Significance of childhood conduct problems to later development of conduct disorder among children with ADHD: a prospective follow-up study

Longitudinal relationship between oppositional defiant disorder symptoms and attention-deficit/hyperactivity disorder symptoms in Chinese children: insights from cross-lagged panel network analyses

Oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common childhood mental disorders, and they have substantial comorbidity. The developmental precursor model has long been widely used to explain the mechanisms of comorbidity between ODD and ADHD, however whether it is equally effective at the symptomatic level is unclear. Therefore, this study aimed to (a) examine the stability of the ODD and ADHD comorbidity network in a longitudinal sample of high-risk children in China; and (b) examine the longitudinal relationship between the ODD and ADHD symptom networks based on a developmental precursor model. Two hundred sixty-three Chinese children aged 6 to 13 years with ODD and/or ADHD were assessed for symptoms of ODD and ADHD in two surveys conducted 1 year apart. We used data from these two time points to construct two cross-sectional networks and a cross-lagged panel network (CLPN) to explore the symptom network for comorbidity of ODD and ADHD. The analysis shows that: (1) the two cross-sectional networks are highly similar in terms of structure, existence of edges, centrality estimates, and the invariance test shows that there is no significant difference between them. The symptoms "follow through", "interrupts/intrudes", "difficulty playing quietly" and "concentration" had the highest expected influence centrality at both time points. (2) Combined with the results of the cross-sectional and cross-lagged networks, we found that "annoy" and "blame" are potential bridge symptoms between the ODD and ADHD symptom networks. The symptom "annoy" forms a reciprocal predictive relationship with "interrupts/intrudes", while "blame" unidirectionally predicts "close attention". In addition, we found that "vindictive" predicted numerous ADHD symptoms, whereas "angry" was predicted by numerous ADHD symptoms. The findings emphasize the broad predictive relationship between ODD and ADHD symptoms with each other, and that ODD symptoms may lead to activation of the ADHD symptom network and vice versa. These findings suggest that the developmental precursor model at the symptom level may partially explain the comorbidity mechanisms of ODD and ADHD, and future studies should further investigate the underlying multiple mechanisms.

Heterotypic and homotypic continuity in psychopathology: a narrative review

Psychopathology is a process: it unfolds over time and involves several different factors. To extend our knowledge of such process, it is vital to understand the trajectories that lead to developing and maintaining a specific disorder. The construct of continuity appears very useful to this aim. It refers to the consistency, similarity, and predictability of behaviors or internal states across different developmental phases. This paper aims to present a narrative review of the literature on homotypic and heterotypic continuity of psychopathology across the lifespan. A detailed search of the published literature was conducted using the PsycINFO Record and Medline (PubMed) databases. Articles were included in the review based on the following criteria: (1) publication dates ranging from January 1970 to October 2022; and (2) articles being written in the English language. To ensure a thorough investigation, multiple combinations of keywords such as "continuity," "psychopathology," "infancy," "childhood," "adolescence," "adulthood," "homotypic," and "heterotypic" were used. Articles were excluded if exclusively focused on epidemiologic data and if not specifically addressing the topic of psychopathology continuity. The literature yielded a total of 36 longitudinal studies and an additional 190 articles, spanning the research published between 1970 and 2022. Studies on continuity focus on the etiology of different forms of mental disorders and may represent a fundamental resource from both a theoretical and clinical perspective. Enhancing our understanding of the different trajectories beneath psychopathology may allow clinicians to implement more effective strategies, focusing both on prevention and intervention. Since literature highlights the importance of early detection of clinical signs of psychopathology, future research should focus more on infancy and pre-scholar age.

Individual differences in white matter of the uncinate fasciculus and inferior fronto-occipital fasciculus: possible early biomarkers for callous-unemotional behaviors in young children with disruptive behavior problems

BACKGROUND

Callous-unemotional (CU) behaviors are important for identifying severe patterns of conduct problems (CP). One major fiber tract implicated in the development of CP is the uncinate fasciculus (UF), which connects amygdala and orbitofrontal cortex (OFC). The goals of the current study were to (a) explore differences in the white matter microstructure in the UF and other major fiber tracks between young typically developing (TD) children and those with a disruptive behavior disorder (DBD) and (b) explore, within the DBD group, whether individual differences in these white matter tracts relate to co-occurring CP and CU behaviors.

METHODS

Participants included 198 young children (69% boys, M_age  = 5.66 years; 80% Latinx; 48.5% TD). CU behaviors and CP were measured via a combination of teacher/parent ratings. Non-invasive diffusion-weighted imaging (DWI) was used to measure fractional anisotropy (FA), an indirect indicator of white matter properties.

RESULTS

Relative to TD children, children in the DBD group had reduced FA on four out of the five fiber tracks we examined (except for cingulum and right ILF), even after accounting for whole brain FA, sex, movement, parental income, and IQ. Within the DBD group, no associations were found between CP and reduced white matter integrity across any of the fiber tracks examined. However, we found that even after accounting for CP, ADHD symptomology, and a host of covariates (whole brain FA, sex, movement, parental income, and IQ), CU behaviors were independently related to reduced FA in bilateral UF and left inferior fronto-occipital fasciculus (IFOF) in the DBD group, but this was not the case for TD children.

CONCLUSIONS

Alterations in the white matter microstructure within bilateral UF and left IFOF may be biomarkers of CU behaviors, even in very young children.

Predicting delinquent behavior in young adults with a childhood diagnosis of ADHD: results from the Cologne Adaptive Multimodal Treatment (CAMT) Study

The aim of this study was to investigate which factors predict lifetime reports of delinquent behavior in young adults who had received adaptive multimodal treatment of attention-deficit/hyperactivity disorder (ADHD) starting at ages 6-10 years. Participants were reassessed 13-24 years (M = 17.6, SD = 1.8) after they had received individualized ADHD treatment in the Cologne Adaptive Multimodal Treatment Study (CAMT). Their behavior was classified as non-delinquent (n = 34) or delinquent (n = 25) based on self-reports regarding the number of police contacts, offenses, and convictions at follow-up. Childhood variables assessed at post-intervention (e.g., externalizing child behavior problems, intelligence, and parenting behavior) that were significantly associated with group membership were entered as possible predictors of delinquency in a Chi-squared automatic interaction detector (CHAID) analysis. Delinquent behavior during adolescence and adulthood was best predicted by (a) meeting the symptom count diagnostic criteria for conduct disorder (CD) according to parent ratings, in combination with a nonverbal intelligence of IQ ≤ 106 at post-intervention, and (b) delinquent behavior problems (teacher rating) at post-intervention. The predictor variables specified in the CHAID analysis classified 81% of the participants correctly. The results support the hypothesis that a childhood diagnosis of ADHD is only predictive of delinquent behavior if it is accompanied by early conduct behavior problems. Low nonverbal intelligence was found to be an additional risk factor. These findings underline the importance of providing behavioral interventions that focus on externalizing behavior problems to children with ADHD and comorbid conduct problems.

The Interplay Between Prenatal Adversity, Offspring Dopaminergic Genes, and Early Parenting on Toddler Attentional Function

Background: Few studies have explored the complex gene-by-prenatal environment-by-early postnatal environment interactions that underlie the development of attentional competence. Here, we examined if variation in dopamine-related genes interacts with prenatal adversity to influence toddler attentional competence and whether this influence is buffered by early positive maternal behavior. Methods: From the Maternal Adversity, Vulnerability and Neurodevelopment cohort, 134 participants (197 when imputing missing data) had information on prenatal adversity (prenatal stressful life events, prenatal maternal depressive symptoms, and birth weight), five dopamine-related genes (DAT1, DRD4, DRD2, COMT, BDNF), observed maternal parenting behavior at 6 months and parent-rated toddler attentional competence at 18 and 24 months. The Latent Environmental and Genetic Interaction (LEGIT) approach was used to examine genes-by-prenatal environment-by-postnatal environment interactions while controlling for sociodemographic factors and postnatal depression. Results: Our hypothesis of a three-way interaction between prenatal adversity, dopamine-related genes, and early maternal parenting behavior was not confirmed. However, consistent two-way interactions emerged between prenatal adversity and dopamine-related genes; prenatal adversity and maternal parenting behavior, and dopamine-related genes and maternal parenting behavior in relation to toddler attentional competence. Significant interaction effects were driven by the DAT1, COMT, and BDNF genotypes; prenatal stressful life events; maternal sensitivity, tactile stimulation, vocalization, and infant-related activities. Conclusions: Multiple dopamine-related genes affected toddler attentional competence and they did so in interaction with prenatal adversity and the early rearing environment, separately. Effects were already visible in young children. Several aspects of early maternal parenting have been identified as potential targets for intervention.

Empirically-informed guidelines for first-time adult ADHD diagnosis

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.

ADHD symptoms, the current symptom scale, and exploratory structural equation modeling: A psychometric study

The aim of the study was to use exploratory structural equation modelling (ESEM) to investigate support for an ADHD factor model with group factors for inattention (IA), hyperactivity (HY), and impulsivity (IM), as proposed in in ICD-10. A total of 202 adults (121 females and 81 males), aged between 18 and 35 years, from the general community, completed the Current Symptoms Scale (CSS). The results for the model showed good global fit, good convergent and divergent validities. However, the IA and IM factors, but not the HY factor, were clearly defined and demonstrated acceptable reliabilities. Taken together, these finding indicate that a revised ESEM model without the HY factor (i.e. with only the IA and IM symptoms) is an appropriate structure for modeling adult ratings of the ADHD behaviors described in the CSS. The taxonomic, theoretical and clinical implications of the findings for ADHD in general are discussed.

Attention-Deficit/Hyperactivity Disorder (ADHD), antisociality and delinquent behavior over the lifespan

Attention-Deficit/Hyperactivity Disorder (ADHD) is closely linked to the development of conduct problems during socialization in early life and to an increased risk for antisocial activities and delinquency over the lifespan. The interaction between ADHD and common comorbid disorders like substance use disorders as well as changing environmental conditions could mediate the course of antisocial and delinquent behavior with increasing age. However, this complex interaction is only partially understood so far. This review presents current knowledge about the association of ADHD with antisociality and the development of delinquent behavior. Thereby, the relationships between ADHD, conduct disorder and antisocial personality disorder in offenders are discussed, as well as the impact of comorbid psychiatric disorders and psychosocial conditions on offending behavior. Also, treatment studies in offender populations with ADHD are presented. Although our understanding of the role of ADHD in the development of criminal behavior has substantially improved during the last two decades, more research is needed to further elucidate the mechanisms generating unfavorable outcomes and to engender adequate treatment strategies for this population at risk. Moreover, more attention is needed on children with conduct problems in order to avoid antisocial or delinquent behaviors over the lifespan.

Environmental and Cognitive Enrichment in Childhood as Protective Factors in the Adult and Aging Brain

Some recent studies have highlighted a link between a favorable childhood environment and the strengthening of neuronal resilience against the changes that occur in natural aging neurodegenerative disease. Many works have assessed the factors – both internal and external – that can contribute to delay the phenotype of an ongoing neurodegenerative brain pathology. At the crossroads of genetic, environmental and lifestyle factors, these relationships are unified by the concept of cognitive reserve (CR). This review focuses on the protective effects of maintaining this CR through the cognitive aging process, and emphasizes the most essential time in life for the development and strengthening of this CR. The in-depth study of this research shows that early stimulation with regard to social and sensory interactions, contributes to the proper development of cognitive, affective and psychosocial capacities. Childhood thus appears to be the most active phase in the development of CR, and as such we hypothesize that this constitutes the first essential period of primary prevention of pathological aging and loss of cognitive capacities. If this hypothesis is correct, early stimulation of the environment would therefore be considered as a true primary prevention and a public health issue. The earlier identification of neurodevelopmental disorders, which can affect personal and professional development across the lifespan, could therefore have longer-term impacts and provide better protection against aging.

Psychometric Properties of a Brief Screening Measure for ADHD in Adults

The use of screening tools is an effective and practical approach within the clinical diagnostic assessment of attention deficit hyperactivity disorder (ADHD) in adults. Existing screening measures for adult ADHD have focused on a younger population. Subsequently, the current study aimed to evaluate the utility and general usability of an adapted four-item screening tool for adult ADHD: a brief version of the Wender Utah Rating Scale (WURS-brief), within a middle-aged population. The sample consisted of 69 adults, aged between 30 and 63 (age M= 45, SD=6.95), who had been referred to a specialist adult ADHD outpatients clinic. Using factor analysis, the WURS-brief screening measure was compared to existing ADHD diagnostic tools that were used as reference measures within the analysis. The WURS-brief had respectable sensitivity when compared with existing diagnostic tools. This study highlights the importance of validating brief screening measures for middle-aged adults with ADHD within clinical settings and offers suggestions for future research.

Comorbidity and Behavior Characteristics of Russian Male Juvenile Delinquents With ADHD and Conduct Disorder

Objective: To test the previously suggested hypothesis that those with comorbid ADHD and Conduct Disorder (CD) diagnoses differ from other antisocially involved youth in terms of higher rates of violent behavior, impulsiveness, and psychopathic traits. Method: Three hundred eighty juvenile incarcerated delinquents from Northern Russia were assessed by means of semi-structured psychiatric interview and by student and teacher self-reports. Results: The study has demonstrated higher rates of psychiatric disorders and of comorbidity, as well as more complicated substance abuse and disruptive behaviors in those with combined ADHD-CD diagnosis, as compared with CD only, ADHD only, and no CD no ADHD groups. The results regarding psychopathic traits were inconclusive. Conclusion: The group with combined ADHD-CD diagnosis is more severely disturbed, both as concerns psychiatric comorbidity and more severe aggressive and disruptive behaviors. However, there is only limited evidence supporting a higher prevalence of psychopathic traits in this group.

WISC-IV Intellectual Profiles in Korean Children and Adolescents with Attention Deficit/Hyperactivity Disorder

OBJECTIVE

This study aimed to compare the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) profiles of children with attention deficit/hyperactivity disorder (ADHD) and typically-developing children (TC) in Korea.

METHODS

The Korean version of the WISC-IV and the Advanced Test of Attention (ATA) were administered to 377 children and adolescents: 224 with ADHD (age 8.2±2.1 years, 182 boys) and 153 TC (age 8.7±2.4 years, 68 boys). Partial correlation and an analysis of covariance were used to investigate the relationship between the scores of the WISC-IV and the ATA.

RESULTS

The mean score of the full-scale intelligence quotient was lower in ADHD children than in TC (p<0.001). In analyses controlling for gender and with the full-scale intelligence quotient as a covariate, the working memory index (WMI) (p<0.001) and values of the Digit span subtest (p=0.001) of the WISC-IV were lower in the ADHD group than in TC. The WMI (r=-0.26, p<0.001) and its subtest Arithmetic scores (r=-0.25, p<0.001) were negatively correlated with Commission errors on the auditory ATA.

CONCLUSION

Children with ADHD have significantly lower WMI scores, which were clinically correlated with Commission errors on the auditory task of the ATA. Thus, the WMI is an indicator of attention deficit in children with ADHD.

Early Childhood Trajectories of Conduct Problems and Hyperactivity/Attention Problems: Predicting Adolescent and Adult Antisocial Behavior and Internalizing Problems

Although conduct problems (CP) and hyperactivity/attention problems (HAP) are thought to covary with regularity, few studies have traced the probability of co-occurring CP and HAP longitudinally, particularly beginning in the toddler period. Further, there is little research examining how early co-occurring trajectories of CP and HAP predict functioning across several domains through late adolescence and early adulthood. Using a cohort of 284 low-income boys, we examined whether separate developmental trajectories of overt CP and HAP symptomatology from ages 2 to 10 relate to violent behavior, established correlates of antisocial behavior, impulsivity, and internalizing problems in adolescence and early adulthood. Co-occurring trajectory patterns of CP and HAP from ages 2 to 10 were also investigated in relation to later maladjustment. Findings indicated that trajectories of CP beginning in early childhood were related to violent behavior in adolescence and adulthood, adolescent correlates of antisocial behavior (i.e., deviant talk with peers), and internalizing problems in adulthood. Early HAP trajectories were also related to later problem behaviors when considered in isolation. However, when examining trajectories of CP and HAP simultaneously, children with chronic CP + chronic HAP, but not HAP-only, were most at risk for multiple types of problem behaviors in adolescence and early adulthood, including violent behavior and depressive and anxiety symptoms. Thus, HAP symptomatology was no longer predictive of adolescent and adult functioning once co-occurring CP was accounted for. Findings extend prior research with older children of HAP and/or CP, highlighting the predictive value of trajectories of CP beginning in the toddler period.

The Conners 3-short forms: Evaluating the adequacy of brief versions to assess ADHD symptoms and related problems

The Conners' Rating Scales are widely used to assess attention deficit/hyperactivity disorder (ADHD) and related difficulties in children and adolescents. A short form of the scales is available, which, along with the several advantages of brief versions, also displays good psychometric properties. Nonetheless, no studies have confirmed them in cultural contexts different from the original one. The present study examined the psychometric properties of the Self-Report, Parent, and Teacher Conners 3-Short Forms in terms of reliability and validity in an Italian sample. Analyses were performed on 591 children and adolescents, 631 parents' ratings, and 325 teachers' ratings. To test for discriminative validity, ADHD clinical samples of 55 youth, 63 parents, and 15 teachers were compared to gender- and age-matched groups. Findings confirmed the original multidimensional structures and supported the Conners 3-Short Form scales as reliable and valid tools to assess ADHD and its main comorbid conditions.

Interplay between genome-wide implicated genetic variants and environmental factors related to childhood antisocial behavior in the UK ALSPAC cohort

We investigated gene-environment (G × E) interactions related to childhood antisocial behavior between polymorphisms implicated by recent genome-wide association studies (GWASs) and two key environmental adversities (maltreatment and smoking during pregnancy) in a large population cohort (ALSPAC). We also studied the MAOA candidate gene and addressed comorbid attention-deficit/hyperactivity disorder (ADHD). ALSPAC is a large, prospective, ethnically homogeneous British cohort. Our outcome consisted of mother-rated conduct disorder symptom scores at age 7;9 years. G × E interactions were tested in a sex-stratified way (α = 0.0031) for four GWAS-implicated variants (for males, rs4714329 and rs9471290; for females, rs2764450 and rs11215217), and a length polymorphism near the MAOA-promoter region. We found that males with rs4714329-GG (P = 0.0015) and rs9471290-AA (P = 0.0001) genotypes were significantly more susceptible to effects of smoking during pregnancy in relation to childhood antisocial behavior. Females with the rs11215217-TC genotype (P = 0.0018) were significantly less susceptible to effects of maltreatment, whereas females with the MAOA-HL genotype (P = 0.0002) were more susceptible to maltreatment effects related to antisocial behavior. After adjustment for comorbid ADHD symptomatology, aforementioned G × E's remained significant, except for rs11215217 × maltreatment, which retained only nominal significance. Genetic variants implicated by recent GWASs of antisocial behavior moderated associations of smoking during pregnancy and maltreatment with childhood antisocial behavior in the general population. While we also found a G × E interaction between the candidate gene MAOA and maltreatment, we were mostly unable to replicate the previous results regarding MAOA-G × E's. Future studies should, in addition to genome-wide implicated variants, consider polygenic and/or multimarker analyses and take into account potential sex stratification.

Longitudinal relations between beliefs supporting aggression and externalizing outcomes: Indirect effects of anger dysregulation and callous-unemotional traits

Aggression is prevalent in early- to mid-adolescence and is associated with physical health and psychosocial adjustment difficulties. This underscores the need to identify risk processes that lead to externalizing outcomes. This study examined the extent to which the effects of three dimensions of beliefs supporting aggression on physical aggression and externalizing behavior are mediated by anger dysregulation and callous-unemotional (CU) traits. Three waves of data were collected from a primarily African American (77%) sample of 265 middle school students between the ages of 11 and 15 (52% were female). We found evidence supporting mediation such that the effects of beliefs supporting instrumental aggression and beliefs that fighting is sometimes necessary at Wave 1 on student-reported physical aggression at Wave 3 were mediated by CU traits at Wave 2, and relations between beliefs supporting reactive aggression at Wave 1 and teacher-report of student frequencies of physical aggression and externalizing behavior at Wave 3 were mediated by anger dysregulation at Wave 2. Our findings demonstrated the importance of distinguishing between dimensions of beliefs supporting aggression, as differential paths emerged between specific beliefs, CU traits and anger dysregulation, and externalizing outcomes. These findings have important clinical implications, as they suggest that specific dimensions of beliefs supporting aggression could be targeted based on whether an individual is at risk for behavior patterns characterizing CU traits or anger dysregulation.

Early childhood predictors of boys' antisocial and violent behavior in early adulthood

Research on early childhood predictors of violent behaviors in early adulthood is limited. The current study investigated whether individual, family, and community risk factors from 18 to 42 months of age were predictive of violent criminal arrests during late adolescence and early adulthood using a sample of 310 low-income male participants living in an urban community. In addition, differences in trajectories of overt conduct problems (CP), hyperactivity/attention problems (HAP), and co-occurring patterns of CP and HAP from age 1½ to 10 years were investigated in regard to their relationship to violent and nonviolent behaviors, depression, and anxiety at age 20. Results of multivariate analyses indicated that early childhood family income, home environment, emotion regulation, oppositional behavior, and minority status were all significant in distinguishing violent offending boys from those with no criminal records. In addition, trajectories of early childhood CP, but not attention deficit hyperactivity disorder, were significantly related to self-reports of violent behavior, depressive symptoms, and anxiety symptoms. Implications for the prevention of early childhood risk factors associated with adolescent and adult violent behavior for males are discussed.

Conners 3-Self-Report Scale: An empirical support to the dimensionality of the content scales

The Conners' Rating Scales are one of the most used instruments for attention deficit/hyperactivity disorder (ADHD). Nonetheless, in the latest edition, the Inattention scale was not statistically supported. This study examined the dimensionality of the Italian version of the Conners 3-Self-Report scale testing both a five-factor structure including Inattention and a four-factor model combining Inattention and Learning Problems. Moreover, the generalizability of the detected structure through measurement invariance was verified. The Italian version of the scale was completed by 971 children (53% males, mean age: 12.76 years) randomly split in a calibration sample ( n = 464) and a validation sample ( n = 507). Confirmatory factor analyses detected a five-factor structure (i.e. Inattention, Hyperactivity/Impulsivity, Learning Problems, Defiance/Aggression, and Family Relations), and measurement invariance was confirmed. Findings provided statistical evidence for the Inattention subscale, supporting the Conners 3-Self-Report Scale as effectively aimed to assess the two dimensions of ADHD and its main comorbid difficulties.

Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan

Attention-deficit/hyperactivity disorder (ADHD) is highly heritable and the most common neurodevelopmental disorder in childhood. In recent decades, it has been appreciated that in a substantial number of cases the disorder does not remit in puberty, but persists into adulthood. Both in childhood and adulthood, ADHD is characterised by substantial comorbidity including substance use, depression, anxiety, and accidents. However, course and symptoms of the disorder and the comorbidities may fluctuate and change over time, and even age of onset in childhood has recently been questioned. Available evidence to date is poor and largely inconsistent with regard to the predictors of persistence versus remittance. Likewise, the development of comorbid disorders cannot be foreseen early on, hampering preventive measures. These facts call for a lifespan perspective on ADHD from childhood to old age. In this selective review, we summarise current knowledge of the long-term course of ADHD, with an emphasis on clinical symptom and cognitive trajectories, treatment effects over the lifespan, and the development of comorbidities. Also, we summarise current knowledge and important unresolved issues on biological factors underlying different ADHD trajectories. We conclude that a severe lack of knowledge on lifespan aspects in ADHD still exists for nearly every aspect reviewed. We encourage large-scale research efforts to overcome those knowledge gaps through appropriately granular longitudinal studies.

Psychopathic Personality Works Better than CU Traits for Predicting Fearlessness and ADHD Symptoms among Children with Conduct Problems

Children with early-onset conduct problems (CP) are at great risk for future behavior problems, and this risk seems to increase when CP co-occur with psychopathic traits. Even though studies are indicating that the entire psychopathic personality construct may be more useful in designating a meaningful subgroup of children with CP, research on psychopathic traits and CP in childhood have mainly focused on the role of callous unemotional (CU) traits. Prospective longitudinal data of 1867 3- to 5-year-olds (47% girls) followed annually for two years was used to compare groups of children with different combinations of CP and psychopathic traits on fearlessness and Attention-Deficit Hyperactivity Disorder (ADHD) symptoms. Children with CP and psychopathic personality had higher baseline and stable levels of ADHD symptoms than children with CP only or children with CP and concurrent CU traits, while baseline levels of fearlessness did not differ. They were also more likely to display stable levels of the risky combination of CP and ADHD symptoms. Results were similar for boys and girls. Findings indicate that there are reasons to consider other traits and behaviors as specifiers for subgroups of children with CP over and above CU traits, in order to optimize both diagnostic practice and treatment outcomes.

A Review of Factors that Promote Resilience in Youth with ADHD and ADHD Symptoms

The vast majority of research on youth with ADHD has focused on risk factors and describing the types of impairment individuals with ADHD experience. However, functional outcomes associated with ADHD are heterogeneous, and although many youth with ADHD experience significant negative outcomes (e.g., school dropout), some are successful in multiple domains of functioning (e.g., pursue and graduate college). There is a growing body of literature supporting the existence of factors that protect youth with ADHD from experiencing negative outcomes, but there is no published synthesis of this literature. Accordingly, the goals of this review are to conceptualize risk-resilience in the context of ADHD using a developmental psychopathology framework and to systematically review and critique evidence for promotive and protective factors in the context of ADHD. The literature search focused specifically on resilience in the context of ADHD symptoms or an ADHD diagnosis and identified 21 studies, including clinic, school, and community samples. Findings of promotive and/or protective factors are summarized across individual, family, and social-community systems. Overall, we know very little of the buffering processes for these youth, given that the study of promotive and protective factors in ADHD is in its infancy. The strongest evidence to date was found for social- and family-level systems. Specifically, multiple longitudinal studies support social acceptance as a protective factor, buffering against negative outcomes such as poor academic performance and comorbid depressive symptoms for youth with ADHD. There was also compelling evidence supporting positive parenting as a promotive factor. In terms of individual-level factors, positive or modest self-perceptions of competence were identified as a promotive factor in multiple studies. Future directions for research that will catalyze the study of resilience with ADHD are provided, and the potential for targeting protective mechanisms with intervention and prevention is discussed.

Early-onset Conduct Problems: Predictions from daring temperament and risk taking behavior

OBJECTIVE

Given its considerable public health significance, identifying predictors of early expressions of conduct problems is a priority. We examined the predictive validity of daring, a key dimension of temperament, and the Balloon Analog Risk Task (BART), a laboratory-based measure of risk taking behavior, with respect to two-year change in parent, teacher-, and youth self-reported oppositional defiant disorder (ODD), conduct disorder (CD), and antisocial behavior.

METHOD

At baseline, 150 ethnically diverse 6- to 10-year old (M=7.8, SD=1.1; 69.3% male) youth with (n=82) and without (n=68) DSM-IV ADHD completed the BART whereas parents rated youth temperament (i.e., daring); parents and teachers also independently rated youth ODD and CD symptoms. Approximately 2 years later, multi-informant ratings of youth ODD, CD, and antisocial behavior were gathered from rating scales and interviews.

RESULTS

Whereas risk taking on the BART was unrelated to conduct problems, individual differences in daring prospectively predicted multi-informant rated conduct problems, independent of baseline risk taking, conduct problems, and ADHD diagnostic status.

CONCLUSION

Early differences in the propensity to show positive socio-emotional responses to risky or novel experiences uniquely predicted escalating conduct problems in childhood, even with control of other potent clinical correlates. We consider the role of temperament in the origins and development of significant conduct problems from childhood to adolescence, including possible explanatory mechanisms underlying these predictions.

Co-Occurrence of ODD and CD in Preschool Children With Symptoms of ADHD

OBJECTIVE

Patterns of co-occurrence between ADHD, Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) were examined in a sample of non-referred preschool children. ADHD subtypes and sex differences were also explored.

METHOD

Children aged 3.5 years ( n = 1,048) with high scores on ADHD characteristics were recruited from the Norwegian Mother and Child Cohort Study and clinically assessed, including a semi-structured psychiatric interview.

RESULTS

In children with ADHD, concurrent ODD was present more often than CD (31% vs. 10%), but having ADHD gave higher increase in the odds of CD than of ODD (ODD: odds ratio [OR] = 6.7, 95% confidence interval [CI] = [4.2, 10.8]; CD: OR = 17.6, 95% CI = [5.9, 52.9]). We found a greater proportion of children having the combined ADHD subtype as well as more severe inattentiveness among children with co-occurring CD compared with ODD. Sex differences were minor.

CONCLUSION

There are important differences in co-occurring patterns of ODD and CD in preschool children with ADHD.

Differences in Executive Functioning in Children with Attention Deficit and Hyperactivity Disorder (ADHD)

In recent years, the interest in Attention Deficit and Hyperactivity Disorder (ADHD) and its relation to deficits in working memory (WM) and more specifically the different executive functions (EFs) has grown, to the point of confirming that these are quite frequent in this disorder. The aim of this study was precisely to explore differences in executive functioning of WM in fourth grade Primary school children with and without ADHD (26 and 29 children, respectively), introducing rigorous control measures in the tests used. Four EFs were analyzed: divided attention, updating, attentional shifting and inhibition, measured through four tasks, the dual-task paradigm (digits and box-crossing), the N-Back task, the Trail Making Test and the Stroop task, respectively. The results showed that participants with ADHD, compared to children with typical development (TD), exhibited a smaller verbal memory span as well as deficits in the attentional shifting and updating functions. However, a similar performance for the EF of inhibition was found for both groups of participants. Finally, an unexpected result was obtained with regard to the role of divided attention, as children with ADHD were less impaired when performing the double task than participants in the TD group.

Predicting aggression in adolescence: The interrelation between (a lack of) empathy and social goals

In an attempt to explain the inconsistent findings and overall weak relation between empathy and aggression, we focused on the role of emotional empathy (emotions of concern, compassion or sympathy toward a (potential) victim), agentic goals (the desire to be dominant during social interaction with peers) and their interplay (mediation or moderation) in the prediction of proactive aggression (learned instrumental behavior) in adolescence. Data were collected from 550 young Dutch adolescents, who filled out multiple questionnaires. Findings showed that the link between a lack of empathic concern and proactive aggression is partly mediated and moderated by agentic goals. The moderation analyses showed that the predictive value of a lack of empathic concern with regard to proactive aggression was greater when adolescents reported a stronger desire to be dominant in social situations with peers. In addition, the findings supported the assumption that the relation between empathic concern and reactive aggression (a hostile and angry response to perceived provocation) is not mediated or moderated by agentic goals. Findings were discussed in terms of their implications for future research. Aggr. Behav. 43:204-214, 2017. © 2016 Wiley Periodicals, Inc.

Poverty and Trends in Three Common Chronic Disorders

OBJECTIVES

For asthma, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), the objectives were to (1) describe the percent increases in prevalence and comorbidity and how these vary by poverty status, and (2) examine the extent to which poverty status is a predictor of higher than average comorbid conditions.

METHODS

Secondary analyses of the National Survey of Children's Health for years 2003, 2007, and 2011-2012 were conducted to identify trends in parent reported lifetime prevalence and comorbidity among children with asthma, ADHD, and ASD and examine variation by sociodemographic characteristics, poverty status, and insurance coverage. Using 2011-2012 data, multivariable regression was used to examine whether poverty status predicted higher than average comorbid conditions after adjusting for other sociodemographic characteristics.

RESULTS

Parent-reported lifetime prevalence of asthma and ADHD rose 18% and 44%, respectively, whereas the lifetime prevalence of ASD rose almost 400% (from 0.5% to 2%). For asthma, the rise was most prominent among the poor at 25.8%. For ADHD, the percent change by poverty status was similar (<100% federal poverty level [FPL]: 43.20%, 100% to 199% FPL: 52.38%, 200% to 399% FPL: 43.67%), although rise in ASD was associated with being nonpoor (200% to 399% FPL: 43.6%, ≥400% FPL: 36.0%). Publicly insured children with asthma, ADHD, and ASD also had significantly higher odds (1.9×, 1.6×, 3.0×, respectively) of having higher than average comorbidities.

CONCLUSIONS

Poverty status differentially influenced parent-reported lifetime prevalence and comorbidities of these target disorders. Future research is needed to examine parent and system-level characteristics that may further explain poverty's variable impact.

A boy with conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), borderline intellectual disability, and 47,XXY syndrome in combination with a 7q11.23 duplication, 11p15.5 deletion, and 20q13.33 deletion

BACKGROUND

This is a case with multiple chromosomal aberrations which are likely etiological for the observed psychiatric phenotype consisting of attention deficit hyperactivity and conduct disorders.

CASE PRESENTATION

We report on an 11 year-old boy, admitted to the pediatric hospital for behavioral difficulties and a delayed neurodevelopmental trajectory. A cytogenetic analysis and high-resolution microarray comparative genomic hybridization (CGH) analysis was performed. The cytogenetic analysis revealed 47,XYY syndrome, while CGH analysis revealed an additional duplication and two deletions. The 7q11.23 duplication is associated with speech and language delay and behavioral symptoms, a 20q13.33 deletion is associated with autism and early onset schizophrenia and the 11p15.5 microdeletion is associated with developmental delay, autism, and epilepsy. The patient underwent a psychiatric history, physical examination, laboratory testing, and a detailed cognitive, psychiatric, and occupational therapy evaluation which are reported here in detail.

CONCLUSIONS

In the case of psychiatric patients presenting with complex genetic aberrations and additional psychosocial problems, traditional psychiatric and psychological approaches can lead to significantly improved functioning. Genetic diagnostic testing can be highly informative in the diagnostic process and may be applied to patients in psychiatry in case of complex clinical presentations.

ADHD symptoms and peer relations of children in a community sample: Examining associated problems, self-perceptions, and gender differences

This study examined children's peer relations in relation to gender, symptoms of attention-deficit/ hyperactivity disorder (ADHD), associated behaviour problems, prosociality, and self-perceptions, in a community sample. Six hundred and thirty-five 12-year-old children (314 girls) provided peer nominations and rated feelings of loneliness and self-perceptions regarding global self-worth and behavioural conduct. We obtained teacher ratings of ADHD symptoms, conduct and internalising problems, and prosociality. ADHD symptoms, conduct problems, internalising problems, and low levels of prosociality were all related to higher levels of peer dislike. Despite ADHD symptoms being related to more peer dislike, children with high levels of ADHD symptoms did not report more feelings of loneliness. The self-perceptions of children with high levels of ADHD were not related to peer dislike. Although high levels of ADHD symptoms were not related to peer dislike in girls, peers tolerated higher levels of ADHD symptoms among boys than among girls, providing support for the “gender appropriateness hypothesis” regarding the impact and influence of ADHD symptomatology upon the peer relations of children within a community sample.

Maternal Depression History Moderates Parenting Responses to Compliant and Noncompliant Behaviors of Children with ADHD

Maternal depression and parenting are robust predictors of developmental outcomes for children with attention-deficit/hyperactivity disorder (ADHD). However, methods commonly used to examine parent-child interactions in these families do not account for temporal associations between child and parent behavior that have been theorized to maintain negative child behavior. Moreover, studies examining associations between maternal depression and parenting in families of children with ADHD have not compared mothers who were currently depressed, remitted, and never clinically depressed. This study utilized sequential analysis to examine how maternal reinforcement of compliant and noncompliant child behavior differs as a function of maternal depression history. Within the 82 participating mother-child dyads, 21 mothers were currently depressed, 29 mothers had a lifetime history of depression but were in remission for at least 1 month, and 32 mothers had never been clinically depressed. 24 girls (29.6 %) and 57 boys (70.4 %) between the ages of 6-12 years old (M = 8.7, SD = 2.0) and were diagnosed with ADHD. Results indicated that all mothers were less likely to respond optimally than non-optimally to child compliant and noncompliant behaviors during observed parent-child interactions; however, currently depressed mothers were least likely to reinforce child compliance and responded most coercively to child noncompliance relative to the other groups. Remitted mothers in this sample were more coercive than never clinically depressed mothers, but were more likely to follow through with commands than never clinically depressed mothers. Implications for behavioral parent training programs aimed at skill development for depressed mothers of children with ADHD are discussed.

Links between within-person fluctuations in hyperactivity/attention problems and subsequent conduct problems

BACKGROUND

The onset of hyperactivity/impulsivity and attention problems (HAP) is typically younger than that of conduct problems (CP), and some research supports a directional relation wherein HAP precedes CP. Studies have tested this theory using between-person and between-group comparisons, with conflicting results. In contrast, prior research has not examined the effects of within-person fluctuations in HAP on CP.

METHOD

This study tested the hypothesis that within-person variation in HAP would positively predict subsequent within-person variation in CP, in two population samples of youth (N = 620) who participated in identical methods of assessment over the course of 30 months. Three-level, hierarchical models were used to test for within-person, longitudinal associations between HAP and CP, as well as moderating effects of between-person and between-family demographics.

RESULTS

We found a small but significant association in the expected direction for older youth, but the opposite effect in younger and non-Caucasian youth. These results were replicated across both samples.

CONCLUSIONS

The process by which early HAP relates to later CP may vary by age and racial identity.

Context-Specific Associations Between Harsh Parenting and Peer Rejection on Child Conduct Problems at Home and School

Although harsh parenting and peer rejection are independently associated with childhood conduct problems (CP), these patterns are often informant specific, suggesting that their associations across contexts (i.e., home and school) should be considered. In a sample of 142 children with and without attention-deficit/hyperactivity disorder (ADHD; ages 5-10; 66% male), we used structural equation modeling to evaluate the structure of multi-informant (parent, teacher) and multimethod (semi-structured interview, questionnaire) rated aggressive, rule-breaking, and oppositional behavior. Next, we explored context-specific associations by modeling harsh parenting and peer rejection as simultaneous and independent predictors of home and school CP. We observed several key findings: (a) the structure of parent- and teacher-reported CP was best accounted by context-specific CP (i.e., home vs. school) and a second-order general CP factor; (b) harsh punishment and peer rejection each independently predicted the second-order general CP factor; and (c) peer rejection was uniquely associated with school CP, whereas harsh punishment was associated only with the second-order general CP factor and did not exhibit specificity with home CP. Whereas harsh parenting and peer rejection were each independently associated with generalized CP, peer rejection showed an additional, unique context-specific association with CP exclusively expressed at school. We discuss potential explanatory mechanisms underlying context-specific associations of CP, as well as address etiological and clinical implications for understanding informant-discrepancies in CP.

Codevelopment of ADHD and externalizing behavior from childhood to adulthood

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) frequently co-occurs with externalizing disorders, but a clear understanding of the etiologic underpinnings is hampered by the limited understanding of the codevelopment of the traits from childhood into early adulthood.

METHODS

Using a birth cohort of 2600 twins, the Swedish Twin study of Child and Adolescent Development study, assessed at ages 8-9, 13-14, 16-17, and 19-20, we investigated the codevelopment of ADHD and externalizing behavior from childhood to adulthood. The analyses examined ADHD-like and externalizing traits, as rated by twins and their parents using the Attention Problems scale and Externalizing scale of the Child Behavior Checklist, and estimated cross-lagged effects (one trait at one time-point predicting the other at the next). The covariation between the traits were decomposed into stable (effects carried over from the prior time-points) and innovative (new effects for each time-point) sources; each source was further decomposed into additive genetics, shared and nonshared environment.

RESULTS

The analysis suggested that externalizing traits in middle childhood (age 8-9) predicted ADHD-like traits in early adolescence (age 13-14), whereas the reverse association was nonsignificant. In contrast, ADHD-like traits in lateadolescence (age 16-17) predicted externalizing traits in early adulthood (age 19-20). The correlation between ADHD-like and externalizing traits increased over time. At all time-points, innovative sources contributed substantially to maintained comorbidity. Genetic effects explained 67% of the covariation at each time-point; importantly, nearly 50% of these effects were innovative.

CONCLUSIONS

This study challenges the belief that ADHD generally precedes externalizing behaviors; rather, change in the etiologic factors across the development is the rule. The effects were due to both new genetic and environmental factors emerging up to young adulthood. Clinicians and researchers needs to consider complex etiologic and developmental models for the comorbidity between ADHD and externalizing behaviors.

Long-term course of ADHD symptoms from childhood to early adulthood in a community sample

Comparatively little information is available from population-based studies on subgroup trajectories of attention-deficit/hyperactivity disorder (ADHD) core symptoms of inattention and hyperactivity-impulsivity (particularly as defined by DSM-IV and ICD-10). Recent report of a subgroup with high and increasing inattention symptoms across development requires replication. To identify the different trajectory subgroups for inattention, hyperactivity-impulsivity and total symptoms of ADHD in children and adolescents aged 7-19 years. Eleven birth cohorts from 2,593 families with children and adolescents who had parent ratings for the outcome measures of inattention, hyperactivity-impulsivity or total symptoms were considered. Data were analysed using an accelerated longitudinal design and growth mixture modelling was applied to detect subgroups. For all three outcome measures, three trajectories with low (78.3-83.3 %), moderate (13.4-18.8 %) and high (2.8-3.2 %) symptom levels were detected. Course within these subgroups was largely comparable across outcome domains. In general, a decrease in symptoms with age was observed in all severity subgroups, although the developmental course was stable for the high subgroups of inattention and total symptoms. About 3 % of children in a community-based sample follow a course with a high level of ADHD symptoms. In this high trajectory group, hyperactivity-impulsivity symptoms decrease with age from 7 to 19 years, whilst inattention and total symptoms are stable. There was no evidence for an increase in symptoms across childhood/adolescence in any of the severity groups.

Conduct behaviors and oppositional defiant behaviors in children and adolescents with ADHD

There is controversy about the association among attention deficit hyperactivity disorder (ADHD), conduct disorder behaviors, and oppositional defiant behaviors. This study examines whether different subcategories of conduct behaviors co-occur in children with ADHD, and investigates the association of conduct behaviors with ADHD symptoms and oppositional defiant behavior, considering the covariant factors of parental age and educational level. A total of 441 children and adolescents with ADHD participated in this study - 342 (77.6%) boys and 99 girls (22.4%). Their mean age was 9.1 (standard deviation = 2.2) years. They came from families with 1 to 8 children. There were statistically significant correlations among different subcategories of conduct disorder (p < 0.001 for all the correlations). Oppositional behavior scores were associated with all 4 subcategories of conduct behaviors. The severity of hyperactivity/impulsivity was associated with the subcategory of "destruction of property." The inattentiveness score was associated with "aggression to people and animals." The current results do not suggest that conduct behaviors exclude oppositional defiant behaviors. The subcategories of conduct behaviors occur in a cluster rather than as a solitary behavior. Larger family size and lower educational level of the father increase the risk of aggression to people and animals in children with ADHD.

Children With Conduct Problems and Co-occurring ADHD: Behavioral Improvements Following Parent Management Training

To scale up evidence-based treatment of conduct problems, parent management training, Oregon model (PMTO) has been disseminated throughout Norway. This study examined whether Attention Deficit Hyperactivity Disorder (ADHD) predicted the outcomes of PMTO. Of 253 children and families, 97 were reported to have an ADHD diagnosis. Although different at intake, the groups with and without ADHD had close to an equal change in behavioral status following treatment. Maternal depression and family income predicted the combined group's behavior following PMTO. The study indicates that reductions in conduct problems following PMTO are of the same magnitude in children with or without ADHD. However, some characteristics may differentially predict outcomes for children with combined problems.

The predictive utility of conduct disorder symptoms in preschool children: a 3-year follow-up study

Conduct disorder (CD) symptoms often emerge during the preschool years, but it is not clear whether they predict later symptoms. The present study examined whether age 3 CD symptoms predict age 6 CD symptoms beyond oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder-hyperactive/impulsive (ADHD-HI) symptoms. Participants were 216 preschool children (M Age  = 44.19 months), including an externalizing sample (n = 161) and a comparison group (n = 55). Parents were administered a diagnostic interview when children were 3 years old and again 3 years later. The externalizing sample exhibited more CD symptoms than the comparison sample. In the externalizing sample, initial CD symptoms predicted later CD symptoms above and beyond ODD and ADHD HI symptoms; this relation was stronger for boys than for girls. Stealing, property destruction, and fighting independently predicted later CD symptoms. CD symptoms also predicted subsequent ADHD HI symptoms and predicted ODD symptoms at a level that approached significance. Results support the predictive validity of CD symptoms in preschool.

Risky behavior in gambling tasks in individuals with ADHD--a systematic literature review

OBJECTIVE

The aim of this review was to gain insight into the relationship between Attention deficit hyperactivity disorder (ADHD) and risky performance in gambling tasks and to identify any potential alternate explanatory factors.

METHODS

PsycINFO, PubMed, and Web of Knowledge were searched for relevant literature comparing individuals with ADHD to normal controls (NCs) in relation to their risky performance on a gambling task. In total, fourteen studies in children/adolescents and eleven studies in adults were included in the review.

RESULTS

Half of the studies looking at children/adolescents with ADHD found evidence that they run more risks on gambling tasks when compared to NCs. Only a minority of the studies on adults with ADHD reported aberrant risky behavior. The effect sizes ranged from small to large for both age groups and the outcome pattern did not differ between studies that applied an implicit or explicit gambling task. Two studies demonstrated that comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) increased risky behavior in ADHD. Limited and/or inconsistent evidence was found that comorbid internalizing disorders (IDs), ADHD subtype, methylphenidate use, and different forms of reward influenced the outcomes.

CONCLUSION

The evidence for increased risky performance of individuals with ADHD on gambling tasks is mixed, but is stronger for children/adolescents with ADHD than for adults with ADHD, which may point to developmental changes in reward and/or penalty sensitivity or a publication bias for positive findings in children/adolescents. The literature suggests that comorbid ODD/CD is a risk factor in ADHD for increased risky behavior. Comorbid IDs, ADHD subtype, methylphenidate use, and the form of reward received may affect risky performance in gambling tasks; however, these factors need further examination. Finally, the implications of the findings for ADHD models and the ecological validity of gambling tasks are discussed.

Gender and the development of oppositional defiant disorder: contributions of physical abuse and early family environment

Research is needed to understand the role of gender in the stability, course and etiology of antisocial behavior. Family environment, given its proximal association with children's behavior, holds great promise in understanding risk for antisocial behavior. The present study examined the role of parental acceptance and emotional responsivity as assessed using the HOME, caregiver report of intimate partner violence (IPV), and levels of physical abuse as assessed using the Conflict Tactics Scales, on subsequent symptoms of Oppositional Defiant Disorder (ODD), a childhood disorder characterized by antisocial behavior. Data were drawn from Waves 1-3, cohorts 3 and 6 of the Project for Human Development in Chicago Neighborhoods. Results suggest only minor gender differences in levels of ODD symptoms, with equal rates of stability from Wave 2 to 3 in symptom levels. For boys and girls, IPV was associated with an increased risk of ODD symptoms, and higher acceptance was associated with reduced risk of ODD symptoms. However, gender differences emerged in the impact of physical abuse and emotional responsiveness, in that the former was a significant predictor for girls only, and the latter was significant for boys only. Potential implications for these findings, including the role of gender socialization are discussed.

The social and cultural construction of psychiatric knowledge: an analysis of NICE guidelines on depression and ADHD

The current paper presents an analysis of the NICE guidelines on depression and attention deficit hyperactivity disorder (ADHD) from the perspective of the philosophy of science, guided particularly by Foucault's notion of the symbiosis of knowledge and power. It examines how data that challenged the orthodox position on the validity and drug treatment of these conditions was managed in the process of guideline development. The depression guideline briefly considered the complexity and heterogeneity of depression, and numerous methodological problems with evaluating treatments, including antidepressants. However, the guideline recommendations made no reference to these issues and ignored evidence that questioned the analysis of antidepressant trials. The guideline on ADHD reviewed validity, but did not consider evidence from the critical literature, and overlooked inconsistencies in the data. The guideline identified that drug trials have shown no long-term benefit in ADHD, but still recommended treatment with stimulant drugs for children with severe symptoms and for all adults claiming consensus for this position. Both guidelines demonstrate how contradictory data are managed so as not to jeopardise the currently predominant view that ADHD and depression are valid and un-contentious medical conditions that should be treated with drugs. The subjective nature of guideline formation that is revealed illustrates Foucault's suggestion that the authority of medicine operates to promote a technological view of the nature of certain human problems, which in turn strengthens medical hegemony over these areas.

Does childhood attention-deficit/hyperactivity disorder predict risk-taking and medical illnesses in adulthood?

OBJECTIVE

To test whether children with attention-deficit/hyperactivity disorder (ADHD), free of conduct disorder (CD) in childhood (mean = 8 years), have elevated risk-taking, accidents, and medical illnesses in adulthood (mean = 41 years); whether development of CD influences risk-taking during adulthood; and whether exposure to psychostimulants in childhood predicts cardiovascular disease. We hypothesized positive relationships between childhood ADHD and risky driving (in the past 5 years), risky sex (in the past year), and between risk-taking and medical conditions in adulthood; and that development of CD/antisocial personality (APD) would account for the link between ADHD and risk-taking. We report causes of death.

METHOD

Prospective 33-year follow-up of 135 boys of white ethnicity with ADHD in childhood and without CD (probands), and 136 matched male comparison subjects without ADHD (comparison subjects; mean = 41 years), blindly interviewed by clinicians.

RESULTS

In adulthood, probands had relatively more risky driving, sexually transmitted disease, head injury, and emergency department admissions (p< .05-.01). Groups did not differ on other medical outcomes. Lifetime risk-taking was associated with negative health outcomes (p = .01-.001). Development of CD/APD accounted for the relationship between ADHD and risk-taking. Probands without CD/APD did not differ from comparison subjects in lifetime risky behaviors. Psychostimulant treatment did not predict cardiac illness (p = .55). Probands had more deaths not related to specific medical conditions (p = .01).

CONCLUSIONS

Overall, among children with ADHD, it is those who develop CD/APD who have elevated risky behaviors as adults. Over their lifetime, those who did not develop CD/APD did not differ from comparison subjects in risk-taking behaviors. Findings also provide support for long-term safety of early psychostimulant treatment.

Motorsports involvement among adolescents and young adults with childhood ADHD

Although children with attention-deficit/hyperactivity disorder (ADHD) are at risk for impulsive, health-endangering behavior, few studies have examined nonsubstance, use-related risk-taking behaviors. This study examined whether adolescents and young adults with ADHD histories were more likely than those without ADHD histories to report frequent engagement in motorsports, a collection of risky driving-related activities associated with elevated rates of physical injury. Path analyses tested whether persistent impulsivity, comorbid conduct disorder or antisocial personality disorder (CD/ASP), and heavy alcohol use mediated this association. Analyses also explored whether frequent motorsporting was associated with unsafe and alcohol-influenced driving. Two hundred twenty-one adolescent and young adult males (16-25 years old) diagnosed with ADHD in childhood and 139 demographically similar males without ADHD histories reported their motorsports involvement. Persistent impulsivity, CD/ASP, heavy drinking, and hazardous driving were also measured in adolescence/young adulthood. Adolescents and young adults with ADHD histories were more likely to report frequent motorsports involvement than those without childhood ADHD. Impulsivity, CD/ASP, and heavy drinking partially mediated this association, such that individuals with ADHD histories, who had persistent impulsivity or CD/ASP diagnoses, were more likely to engage in heavy drinking, which was positively associated with frequent motorsporting. Motorsports involvement was associated with more unsafe and alcohol-influenced driving, and this association was more often found among those with, than without, ADHD histories. Adolescents and young adults with ADHD histories, especially those with persisting impulsivity, comorbid CD/ASP and heavy drinking tendencies, are more likely to engage in motorsports, which may heighten risk of injury.

Durch Jugendliche mit Störungen des Sozialverhaltens ausgelöste Krankenkassenausgaben

Die Studie basiert auf Abrechnungsdaten einer großen gesetzlichen Krankenkasse (AOK Nordost). Es wurden Patienten im Alter von 13 bis 18 Jahren mit dokumentierter ICD-10-Diagnose einer Störung des Sozialverhaltens eingeschlossen (Indexgruppe, IG, N=665) und mit einer nach Alter und Geschlecht parallelisierten Kontrollgruppe (KG, N=16.625) verglichen. Während in der KG mittlere Jahreskosten von 687 € zu verzeichnen waren, beliefen sich diese bei der IG mit 2.632 € auf das 3,83fache (p<0,001). In beiden Gruppen verursachten weibliche Versicherte höhere Kosten als männliche (IG: 2.883 € vs. 2.501 €, p=0,41; KG: 758 € vs. 649 €, p=0,22). Jugendliche mit Störungen des Sozialverhaltens lösten deutlich höhere Krankenkassenausgaben aus als Jugendliche ohne diese Diagnose. Dieses Ergebnis weist auf die gesundheitsökonomische Bedeutung des Störungsbildes hin.

Attention-deficit/hyperactivity disorder and adverse health outcomes

Attention-deficit/hyperactivity disorder (ADHD) is defined by extreme levels of inattention-disorganization and/or hyperactivity-impulsivity. In DSM-IV, the diagnostic criteria required impairment in social, academic, or occupational functioning. With DSM-5 publication imminent in 2013, further evaluation of impairment in ADHD is timely. This article reviews the current state of knowledge on health-related impairments of ADHD, including smoking, drug abuse, accidental injury, sleep, obesity, hypertension, diabetes, and suicidal behavior. It concludes by suggesting the need for new avenues of research on mechanisms of association and the potential for ADHD to be an early warning sign for secondary prevention of some poor health outcomes.

Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later

CONTEXT Prospective studies of childhood attention-deficit/hyperactivity disorder (ADHD) have not extended beyond early adulthood. OBJECTIVE To examine whether children diagnosed as having ADHD at a mean age of 8 years (probands) have worse educational, occupational, economic, social, and marital outcomes and higher rates of ongoing ADHD, antisocial personality disorder (ASPD), substance use disorders (SUDs), adult-onset psychiatric disorders, psychiatric hospitalizations, and incarcerations than non-ADHD comparison participants at a mean age of 41 years. DESIGN Prospective, 33-year follow-up study, with masked clinical assessments. SETTING Research clinic. PARTICIPANTS A total of 135 white men with ADHD in childhood, free of conduct disorder, and 136 men without childhood ADHD (65.2% and 76.4% of original cohort, respectively). MAIN OUTCOME MEASURES Occupational, economic, and educational attainment; marital history; occupational and social functioning; ongoing and lifetime psychiatric disorders; psychiatric hospitalizations; and incarcerations. RESULTS Probands had significantly worse educational, occupational, economic, and social outcomes; more divorces; and higher rates of ongoing ADHD (22.2% vs 5.1%, P < .001), ASPD (16.3% vs 0%, P < .001), and SUDs (14.1% vs 5.1%, P = .01) but not more mood or anxiety disorders (P = .36 and .33) than did comparison participants. Ongoing ADHD was weakly related to ongoing SUDs (ϕ = 0.19, P = .04), as well as ASPD with SUDs (ϕ = 0.20, P = .04). During their lifetime, probands had significantly more ASPD and SUDs but not mood or anxiety disorders and more psychiatric hospitalizations and incarcerations than comparison participants. Relative to comparisons, psychiatric disorders with onsets at 21 years or older were not significantly elevated in probands. Probands without ongoing psychiatric disorders had worse social, but not occupational, functioning. CONCLUSIONS The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence, without increased onsets of new disorders after 20 years of age. Findings highlight the importance of extended monitoring and treatment of children with ADHD.

Psychopathology and offense types in detained male juveniles

A substantial proportion of violent crime is committed by juveniles. In detained juveniles, high rates of psychopathology have been found. The objective of this study was to determine psychopathology associated with offense characteristics in detained male adolescents. The Mini International Neuropsychiatric Interview was used to assess juvenile detainees. The final sample included 275 males (mean age=16.45, S.D.=1.27 years). Multivariate logistic regressions yielded significant associations between psychopathology and specific offense types: The presence of substance use disorders (without alcohol) (SUD) was found to predict drug-related crimes, and the presence of alcohol use disorders (AUD) without further SUD were a predictor of violent crime, especially in older juveniles. The absence of anxiety disorder, especially in younger juveniles, was found to be relevant for the prediction of robbery. The results of the study suggest that the use and abuse of legal and illegal substances might be a trigger for serious violent and drug-related crimes in juveniles. In particular, the presence of AUD is presumed to have a pivotal role in the development of impulsive aggression. These findings are important when considering the serious social impact of violent behaviors in adolescents.