Attention-deficit/hyperactivity Disorder Symptomatology Research Articles

Functional Connectivity and Temporal Variability of Brain Connections in Adults with Attention Deficit/Hyperactivity Disorder and Bipolar Disorder

Objectives: To assess brain functional connectivity and variability in adults with attention deficit/hyperactivity disorder (ADHD) or euthymic bipolar disorder (BD) relative to a control (CT) group. Methods: Electroencephalography (EEG) was measured in 35 participants (BD = 11; ADHD = 9; CT = 15) during an eyes-closed 10-min rest period, and connectivity and graph theory metrics were computed. A coefficient of variation (CV) computed also the connectivity's temporal variability of EEG. Multivariate associations between functional connectivity and clinical and neuropsychological profiles were evaluated. Results: An enhancement of functional connectivity was observed in the ADHD (fronto-occipital connections) and BD (diffuse connections) groups. However, compared with CTs, intrinsic variability (CV) was enhanced in the ADHD group and reduced in the BD group. Graph theory metrics confirmed the existence of several abnormal network features in both affected groups. Significant associations of connectivity with symptoms were also observed. In the ADHD group, temporal variability of functional connections was associated with executive function and memory deficits. Depression, hyperactivity and impulsivity levels in the ADHD group were associated with abnormal intrinsic connectivity. In the BD group, levels of anxiety and depression were related to abnormal frontotemporal connectivity. Conclusions: In the ADHD group, we found that intrinsic variability was associated with deficits in cognitive performance and that connectivity abnormalities were related to ADHD symptomatology. The BD group exhibited less intrinsic variability and more diffuse long-range brain connections, and those abnormalities were related to interindividual differences in depression and anxiety. These preliminary results are relevant for neurocognitive models of abnormal brain connectivity in both disorders.

OROS-methylphenidate efficacy on specific executive functioning deficits in adults with ADHD: A randomized, placebo-controlled cross-over study

Attention-deficit/hyperactivity disorder (ADHD) is linked to impaired executive functioning (EF). This is the first study to objectively investigate the effects of a long-acting methylphenidate on neurocognitive test performance of adults with ADHD. Twenty-two adults with ADHD participated in a 6-weeks study examining the effect of osmotic-release oral system methylphenidate (OROS-mph) on continuous performance tests (CPTs; objective measures), and on the self-reported ADHD rating scale (subjective measure) using a randomized, double-blind, placebo-controlled cross-over design. OROS-mph significantly improved reaction time variability (RTV), commission errors (CE) and d-prime (DP) as compared to baseline (Cohen's d>.50), but did not affect hit reaction time (HRT) or omission errors (OE). Compared to placebo, OROS-mph only significantly influenced RTV on one of two CPTs (p<.050). Linear regression analyses showed predictive ability of more beneficial OROS-mph effects in ADHD patients with higher EF severity (RTV: β=.670, t=2.097, p=.042; omission errors (OE): β=−.098, t=−4.759, p<.001), and with more severe ADHD symptoms (RTV: F=6.363, p=.019; HRT: F=3.914, p=.061). Side effects rates were substantially but non-significantly greater for OROS-mph compared to placebo (77% vs. 46%, p=.063). OROS-mph effects indicated RTV as the most sensitive parameter for measuring both neuropsychological and behavioral deficits in adults with ADHD. These findings suggest RTV as an endophenotypic parameter for ADHD symptomatology, and propose CPTs as an objective method for monitoring methylphenidate titration.

EPA-0455 – Patterns of response to atomoxetine for the treatment of adult patients with attention deficit hyperactivity disorder

Introduction In studies of adult patients with attention deficit hyperactivity disorder (ADHD) atomoxetine (ATX) has demonstrated substantial improvements in ADHD symptomatology using Conners’ Adult ADHD Rating Scales (CAARS). The pattern suggests incremental response over time with no clear plateau of response. Objectives To identify patterns of response to ATX in adult ADHD patients and to describe those trajectories over time Aims To determine if patients have distinct response trajectories using CAARS in two populations, short term (12 weeks) and long term (24 weeks) treatment data. Methods Data from 2502 ATX patients, who had an investigator-rated CAARS total score at ≥ short or long term time point, The numbers of trajectory clusters for short term (n=2502) and long term (n=1139) data were identified using hierarchical clustering methods. Linear mixed modelling was used to describe those different trajectories over time. Results Using CAARS total, 4 trajectory clusters were identified in short term treated patients and 5 in long term. Three out of 4 short term trajectory clusters (representing 84% of patients) and 4 out 5 long term (representing 96%) showed more successful trajectories. In general clusters with less improvement were those with the worst baseline CAARS and minimal initial improvement. Distinct trajectory patterns of response were found that were incremental over time in all clusters. Conclusions Adult ADHD patients receiving atomoxetine have individual trajectories of response that can be divided into 4 short term trajectories and 5 long term trajectories. Further analysis is ongoing to describe these cohorts.

Sensory processing abilities of children with ADHD.

OBJECTIVE: To assess and compare the sensory processing abilities of children with Attention Deficit/Hyperactivity Disorder (ADHD) and children without disabilities, and to analyze the relationship between sensory processing difficulties and behavioural symptoms presented by children with ADHD. METHOD: Thirty-seven children with ADHD were compared with thirty-seven controls using a translated and adapted version of the "Sensory Profile" answered by the parents/caregivers. For the ADHD group, Sensory Profile scores were correlated to behavioural symptoms assessed using the Child Behaviour Check List (CBCL) and the Behavioural Teacher Rating Scale (EACI-P). The statistical analyses were conducted using the Mann Whitney test and Pearson correlation coefficients.RESULTS: Children with ADHD showed significant impairments compared to the control group in sensory processing and modulation, as well as in behavioural and emotional responses as observed in 11 out of 14 sections and 6 out of 9 factors. Differences in all Sensory Profile response patterns were also observed between the two groups of children. Sensory Profile scores showed a moderately negative correlation with CBCL and EACI-P scores in the ADHD group. CONCLUSION: These results indicate that children with ADHD may present sensory processing impairments, which may contribute to the inappropriate behavioural and learning responses displayed by children with ADHD. It also suggests the importance of understanding the sensory processing difficulties and its possible contribution to the ADHD symptomatology.

Analysis of individual items on the attention-deficit/hyperactivity disorder symptom rating scale in children and adults: the effects of age and sex in pivotal trials of lisdexamfetamine dimesylate

BackgroundAttention-deficit/hyperactivity disorder (ADHD) symptom presentation across age and sex has not been fully elucidated. The present post hoc analyses qualitatively explored the baseline levels of ADHD symptomatology across subgroups in two clinical trials of children and adults with ADHD to elucidate differences in participant presentation. The response to treatment was examined to determine patterns of response among items of the ADHD Rating Scale IV.MethodsExploratory post hoc analyses of ADHD Rating Scale IV item scores were conducted on data from two 4-week placebo-controlled trials in children (6–12 years) and in adults (18–55 years) with ADHD. Baseline and endpoint mean item scores were determined for subgroups defined by age (6–9, 10–12, 18–39, and 40–55 years) and sex.ResultsThe baseline mean item scores were generally numerically similar for all age-by-sex subgroups. The inattention (IA) items were numerically higher than hyperactivity/impulsivity (H/I) items among older children and adults. The endpoint mean item scores were numerically lower after lisdexamfetamine dimesylate treatment for IA and H/I items in all subgroups.ConclusionThese results suggest that regardless of age or sex, baseline IA and H/I symptom profiles were comparable; however, IA vs H/I symptoms were more severe in older participants. In all age-by-sex subgroups, IA and H/I symptoms appeared to decrease after active treatment.

Family environment and attention‐deficit/hyperactivity disorder in adopted children: associations with family cohesion and adaptability

Positive family environments are crucial in promoting children's emotional and behavioural well-being, and may also buffer development of attention-deficit/hyperactivity disorder (ADHD). ADHD is highly heritable, but psychosocial factors in the family environment, particularly family cohesion and communication, may mediate genetic predispositions. The purpose of the current study is to examine the mediating influence of the adoptive family environment between pre-adoptive risk factors and youths' ADHD symptomatology at 14 years post adoption. The data used in this study were obtained from the fourth wave of the California Long-Range Adoption Study (CLAS) (n = 449). Using structural equation modelling (SEM), family sense of coherence and family adaptability were tested as possible mediators between environmental and biological predictors and ADHD symptomatology. Predictors included birthweight, gender, age at adoption, adoption from foster care, transracial adoption status, ethnicity and having a previous diagnosis of ADHD. Results show that, while adoption from foster care is negatively associated with family functioning, higher family cohesion and adaptability mediate this influence on children's ADHD symptomatology. Older age of adoption directly predicts greater ADHD symptoms with no mediating influence of the family environment. The mediating influence of the family environment between children's risk factors and ADHD symptoms suggests that family intervention strategies may be helpful in improving adopted children's outcomes. Once children are adopted, targeting family communication patterns and dynamics may be an additional part of developing an evidence-based, post-adoption services toolkit.

The effect of lisdexamfetamine dimesylate on body weight, metabolic parameters, and attention deficit hyperactivity disorder symptomatology in adults with bipolar I/II disorder

We primarily sought to determine the effect of adjunctive lisdexamfetamine dimesylate (LDX) on anthropometric and metabolic parameters. Our secondary aim was to evaluate the effect of LDX on attention deficit hyperactivity disorder (ADHD) symptom severity in adults with bipolar I/II disorder. Forty-five stable adults (i.e., non-rapid cycling, absence of clinically significant hypo/manic symptoms) with bipolar I/II disorder and comorbid ADHD were enrolled in a phase IV, 4-week, flexible dose, open-label study of adjunctive LDX. All subjects were initiated at 30 mg/day of adjunctive LDX for the first week with flexible dosing (i.e., 30-70 mg/day) between weeks 2 and 4. Of the 45 subjects enrolled, 40 received adjunctive LDX (mean dose = 60 ± 10 mg/day). A statistically significant decrease from baseline to endpoint was evident in weight (p < 0.001), body mass index (p < 0.001), fasting total cholesterol (p = 0.011), low density lipoprotein cholesterol (p = 0.044), high density lipoprotein cholesterol (p = 0.015) but not triglycerides, or blood glucose. Significant reductions were also observed in leptin (p = 0.047), but not in ghrelin, adiponectin, or resistin levels. Diastolic blood pressure and pulse increased significantly over time but on average remained within the normal range (p < 0.001). There was a significant reduction from baseline to endpoint in the total score of the ADHD Self-Report Scale. Significant improvement from baseline to endpoint was also observed in the Montgomery-Åsberg Depression Rating Scale total score as well as the Clinical Global Impression Severity and Improvement score. Short-term adjunctive LDX treatment was well tolerated by this sample of adults with stable bipolar I/II disorder. Lisdexamfetamine dimesylate offered beneficial effects on body weight, body mass index and several metabolic parameters. In addition to demonstrating short-term (i.e., 4 weeks) safety and tolerability, beneficial effects of LDX were also observed in mitigating depressive and ADHD symptom severity.

Genetic Overlap between Evoked Frontocentral Theta-Band Phase Variability, Reaction Time Variability, and Attention-Deficit/Hyperactivity Disorder Symptoms in a Twin Study

Electrophysiological and hemodynamic activity is altered in attention-deficit/hyperactivity disorder (ADHD) during tasks requiring cognitive control. Frontal midline theta oscillations are a cortical correlate of cognitive control influencing behavioral outcomes including reaction times. Reaction time variability (RTV) is consistently increased in ADHD and is known to share genetic effects with the disorder. The etiological relationship between the cognitive control system, RTV, and ADHD is unknown. In a sample of twins selected for ADHD and matched control subjects, we aimed to quantify the strength of the phenotypic, genetic, and environmental relationships between event-related midline theta oscillations, RTV, and ADHD. Our sample included 134 participants aged 12 to 15 years: 67 twin pairs (34 monozygotic; 33 dizygotic) with concordance or discordance for ADHD symptomatology assessed at 8, 10, and 12 years of age. Our main outcome measures were frontal midline theta activity, derived from both channel and source decomposed electroencephalographic data, and behavioral performance on a response-choice arrow flanker task known to elicit theta activity. Variability in stimulus event-related theta phase from frontal midline cortex is strongly related to both RTV and ADHD, both phenotypically and genetically. This is the first finding to confirm the genetic link between the frontal midline cognitive control system and ADHD and the first to identify a genetically related neurophysiological marker of RTV in ADHD. Variability in the timing of the theta signal in ADHD may be part of a dysfunctional brain network that impairs regulation of task-relevant responses in the disorder.

The Relationship between Attention Deficit Hyperactivity Disorder Symptomatology and Nutrition-Related Health Behaviors among University Athletes and Non-Athletes

The Relationship between Attention Deficit Hyperactivity Disorder Symptomatology and Nutrition-Related Health Behaviors among University Athletes and Non-Athletes

Self-efficacy for self-regulated learning in adolescents with and without attention deficit hyperactivity disorder (ADHD)

This study examined the self-efficacy for self-regulated learning (SESRL) beliefs of male and female youth with and without Attention-Deficit/Hyperactivity Disorder (ADHD) and explored the contribution of youth self-reports of inattention, internalizing symptoms, and academic achievement to SESRL beliefs. Thirty-one youth with ADHD (18 males, 13 females) and 31 youth without ADHD (17 males, 14 females) aged 13 to 18 completed measures of self-efficacy, ADHD symptomatology, achievement, and internalizing problems. Female youth with ADHD reported the lowest levels of confidence in their ability to self-regulate their learning. Male youth with ADHD reported similar levels of SESRL beliefs as youth without ADHD. A multiple mediation analysis with the full sample revealed that internalizing symptoms and academic achievement did not mediate the relationship between self-reported inattention symptoms and SESRL beliefs. The findings suggest a need for ongoing research into the SESRL beliefs of youth with ADHD.

ADHD symptomatology in eating disorders: a secondary psychopathological measure of severity?

BackgroundAttention-deficit/hyperactivity disorder (ADHD) has commonly been described in psychiatric disorders. Although several studies have found positive associations between abnormal eating patterns during childhood and ADHD, there is a lack of studies on ADHD and Eating Disorders (ED). The aims of this exploratory study were 1) to assess the ADHD symptoms level in ED and to ascertain whether there are differences among ED subtypes; 2) to analyze whether the presence of ADHD symptoms is associated with more severe eating disorder symptoms and greater general psychopathology; and 3) to assess whether the ADHD symptoms level is associated with specific temperament and character traits.Methods191 female ED patients were included. Assessment was carried out with the EDI-2, ASRS-v1.1, the SCL-90-R and the TCI-R.ResultsThe ADHD symptoms level was similar in bulimia, eating disorder not otherwise specified and binge eating subtypes, and lower in anorexic patients. Obsessiveness and Hostility were significantly positively associated with ADHD symptoms. A path model showed that ADHD was associated with high Novelty Seeking and low Self-Directedness, whereas ED severity was influenced by ADHD severity and low Self-Directedness.ConclusionsBingeing/purging ED subtypes have a high ADHD symptoms level, also related with more severe eating, general and personality psychopathology.

The importance of considering ADHD in smoking cessation clinical trials

Tobacco use is a leading cause of preventable death worldwide. A large proportion of smokers are motivated to quit smoking and there are a number of available treatments that can increase quit rates [1]. However, relapse to smoking is common, with only 10–40% achieving long-term abstinence even after undergoing intensive treatment [1]. Hence, there continues to be a critical need for the development of novel smoking cessation treatments and clinical trials to empirically test the efficacy of attention deficit/hyperactivity disorder (ADHD) treatments. While the literature has been instrumental in providing clear guidelines for statistical analysis and measurement of outcomes and mediators in smoking cessation clinical trials [2,3], less attention has been paid to patient characteristics, such as psychiatric disorders, which are clinically important to smoking cessation processes. ADHD – a common and disabling behavioral condition in both children and adults [4] – is strongly associated with nicotine dependence [5]. Importantly, ADHD may heighten risk for persistent smoking and poorer smoking cessation outcomes [6,7]. However, ADHD is rarely assessed or targeted in smoking cessation trials. The aim of this editorial is to highlight the importance of considering ADHD in smoking cessation clinical trials. Below, we describe ADHD symptomatology, assessment, and clinical issues related to smoking and cessation processes, with the goal of providing guidance for smoking cessation research. It is our hope that the following discussion will stimulate heightened consideration of ADHD in smoking cessation clinical trials, which we feel will ultimately advance the science of smoking cessation more broadly.

Association between Craving and Attention Deficit/Hyperactivity Disorder Symptoms among Patients with Alcohol Use Disorders

Adult Alcohol Use Disorders (AUD) patients with Attention Deficit/Hyperactivity Disorder (ADHD) symptoms may suffer more from craving than patients who only have AUD. However, craving may be even more strongly related to withdrawal and psychiatric symptoms; therefore, the association between craving and ADHD may be misinterpreted. The purpose of this study is to examine the association between craving and ADHD symptoms among AUD patients in more detail. In a multisite study, 385 patients with and without ADHD symptoms who were attending treatment for alcohol dependence were compared in terms of craving, withdrawal, and psychiatric symptoms. The contribution of ADHD symptoms to craving was estimated in a hierarchical regression analysis by controlling for psychiatric and withdrawal symptoms. Patients with probable adult ADHD showed higher craving, more withdrawal and psychiatric symptoms, and rated withdrawal symptoms as more severe than did patients without ADHD symptoms. In the regression model, only about 3% of variance in alcohol craving was explained by ADHD symptomatology, whereas 23% of the variance was explained when withdrawal and psychiatric symptoms were added to the model. Alcohol craving is likely related to withdrawal and psychiatric symptoms more strongly than to ADHD symptoms.

Altered serum mono- and polyunsaturated fatty acid levels in adults with ADHD

Other than in children diagnosed with attention deficit hyperactivity disorder (ADHD), the connection between ADHD and lipids has not been sufficiently investigated so far in adults. Blood serum lipoproteins and fatty acids (FA) composition were measured and analyzed by colorimetry and gaschromatography in eight male and seven female adults diagnosed with ADHD as well as in 15 age- and gender-matched healthy control subjects. In ADHD patients, polyunsaturated FAs [docosahexaenoic, arachidonic and dihomogammalinolenic acid (p = 0.048; 0.003; 0.012)] showed lower concentrations, while monounsaturated acids (palmitoleic and oleic acid) as well as total and LDL cholesterol showed higher concentrations (p = 0.011; 0.005). ADHD scores positively correlated with palmitoleic (R = -0.56; p = 0.032), stearic (R = 0.53; p = 0.044), eicosapentaenoic (R = 0.62; p = 0.014), docosahexaenoic (R = 0.51; p = 0.050), gammalinolenic (R = 0.62; p = 0.018) and alphalinolenic acid (R = 0.56; p = 0.031) concentration. Even though the total and LDL cholesterol concentrations in blood serum were significantly higher among the ADHD patients than in controls, none of the ADHD symptom scores were significantly associated with any of the lipoproteine measures. We could demonstrate that a lack of polyunsaturated FAs in blood serum of subjects with ADHD persists into adulthood. Furthermore, we could show that adult ADHD symptomatology positively correlates with elevated levels of saturated stearic and monounsaturated FAs.

Association between Craving and Attention Deficit/Hyperactivity Disorder Symptoms among Patients with Alcohol Use Disorders

Background/Aim Adult Alcohol Use Disorders (AUD) patients with Attention Deficit/Hyperactivity Disorder (ADHD) symptoms may suffer more from craving than patients who only have AUD. However, craving may be even more strongly related to withdrawal and psychiatric symptoms; therefore, the association between craving and ADHD may be misinterpreted. The purpose of this study is to examine the association between craving and ADHD symptoms among AUD patients in more detail. Methods In a multisite study, 385 patients with and without ADHD symptoms who were attending treatment for alcohol dependence were compared in terms of craving, withdrawal, and psychiatric symptoms. The contribution of ADHD symptoms to craving was estimated in a hierarchical regression analysis by controlling for psychiatric and withdrawal symptoms. Results Patients with probable adult ADHD showed higher craving, more withdrawal and psychiatric symptoms, and rated withdrawal symptoms as more severe than did patients without ADHD symptoms. In the regression model, only about 3% of variance in alcohol craving was explained by ADHD symptomatology, whereas 23% of the variance was explained when withdrawal and psychiatric symptoms were added to the model. Conclusions Alcohol craving is likely related to withdrawal and psychiatric symptoms more strongly than to ADHD symptoms. (Am J Addict 2013; 22:292–296)

Response Inhibition in Preschoolers at Familial Risk for Attention Deficit Hyperactivity Disorder: A Behavioral and Electrophysiological Stop‐Signal Study

Children participating in the Ben-Gurion Infant Development Study were assessed with a dynamic-tracking version of the stop-signal task at the age of 5years. The sample consisted of 60 males. Stop-signal reaction time (SSRT) was correlated with concurrent ratings of the child's attention deficit hyperactivity disorder (ADHD) symptoms. Paternal symptoms measured in the child's early infancy predicted the child's performance in the stop-signal task: Paternal inattentiveness predicted SSRT, whereas hyperactivity predicted error proportion. Maternal symptoms were not correlated with the performance of the child in the task. A subsample of children, who were tested while electrophysiological brain activity was measured, showed that having higher ADHD symptomatology, especially hyperactivity, correlated with less activity in the brain areas that are usually recruited by children for successful inhibition.

Different heritabilities but shared etiological influences for parent, teacher and self-ratings of ADHD symptoms: an adolescent twin study

Parent and teacher ratings of attention deficit hyperactivity disorder (ADHD) symptoms yield high estimates of heritability whereas self-ratings typically yield lower estimates. To understand why, the present study examined the etiological overlap between parent, teacher and self-ratings of ADHD symptoms in a population-based sample of 11-12-year-old twins. Method Participants were from the Twins Early Development Study (TEDS). ADHD symptoms were assessed using the Strengths and Difficulties Questionnaire (SDQ) hyperactivity scale completed by parents, teachers and children. Structural equation modeling was used to examine genetic and environmental contributions to phenotypic variance/covariance. The broad-sense heritability of ADHD symptoms was 82% for parent ratings, 60% for teacher ratings and 48% for self-ratings. Post-hoc analyses revealed significantly higher heritability for same-teacher than different-teacher ratings of ADHD (76% v. 49%). A common pathway model best explained the relationship between different informant ratings, with common genetic influences accounting for 84% of the covariance between parent, teacher and self-rated ADHD symptoms. The remaining variance was explained by rater-specific genetic and non-shared environmental influences. Despite different heritabilities, there were shared genetic influences for parent, teacher and self-ratings of ADHD symptoms, indicating that different informants rated some of the same aspects of behavior. The low heritability estimated for self-ratings and different-teacher ratings may reflect increased measurement error when different informants rate each twin from a pair, and/or greater non-shared environmental influences. Future studies into the genetic influences on ADHD should incorporate informant data in addition to self-ratings to capture a pervasive, heritable component of ADHD symptomatology.

Reduced Cortisol in Boys with Early-Onset Conduct Disorder and Callous-Unemotional Traits

Background. A growing body of evidence suggests an association between altered hypothalamic-pituitary-adrenal axis reactivity and the development of persistent antisocial behavior in children. However the effects of altered cortisol levels remain poorly understood in the complex context of conduct disorder, callous-unemotional (CU) personality traits, and frequent comorbidities, such as attention deficit hyperactivity disorder (ADHD). The aim of the current study was to investigate associations among CU traits, antisocial behavior, and comorbid ADHD symptomatology with cortisol levels in male children and adolescents. Methods. The study included 37 boys with early-onset conduct disorder (EO-CD, mean age 11.9 years) and 38 healthy boys (mean age 12.5 years). Participants were subjected to multiple daytime salivary cortisol measurements and a psychometric characterization. Results. Subjects in the EO-CD group with elevated CU traits showed a diminished cortisol awakening response compared to healthy participants. In the EO-CD group, high CU traits and impulsivity were associated with decreased diurnal cortisol levels, while associations with antisocial behavior were not detected. The cortisol awakening response was significantly inversely associated with hyperactivity (P = 0.02) and marginally significant with CU traits (P = 0.07). Conclusions. These results indicate a specific association between CU traits and a diminished stress response, which is not explained by antisocial behavior in general.

Associations between attention deficit hyperactivity disorder symptom domains and DSM-IV lifetime substance dependence.

Most studies of attention deficit hyperactivity disorder (ADHD) in the substance dependence literature have assessed ADHD as a single, categorical entity. This approach limits characterization across the spectrum of ADHD symptomatology and may mask differences across the two core domains of ADHD symptoms-hyperactive-impulsive (HI) and inattention (IN). Further, it is unclear whether relations of HI and IN symptoms to substance dependence extend across drug classes and to the general population. This cross-sectional study investigated associations of lifetime ADHD HI and IN symptom levels to individual classes of lifetime substance dependence (alcohol, nicotine, depressants, opioids, stimulants, cannabis, hallucinogens, polysubstance) in a population-based sample of 34,653 American adults. HI and IN were associated with the majority of dependence diagnoses in a linear pattern, such that each additional symptom was associated with a proportional increase in odds of dependence. After adjusting for the overlap between symptom domains, both HI and IN uniquely associated with alcohol, nicotine, and polysubstance dependence, but only HI uniquely associated with dependence on illicit substances. These findings suggest that individuals in the general population with elevated levels of ADHD (particularly HI) symptoms are at risk for various forms of substance dependence and could benefit from preventive interventions.

Friendship Intimacy Exchange Buffers the Relation between ADHD Symptoms and Later Social Problems among Children Attending an After-School Care Program

The friendships of children displaying symptoms of attention-deficit/hyperactivity disorder (ADHD) have been understudied, particularly in comparison to the domain of peer rejection. This study tested whether friendship intimacy exchange buffers the prospective relation between ADHD symptoms and social problems 1 year later in a sample of children attending a community-based after-school program. Children (N = 131; 53 % boys; 66 % African American) ranging from 5 to 13 years of age participated in this study. At baseline, children reported on friendship intimacy exchange with their identified best friend, and program staff rated children on ADHD symptoms and social problems. Staff ratings of children’s social problems were collected again 1 year later. Multiple regression analyses indicated that, after controlling for demographic variables and baseline social problems, friendship intimacy exchange significantly moderated the association between ADHD symptoms and social problems at the one-year follow-up. Specifically, the relation between ADHD and social problems was no longer significant for children reporting high levels of friendship intimacy exchange. This moderation was not further qualified by either child age or sex, although boys were more likely than girls to report low rates of friendship intimacy exchange. These findings indicate the importance of friendship intimacy for children displaying ADHD symptoms, who often experience significant peer problems. Friendship quality may be a promising target for prevention and intervention efforts in mitigating some of the long-term social problems associated with ADHD symptomatology, and future research is needed to extend these findings to other domains of friendship quality and clinical samples of children with ADHD.