ADHD Outcomes Research Articles

Comparing Pharmacotherapies for ADHD in Adults: Evidence From Outcome-Focused Analysis of Food and Drug Administration Drug Label Registration Trials

Objective: We appraised whether FDA registration trials for ADHD pharmacotherapy in adults provides comparable information to inform treatment expectations. Method: Comparison of ADHD outcome measure patterns in ADHD pharmacotherapy FDA drug label source studies. Results: Among stimulants, from fixed-dose titration data, amphetamine agents had numerically higher placebo-corrected symptom improvement and symptom effect sizes than methylphenidate agents. Symptom effect sizes were lower in the flexible dosing registration studies of atomoxetine and viloxazine. Varying responder definitions were analyzable, based on ≥30% symptom improvement and/or CGI-I improvement of “much” or “very much improved.” Number of exposures needed to create these responses were lower for stimulants than for viloxazine. Conclusion: Heterogeneity in the design and analysis of FDA drug label source trials restricts implications for clinical practice. Research conducted using replicated designs, direct comparison of available treatments, and outcome analyses that generalize to clinical care could better inform clinical decision making.

11.2 ADHD, COVID-19 Infection, and Clinical Outcomes: A Retrospective Cohort Study of Adults and Adolescents

11.2 ADHD, COVID-19 Infection, and Clinical Outcomes: A Retrospective Cohort Study of Adults and Adolescents

Neurogenetic mechanisms of risk for ADHD: Examining associations of polygenic scores and brain volumes in a population cohort

BackgroundADHD polygenic scores (PGSs) have been previously shown to predict ADHD outcomes in several studies. However, ADHD PGSs are typically correlated with ADHD but not necessarily reflective of causal mechanisms. More research is needed to elucidate the neurobiological mechanisms underlying ADHD. We leveraged functional annotation information into an ADHD PGS to (1) improve the prediction performance over a non-annotated ADHD PGS and (2) test whether volumetric variation in brain regions putatively associated with ADHD mediate the association between PGSs and ADHD outcomes.MethodsData were from the Philadelphia Neurodevelopmental Cohort (N = 555). Multiple mediation models were tested to examine the indirect effects of two ADHD PGSs—one using a traditional computation involving clumping and thresholding and another using a functionally annotated approach (i.e., AnnoPred)—on ADHD inattention (IA) and hyperactivity-impulsivity (HI) symptoms, via gray matter volumes in the cingulate gyrus, angular gyrus, caudate, dorsolateral prefrontal cortex (DLPFC), and inferior temporal lobe.ResultsA direct effect was detected between the AnnoPred ADHD PGS and IA symptoms in adolescents. No indirect effects via brain volumes were detected for either IA or HI symptoms. However, both ADHD PGSs were negatively associated with the DLPFC.ConclusionsThe AnnoPred ADHD PGS was a more developmentally specific predictor of adolescent IA symptoms compared to the traditional ADHD PGS. However, brain volumes did not mediate the effects of either a traditional or AnnoPred ADHD PGS on ADHD symptoms, suggesting that we may still be underpowered in clarifying brain-based biomarkers for ADHD using genetic measures.

Predictors of Attention Deficit/Hyperactivity Disorder Behaviors in Chinese Adoptees: A 10-Year Longitudinal Study

ABSTRACT This longitudinal study examined predictors of ADHD behaviors in Chinese adoptees. We collected the data over 10 years from 173 adoptees and their adoptive mothers. We analyzed the data to explore the associations between age at adoption, family type, internalizing problems, externalizing problems, adverse life events, and the adoptees’ ADHD outcomes. Results showed that internalizing problems, externalizing problems, and adverse life events significantly predicted later ADHD behaviors, explaining 13% variance of the outcomes. The study shed light on contributing factors of ADHD behaviors in Chinese adoptees and offered implications for counselors working with Chinese adoptees.

A Randomized Community-Based Trial of Behavior Therapy vs. Usual Care for Adolescent ADHD: Secondary Outcomes and Effects on Comorbidity

Though behavior therapy (BT) for ADHD in adolescence is evidence-based, almost no work examines its implementation and effectiveness in community settings. A recent randomized community-based trial of an evidence-based BT for adolescent ADHD (Supporting Teens’ Autonomy Daily; STAND; N = 278) reported high clinician, parent, and youth acceptability but variable implementation fidelity. Primary outcome analyses suggested no significant differences between STAND and usual care (UC) unless the clinician delivering STAND was licensed. The present study reports secondary outcomes for this trial on indices of comorbidity (anxiety, depression, oppositional defiant disorder, conduct disorder) and ADHD outcomes not targeted by the active treatment (social skills, sluggish cognitive tempo). We also examine whether therapist licensure moderated treatment effects (as in primary outcome analyses). Using intent-to-treat and per protocol linear mixed models, patients randomized to STAND were compared to those randomized to UC over approximately 10 months of follow-up. Group × Time effects revealed that, overall, STAND did not outperform usual care when implemented by community clinicians. However, a Group × Time × Licensure interaction revealed a significant effect on conduct problems when STAND was delivered by licensed clinicians (d = .19–.47). When delivered in community settings, behavior therapy for adolescent ADHD can outperform UC with respect to conduct problems reduction. Community mental health clinics should consider: (1) assigning adolescent ADHD cases to licensed professionals to maximize impact and (2) choosing psychosocial approaches when ADHD presents with comorbid conduct problems. There is also a need to reduce implementation barriers for unlicensed clinicians in community settings.

Preschool development, temperament and genetic liability as early markers of childhood ADHD: A cohort study.

ADHD is associated with multiple adverse outcomes and early identification is important. The present study sets out to identify early markers and developmental characteristics during the first 30months of life that are associated with ADHD 6years later. 9201 participants from the prospective Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort were included. Outcome measures were parent-rated ADHD symptom scores (Strengths and Difficulties Questionnaire, SDQ) and ADHD diagnosis (Development and Wellbeing Assessment, DAWBA) at age 7. Seventeen putative markers were identified from previous literature and included: pre- and peri-natal risk factors, genetic liability (ADHD polygenic risk scores, PRS), early development, temperament scores and regulatory problems. Associations were examined using regression analysis. Univariable regression analysis showed that multiple early life factors were associated with future ADHD outcomes, even after controlling for sex and socio-economic status. In a multivariable linear regression model; temperament activity scores (B=0.107, CI=0.083-0.132), vocabulary delay (B=0.605, CI=0.211-0.988), fine motor delay (B=0.693, CI=0.360-1.025) and ADHD PRS (B=0.184, CI=0.074-0.294) were associated with future symptoms (R 2=10.7%). In a multivariable logistic regression model, ADHD PRS (OR=1.39, CI=1.10-1.77) and temperament activity scores (OR=1.09, CI=1.04-1.16) showed association with ADHD diagnosis. As well as male sex and lower socio-economic status, high temperament activity levels and motor and speech delays in the first 30months of life, are associated with childhood ADHD. Intriguingly, given that genetic risk scores are known to explain little of the variance of ADHD outcomes, we found that ADHD PRS added useful predictive information. Future research needs to test whether predictive models incorporating aspects of early development and genetic risk scores are useful for predicting ADHD in clinical practice.

Challenges and opportunities for the early identification of ADHD across multiple levels of analysis - Areflection on Tobarra-Sanchez etal. (2022).

Challenges and opportunities for the early identification of ADHD across multiple levels of analysis - Areflection on Tobarra-Sanchez etal. (2022).

43.8 Changes in Cannabis and Alcohol Use and Their Impact on ADHD Symptoms in Adolescents Receiving ADHD Pharmacotherapy and Substance Use Treatment

Adolescents with ADHD commonly use and co-use cannabis and alcohol. Whether these substances act as complements vs substitutes is debated in the literature. Little is known about the impact of cannabis use on alcohol use disorder (AUD) treatment outcomes (and vice versa) in ADHD youth. The present study used data from the NIDA-CTN-0028 trial to investigate the relationships between change in cannabis use (CU) and alcohol use (AU) and their impact on ADHD outcomes in 303 adolescents (aged 13-18 years) meeting DSM-IV criteria for ADHD and substance use disorder (SUD) who participated in a 16-week randomized controlled multisite trial of osmotic-controlled release oral delivery system methylphenidate (OROS-MPH) vs placebo with both groups receiving CBT for SUD. In the ADHD/SUD sample, cannabis use disorders (89%) and AUD (60%) were the most common SUD diagnoses. During treatment, 79% and 48% of participants reduced and 12% and 24% of participants increased their CU and AU, respectively. After controlling for age, race, and sex, during treatment, reduction in the amount of cannabis used was positively correlated with during-treatment reductions in the number of drinks (r = 0.14; p = 0.02) and drinking days (r = 0.14; p = 0.02). Reduction in drinking days was associated with reductions in ADHD symptoms (β = 0.26; p = 0.04), and reductions in both CU and AU were associated with improvements in global functioning (β’s = 0.26-0.44; all p’s < 0.05) during treatment. Our findings indicate that reductions in CU track with reductions in AU during SUD treatment with both contributing to posttreatment improved functioning in youth with ADHD/SUD. These results provide preliminary support for a complementary relationship between CU and AU in this population. Additional research is warranted to clarify the clinical implications of different patterns of change in cannabis and alcohol use across the continuum of co-use in ADHD and non-ADHD samples.

43.7 Sex-Based Differences in Clinical Profiles and Cannabis Abstinence in Adolescents Receiving Combination Treatment for ADHD and Comorbid Cannabis Use Disorder

Recent studies indicate sex-based differences in clinical presentation and treatment response for both ADHD and cannabis use disorders (CUDs). Given the high rate of comorbidity of ADHD and CUD, the present study sought to investigate whether sex differences are present in adolescents (ages 13-18 years) with co-occurring ADHD and CUD. This post hoc analysis examined sex-based differences in baseline clinical profiles, cannabis abstinence, and ADHD and substance use disorder (SUD) treatment outcomes in 271 adolescents (19% female, mean age = 16.5 years) meeting DSM-IV criteria for ADHD and comorbid CUD. The sample represents a subset of participants from a 16-week multisite randomized controlled trial of osmotic-release methylphenidate (OROS-MPH) + CBT vs placebo + CBT for the treatment of ADHD and nontobacco SUD (CTN-0028). Compared to males, females with ADHD and CUD had lower self-reported ADHD symptoms and higher global functioning measured via Children's Global Assessment Scale (CGAS) scores at baseline. Both males and females showed significant reductions in days of cannabis use and ADHD symptoms following treatment. There was no evidence of differential improvement in ADHD and nontobacco/noncannabis substance use outcomes with treatment, with persistent sex differences in ADHD symptoms and CGAS scores. Female participants showed greater reductions in cannabis use compared to males, but these differences did not reach statistical significance (eg, reduction in days of cannabis use: –12.0 vs –9.4 days; p = 0.07; end-of-treatment cannabis abstinence: 35% vs 25%; p = 0.13). Sex-based differences in the severity of ADHD symptoms and global functioning are present in adolescents with ADHD and comorbid CUD and largely persist during OROS-MPH + CBT treatment. Identifying overlapping and distinct mechanisms of behavioral change in males and females with co-occurring ADHD and CUD may guide sex-specific and sex-shared intervention development.

White matter abnormalities associated with ADHD outcomes in adulthood.

It remains unclear if previously reported structural abnormalities in children with ADHD are present in adulthood regardless of clinical outcome. In this study, we examined the extent to which focal-rather than diffuse-abnormalities in fiber collinearity of 18 major white matter tracts could distinguish 126 adults with rigorously diagnosed childhood ADHD (ADHD; mean age [SD] = 34.3 [3.6] years; F/M = 12/114) from 58 adults without ADHD histories (non-ADHD; mean age [SD] = 33.9 [4.1] years; F/M = 5/53) and if any of these abnormalities were greater for those with persisting ADHD symptomatology. To this end, a tract profile approach was used. After accounting for age, sex, handedness, and comorbidities, a MANCOVA revealed a main effect of group (ADHD < non-ADHD; F[18,155] = 2.1; p = 0.007) on fractional anisotropy (FA, a measure of fiber collinearity and/or integrity), in focal portions of white matter tracts involved in visuospatial processing and memory (i.e., anterior portion of the left inferior longitudinal fasciculus, and middle portion of the left and right cingulum angular bundle). Only abnormalities in the anterior portion of the left inferior longitudinal fasciculus distinguished probands with persisting versus desisting ADHD symptomatology, suggesting that abnormalities in the cingulum angular bundle might reflect "scarring" effects of childhood ADHD. To our knowledge, this is the first study using a tract profile approach to identify focal or widespread structural abnormalities in adults with ADHD rigorously diagnosed in childhood.

Failure of Healthcare Provision for Attention-Deficit/Hyperactivity Disorder in the United Kingdom: A Consensus Statement.

Background: Despite evidence-based national guidelines for ADHD in the United Kingdom (UK), ADHD is under-identified, under-diagnosed, and under-treated. Many seeking help for ADHD face prejudice, long waiting lists, and patchy or unavailable services, and are turning to service-user support groups and/or private healthcare for help.Methods: A group of UK experts representing clinical and healthcare providers from public and private healthcare, academia, ADHD patient groups, educational, and occupational specialists, met to discuss shortfalls in ADHD service provision in the UK. Discussions explored causes of under-diagnosis, examined biases operating across referral, diagnosis and treatment, together with recommendations for resolving these matters.Results: Cultural and structural barriers operate at all levels of the healthcare system, resulting in a de-prioritization of ADHD. Services for ADHD are insufficient in many regions, and problems with service provision have intensified as a result of the response to the COVID-19 pandemic. Research has established a range of adverse outcomes of untreated ADHD, and associated long-term personal, social, health and economic costs are high. The consensus group called for training of professionals who come into contact with people with ADHD, increased funding, commissioning and monitoring to improve service provision, and streamlined communication between health services to support better outcomes for people with ADHD.Conclusions: Evidence-based national clinical guidelines for ADHD are not being met. People with ADHD should have access to healthcare free from discrimination, and in line with their legal rights. UK Governments and clinical and regulatory bodies must act urgently on this important public health issue.

Attention-deficit/hyperactivity disorder and occupational outcomes: The role of educational attainment, comorbid developmental disorders, and intellectual disability.

BackgroundIndividuals with ADHD are at increased risk for poor occupational outcomes. Educational attainment and psychiatric comorbidity may be important contributing factors for these outcomes, but the role of these factors is not well characterized. This study aimed to investigate the associations between ADHD and occupational outcomes, and to examine the influence of educational attainment, comorbid developmental disorders and intellectual disability on these associations.MethodsWe linked the Swedish population graduating from compulsory school 1998–2008 (N = 1.2 millions) to population-wide register-based data on clinical psychiatric diagnoses and medications, objective annual measures of educational, and occupational outcomes. Individuals were followed for between 6 to 16 years after graduation.ResultsIndividuals with ADHD had annually on average 17 percent lower income, ratio = 0.83 (95% CI 0.83–0.84), 12.19 (11.89–12.49) more days of unemployment, and a higher likelihood of receiving disability pension, odds-ratio = 19.0 (18.4–19.6), compared to controls. Comorbid diagnoses of intellectual disability and developmental disorder explained most of the association between ADHD and disability pension, while lifetime educational attainment partially explained associations between ADHD and all occupational outcomes. Analyses of occupational trajectories found that income was lower and unemployment elevated relative to controls with the same educational attainment. Higher educational attainment correlated with higher income similarly among individuals with ADHD and controls after accounting for individual background factors.ConclusionsThe occupational burden associated with ADHD is substantial. Comorbid developmental disorders, intellectual disability and educational difficulties (e.g., failing grades) from childhood to adulthood are important factors to consider when designing interventions to improve occupational outcomes in individuals with ADHD.

Five-year outcomes of ADHD diagnosed in adulthood.

There is a dearth of long‐term follow‐up studies of adults diagnosed with ADHD. Here, the aim was to evaluate long‐term outcomes in a group of ADHD patients diagnosed in adulthood and receiving routine psychiatric health care. Adults diagnosed with any type of ADHD (n = 52) and healthy controls (n = 73) were assessed at baseline and at a 5‐year follow‐up, using Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), Brown ADD Scale (BADDS) and Adult ADHD Self‐Report Scale (ASRS). A multivariate regression method was used to identify factors predicting 5‐year outcomes, including baseline ratings, medication intensity, comorbidity, intelligence quotient (IQ), age, and sex. After 5 years, ADHD patients reported fewer and/or less severe symptoms compared to baseline, but remained at clinically significant symptom levels and with functional deficits. Baseline self‐reports of ADHD symptoms predicted their own 5‐year outcome and low baseline functioning level predicted improved global functioning at follow‐up. Factors previously reported to predict short‐term outcomes (i.e., medication, comorbidity, IQ, age, and sex) did not anticipate long‐term outcomes in present study.

Neural Correlates of Working Memory Deficits in Different Adult Outcomes of ADHD: An Event-Related Potential Study.

BackgroundWe investigated working memory (WM) processing in a longitudinal sample of young adults with persistent and remittent childhood-onset ADHD to investigate the neural correlates of working memory with adult outcomes of ADHD.MethodsForty-seven young Chinese adults who had been diagnosed with ADHD during childhood underwent follow-up assessments for an average of 9 years. The ADHD sample consisted of 25 ADHD persisters (mean age =18.38 ± 0.5 years) and 22 remitters (mean age = 18.78 ± 1.10 years), who were compared with 25 sex ratio- and IQ-matched healthy adults (mean age = 19.60 ± 1.22 years) in a verbal n-back task.ResultsNo differences in behavioral measures were observed across the three groups. Compared with the healthy controls, the ADHD persisters and remitters had larger N1 amplitudes and smaller P2 amplitudes, while no significant differences between the persistence and remission groups were observed. The P3 amplitudes of the remission and control groups were higher than that of the persistence group, but there was no significant difference between the remitters and healthy controls.ConclusionThe P3 amplitudes reflecting postdecisional processing and/or WM updating were sensitive to ADHD remission, as they might improve concurrently with ADHD symptoms. These results indicate that the N1, P2, and P3 components of WM processing might be potential biomarkers for different ADHD outcomes.

Pre-school attention deficit hyperactivity disorder: 12 weeks prospective study.

Extant literature lack studies on behavioural training or pharmacotherapy in Indian preschool children. With adverse long term outcomes, effective, safe and affordable early interventions for ADHD are a priority. Aim of this prospective study is to report on short term outcome of preschool ADHD with specific focus on safety and tolerability of medications. Children with ADHD aged 2.5-6 years were assessed for severity and adverse events at baseline and follow-up using Conner's abbreviated rating scale and Clinical Global Impression-Severity scale. Children with Autism spectrum disorder and those with social quotient less than 50 were excluded. Statistical Analysis included descriptive statistics and Repeated measures ANOVA. Of 56 children recruited, 33.93 %(N = 19) were on behavioural interventions alone, 66.07 %(N = 37) were on a combination of medication and behavioural intervention. All children received treatment according to standard care. The most prescribed drug was clonidine (44.64%), then risperidone (28.7%), methylphenidate (10.7%) and atomoxetine (10.7%). Medication choice was determined by affordability, availability and comorbidity profile. Sedation occurred in 24 % of children on clonidine. Atomoxetine was not well tolerated in 2 children. Methylphenidate was well tolerated. Irrespective of medication choice, all children showed significant improvement at 12 weeks (p < 0.001). Choice of interventions is largely determined by availability and affordability. There is a need for structured parent behavioural training program deliverable in low resource setting. Anti-ADHD medications should be made available under the NMHP, RBSK program and all government settings in India, to address over-prescription of antipsychotics in preschool ADHD.

Preconception and Prenatal Nutrition and Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis.

Preconception and prenatal nutrition is critical for fetal brain development. However, its associations with offspring neurodevelopmental disorders are not well understood. This study aims to systematically review the associations of preconception and prenatal nutrition with offspring risk of neurodevelopmental disorders. We searched the PubMed and Embase for articles published through March 2019. Nutritional exposures included nutrient intake or status, food intake, or dietary patterns. Neurodevelopmental outcomes included autism spectrum disorders (ASD), attention deficit disorder-hyperactivity (ADHD) and intellectual disabilities. A total of 2169 articles were screened, and 20 articles on ASD and 17 on ADHD were eventually reviewed. We found an overall inverse association between maternal folic acid or multivitamin supplementation and children’s risk of ASD; a meta-analysis including six prospective cohort studies estimated an RR of ASD of 0.64 (95% CI: 0.46, 0.90). Data on associations of other dietary factors and ASD, ADHD and related outcomes were inconclusive and warrant future investigation. Future studies should integrate comprehensive and more objective methods to quantify the nutritional exposures and explore alternative study design such as Mendelian randomization to evaluate potential causal effects.

Factors Associated with Parental Treatment Attitudes and Information-Seeking Behaviors for Childhood ADHD

Objective: Despite the association between childhood ADHD and long-term negative outcomes, there is a significant delay to treatment and a low rate of lifetime treatment contact for individuals with ADHD. Method: The current study examined (a) variables associated with parental treatment-seeking attitudes and information-seeking behaviors and (b) the relationship between these attitudes and behaviors in 87 non–treatment-seeking parents whose children had elevated ADHD symptoms. Results: Regressions indicated that attitudes toward ADHD treatment were associated with ADHD knowledge and misconceptions (ps < .01), susceptibility to ADHD stigma (p < .001), and satisfaction with past providers (ps < .01). Experience with past providers was significantly associated with information-seeking behavior (ps < .01). Conclusion: Parental knowledge of ADHD, low levels of stigma, and positive experiences with past providers were the strongest predictors of positive attitudes about ADHD treatment. Experience with past providers was the only factor related to treatment-seeking behavior. These results offer avenues to decreasing barriers to treatment in pediatric ADHD.

Attendance and Engagement in Parent Training Predict Child Behavioral Outcomes in Children Pharmacologically Treated for Attention-Deficit/Hyperactivity Disorder and Severe Aggression.

We examined the association of parent training (PT)-related factors with therapeutic success in the Treatment of Severe Childhood Aggression (TOSCA) study. Our aims were (1) to evaluate demographic and clinical characteristics as predictors of parent attendance and engagement in PT and (2) to examine the associations of parent attendance and engagement in PT with study-targeted child behavior outcomes (i.e., attention-deficit/hyperactivity disorder [ADHD] and disruptive behavior symptoms). TOSCA was a randomized clinical trial evaluating the effect of placebo versus risperidone when added to PT and psychostimulant for childhood ADHD with severe aggression. Data for 167 parents and children 6-12 years old with ADHD, oppositional defiant disorder (ODD) or conduct disorder, and severe physical aggression were examined. Analyses used generalized linear models. Most parents (72%) attended seven or more of nine sessions. The average parental engagement, that is, the percentage of PT elements fully achieved across participants and sessions, was 85%. The average therapist rating of goal completion was 92%. Parents of non-white and/or Hispanic children (p = 0.01) and children with lower intelligence quotient (p = 0.02) had lower PT attendance; parents with lower family incomes (p = 0.01) were less engaged. Attendance and engagement predicted better scores on the primary child behavior outcomes of disruptive behavior (Nisonger Child Behavior Rating Form Disruptive Behavior Total) and ADHD and ODD symptoms, adjusting for baseline severity. When the clinical picture is sufficiently severe to warrant prescribing an atypical antipsychotic, PT is feasible for families of children with ADHD and co-occurring severe aggression. The promotion of attendance and engagement in PT is important to enhance clinical outcomes among this challenging population. Methods for overcoming barriers to participation in PT deserve vigorous investigation, particularly for those with low family income, non-white race, Hispanic ethnicity, or when children have lower cognitive level.

Substance use and nicotine dependence in persistent, remittent, and late-onset ADHD: a 10-year longitudinal study from childhood to young adulthood

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is associated with substance use disorders (SUD; alcohol and/or drug dependence) and nicotine dependence. This study aims to advance our knowledge about the association between SUD, nicotine dependence, and the course of ADHD (persistent versus remittent ADHD and late-onset ADHD).MethodsADHD, SUD, and nicotine dependence were longitudinally assessed (mean age at study entry 11.3 years, mean age at follow-up 21.1 years) using structured psychiatric interviews and multi-informant questionnaires in a subsample of the Dutch part of the International Multicenter ADHD Genetics study. Individuals with persistent ADHD (n = 62), remittent ADHD (n = 12), late-onset ADHD (n = 18; age of onset after 12 years), unaffected siblings (n = 50), and healthy controls (n = 47) were assessed. Hazard ratios (HR) with 95% confidence intervals (CIs) were estimated by Cox regression and adjusted for clustered family data, gender, follow-up length, and current age.ResultsIndividuals with persistent ADHD were at significantly higher risk of development of SUD relative to healthy controls (HR = 4.56, CI 1.17–17.81). In contrast, levels of SUD in those with remittent ADHD were not different from healthy controls (HR = 1.00, CI .07–13.02). ADHD persisters had also higher prevalence rates of nicotine dependence (24.2%) than ADHD remitters (16.7%) and healthy controls (4.3%). A similar pattern was found in initially unaffected siblings who met ADHD criteria at follow-up (“late-onset” ADHD); they had also a higher prevalence of SUD (33%) compared to stable unaffected siblings (20%) and were at significantly increased risk of development of nicotine dependence compared to healthy controls (HR = 13.04, CI 2.08–81.83).ConclusionsSUD and nicotine dependence are associated with a negative ADHD outcome. Results further emphasize the need for clinicians to comprehensively assess substance use when diagnosing ADHD in adolescents and adults.

2.41 Efficacy and Long-Term Clinical Outcome of Comorbid PTSD and ADHD After Reminder Focused Positive Psychiatry Intervention

2.41 Efficacy and Long-Term Clinical Outcome of Comorbid PTSD and ADHD After Reminder Focused Positive Psychiatry Intervention