ADHD-I Research Articles

Response inhibition in children with different subtypes/presentations of attention deficit hyperactivity disorder: A near-infrared spectroscopy study.

Executive dysfunction in children with attention deficit hyperactivity disorder (ADHD) is thought to be closely related to the prefrontal cortex (PFC). However, there is controversy over the activation of the PFC in children with ADHD. Differences could be related to the subtype. Meanwhile, no study to date has used functional near-infrared spectroscopy (fNIRS) to explore the differences between subtypes. Thus, this study aimed to explore the activation of the PFC in children with different subtypes of ADHD during executive function task. Participants in this study include typically developing (TD) children (n = 28), ADHD-predominantly inattentive (ADHD-PI) (n = 39) and ADHD-combined (ADHD-C) (n = 24). To examine the executive function of ADHD, the Go/No-go task is chosen to assess the response inhibition function. The activation of PFC in all participants during the Go/No-go task was recorded by fNIRS. Meanwhile, behavioral data were also recorded. Both TD and ADHD children activated the right PFC [middle frontal gyrus (MFG) and inferior frontal gyrus (IFG)] during response inhibition. However, the range and degree of activation differed among these groups. Compared with TD children, those with ADHD-PI had a smaller extent of activation in the right PFC, and those with ADHD-C only had a tendency to enhance activation. In addition, children with ADHD-PI and ADHD-C had impaired activation of the temporal gyrus. Besides, compared with ADHD-C and TD, those with ADHD-PI also had impaired activation of the right precentral gyrus (PG), and the supplementary motor area (SMA). Compared with ADHD-PI, ADHD-C showed decreased activation of the right MFG. The activation of Ch34 (BA44, rPFC) in children with ADHD-PI and ADHD-C was negatively correlated with their clinical symptoms. The activation of the PFC in children with different subtypes of ADHD has both commonalities and differences. The degree of activation of the right PFC Ch34 in children with ADHD is negatively correlated with clinical symptoms. fNIRS could be served as a candidate hemodynamic biomarker for the diagnosis of ADHD.

Cross-Sectional Age Analysis of Sleep Problems in 2 to 17 Year Olds with ADHD Combined, ADHD Inattentive, or Autism.

Sleep problems are common in autism and ADHD. No study has compared sleep problems by age in 2 to 17 year olds with autism versus ADHD-Combined versus ADHD-Inattentive type. Mothers rated 1415 youth with autism and 1041 with ADHD on 10 Pediatric Behavior Scale sleep items. Nighttime sleep problems were most severe in autism, followed by ADHD-Combined, and then ADHD-Inattentive. Difficulty falling asleep, restless during sleep, and waking during the night were the most common problems. Adolescents slept more at night than other age groups, and youth who slept more at night were sleepier during the day. Sleep problems declined with age, but correlations were small. In adolescence, 63% with autism, 53% with ADHD-Combined, and 57% with ADHD-Inattentive had difficulty falling asleep. Given that the majority of children in all age groups had one or more sleep problem, developmentally appropriate interventions are needed to address sleep difficulties and limit their adverse effects.

Inattention, Impulsivity, and Hyperactivity in Deaf Children Are Not Due to Deficits in Inhibitory Control, but May Reflect an Adaptive Strategy.

The present study had two main aims: (1) to determine whether deaf children show higher rates of key behaviors of ADHD (inattentive, hyperactive, and impulsive behaviors) and of Conduct Disorder—CD—(disruptive, aggressive, or antisocial behaviors) than hearing children, also examining whether the frequency of these behaviors in deaf children varied based on cochlear implant (CI) use, type of school (regular vs. specific for deaf) and level of receptive vocabulary; and (2) to determine whether any behavioral differences between deaf and hearing children could be explained by deficits in inhibitory control. We measured behaviors associated with ADHD and CD in 34 deaf and hearing children aged 9–10 years old, using the revised Spanish version of the Conners scale. We then assessed inhibitory control ability using a computerized Stroop task and a short version of the Attention Network Test for children. To obtain a measure of the level of receptive vocabulary of the deaf children we used a Spanish version of the Carolina Picture Vocabulary Test for Deaf and hearing-impaired children. Deaf children showed significantly higher rates of behaviors associated with ADHD and CD, and over 85% of cases detected with high risk of ADHD-inattentive type in the entire present sample were deaf children. Further, in the group of deaf children a negative correlation was found between receptive vocabulary and frequency of disruptive, aggressive, or antisocial behaviors associated with CD. However, inhibitory control scores did not differ between deaf and hearing children. Our results suggested that the ADHD-related behaviors seen in deaf children were not associated with a deficit in inhibitory control, at least in the interference suppression subcomponent. An alternative explanation could be that these behaviors are reflecting an adaptive strategy that permits deaf children to access information from their environment which is not available to them via audition.

Sluggish cognitive tempo in autism, ADHD, and neurotypical child samples

BackgroundSluggish cognitive tempo (SCT) recently experienced a resurgence of interest in children with ADHD, but only three small studies have investigated SCT in autism. MethodMothers rated 1,436 children with autism, 1,056 with ADHD without autism, and 186 typical controls, 2-17 years, on six SCT items from the Pediatric Behavior Scale. ResultsAlmost half (49%) of children with autism scored 1.5 standard deviations or more above the typical SCT mean, as did 40% with ADHD-Inattentive and 31% with ADHD-Combined. The significantly greater prevalence in autism versus ADHD is largely explained by the high frequency of ADHD in autism and the increased risk of SCT when both disorders are present. However, the higher than normal prevalence of SCT in autism is not accounted for by co-occurring ADHD because SCT scores were higher than the norm in children with autism who did not have ADHD and SCT scores did not differ significantly between children with autism without ADHD and children with ADHD without autism. ConclusionsPrevious research indicated SCT was associated with ADHD-Inattentive type, but our findings show that SCT is even more prevalent in autism. SCT is most common when autism and ADHD co-occur. Because autism without ADHD is rare (whereas ADHD without autism is not), it is important to assess both SCT and ADHD in children referred for autism evaluations and rule-out autism in children referred for ADHD. SCT may be another neurocognitive problem shared by children with autism and children with ADHD in need of assessment and intervention.

Characteristics of child psychiatric outpatients with slow processing speed and potential mechanisms of academic impact.

While slow processing speed (PS) is well documented in youth with ADHD, growing evidence suggests that this difficulty affects children with other neuropsychiatric conditions. Clarifying the relationship between slow PS and different forms of psychopathology is important clinically, given the potential impact of PS on academic functioning, and conceptually. In 751 youth, ages 6-21, consecutively referred for neuropsychiatric evaluation, we examined the association between slow PS (i.e., Wechsler PS Index < 85) and seven neuropsychiatric diagnostic groups. In 492 of these youth, we also related slow PS to eight psychopathology symptom dimensions. Finally, we modeled the relationship between PS, other cognitive functions and academic achievement. Data are from the Longitudinal Study of Genetic Influences on Cognition. Analyses included one-sample t tests, ANOVA, logistic regression, mixed modeling, and structural equation modeling (SEM), controlling for age, sex, and medication. Compared to normative data, all clinical groups showed PS decrements. Compared to referred youth without full diagnoses and accounting for other psychopathology, risk for slow PS was elevated in youth with autism spectrum disorder (OR = 1.8), psychotic disorders (OR = 3.4) and ADHD-inattentive type (OR = 1.6). Having multiple comorbidities also increased risk for slow PS. Among dimensions, inattention (OR = 1.5) associated with slow PS but did not fully explain the association with autism or psychosis. In SEM, PS had direct effects on academic achievement and indirect effects through working memory. Findings extend evidence that PS relates to multiple aspects of child psychopathology and associates with academic achievement in child psychiatric outpatients.

Sex and racial/ethnic differences in the association between childhood attention-deficit/hyperactivity disorder symptom subtypes and body mass index in the transition from adolescence to adulthood in the United States.

While attention-deficit/hyperactivity disorder (ADHD) has been associated with higher body mass index (BMI), little research has focused on how this association differs by sex or race/ethnicity. To investigate the association between ADHD and BMI by sex and race/ethnicity (ie, European [EA], African [AA], and Hispanic American [HA]). Data came from the National Longitudinal Survey of Adolescent to Adult Health Waves II to IV (n=13332, age: 12-34years). On the basis of self-reported childhood ADHD symptoms between the ages of 5 and 12years, participants were categorized into: ADHD predominantly hyperactive/impulsive (ADHD-HI); ADHD predominantly inattentive (ADHD-I); ADHD combined (ADHD-C; a combination of ADHD-HI and ADHD-I symptoms); and non-ADHD. The patterns of ADHD-BMI associations in the transition period between adolescence and young adulthood differed by sex and race/ethnicity. Compared with non-ADHD, ADHD-HI was associated with higher BMI among EA males and females, while ADHD-I was associated with higher BMI among EA females. ADHD-C was associated with higher BMI for HA females. We found no evidence of an association among AA males and females and HA males. These study results suggest that the association between ADHD subtypes and BMI might differ across population subgroups in the United States.

Cost-Effectiveness of a Behavioral Psychosocial Treatment Integrated Across Home and School for Pediatric ADHD-Inattentive Type.

We conducted a cost-effectiveness analysis (CEA) of two behavioral psychosocial interventions for children with ADHD-inattentive type: Child Life and Attention Skills (CLAS) program and parent-focused treatment (PFT) compared to community-based treatment as usual (TAU). The CEA evaluated cost per ADHD case resolved measured by parent and teacher reports of ADHD inattentive symptoms. Total cost per patient for CLAS, PFT, and TAU were $1559, $710, and $0. CLAS, the costliest treatment, was more effective than PFT and TAU. The incremental cost-effectiveness ratios (ICER) per disordered case resolved are: $3997 for CLAS versus TAU, $3227 for PFT versus TAU, and $4994 for CLAS versus PFT. PFT is the more cost-effective option based on initial CEA. However, CLAS may be comparably cost-effective by streamlining the model, which resulted in an ICER of $29 compared to PFT. Notably, cost for CLAS is substantially below the annual cost for unresolved ADHD.

Improved Parent Cognitions Relate to Immediate and Follow-Up Treatment Outcomes for Children With ADHD-Predominantly Inattentive Presentation

We investigated treatment effects on parenting self-efficacy and parent cognitive errors, and whether these parent cognitions are related to short- and long-term outcomes in parenting behaviors in psychosocial treatment for youth with attention-deficit/hyperactivity disorder, predominantly inattentive presentation (ADHD-I). In a randomized controlled trial across two sites (University of California, San Francisco, and University of California, Berkeley), 199 children between the ages of 7 and 11 were randomized to the Child Life and Attention Skills (CLAS; n = 74) program, parent-focused treatment (PFT; n = 74), or treatment as usual (TAU; n = 51). Parents reported on self-efficacy, cognitive errors, positive parenting, and negative parenting prior to treatment, immediately after treatment, and in the next school year at follow-up. Compared to TAU, CLAS and PFT had higher posttreatment parenting self-efficacy, and CLAS alone had lower posttreatment parent cognitive errors. At follow-up, only CLAS had improved parent cognitive errors compared to TAU. No other between-group differences were found in parenting self-efficacy or cognitive errors. Improved parenting self-efficacy was associated with improved posttreatment negative parenting outcomes for PFT and CLAS, and improved parent cognitive errors were also related to improvements in positive and negative posttreatment parenting outcomes for CLAS. Posttreatment parenting self-efficacy mediated follow-up negative parenting outcomes for CLAS and posttreatment parent cognitive errors mediated improved follow-up positive and negative parenting outcomes for CLAS. PFT and CLAS led to enhanced parenting self-efficacy, and CLAS appears especially robust in improving parent cognitive errors both in the short and long term. Pathways provide support for the possibility of parent cognitions as mediators of treatment effects on parenting; clinical focus on such cognitions may be useful.

Comparative Analysis of the WISC between Two ADHD Subgroups.

ObjectiveThe prevalence of attention deficit/hyperactivity disorder (ADHD) in school-age children is 7.2%, and ADHD is divided into clinical subtypes. MethodsThe current study explored whether specific cognitive profiles as assessed using the Wechsler Intelligence Scale for Children (WISC)-IV could be obtained for each clinical ADHD subtype (ADHD-Inattentive type and ADHD-Combined type) and investigated the correlation between WISC scores and parental age at their children’s birth or birthweight. The enrolled sample comprised 12 ADHD-I and 15 ADHD-C subjects. ResultsAn impaired Processing Speed Index was found in ADHD-I. The age of the father at the child’s birth and birthweight positively correlated with the full scale intelligence quotient (FSIQ) score in the WISC assessment. ConclusionInattentiveness within the behaviors of the children with ADHD-I is partly due to the impaired processing speed, therefore effective support for ADHD will be conducted if educator decreases their speaking speed. Since biological basis of ADHD is still largely unknown, future studies using both psychological and biological methods will reveal the etiology of ADHD. These scientific assessments will provide information for more effective approaches in the care of children with ADHD.

Investigation of attention deficit hyperactivity disorder (ADHD) sub-types in children via EEG frequency domain analysis

ABSTRACTAim of the study: To investigate the frequency domain effects and changes in electroencephalography (EEG) signals in children diagnosed with attention deficit hyperactivity disorder (ADHD).Patients and methods: The study contains 40 children. All children were between the ages of 7 and 12 years. Participants were classified into four groups which were ADHD (n=20), ADHD-I (ADHD-Inattentive type) (n=10), ADHD-C (ADHD-Combined type) (n=10), and control (n=20) groups. In this study, the frequency domain of EEG signals for ADHD, subtypes and control groups were analyzed and compared using Matlab software. The mean age of the ADHD children's group was 8.7 years and the control group 9.1 years.Results: Spectral analysis of mean power (μV2) and relative-mean power (%) was carried out for four different frequency bands: delta (0--4 Hz), theta (4--8 Hz), alpha (8--13 Hz) and beta (13--32 Hz). The ADHD and subtypes of ADHD-I, and ADHD-C groups had higher average power value of delta and theta band than that of control group. However, this is not the case for alpha and beta bands. Increases in delta/beta ratio and statistical significance were found only between ADHD-I and control group, and in delta/beta, theta/delta ratio statistical significance values were found to exist between ADHD-C and control group.Conclusion: EEG analyzes can be used as an alternative method when ADHD subgroups are identified.

Childhood ADHD and Negative Self-Statements: Important Differences Associated With Subtype and Anxiety Symptoms

The current study examined the role negative self-statements have on the comorbidity between anxious symptomatology and ADHD-combined presentation (ADHD-C) and ADHD-predominantly inattentive (ADHD-I). A total of 114 children and adolescents with ADHD (M age = 10.15; SD = 2.30; range = 7–16) from a clinic-referred sample were grouped based on a semistructured diagnostic interview and consensus approach (ADHD-C, n = 62; ADHD-I, n = 52). Negative self-statements were measured using the Children’s Automatic Thoughts Scale and the total score from the Multidimensional Anxiety Scale for Children was used to measure anxious symptomatology. Findings indicated youth diagnosed with ADHD-C, compared to those diagnosed with ADHD-I, had more frequent personal failure (Cohen’s d =.40) and hostile intent negative self-statements (Cohen’s d =.47). The association of ADHD subtype and negative self-statements was moderated by anxiety; negative self-statements of personal failure were highest in anxious ADHD-C children (β =.31). A second sample of 137 children and adolescents (M age = 10.61; SD = 2.26; range = 7–16) from a larger clinic-referred sample was utilized to replicate our results dimensionally. Results indicated that both hyperactivity/impulsivity (β = .23, p < .01) and the interaction of hyperactivity/impulsivity and anxiety (β = .17, p < .05) were significant predictors of negative self-statements regarding personal failure, while holding child age, child gender, oppositional symptoms, and inattention constant. In all, negative self-statements should be considered in the treatment and assessment of ADHD with particular attention paid to ADHD subtype and internalizing comorbidity.

Deficits in spatial learning and memory in adult mice following acute, low or moderate levels of prenatal ethanol exposure during gastrulation or neurulation

Debate continues on the merits of strictly limiting alcohol consumption during all of pregnancy, and whether “safe” consumption levels and/or times exist. Only a relatively few experimental studies have been conducted that limit the timing of exposure to specific events during development and the exposure level to one that might model sporadic, incidental drinking during pregnancy. In the present study, the effects of two acute gavage exposures to low and moderate levels of ethanol (peak blood ethanol concentrations (BEC) of 104 and 177mg/dl, respectively) either during gastrulation on gestational day (GD) 7 (at GD7:0h and GD7:4h) or during neurulation on GD8 (at GD8:6h and GD8:10h) on the spatial learning and memory abilities of adult mice in the radial arm maze (RAM) were examined. Mice were selected from a prenatal ethanol exposure (PAE) cohort that had been tested as neonates for their sensorimotor development (Schambra et al., 2015) and as juveniles and young adults for open field activity levels and emotionality (Schambra et al., 2016). Mice exposed on either of the two gestational days to acute, low or moderate levels of ethanol were deficient in overall performance in the RAM in adulthood. Importantly, mice in ethanol exposed groups took longer to reach criterion in the RAM, and many mice in these groups failed to do so after 48 trials when testing was terminated. Exposure to a low level of ethanol on either GD7 or GD8, or a moderate level on GD7, resulted in significant impairment in spatial reference (long-term) memory, while only mice exposed on GD7 to the low level of ethanol were significantly impaired in spatial working (short-term) memory. Mice exposed to the low ethanol level on either day had significantly shorter response latencies, which may reflect impairment of processes related to response inhibition or executive attention in these mice. For all measures, distributions of individual scores revealed a relatively small subset of mice in each PAE group who scored well outside the range of the control group, which skewed the population distributions to varying degrees in the direction of worse performance for the PAE groups. Overall the data suggest that after acute, low level ethanol exposure early in gestation, the likelihood that an individual mouse embryo experienced measureable ill-effects due to the exposure was rather low, but in a few of the embryos, damage occurred that resulted in significant deficits in later performance. The overall characteristics of our cohort of PAE mice, including delayed sensorimotor development, mild hypoactivity and increased emotionality, as shown in previous studies, together with deficits in spatial learning and memory as shown here, resemble those in a subset of human Fetal Alcohol Spectrum Disorder (FASD) diagnoses, specifically ADHD-Inattentive type (ADHD-I) and/or Sluggish Cognitive Tempo (SCT). Although possible correspondences between mechanisms underlying PAE-induced deficits in mice and those operating in humans remain undefined, further study with this mouse PAE model may ultimately help advance understanding of the causes of these conditions in affected children. This study highlights the possibility of risk associated with low to moderate sporadic alcohol consumption during the first month of human pregnancy.

Patterns and Predictors of Service Utilization Among Youth With ADHD-Predominantly Inattentive Presentation

Objective: This study examined rates and predictors of educational and mental health service utilization among youth with ADHD-predominantly inattentive presentation (ADHD-I). Method: Participants were 199 children with ADHD-I in Grades 2 to 5. Parents reported past-year child service utilization. Parents and teachers rated child ADHD and oppositional defiant disorder (ODD) symptom severity and functional impairment. Children completed an academic achievement test. Results: All children had impairment at school and home. Most received some sort of school service (79%), but only 23% received community-based services. ADHD symptom severity was unrelated to service utilization. However, higher parent-rated functional impairment predicted community service utilization. Academic underachievement and higher teacher-rated functional impairment predicted school service utilization. Conclusion: Many youth with ADHD-I experience impairment across domains without receiving adequate services for these problems. Functional impairment appears to be a stronger predictor of service utilization than ADHD symptom severity, demonstrating the importance of impairment in understanding service needs for ADHD-I.

Stimulus control in two rodent models of attention-deficit/hyperactivity disorder

The spontaneously hypertensive (SHR/NCrl) rat from Charles River is one of the most widely used models of the combined subtype of Attention-Deficit/Hyperactivity Disorder (ADHD-C). Although often used as its control strain, the Wistar Kyoto (WKY/NCrl) from Charles River has been proposed as a model of the predominately inattentive subtype of ADHD (ADHD-PI). In Experiment 1 SHR/NCrl, WKY/NCrl, and Wistar (WI; the progenitor strain for the two models) rats were trained on a left→right lever-press sequence in the presence of light discriminative stimuli that signaled the active lever in the sequence. In subsequent conditions the discriminative light cues were removed or reversed. WKY/NCrl accuracy remained relatively stable across cue light transitions. SHR/NCrl and WI accuracy was more disrupted when light cues were removed or reversed—an indication that behavior of the WKY/NCrl rats may not have come under control of the discriminative light cues as it did for the other strains, but relied more on past behavior and spatial cues. In Experiment 2, all three strains were exposed to a response-initiated fixed-interval (RIFI) 8-s schedule of reinforcement. In RIFI schedules behavior must be timed from a past instance of the target response. Replicating previous work, timing during the FI was roughly equivalent across the three strains; however, latencies to initiate the FI were significantly longer for SHR/NCrl than WKY/NCrl and WI rats, suggesting SHR/NCrl behavior was less sensitive to the first-response:food contingency in the RIFI schedule. These findings identify differences in stimulus control between the three strains and may help determine the efficacy of SHR/NCrl and WKY/NCrl as models of ADHD subtypes in humans.

Predictors of Response to Behavioral Treatments Among Children With ADHD-Inattentive Type

The goal of the study was to examine baseline characteristics—child gender, IQ, age, internalizing problems, symptoms of hyperactivity/impulsivity (HI), oppositional defiant disorder, and sluggish cognitive tempo, and parent income, education, attention deficit/hyperactivity disorder (ADHD) severity, and anxiety/depression (A/D)—associated with response to behavioral treatments for ADHD, predominantly inattentive type. We employed data from 148 children (M = 8.7 years), 58% male, and 57% Caucasian in a randomized clinical trial. Positive treatment response was defined as (a) 5 or fewer inattentive symptoms and (b) a decrease of at least 3 inattentive symptoms from baseline to posttreatment. Child HI, parental A/D, and child IQ were associated with positive response, as follows: Child HI had a main effect in which it was negatively associated with treatment response (36% with 2 or more HI symptoms were positive responders vs. 59% of those with 1 or no symptoms) that was qualified by parental A/D and child IQ. When children had 2 or more symptoms of HI and higher parental A/D, positive response rate was low at 25%; when children had 2 or more symptoms of HI, low parental A/D, and an IQ of 105 or higher, positive response rate was 85%. Furthermore, the group with the poorest response rate (25%) had parents who self-reported greater ADHD severity, and the group with a relatively good rate of positive response (59%) had the lowest number of oppositional defiant disorder symptoms. Likelihood of positive response to our behavioral treatment for ADHD-I is dependent on child and parent factors.

Prevalence and Correlates of Self-Reported ADHD Symptoms in Children Attending School in India

Objective: To study the prevalence and correlates of self-reported ADHD symptoms among school-going adolescents from Kerala, India. Method: Seven thousand five hundred sixty students from Classes 8, 10, and 12, aged 12 to 19 years, across 73 schools selected by cluster random sampling, were invited to participate, but only 7,150 successfully completed the questionnaire incorporating standardized instruments. Results: Three hundred five (4.3%) self-reported symptoms for ADHD combined type, 131 (1.8%) for ADHD hyperactive–impulsive type, and 102 (1.4%) for ADHD inattentive type with a male predominance. Binary logistic regression analysis showed that those with symptoms of ADHD (combined type) compared with the non-ADHD group had poorer academic performance, significantly higher substance use, psychological distress, suicidality, and sexual abuse. Conclusion: The high prevalence of self-reported ADHD symptoms and its association with negative correlates previously reported in literature in those with a diagnosis of ADHD suggests that clinically significant self-reported ADHD symptoms could be as disabling as ADHD.

A Comparison of Mindfulness-Based Group Training and Skills Group Training in Adults With ADHD

Objective: To compare a novel “third wave” mindfulness-based training program with an established skills training derived from dialectical behavior therapy, to reduce ADHD symptoms and improve mindfulness and self-efficacy. Method: Ninety-one adults with ADHD (combined and inattentive type, mainly medicated) were non-randomly assigned to and treated within a mindfulness-based training group (MBTG, n = 39) or a skills training group (STG, n = 52), each performed in 13 weekly 2-hr sessions. Results: General linear models with repeated measures revealed that both programs resulted in a similar reduction of ADHD symptoms, and improvement of mindfulness and self-efficacy. However, the effect sizes were in the small-to-medium range. A decrease in ADHD symptoms ≥30% was observed in 30.8% of the MBTG participants and 11.5% of the STG participants. Conclusion: The comparatively weak results may be due to limitations such as the absence of randomization, the lack of a control group without intervention, and the lack of matching groups for borderline, depression, and anxiety status. Moreover, audio instructions for home exercises and more stringent monitoring of participants’ progress and eventual absence from sessions might have improved the outcome.

Diagnostic profiles of adult psychiatric outpatients with and without attention deficit hyperactivity disorder

ObjectiveDespite growing recognition that attention deficit/hyperactivity disorder (ADHD) is a highly prevalent, impairing, and comorbid disorder that persists into adulthood, reports on the nature and extent of its psychiatric comorbidities have been mixed to date. This study compared the prevalence rates of all major Axis I disorders as well as borderline personality disorder in an unselected sample of adult psychiatric outpatients with and without ADHD. MethodsAs part of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we administered a DSM-IV-based semi-structured diagnostic interview assessing ADHD and other psychiatric disorders to 1134 patients presenting for initial evaluation at an outpatient psychiatric practice. Logistic regression analyses were used to compare the rates of each disorder in patients with versus without an ADHD diagnosis (both overall and by Combined and Inattentive type). ResultsPatients with (versus without) any ADHD diagnosis had significantly higher rates of bipolar disorder, social phobia, impulse control disorders, eating disorders, and BPD, and significantly lower rates of major depressive disorder and adjustment disorder (all p<.05). Patients with (versus without) ADHD-Inattentive type had significantly higher rates of social phobia and eating disorders, whereas those with (versus without) the ADHD-Combined type had significantly higher rates of bipolar disorder, alcohol dependence, and BPD (all p<.05). ConclusionIn this novel investigation of the psychiatric profiles of an unselected sample of treatment-seeking adult outpatients with versus without ADHD, a distinct pattern of comorbidities emerged across subtypes, with implications for the accurate assessment and treatment of patients presenting for psychiatric care.

Global and local grey matter reductions in boys with ADHD combined type and ADHD inattentive type

Attention-deficit/hyperactivity disorder (ADHD) has reliably been associated with global grey matter reductions but local alterations are largely inconsistent with perhaps the exception of the caudate nucleus. The aim of this study was to examine local and global brain volume differences between typically developing children (TD) and children with a diagnosis of ADHD. We also addressed whether these parameters would differ between children with the ADHD-combined type (ADHD-C) and those with the ADHD-inattentive type (ADHD-I). Using an ROI approach caudate volume differences were also examined. 79 boys between the ages of 8 and 17 participated in the study. Of those 33 met diagnostic criteria for the ADHD-C and 15 for the ADHD-I subtype. 31 boys were included in the TD group. Structural magnetic resonance imaging data were analysed using voxel-based morphometry. The ADHD group had significantly lower global and local grey matter volumes within clusters in the bilateral frontal, right parietal and right temporal regions compared to TD. A significant group by age interaction was found for right caudate nucleus volume. No differences between the ADHD-C and ADHD-I groups were found. Right caudate nucleus volume and age are more strongly related in ADHD than in TD consistent with previous research.

Unique white matter microstructural patterns in ADHD presentations-a diffusion tensor imaging study.

Attention-deficit/hyperactivity disorder predominantly inattentive (ADHD-PI) and combined (ADHD-C) presentations are likely distinct disorders that differ neuroanatomically, neurochemically, and neuropsychologically. However, to date, little is known about specific white matter (WM) regions differentiating ADHD presentations. This study examined differences in WM microstructure using diffusion tensor imaging (DTI) data from 20 ADHD-PI, 18 ADHD-C, and 27 typically developed children. Voxel-wise analysis of DTI measurements in major fiber bundles was carried out using tract-based spatial statistics (TBSS). Clusters showing diffusivity abnormalities were used as regions of interest for regression analysis between fractional anisotropy (FA) and neuropsychological outcomes. Compared to neurotypicals, ADHD-PI children showed higher FA in the anterior thalamic radiations (ATR), bilateral inferior longitudinal fasciculus (ILF), and in the left corticospinal tract (CST). In contrast, the ADHD-C group exhibited higher FA in the bilateral cingulum bundle (CB). In the ADHD-PI group, differences in FA in the left ILF and ATR were accompanied by axial diffusivity (AD) abnormalities. In addition, the ADHD-PI group exhibited atypical mean diffusivity in the forceps minor (FMi) and left ATR and AD differences in right CB compared to healthy subjects. Direct comparison between ADHD presentations demonstrated radial diffusivity differences in FMi. WM clusters with FA irregularities in ADHD were associated with neurobehavioral performance across groups. In conclusion, differences in WM microstructure in ADHD presentations strengthen the theory that ADHD-PI and ADHD-C are two distinct disorders. Regions with WM irregularity seen in both ADHD presentations might serve as predictors of executive and behavioral functioning across groups. Hum Brain Mapp 37:3323-3336, 2016. © 2016 Wiley Periodicals, Inc.