, a greater effort must be made to diagnose the disorder in parents.

Observed temperament from ages 6 to 36 months predicts parent- and teacher-reported attention-deficit/hyperactivity disorder symptoms in first grade

This study tested the prospective association between observational indicators of temperament, which were obtained across multiple assessments when children were 6-36 months of age, and parent and teacher reports of children's attention-deficit/hyperactivity disorder (ADHD) behaviors, when children were in first grade. Data were drawn from the Family Life Project and included 1,074 children for whom temperament and either parent- or teacher-reported ADHD behavioral data were available. The results of variable-centered regression models indicated that individual differences in temperament regulation, but not temperamental reactivity, was uniquely predictive of parent- and teacher-reported ADHD behaviors. Latent profile analyses were used to characterize configurations of temperamental reactivity and regulation. Person-centered regression models were subsequently estimated in which temperamental profile membership replaced continuous indicators of temperamental reactivity and regulation as predictors. The results of person-centered regression models indicated that temperamental reactivity and regulation both contributed (both alone and in combination) to the prediction of subsequent ADHD behaviors. In general, the predictive associations from early temperament to later ADHD were of modest magnitude (R 2 = .10-.17). Results are discussed with respect to interest in the early identification of children who are at elevated risk for later ADHD.

Childhood predictors of adolescent and young adult outcome in ADHD

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, but it remains unclear which childhood factors predict future outcome.

AIM

To identify childhood predictors of ADHD outcome using both dimensional and categorical approaches.

METHODS

116 adolescents and young adults with childhood ADHD were followed up on average 6.6 years later. ADHD outcome variables were interview-based parent-reported ADHD symptoms and impairment. Childhood predictors included parent- and teacher-rated ADHD symptoms and co-occurring behaviours; actigraph measures of activity level; socio-economic status (SES); and cognitive measures previously associated with ADHD.

RESULTS

Of the sample, 79% continued to meet clinical criteria of ADHD in adolescence and young adulthood. Higher parent-rated ADHD symptoms and movement intensity in childhood, but not teacher-rated symptoms, predicted ADHD symptoms at follow up. Co-occurring symptoms of oppositional behaviours, anxiety, social and emotional problems were also significant predictors, but these effects disappeared after controlling for ADHD symptoms. IQ and SES were significant predictors of both ADHD symptoms and impairment at follow up, but no other cognitive measures significantly predicted outcome.

CONCLUSIONS

SES and IQ emerge as potential moderators for the prognosis of ADHD. Childhood severity of ADHD symptoms, as measured by parent ratings and actigraph movement intensity, also predicts later ADHD outcome. These factors should be considered when identifying ADHD children at most risk of poor long-term outcomes and for the development of interventions to improve prognosis.

Parental psychopathology in families of children with attention-deficit/hyperactivity disorder and exposed to maternal smoking during pregnancy

BACKGROUND

Both genetic and environmental factors have been implicated in the etiology of attention-deficit/hyperactivity disorder (ADHD). We had previously suggested that exposure to maternal smoking during pregnancy (MSDP) may be a valid basis for delineating a distinct subtype of ADHD, where children exposed to MSDP present with a more severe clinical picture. Here, we examine the psychopathology of parents in this group, to better understand the etiology of ADHD.

METHODS

Using the Family Interview for Genetic Studies in a sample of 514 families of children with ADHD, we collected data pertaining to lifetime parental psychopathology. Families were stratified based on maternal smoking during the complete gestational period. The frequency of different disorders was compared using the χ2 statistic.

RESULTS

In the group where mothers smoked during pregnancy, both parents were significantly more likely to have antisocial personality disorder, and problems with alcohol and drug abuse. Mothers had a significantly higher frequency of major depressive disorder (MDD), while fathers showed a trend for both MDD and bipolar disorder.

CONCLUSIONS

Based on the pattern of psychopathology in parents of children exposed to MSDP, as well as earlier reports of the severe clinical, behavioral, and cognitive phenotype in these children, combined with the large body of epidemiological evidence, we propose that these children present a distinct subtype of ADHD with comorbid conduct disorder. Furthermore, we propose that MSDP may be a proxy measure to help delineate this subtype.

Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder

BACKGROUND

Adults with attention-deficit hyperactivity disorder (ADHD) frequently report emotional lability (EL). However, it is not known whether EL may be accounted for by comorbid psychiatric conditions or symptoms. This study evaluates the influence of comorbid clinical symptoms on EL, and investigates the relationship between EL and impairment.

METHODS

Over 500 consecutive male adult referrals at the ADHD Clinic for adults at the South London and Maudsley Hospital (U.K) were screened. 41 individuals with ADHD without comorbidity, current medication or frequent substance were identified, and compared with 47 matched healthy male control participants. Measures included IQ, clinical interview and self-reported ADHD symptoms, EL, impairment and antisocial behaviour.

RESULTS

ADHD participants reported elevated EL, showing good case-control differentiation in receiver operating curve analysis. EL was most strongly predicted by hyperactivity-impulsivity rather than subsyndromal comorbid symptoms, and contributed independently to impairment in daily life.

LIMITATIONS

Results may not generalise to children with ADHD, or many adults with ADHD, who are frequently affected by comorbid psychiatric conditions and substance use disorders.

CONCLUSIONS

EL in adults with ADHD appears to be primarily associated with ADHD itself rather than comorbid conditions, and helps to explain some of the impairments not accounted for by classical features of the disorder. Results indicate that adults presenting with long-term problems with EL should routinely be screened for the presence of ADHD.

Parents psychopathology of children with Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder with extremely complex etiology, not yet well defined but certainly multi-factorial. This study investigated the possible etiopathogenetic role of ADHD symptoms and psychopathology disorders in parents of children with ADHD. We present a case-control study of parents of 50 children affected by ADHD and of 45 healthy children, matched to age and gender. Parents of ADHD children reported higher levels of ADHD symptoms, depressive disorders and Depressive Personality Disorders than parents of healthy children. Mothers displayed greater presence of depression, while fathers showed problems concerning alcohol use. The occurrence of ADHD symptoms, psychopathology and personality disorders in parents highlights the importance to integrate the treatment programs in the ADHD children with the screening and treatment for psychopathological symptoms of the parents.

Genetic and environmental influences on adult attention deficit hyperactivity disorder symptoms: a large Swedish population-based study of twins

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) frequently persists into adulthood. Family and twin studies delineate a disorder with strong genetic influences among children and adolescents based on parent- and teacher-reported data but little is known about the genetic and environmental contribution to DSM-IV ADHD symptoms in adulthood. We therefore aimed to investigate the impact of genetic and environmental influences on the inattentive and hyperactive-impulsive symptoms of ADHD in adults.

METHOD

Twin methods were applied to self-reported assessments of ADHD symptoms from a large population-based Swedish twin study that included data from 15 198 Swedish male and female twins aged 20 to 46 years.

RESULTS

The broad heritability [i.e., A + D, where A is an additive genetic factor and D (dominance) a non-additive genetic factor] was 37% (A = 11%, D = 26%) for inattention and 38% (A = 18%, D = 20%) for hyperactivity-impulsivity. The results also indicate that 52% of the phenotypic correlation between inattention and hyperactivity-impulsivity (r = 0.43) was explained by genetic influences whereas the remaining part of the covariance was explained by non-shared environmental influences. These results were replicated across age strata.

CONCLUSIONS

Our findings of moderate broad heritability estimates are consistent with previous literature on self-rated ADHD symptoms in older children, adolescents and adults and retrospective reports of self-rated childhood ADHD by adults but differ from studies of younger children with informant ratings. Future research needs to clarify whether our data indicate a true decrease in the heritability of ADHD in adults compared to children, or whether this relates to the use of self-ratings in contrast to informant data.

The genetics of attention deficit/hyperactivity disorder in adults, a review

The adult form of attention deficit/hyperactivity disorder (aADHD) has a prevalence of up to 5% and is the most severe long-term outcome of this common neurodevelopmental disorder. Family studies in clinical samples suggest an increased familial liability for aADHD compared with childhood ADHD (cADHD), whereas twin studies based on self-rated symptoms in adult population samples show moderate heritability estimates of 30-40%. However, using multiple sources of information, the heritability of clinically diagnosed aADHD and cADHD is very similar. Results of candidate gene as well as genome-wide molecular genetic studies in aADHD samples implicate some of the same genes involved in ADHD in children, although in some cases different alleles and different genes may be responsible for adult versus childhood ADHD. Linkage studies have been successful in identifying loci for aADHD and led to the identification of LPHN3 and CDH13 as novel genes associated with ADHD across the lifespan. In addition, studies of rare genetic variants have identified probable causative mutations for aADHD. Use of endophenotypes based on neuropsychology and neuroimaging, as well as next-generation genome analysis and improved statistical and bioinformatic analysis methods hold the promise of identifying additional genetic variants involved in disease etiology. Large, international collaborations have paved the way for well-powered studies. Progress in identifying aADHD risk genes may provide us with tools for the prediction of disease progression in the clinic and better treatment, and ultimately may help to prevent persistence of ADHD into adulthood.

Pharmacotherapy for parents with attention-deficit hyperactivity disorder (ADHD): impact on maternal ADHD and parenting

Given the high heritability of the disorder, attention-deficit hyperactivity disorder (ADHD) is common among parents of children with ADHD. Parental ADHD is associated with maladaptive parenting, negative parent-child interaction patterns and a diminished response to behavioural parent training. We describe our previous research demonstrating that stimulant medications for mothers with ADHD are associated with reductions in maternal ADHD symptoms. Although limited beneficial effects on self-reported parenting were also found in our study, the impact of ADHD medications on functional outcomes related to parenting and family interactions may not be sufficient for many families. Many questions remain with regard to how best to treat multiplex ADHD families in which a parent and child have ADHD. In particular, future studies are needed: (1) to evaluate how best to sequence pharmacotherapy, psychosocial treatment for adult ADHD and behavioural parenting interventions; (2) to determine the best approach to maintaining treatment effects over the long term for both parents and children; and (3) to identify individual predictors of treatment response.

Multi-Method Assessment of ADHD Characteristics in Preschool Children: Relations between Measures

Several forms of assessment tools, including behavioral rating scales and objective tests such as the Continuous Performance Test (CPT), can be used to measure inattentive and hyperactive/impulsive behaviors associated with Attention-Deficit/Hyperactivity Disorder (ADHD). However, research with school-age children has shown that the correlations between parent ratings, teacher ratings, and scores on objective measures of ADHD-characteristic behaviors are modest at best. In this study, we examined the relations between parent and teacher ratings of ADHD and CPT scores in a sample of 65 preschoolers ranging from 50 to 72 months of age. No significant associations between teacher and parent ratings of ADHD were found. Parent-ratings of both inattention and hyperactivity/impulsivity accounted for variance in CPT omission errors but not CPT commission errors. Teacher ratings showed evidence of convergent and discriminant validity when entered simultaneously in a hierarchical regression. These tools may be measuring different aspects of inattention and hyperactivity/impulsivity.

Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study

This study examined the relationship between family functioning and attention-deficit/hyperactivity disorder (ADHD) symptoms in an Australian community-based sample. Children were screened for ADHD in their second year of formal schooling. Two hundred and two (202) primary caregivers completed validated measures of family quality of life (QoL), parent mental health, parenting styles and parental relationship quality. Compared with controls, parents of children screening positive for ADHD reported poorer family QoL in the domains of emotional impact (mean difference [MD] -20.1; 95% CI -38.2 to -1.9, p = 0.03) and impact on family activities (MD -17.2; 95% CI -27.9 to -6.5, p = 0.002), less parental warmth (MD -3.4; 95% CI -6.0 to -0.9, p = 0.01) and higher parental depression (MD 6.8; 95% CI 1.8 to 11.7, p = 0.009) and anxiety (MD 6.2; 95% CI 1.7 to 10.6, p = 0.008) after adjusting for socio-demographic characteristics and child conduct symptoms. Parents of children screening positive for ADHD reported higher stress (MD 4.5; 95% CI 1.2 to 7.1, p = 0.007) and more inconsistent (MD 3.0; 95% CI 1.2 to 4.8, p = 0.002) and hostile (MD = 2.2; 95% CI 1.0 to 3.4, p = 0.001) parenting after adjusting for socio-demographic factors only. No difference in parental relationship quality and parental inductive reasoning was identified.

CONCLUSION

These findings suggest a strong association between poor family functioning and ADHD symptoms and carry implications for comprehensive ADHD management and the importance of seeing the child within the family context.

Quantitative and molecular genetics of ADHD

ADHD is a common and highly heritable disorder. Family, twin, and adoption studies confirm a strong genetic influence in risk for ADHD and there has been a great deal of interest in identifying the genetic factors involved. Quantitative genetic studies find that genetic risk for ADHD is continuously distributed throughout the population, that there are both shared and unique genetic influences on inattention and hyperactivity-impulsivity, and that ADHD shares genetic risk factors with commonly co-occurring clinical syndromes and traits. ADHD is found at all ages and the underlying genetic architecture is similar across the lifespan. In terms of specific genetic findings, there is consistent evidence of monoamine neurotransmitter involvement with the best evidence coming from genetic markers in or near the dopamine D4 and D5 receptor genes. Recent genome-wide association studies have identified new association findings, including genes involved in cell division, cell adhesion, neuronal migration, and neuronal plasticity. However, as yet, none of these pass genome-wide levels of significance. Finally, recent data confirm an important role for rare copy number variants, including those that are found in schizophrenia and autism. Future work should use genetic association data to determine the nature of the cognitive, neuronal and cellular processes that mediate genetic risks on behaviour, and identify environmental factors that interact with genetic risks for ADHD.

The role of maternal and child ADHD symptoms in shaping interpersonal relationships

The current study investigated the influence of maternal ADHD symptoms on: (a) mothers' own social functioning; (b) their child's social functioning; and (c) parent-child interactions following a lab-based playgroup involving children and their peers. Participants were 103 biological mothers of children ages 6-10. Approximately half of the children had ADHD, and the remainder were comparison youth. After statistical control of children's ADHD diagnostic status and mothers' educational attainment, mothers' own inattentive ADHD symptoms predicted poorer self-reported social skills. Children with ADHD were reported to have more social problems by parents and teachers, as well as received fewer positive sociometric nominations from playgroup peers relative to children without ADHD. After control of child ADHD status, higher maternal inattention and hyperactivity/impulsivity each predicted children having more parent-reported social problems; maternal inattention predicted children receiving more negative sociometric nominations from playgroup peers. There were interactions between maternal ADHD symptoms and children's ADHD diagnostic status in predicting some child behaviors and parent-child relationship measures. Specifically, maternal inattention was associated with decreased prosocial behavior for children without ADHD, but did not influence the prosocial behavior of children with ADHD. Maternal inattention was associated with mothers' decreased corrective feedback and, at a trend level, decreased irritability toward their children with ADHD, but there was no relationship between maternal inattention and maternal behaviors for children without ADHD. A similar pattern was observed for maternal hyperactivity/impulsivity and mothers' observed irritability towards their children. Treatment implications of findings are discussed.

Life History of Aggression scores are predicted by childhood hyperactivity, conduct disorder, adult substance abuse, and low cooperativeness in adult psychiatric patients

The prevention of aggressive behaviours is a core priority for psychiatric clinical work, but the association between the diagnostic concepts used in psychiatry and aggression remains largely unknown. Outpatients referred for psychiatric evaluations of childhood-onset neuropsychiatric disorders (n=178) and perpetrators of violent crimes referred to pre-trial forensic psychiatric investigations (n=92) had comprehensive, instrument-based, psychiatric assessments, including the Life History of Aggression (LHA) scales. Total and subscale LHA scores were compared to the categorical and dimensional diagnoses of childhood and adult DSM-IV axis I and II mental disorders, general intelligence (IQ), Global Assessment of Functioning (GAF), and personality traits according to the Temperament and Character Inventory (TCI). Overall, the two groups had similar LHA scores, but the offender group scored higher on the Antisocial subscale. Higher total LHA scores were independently associated with the hyperactivity facet of attention-deficit/hyperactivity disorder (AD/HD), childhood conduct disorder, substance-related disorders, and low scores on the Cooperativeness character dimension according to the TCI. IQ and GAF-scores were negatively correlated with the LHA subscale Self-directed aggression. Autistic traits were inversely correlated with aggression among outpatients, while the opposite pattern was noted in the forensic group. The findings call for assessments of aggression-related behaviours in all psychiatric settings.

The impact of perinatal stress on the functional maturation of prefronto-cortical synaptic circuits: implications for the pathophysiology of ADHD?

Enriched as well as impoverished or adverse perinatal environment plays an essential role in the development and refinement of neuronal pathways, which are the neural substrate of intellectual capacity and socioemotional competence. Perinatal experience and learning events continuously interact with the adaptive shaping of excitatory, inhibitory, and neuromodulatory synaptic as well as the endocrine stress systems, including the neuronal corticotropin-releasing factor (CRF) pathways. Adverse environments, such as stress and emotional deprivation can not only delay experience-dependent maturation of these pathways, but also induce permanent changes in prefronto-cortical wiring patterns. We assume that such dysfunctional connections are the neuronal basis for the development of psychosocially induced mental disorders during later life. The aim of this review is to focus on the impact of perinatal stress on the neuronal and synaptic reorganization during brain development and possible implications for the etiology and therapy of mental disorders such as ADHD.

Adults with ADHD: who are we missing?

Attention deficit hyperactivity disorder (ADHD) has long been identified as a common disorder of childhood. There is increasing recognition that adults also are affected by this disorder. Many adults, however, are often undiagnosed or misdiagnosed until their child is diagnosed with the disorder. Improved recognition and treatment for parental ADHD needs to occur given the genetic and environmental etiologies of the disorder. This paper examines three areas where there is a dearth of data in extant literature: parental ADHD culture and ethnicity; parenting and undiagnosed ADHD; and professional care and ADHD, and focuses on parents from ethnic minority cultures.

Family aggregation of mental disorders in the nationwide Danish three generation study

OBJECTIVE

The study of familial aggregation of major mental disorders in a national population.

METHOD

Within a Danish register-based cohort study, aggregation of mental disorders was analysed in all case-probands with first psychiatric contact before the age of 19 years in the time period between 1 April 1969 and 29 June 2004 followed up until the age of 35 years, their first-degree relatives, and a matched group of control-probands including their first-degree relatives.

RESULTS

Hazard rate ratios were significantly elevated for cases as compared to controls for all diagnoses among probands, parents, and siblings. Among children of the probands, these ratios were significantly elevated for neurotic (anxiety) disorders, mental retardation, developmental disorders, behavioural and emotional disorders of childhood and adolescence, and miscellaneous disorders. Family aggregation of any diagnosis was significantly higher in probands with substance use disorder, schizophrenia, affective disorders, neurotic (anxiety) disorders, and miscellaneous disorders. There was specificity of familial transmission for affective and neurotic (anxiety) disorders.

CONCLUSION

This large nationwide study found some differential patterns of familial aggregation of major mental disorders.

A randomised controlled trial of the Neuro Emotional Technique (NET) for childhood Attention Deficit Hyperactivity Disorder (ADHD): a protocol

BACKGROUND

An abundance of literature is dedicated to research for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Most, is in the area of pharmacological therapies with less emphasis in psychotherapy and psychosocial interventions and even less in the area of complementary and alternative medicine (CAM).The use of CAM has increased over the years, especially for developmental and behavioral disorders, such as ADHD. 60-65% of parents with children with ADHD have used CAM. Medical evidence supports a multidisciplinary approach (i.e. pharmacological and psychosocial) for the best clinical outcomes. The Neuro Emotional Technique (NET), a branch of Chiropractic, was designed to address the biopsychosocial aspects of acute and chronic conditions including non-musculoskeletal conditions. Anecdotally, it has been suggested that ADHD may be managed effectively by NET.

DESIGN/METHODS

A placebo controlled, double blind randomised clinical trial was designed to assess the effectiveness of NET on a cohort of children with medically diagnosed ADHD. Children aged 5-12 years who met the inclusion criteria were randomised to one of three groups. The control group continued on their existing medical regimen and the intervention and placebo groups had the addition of the NET and sham NET protocols added to their regimen respectively. These two groups attended a clinical facility twice a week for the first month and then once a month for six months. The Conners' Parent and Teacher Rating Scales (CRS) were used at the start of the study to establish baseline data and then in one month and in seven months time, at the conclusion of the study. The primary outcome measures chosen were the Conners' ADHD Index and Conners' Global Index. The secondary outcome measures chosen were the DSM-IV: Inattentive, the DSM-IV:Hyperactive-Impulsive, and the DSM-IV:Total subscales from the Conners' Rating Scales, monitoring changes in inattention, hyperactivity and impulsivity. Calculations for the sample size were set with a significance level of 0.05 and the power of 80%, yielding a sample size of 93.

DISCUSSION

The present study should provide information as to whether the addition of NET to an existing medical regimen can improve outcomes for children with ADHD.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registration Number: ANZCTRN 012606000332527.

Two cases of pheochromocytoma presenting with ADHD (attention deficit hyperactivity disorder)-like symptoms

Two patients with pheochromocytoma initially presented with behavioral symptoms similar to those seen with attention deficit hyperactivity disorder (ADHD): inability to concentrate, hyperactivity, and poor school performance. One patient was treated with dextroamphetamine/amphetamine for 4 months, at which time medication was discontinued when hypertension appeared. The second patient had hypertension when initially seen. All behavioral abnormalities resolved following tumor resection. Children with ADHD-like symptoms who present atypically at an older age or have other somatic signs and symptoms such as headaches and hypertension should undergo evaluation to rule out an organic etiology.

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

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

Symptoms of attention-deficit/hyperactivity disorder in first-time expectant women: Relations with parenting cognitions and behaviors

The relationship between maternal symptoms of attention-deficit/hyperactivity disorder (ADHD) and parenting cognitions and behaviors was studied in 86 first-time expectant women. Women high on ADHD symptoms were less likely to be married, less likely to have obtained at least some university education, and less likely to report that they wanted to get pregnant at the time they became pregnant. As predicted, ADHD symptoms were positively correlated with symptoms of anxiety and depression, and predicted less positive prenatal expectations regarding the infant and the future maternal role and lower maternal self-efficacy. Contrary to predictions, ADHD did not predict any incremental variance in maternal stressful life events or social support. Symptoms of ADHD were negatively correlated with attendance at recommended prenatal checkups, but were unrelated to other behaviors during pregnancy. Findings suggest that even prior to any contact with their infant, women with ADHD symptoms have maladaptive cognitions regarding their expectations of motherhood and parenting abilities. As a result, they may benefit from early interventions that focus on attenuating the potential negative effects that these maladaptive cognitions might have on the mother-infant relationship and later developmental outcomes for their children.

Attention-deficit hyperactivity disorder in girls: epidemiology and management

Attention-deficit hyperactivity disorder (ADHD) in girls is a topic of growing research and clinical interest. For many years, girls with ADHD have been ignored and overshadowed by hyperkinetic and impulsive boys, but they are now attracting interest in an effort to understand the similarities and differences in the prevalence, symptoms, familial risk, comorbidities and treatment of ADHD in the two sexes. A review of past and current literature finds that the symptoms of ADHD are not sex specific, but that identification of girls with ADHD is hampered by parental and teacher bias, and confusion. Girls are more likely to be inattentive without being hyperactive or impulsive, compared with boys. Girls and boys share the same familial risk patterns, as well as similar, although not identical, comorbidity or impairment patterns. The risk of non-treatment is as great in girls as it is in boys; up to 70-80% of identified children will have persistent symptoms and impairment that extends into adolescence and adulthood. Treatment modalities are equally effective in girls and boys. Stimulants, non-stimulants and behavioural modalities are the mainstays of effective treatment.

Effects of maternal separation, early handling, and standard facility rearing on orienting and impulsive behavior of adolescent rats

Effects of maternal separation in rats have been extensively investigated, but no studies have examined its effects in rat adolescence. We examined the effects of neonatal infant-mother separation (MS) for 6h/day and early handling (EH) for 10 days during the first 2 weeks of life by comparing MS and EH groups to standard facility reared (SFR) controls. At adolescence, the animals were evaluated in a novel and familiar open-field, the light-dark box, and the sucrose consumption test. Behavioral indices included orienting behavior (rearing frequency and duration), impulsive behavior (movement velocity and risk taking by entering the center of the open field or the light compartment of the light-dark box), hyperactivity (ambulatory distance and stereotypic movement), and reward-seeking behavior (sucrose drinking time). The prolonged MS during the first 2 weeks of life resulted in decreased orienting behavior and increased impulsive behavior in adolescence. Measures of ambulatory and stereotypic movements showed that MS rats were hyperactive in the novel environment whereas EH rats were less active overall. The impulsive/hyperactive phenotype produced by this MS protocol may provide a useful animal model to investigate the neurological basis for the similar behavioral phenotype found in attention deficit/hyperactivity disorder.

Teachers' perceptions of the incidence and management of attention-deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) continues to be a common diagnosis of school children, and according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994), it affects approximately 3%-5% of the population. Teachers are often the primary source of information regarding ADHD diagnoses in school children. A previous study by Glass and Wegar (2000) found that teachers were overidentifying children with ADHD and that medication was preferred as the primary treatment for these students. This study further examined teacher perceptions on the causes, incidence, and appropriate treatment methods of ADHD. In addition, this study also examined the prevalence of ADHD as determined by ADHD Rating Scale-IV (School Version; DuPaul et al., 1998) and examined differential identification rates by gender and ethnicity. Results showed that teachers were likely to identify children as having ADHD at rates higher than the expected prevalence rates specified in DSM-IV. Out of 121 rating scales analyzed, 23.97% of students were identified by teachers as meeting criteria for 1 of the 3 types of ADHD. Males had significantly higher scores than females and Whites had significantly higher scores than Hispanics. Class size was also associated with the likelihood that teachers would identify more than 5% of their students as having ADHD. Results suggest that, despite increasing evidence of a connection between biological factors and ADHD, environmental factors (i.e., class size and culture) may still influence teachers' perceptions about what students have the disorder.

Attention deficit and hyperactivity disorder/learning disabilities (ADHD/LD): parental characterization and perception

Sixty-six parents of adolescents (mean age, 14.8 years), who attended special education classes and who were diagnosed as having attention deficit and hyperactivity disorder/learning disabilities (ADHD/LD), were interviewed. The comorbidity of the ADHD group included emotional lability and/or depression, 70%; oppositional defiant disorder (ODD), 67%; obsessive-compulsive disorder (OCD), 44%; addiction to buying, 44%; and aggressiveness, 62%. Twenty-one percent were either involved in the past or presently using drugs. Nine percent had attempted suicide. According to their parents, the main characteristic of these adolescents was low self-image. Parents enumerated five negative characteristics: impulsiveness; nervousness; angered easily ('short fused'); aggressiveness with cursing and outbursts; and impaired sociability with impoliteness.

Modes of entry into services for young children with disruptive behaviors

The authors undertook this study to describe Latina mothers' professional help seeking for their young children's disruptive behaviors. They interviewed 62 Cuban, Puerto Rican, and Dominican first-time help seekers and found four modes of entry: (a) coercion, (b) acceptance of offered referral, (c) responsive and resourceful help seeking subsequent to school reports of behavior problems, and (d) a laborious and convoluted path that was characteristic of 52% of the sample. Schools, maternal and child characteristics, and social network forces played significant roles for all mothers, but the final determinants of service entry varied by the mode of entry followed. Findings suggest that problem labeling is not a necessary precursor to service entry and that direct referrals might effectively shortcut the help-seeking process. Finally, the process that underlies service entry would be described more aptly as a Theory of Affective Action than a Theory of Reasoned Action.

Self-report and objective measures of ADHD-related behaviors in parents of preschool children at risk for ADHD

OBJECTIVE

Few studies have used a combination of objective and self-report measures to examine neuropsychological and behavioral functioning in parents of children with attention-deficit/hyperactivity disorder (ADHD). This study examined attention and inhibitory control in the parents of preschool children who were rated as "at risk" for developing ADHD as compared with parents of controls.

METHODS

Preschool children (N=53) were divided into at risk for ADHD and control groups based on parent and teacher ratings of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ADHD symptoms. One parent of each child was administered an identical pairs Continuous Performance Test (CPT-IP), a Go/No-Go task, and the Brown Attention-Deficit Disorder Scale for Adults.

RESULTS

Parents of preschoolers at risk for ADHD showed a pattern of responding on measures of vigilance characterized by slower reaction times and increased commission errors as compared with parents of controls. There were no significant group differences on self-report measures on the Brown Attention-Deficit Disorder Scale for Adults.

CONCLUSION

Parents of preschoolers at risk for ADHD appear to exhibit cognitive processing deficits that may not be evident using self-report measures. Further research is needed to more clearly identify the specific nature of these neuropsychological deficits and to determine whether they have a negative impact on their children.

Family dynamics and preadolescent girls with ADHD: the relationship between expressed emotion, ADHD symptomatology, and comorbid disruptive behavior

BACKGROUND

Despite the strong biological underpinnings of attention-deficit/hyperactivity disorder (ADHD), family factors remain salient influences on the course of the disorder. However, relatively little is known about how family-level variables relate to ADHD in girls and whether these variables are linked primarily to core ADHD symptomatology or to comorbid aggressive conditions.

METHODS

We investigated the relationship between parental expressed emotion (EE), measured via the five-minute speech sample (FMSS), and ADHD as well as comorbid disruptive behavior disorders, in a diverse sample of 131 girls aged 6-12 years.

RESULTS

High parental EE was associated with both ADHD and aggression, whether these constructs were measured categorically or continuously. The EE component of criticism, as opposed to emotional overinvolvement (EOI), showed the stronger associations with both constructs. ADHD subtypes (Inattentive vs. Combined) were equivalent with respect to prediction from high EE status. Whereas linkages with EE were stronger for ADHD than for aggression and withstood control of comorbid aggression, the converse was not true--i.e., the link between EE and aggression did not hold with control of ADHD. Multiple regression analyses revealed that the associations were independent of parenting stress and maternal depression; exploratory analyses revealed interactions between EE and (a) maternal depression and (b) Child Verbal IQ with respect to predictions of disruptive behavior.

CONCLUSIONS

These findings add to a growing body of literature on ADHD in girls and highlight a pivotal link between family dynamics and the spectrum of ADHD-related behaviors. They also indicate that inattentive symptoms may be equally challenging to parents as hyperactive/impulsive symptoms.

From awareness to acknowledgement: the development of concern among Latina mothers of children with disruptive behaviors

The purpose of this study was to describe the process by which Latina mothers become concerned about their children's disruptive behaviors and deem professional help to be a necessary measure. A sample of 62 Latina first-time help seekers were asked to narrate their stories of their children's behavior, the process by which they became concerned, and their decision to seek professional services. Both qualitative and quantitative measures and procedures were used. Key findings include the following. Most mothers described onset after age 3.75. Earlier recognition of disruptive behaviors and earlier concern over these were associated with greater perceptions of functional impairment and with a greater degree of maternal distress at the time of the interview. Increases in awareness and in concern were associated with life events such as moving, migration, and changes in family composition. Mothers often assumed these life events to be causally linked to children's difficulties. Earlier concern did not speed the awareness process. A "saturation point" was a better descriptor of the culmination of maternal concern than "problem recognition" or "problem labeling." School report of negative behavior was the strongest catalyst to problem acknowledgement. Mothers who recognized onset after their children entered school progressed through the concern process significantly faster than mothers who became concerned at younger child ages.

Response to commentary on the multimodal treatment study of ADHD (MTA): mining the meaning of the MTA

In the December 2000 issue of the Journal of Abnormal Child Psychology, we published a set of papers presenting secondary analyses of the Multimodal Treatment Study of ADHD (MTA), and R. A. Barkley (2000) provided a commentary. A critique of the design of the study (MTA Cooperative Group, 1999) was presented based on a theoretical perspective of a "behavioral inhibition" deficit that has been hypothesized as the core deficit of ADHD (R. A. Barkley, 1997). The commentary questioned the design and analysis of the MTA in terms of (1) the empirical criteria for selection of components of behavioral (Beh) intervention, (2) the effectiveness of the Beh intervention, (3) the methods for analyses at the group and individual level, (4) implications of the MTA findings for clinical practice, (5) the role of genetics in response to treatment, and (6) the lack of a nontreatment control group. In this response, we relate the content of the papers to the commentary, (1) by reviewing the selection criteria for the Beh treatment, as outlined by K. C. Wells, W. E. Pelham, et al. (2000), (2) by addressing the myth that the MTA Beh treatment was ineffective (Pelham, 1999), (3) by describing the use of analyses at the level of the individual participant, as presented by J. S. March et al. (2000) and W. E. Pelham et al. (2000) as well as elsewhere by J. M. Swanson et al. (2001) and C. K. Conners et al. (2001), (4) by relating some of the suggestions from the secondary analyses about clinically relevant factors such as comorbidity (as presented by J. S. March et al., 2000) and family and parental characteristics (as presented by B. Hoza et al., 2000, S. P. Hinshaw et al., 2000, and K. C. Wells, J. N. Epstein, et al., 2000), (5) by discussing the statistical concept of heritability and the lack of a significant difference in the presence of ADHD symptoms in parents of the MTA families compared to parents in the classmate-control families (as presented by J. N. Epstein, et al., 2000), and (6) by acknowledging that an ethically necessary weakness of the MTA design is that it did not include a no-treatment control group. We discuss the use of secondary analyses to suggest how, when, and for what subgroups effectiveness of the Beh treatment may have been manifested. Finally, we invite others to use the large and rich data set that will soon be available in the public domain, to perform secondary analyses to mine the meaning of the MTA and to evaluate theories of ADHD and response to treatments.

Does maternal ADHD reduce the effectiveness of parent training for preschool children's ADHD?

OBJECTIVE

To assess the impact of maternal attention-deficit/hyperactivity disorder (ADHD) symptoms on the effectiveness of a parent training (PT) program for preschool ADHD.

METHOD

Eighty-three 3-year-old children with ADHD and their mothers selected from two community cohorts living in Hampshire, England (1992-93 and 1995-96, respectively), completed an 8-week PT program. ADHD symptoms and a number of other parent and child factors, including adult ADHD symptoms, were measured prior to the start of treatment (week 1: T1), immediately after treatment (week 8: T2), and at 15 weeks follow-up (week 23: T3).

RESULTS

Mothers were divided into three groups on the basis of their scores (T1) on the Adult AD/HD Rating Scale (high, medium, low). Children of mothers in the high-ADHD group displayed no improvement after PT, whereas the levels of ADHD symptoms of the children of mothers in either the medium or low ADHD groups reduced substantially (F(4,60) = 3.13, p < .05). This association persisted after other child and maternal factors were controlled for in multiple regression analyses (beta > .30, p < .05).

CONCLUSIONS

High levels of maternal ADHD symptoms limit the improvement shown by children with ADHD after a program of PT. This effect was unrelated to other aspects of maternal mental health and child functioning. The treatment of parental ADHD may be a prerequisite for the success of psychosocial interventions for childhood ADHD.