Attention Deficit Hyperactivity Disorder Research Articles

Breaking Down Barriers: Understanding Determinants of Exercise in Adults with ADHD Symptoms

AbstractAutonomous/intrinsic exercise motivation has been found to be negatively linked with Attention Deficit Hyperactivity Disorder (ADHD) symptomatology, but it is unclear how this might be expressed in terms of different determinants of exercise (barriers/facilitators) to Physical Exercise (PE). Additionally, ADHD symptomatology has been found to be linked with increased Exercise Dependence (ED) risk, meaning the relationship between these determinants of exercise and ED should also be considered. This cross-sectional study investigated the relationship between PE, ADHD symptoms, barriers/determinants of exercise, and ED. 362 participants (77.07% female) completed an online survey measuring: PE level (IPAQ-L); ADHD symptomatology (ADHD-RS-IV); subclinical ADHD diagnosis (ADHD-RS-IV); ED (EDS-R) and determinants of exercise (DPAQ). Significant differences were found in the levels of barriers to PE (Coping Planning; Emotion; Beliefs about Capabilities; and Motivation) between subclinical and Non-ADHD participants, with subclinical ADHD participants experiencing more. Additionally, significant positive correlations were observed between determinants of exercise and ED (Motivation; Beliefs about Capabilities; Skills; Emotion; Action Planning; Coping Planning; Goal Conflict; Social). Subclinical ADHD diagnosis did not significantly moderate the relationship between any of the determinants of exercise and PE level. These findings suggest that individuals with subclinical ADHD experience greater levels of certain barriers to exercise, which may need to be overcome or targeted in any potential PE based intervention. However, since some of these barriers were linked with ED risk, caution should be exercised to avoid increasing ED rates further.

Low perceived social support in mothers during pregnancy and early childhood; associations with anxiety and ADHD symptoms in children at 3 and 8 years.

Low perceived social support is associated with adverse effects on maternal mental health, and often coexists with other risk factors for offspring anxiety and attention-deficit/hyperactivity disorder (ADHD). We aimed to investigate whether low maternal social support during pregnancy and early childhood predicted anxiety and ADHD symptoms in children at ages 3.5 and 8 years. This study is part of the longitudinal, population-based Norwegian Mother, Father, and Child Cohort Study. Mothers were queried about perceived social support twice during pregnancy, and again at child ages 18 months and 3 years. They were interviewed about their children's symptoms of anxiety and ADHD at 3.5 years. At 8 years (n = 781), the Child Symptom Inventory-4 was used to identify children who fulfilled the criteria for anxiety disorders and ADHD. Logistic regression models estimated the risk of child anxiety and ADHD, depending on maternal social support. Low maternal social support predicted child anxiety symptoms at both ages 3.5 and 8 years as well as ADHD symptoms at 8 years. When including other maternal stressors and child risk factors, low maternal social support remained a significant predictor for child anxiety symptoms at 3.5 years, and there was a trend towards also predicting child anxiety and ADHD symptoms at 8 years. The associations between low maternal social support and child symptoms of anxiety and ADHD found in the present study, suggest that focusing on mothers with low social support may hold significance for child symptoms years later.

Exploring the impact of probiotics on adult ADHD management through a double-blind RCT.

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric condition often persisting into adulthood, characterized by inattention, impulsivity, and hyperactivity. Emerging research suggests a connection between ADHD and gut microbiota, highlighting probiotics as potential therapeutic agents. This study involved a double-blind, randomized controlled trial where college students with ADHD received either a multi-strain probiotic supplement or a placebo daily for three months. ADHD symptoms were evaluated using a computerized performance test (MOXO) and the MATAL questionnaire. Academic records provided performance data. Additionally, eating and sleeping habits, gastrointestinal symptoms, and anthropometrics were assessed through questionnaires before and after the intervention. Fingernail cortisol concentrations (FCC) measured the long-term activity of the hypothalamic-pituitary-adrenal axis. The findings indicated that the probiotic significantly decreased hyperactivity, improved gastrointestinal symptoms, and enhanced academic performance. A multivariate analysis identified age as a significant predictor, with younger participants experiencing greater overall benefits from the intervention. There was also a negative correlation between FCC and symptoms of attention and impulsivity. Furthermore, higher academic grades were associated with lower levels of hyperactivity and impulsivity. These results suggest a beneficial impact of probiotics on ADHD symptoms and lay the groundwork for further studies to evaluate the effects of various probiotic strains on clinical outcomes in ADHD.

Impaired emotional multimodal integration in inhibition of return in children with attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children. Previous studies have shown that children with ADHD have impaired processing of emotional stimuli, but it is unclear whether their ability to integrate multimodal emotional stimuli is impaired and at which processing pathway this impairment exists. The present study investigated the ability of children with ADHD to integrate emotional audiovisual stimuli under different emotional conditions, and the effect of audiovisual integration on IOR to reveal the impaired processing pathway of their emotional audiovisual integration. Fifty-eight school-age children (29 with ADHD and 29 matched typically developing (TD) children) performed an emotional valence discrimination task with a cue-target paradigm. The results showed that children with ADHD did not exhibit audiovisual integration of emotional stimuli in all experimental conditions. In addition, the IOR effect was significantly smaller for audiovisual targets than for visual targets under the negative but not the neutral emotion condition in children with ADHD, whereas this effect was present in all emotion conditions in TD children. These results indicate that the ability to integrate emotional audiovisual information is impaired in children with ADHD and this impairment exists in both bottom-up and top-down pathways. Additionally, although presenting emotional auditory stimuli at the same time as emotional faces reduced IOR both in children with ADHD and TD, the manner of reduction differed. These findings provide new evidence of emotional processing deficits and multimodal integration deficits in children with ADHD, and help provide support for children in educational settings.

Response inhibition as a critical executive function in differentiating attention-deficit/hyperactivity disorder from autism spectrum disorder: a comprehensive attention test study

BackgroundAutism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are both associated with impairment in executive function, particularly in complex attention. Although previous studies using clinical assessments have attempted to delineate differences between these disorders, the findings have been inconclusive. Our study aims to elucidate the differences of endophenotype between ASD, ADHD, and their co-occurring condition utilizing a uniform computerized test.MethodsThe study included children diagnosed with ASD, ASD co-occurring with ADHD (ASD+ADHD), or ADHD who completed the comprehensive attention test (CAT) at Severance Hospital between October 2013 to May 2023. We excluded children with intellectual disability and comorbid major psychiatric or neurologic disorders possibly affecting attention measurement. The participants were categorized into three groups for the comparative analysis of CAT measures: (a) ASD (n=112), (b) ASD+ADHD (n=155), and (c) ADHD (n=104). The study also conducted an exploratory analysis utilizing multivariate linear regression analysis to examine the association between the CAT measures and parent-reported scales.ResultsNotably, the ASD+ADHD and ADHD groups exhibited higher frequency of commission errors (CE) and perseveration errors (PE) compared to the ASD group. In the exploratory analysis, a significant negative association was observed between reaction time (RT) and both the social communication questionnaire (SCQ) and the child behavior checklist (CBCL) externalization scores in the ASD+ADHD and ADHD groups. The ASD+ADHD group tended to show higher standard deviation of reaction time (RTSD) compared to the ASD group.ConclusionsOur findings suggest that impaired response inhibition is more pronounced in ADHD compared to ASD. We propose altered visual attention, reflecting response inhibition, may serve as potential endophenotypic markers differentiating ADHD from ASD in attentional assessment. Elevated RTSD in the ASD+ADHD group demonstrates additive pathology, suggesting that the neurological mechanisms underpinning impaired sustained attention may differ between the two conditions.

Nationwide trends in the use of ADHD medications in the period 2006-2022: a study from the Norwegian prescription database.

The use of medication for Attention-Deficit/Hyperactivity Disorder (ADHD) increased globally throughout the early 2000s. This study examine trends in prevalences and incidences of medication use in Norway from 2006 to 2022. Data from the Norwegian Prescription Database were used to present one-year-prevalence and incidence rates of ADHD medication (ATC-group N06BA and C02AC02) for the overall population (ages 6-64) and within sex and age subgroups of children (ages 6-17) and adults (ages 18-64). Incident use was defined as the dispensing of medication, with no recorded use in the previous two calendar years. The overall prevalence of ADHD medication use in 6- to 64-year-olds increased from 5.2 to 19.4 per 1000 in the period, most pronounced from 2020 and onwards. While males experienced a nearly threefold increase in use (from 7.3 to 20.6 per 1000), the use among females increased almost sixfold during the study period (from 3.0 to 18.1 per 1000). Consequently, the male-to-female prevalence-ratio decreased from 2.4 to 1. Children exhibited a higher prevalence of use compared to adults throughout the period, although the largest relative increase was observed in adults, particularly in female adults. In children the male-to-female ratio decreased from 3.2 to 2.0, primarily due to an increasing use in 13-17-year-old females. Among adults, prevalences were similar across most age groups, with the highest rates observed among those aged 18-24, where female use exceeded male use by the end of the period. The male-to-female prevalence-ratio in adults decreased from 1.6 to 0.9 during the period. Parallel to prevalent use, overall incident use increased from 1.4 to 5.0 per 1000 during the period, with the most pronounced increase occurring from 2020 and onwards. From this point, incident use among females aged 13-17, 18-24, and 25-34, exceeded that of males. The male-to-female incidence-ratio decreased from 1.8 to 0.9. The overall incidence to prevalence ratio remained similar throughout the period, being 0.27 in 2006 and 0.25 in 2022. A sustained increase in the prevalence of ADHD medication use was observed, with the most pronounced rise occurring among females and adults from 2020 and onwards. By 2022, the overall gender disparity in ADHD medication use had diminished, which should be considered in the context of a steep increase in incident use among adolescent and young adult females starting from 2020.

Methylphenidate and Atomoxetine in Pregnancy and Possible Adverse Fetal Outcomes: A Systematic Review and Meta-Analysis.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders, and it afflicts about 7% of young people. As a consequence, many young women might be pregnant while taking medication for ADHD, but data about safety have not yet been strictly examined. To examine adverse effects in offspring of mothers receiving treatment with atomoxetine and methylphenidate during pregnancy. Electronic databases (PubMed, Embase, and PsycINFO) were searched for articles published through December 31, 2023, with the following search terms: (atomoxetine OR methylphenidate) AND (pregnancy). Observational studies (eg, cohort studies, case-control studies, case-crossover studies, cross-sectional studies, and registry-based studies) that reported offspring outcomes in pregnancy with atomoxetine and/or methylphenidate and in mothers with ADHD but unexposed to ADHD treatment during pregnancy or from the general population were included. Ten studies of 656 records satisfied criteria. Two independent reviewers performed data extraction according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses were conducted based on reported odds ratios (ORs) and corresponding 95% CIs using a linear random effects model. Each study was inversely weighted by the reported variance of the estimators. Risk of publication bias and analysis of heterogeneity through univariate and multivariate metaregressions were also rated. Data were analyzed from January to March 2024. Study outcomes included miscarriages and congenital anomalies. Ten studies involving 16 621 481 pregnant women, 30 830 of them affected by ADHD, were included. Congenital anomalies or miscarriages were not more frequent in offspring of mothers receiving treatment with methylphenidate or atomoxetine during pregnancy compared with unexposed offspring (OR, 1.14; 95% CI, 0.83-1.55; P = .41; I2 = 8% for congenital anomalies; OR, 1.01; 95% CI, 0.70-1.47; P = .96; I2 = 0% for miscarriages) or compared with the general population (OR, 1.19; 95% CI, 0.93-1.53; P = .16; I2 = 74% for congenital anomalies; OR, 1.05, 95% CI, 0.81-1.37; P = .70; I2 = 0% for miscarriage). Evidence from this meta-analysis, which involves a substantial sample of pregnant women with and without ADHD, suggests the maintenance of methylphenidate or atomoxetine during pregnancy is safe, given that congenital anomalies and miscarriages did not appear to significantly increase. Further studies are recommended to support and confirm these findings.

Identifying Factors that Increase False-Positive Rates on Embedded Performance Validity Testing in ADHD Evaluations.

This study investigated why certain embedded performance validity indicators (EVIs) are prone to higher false-positive rates (FPRs) in attention-deficit/hyperactivity disorder (ADHD) evaluations. The first aim was to establish the relationship between FPRs and 15 EVIs derived from six cognitive tests when used independently and together among adults with ADHD who have valid test performance. The second aim was to determine which specific EVIs increase the FPRs in this population. Participants were 517 adult ADHD referrals with valid neurocognitive test performance as determined by multiple performance validity tests and established empirical criteria. FPRs were defined by the proportion of participants who scored below an empirically established EVI cutoff with ≥0.90 specificity. EVIs derived from two of the six tests exhibited unacceptably high FPRs (>10%) when used independently, but the total FPR decreased to 8.1% when the EVIs were aggregated. Several EVIs within a sustained attention test were associated with FPRs around 11%. EVIs that did not include demographically adjusted cutoffs, specifically for race, were associated with higher FPRs around 14%. Conversely, FPRs did not significantly differ based on whether EVIs included timed versus untimed, verbal versus nonverbal, or graphomotor versus non-graphomotor components, nor whether they had raw versus standardized cut scores. Findings suggest that practitioners should consider both the type of test from which an EVI is derived and the aggregate number of EVIs employed to minimize the FPRs in ADHD evaluations. Findings also indicate that more nuanced approaches to validity test selection and development are needed.

A systematic review and meta-analysis comparing the severity of core symptoms of attention-deficit hyperactivity disorder in females and males.

In the past decade, there have been substantial changes in diagnostic nomenclature. This study investigated sex differences in attention-deficit/hyperactivity disorder (ADHD) symptom severity based on Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV, DSM-IV(TR), and DSM-5 criteria, separating rating scale and clinical interview data in children and adults with ADHD. PubMed, PsycINFO, and Scopus were searched for published studies (1996-2021) reporting severity of attention, and hyperactivity/impulsivity in males and females. We compared data: (1) across the entire lifespan aggregating rating scale and clinical interview data (51 studies), (2) drawing solely on rating scale data (18 studies), and (3) drawing solely on clinical interview data (33 studies). Fifty-two studies met inclusion criteria comparing data for females (n = 8423) and males (n = 9985) with ADHD across childhood and/or adulthood. In total, 15 meta-analyses were conducted. Pooled data across the lifespan aggregating both rating scale and clinical diagnostic interview data, showed males had significantly more severe hyperactivity/impulsivity symptoms than females. Rating scale data were similar; boys had significantly more severe hyperactivity/impulsivity than girls. In adulthood, men were rated to have significantly more severe inattention than women with no difference in the hyperactivity/impulsivity dimension. All significant differences were of small effect size. No significant sex differences in the severity of symptoms emerged for clinical interview data for children or adults, in contrast. Possible reasons for the discrepancy in findings between rating scales and clinical diagnostic interviews are discussed.

Callous-unemotional traits, cognitive functioning, and externalizing problems in a propensity-matched sample from the ABCD study.

Many studies show that both callous-unemotional (CU) traits (e.g., low empathy, lack of guilt) and cognitive difficulties increase risk for externalizing psychopathology across development. However, other work suggests that some aggression (e.g., relational, proactive) may rely on intact cognitive function, which could vary based on the presence of CU traits. Moreover, no prior research has adequately accounted for common risk factors shared by CU traits, cognitive difficulties, and externalizing problems, which confounds conclusions that can be drawn about their purported relationships. The current study addressed these knowledge gaps by leveraging rigorous propensity matching methods to isolate associations between CU traits and different dimensions of cognitive function and externalizing problems. Associations between CU traits, cognitive functioning, and externalizing outcomes were tested within dimensional (n = 11,868) and propensity-matched group-based (n = 1,224) models using data from the Adolescent Brain Cognitive Development Study®, with rigorous statistical control for shared sociodemographic risk factors. Cross-sectional outcomes were parent-reported symptoms of conduct disorder (CD), oppositional defiant disorder (ODD), and attention deficit hyperactivity disorder (ADHD). Longitudinal outcomes were child-reported overt and relational aggression. CU traits were uniquely related to more parent-reported CD, ODD, ADHD symptoms, as well as more child-reported aggressive behaviors. Effects of cognitive difficulties were domain specific and were not consistent across dimensional and propensity matched models. There was minimal evidence for divergent associations between CU traits and externalizing outcomes as a function of cognition (i.e., no moderation). Rigorous control for sociodemographic factors within propensity-matched models establish CU traits as a robust and unique risk factor for externalizing psychopathology, over and above difficulties with cognitive functioning.

Effect of bariatric surgery on the pharmacokinetics of drugs used for attention-deficit hyperactivity disorder-A case series.

Changes in gastrointestinal physiology following bariatric surgery may affect the pharmacokinetics of drugs. Data on the impact of bariatric surgery on drugs used for attention-deficit/hyperactivity disorder (ADHD) are limited. In patients treated with ADHD medication and undergoing bariatric surgery, serial drug concentrations were measured for 24 h preoperatively and one, six and 12months postoperatively. Primary outcome was change in area under the concentration-time curve from 0 to 24 h (AUC0-24), with other pharmacokinetic variables as secondary outcomes. Eight patients treated with lisdexamphetamine (n= 4), dexamphetamine (n= 1), methylphenidate (n= 1) and atomoxetine (n= 2) were included. In total, 409 samples were analysed. Patients underwent sleeve gastrectomy (n= 5) and Roux-en-Y gastric bypass (n= 3). AUC0-24 and Cmax of dexamphetamine increased after surgery in those using the prodrug lisdexamphetamine. There was no clear-cut reduction in tmax postoperatively. For ritalinic acid and atomoxetine, no changes in AUC0-24 were observed, but for atomoxetine, a higher Cmax and a shorter tmax were observed postoperatively. Bariatric surgery may increase the systemic exposure of dexamphetamine after intake of lisdexamphetamine. Patients using lisdexamphetamine should be followed with regard to adverse drug reactions after bariatric surgery, and, if available, therapeutic drug monitoring should be considered.

Attention Deficit Hyperactivity Disorder: trends and themes of information seeking and needs

Attention Deficit Hyperactivity Disorder: trends and themes of information seeking and needs

Modeling Functional Brain Networks for ADHD via Spatial Preservation-Based Neural Architecture Search.

Modeling functional brain networks (FBNs) for attention deficit hyperactivity disorder (ADHD) has sparked significant interest since the abnormal functional connectivity is discovered in certain functional magnetic resonance imaging (fMRI)-based brain regions compared to typical developmental control (TC) individuals. However, existing models for modeling FBNs generally use dimensionality reduction techniques to process the high dimensional input data, which results in confusion and an inaccurate representation of voxel interactions between spatially close brain regions, causing misdiagnosis of the disease. To address these issues, we propose a spatial preservation-based neural architecture search (SP-NAS) for FBNs modeling in ADHD. The main work includes three-fold: 1) A spatial preservation module is designed to embed original spatial information into dimensionality reduction data, addressing the challenge of a large number of parameters in the original data and mitigating disease misdiagnosis resulting from voxel confusion between different brain regions caused by dimensionality reduction. 2) A search space using more suitable search operations is constructed to efficiently extract spatial-temporal interaction characteristics of fMRI data in ADHD while narrowing the search space. 3) Cross-regional association differences between ADHD and TC groups are explored for ADHD auxiliary diagnosis since the abnormal activation regions of ADHD relative to TC on the brain regions and the abnormal connectivity between the lesion brain regions are identified. Model validation results on the ADHD-200 dataset show that the FBNs obtained from SP-NAS not only achieve competitive results in ADHD diagnosis but also reveal abnormal connections in the lesion regions of ADHD consistent with clinical diagnosis.

Is hyperactivity in children with attention deficit/hyperactivity disorder (ADHD) a functional response to demands on specific executive functions or cognitive demands in general?

Hyperactivity is a core and impairing deficit in the clinical model of attention-deficit/hyperactivity disorder (ADHD). However, the extent to which hyperactivity in ADHD is evoked by cognitively challenging tasks in general or by demands on specific executive functions remains unclear. A clinically evaluated and carefully phenotyped community-referred sample of 184 children ages 8-13 (M = 10.40, SD = 1.50; 61 girls) with ADHD (n = 119) and without ADHD (neurotypical children and children with psychiatric disorders other than ADHD) were administered multiple, counterbalanced executive (working memory, inhibitory control, set shifting) and nonexecutive tests. Objective measures of gross motor movement (hyperactivity) were obtained using actigraphy. Using bifactor s-1 modeling, results indicate that children with ADHD demonstrate moderately elevated levels of motor movement relative to non-ADHD children. Additionally, findings indicated that hyperactivity in ADHD reflects the outcome of at least two similarly important factors: (a) a baseline level of elevated motor movement that is independent of environmental demands on their executive and nonexecutive cognitive abilities (d = 0.72); and (b) additional elevations attributable to demands placed on specific executive functions, with working memory and inhibition demands evoking similarly large, differential increases in movement for children with ADHD above and beyond their elevated baselines (Δd = 0.80). These findings suggests that executive function demands exacerbate, but do not fully explain, hyperactivity in ADHD, and/or there are at least two pathways to hyperactivity in ADHD-hyperactivity caused by environmental demands that challenge their underdeveloped executive functions, and hyperactivity caused by one or more other factors that need future research to identify. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Attention Deficit Hyperactivity Disorder, Cannabis Use, and the Endocannabinoid System: A Scoping Review.

There is emerging evidence that the endocannabinoid system (ECS) plays a significant role in the pathophysiology of many psychiatric disorders, including attention deficit hyperactivity disorder (ADHD). Increasing evidence suggests that a number of neurobiological correlates between endogenous cannabinoid function and cognitive dysfunction are seen in ADHD, making the ECS a possible target for therapeutic interventions. Cannabis use and cannabis use disorder are more prevalent in individuals with ADHD, compared to the general population, and there is growing popular perception that cannabis is therapeutic for ADHD. However, the relationship between cannabis use and ADHD symptomology is poorly understood. Further understanding of the role of the ECS in ADHD pathophysiology and the molecular alterations that may be a target for treatment is needed. To further the science on this emerging area of research, this scoping review describes the preclinical and clinical evidence seeking to understand the relationship between the ECS and ADHD.

Assessing suicidality in adult ADHD patients: prevalence and related factors

BackgroundThe association between Attention-deficit hyperactivity disorder (ADHD) and suicidality has been subject of growing interest for research in the latest years. Suicidality was generally assessed categorically and without the use of validated instruments, leading to heterogeneous or even conflicting evidence. The prevalence of both suicidal ideation and attempts varies considerably, and the associated risk factors remain unclear. Our study investigated suicidality in ADHD using a dimensional approach and a validated and internationally recognized instrument. Our primary aim was to evaluate the prevalence of suicidal ideation (SI), severe suicidal ideation (SSI), suicidal behavior (SB) and non suicidal self-injury behavior (NSSIB) in a sample of adult patients with ADHD. The second objective was to identify sociodemographic and clinical features associated with increased risk of suicidality in these patients.MethodsThe sample included 74 adult patients with clinical diagnosis of ADHD. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic regressions were used to examine predictors of SI, SSI, SB and NSSIB.ResultsThe lifetime prevalence of SI and SSI were 59.5% and 16.2%, respectively. The 9.5% of patients showed lifetime SB, while NSSIB was found in 10.8% of the subjects. Lifetime SI was associated with severity of inattentive symptoms during adulthood, low self-esteem and impairment in social functioning. Lifetime SSI appeared related to severity of inattentive symptoms during childhood, attentional impulsiveness and number of hospitalizations, while physical activity appeared to be protective. The prevalence of lifetime SB and NSSIB did not appear significantly related to any socio-demographic or clinical feature.ConclusionsAdults with ADHD should be considered at risk of suicide and it is important to determine which patients are at higher risk, in order to guide preventive interventions. The association between ADHD and suicidal ideation did not appear to be influenced by psychiatric comorbidities, but rather by inattention itself, which represents the core symptom of ADHD.

Diagnosis and Treatment of Adults with Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is a mental health diagnosis that affects an individual’s brain development and activity, resulting in inattention and/or hyperactivity-impulsivity that interferes with functioning in many aspects of life. A growing number of adults have a diagnosis of ADHD, with approximately one-third of those being diagnosed in adulthood rather than childhood. Symptoms and treatment of adults with ADHD are different than in the pediatric population. Evidence-based practices on identification, diagnosis, and treatment for adults with ADHD will be explored. Clinicians in primary care must be knowledgeable of treatment for adults with ADHD to meet this growing demand.

Making the most of errors: Utilizing erroneous classifications generated by machine-learning models of neuroimaging data to capture disorder heterogeneity.

Within-disorder heterogeneity complicates mapping the neurobiological features of psychopathology to Diagnostic and Statistical Manual of Mental Disorders conceptualizations. The present study explored the patterns of diagnostic classification errors among disorders with commonly co-occurring features to examine this heterogeneity. Classification analyses were conducted with the University of California, Los Angeles Phenomics Study database using a support-vector classifier to differentiate disorders via whole brain task-based functional connectivity, predicting that model misclassifications would provide insight about brain connectivity characteristics shared across disorders. Whether symptoms and specific brain networks could account for misclassification rates was also explored. The classification model performed better than chance (44% accuracy, p = .01) and revealed that misclassification of schizophrenia (SCZ) as bipolar disorder (BD; 38%) and BD as SCZ (36%) was symmetrical. Attention-deficit/hyperactivity disorder (ADHD) was misclassified as BD at the highest rate (46%) and higher than the converse (17%). SCZ and ADHD were misclassified least (15% SCZ as ADHD and 22% ADHD as SCZ). Considerable variance in misclassification of SCZ as BD (R2 = .83) and BD as SCZ (R2 = .71) could be accounted for by symptoms of both SCZ and BD. Permutation testing revealed disorder- and network-specific effects, with certain networks improving classification accuracy and others hindering it for specific disorders. An approach focused on classification errors replicated known disorder overlap, producing errors in the expected configuration. Further, it identified clinical and neural features within and across diagnostic categories that contribute to disorder misclassification and within-disorder heterogeneity. This approach may facilitate neurobiologically informed phenotypic differentiation within diagnostic groups. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Identifying childhood pesticide exposure trajectories and critical window associated with behavioral problems at 10 years of age: Findings from SMBCS

BackgroundPesticides may impact children’s neurodevelopment. As children’s metabolic function and neural plasticity change throughout their growth and development, the effects of pesticide exposure may also vary. ObjectivesWe aimed to identify the trajectories of combined pesticide exposure during childhood, and examine the associations of the exposure trajectories with children’s neurobehavior at the age of 10. MethodsWe involved repeated measurements of three pesticide metabolites [Pentachlorophenol (PCP), 3,5,6-Trichloro-2-pyridinol (TCPy), and Carbofuran phenol (CFP)], in urine samples collected from children in a cohort study at ages 1, 2, 3, 6, 7, 8, 9, and 10 years. The group-based multi-trajectory model (GBMT) and latent class analysis (LCA) were separately utilized to describe the distinct trajectories and patterns of pesticide mixture exposure during childhood. Meanwhile, the Strengths and Difficulties Questionnaire (SDQ) and attention deficit hyperactivity disorder (ADHD) Criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) list were applied to assess behavioral disorders in children. The associations between exposure trajectories and behavioral problem scores were then examined. ResultsThe GBMT model delineated three distinct trajectories of combined pesticide exposure among children: consistently low, higher levels in early childhood transitioning to lower levels during pre-school age, and lower levels in early childhood followed by higher levels in the middle childhood. The LCA model identified three similar longitudinal exposure patterns. Further, the children in the second trajectory group identified by GBMT, characterized by higher early childhood exposure levels, exhibited significantly elevated hyperactivity/inattention scores of the SDQ compared to the other two groups (β = 0.46, 95 %CI: 0.11, 0.81; β = 0.44, 95 %CI: 0.02, 0.86). ConclusionsOur study revealed that exposure to pesticides during early childhood (especially before the age of two), rather than other age periods, was linked to hyperactivity/inattention problems in children aged 10 years. We also provided a novel perspective on characterizing the fluctuation in repeated measurements of multiple environmental chemicals and identifying the potential critical windows.

Mindfulness, crashes, and risky driving behaviors among adolescents and young adults in the United States

PurposeThe purpose of this study was to examine the association between individual-level mindfulness and a range of risky driving behaviors among U.S. adolescents. MethodsWe conducted a survey of a nationally representative sample of 16–19-year-olds, recruited from the National Opinion Research Center AmeriSpeak panel, a probability-based sample. Participants completed the Mindful Attention Awareness Scale. Risky driving measures were adapted from the Youth Risk Behavior Survey. Spline regression analysis was performed to identify the threshold where mindfulness scores significantly changed driving behaviors. ResultsAfter adjusting for age, gender, and race, adolescents reporting higher mindfulness scores were significantly less likely to engage on all risky driving behaviors and significantly less likely to have been involved in a crash. Spline regression analysis indicated that a mindfulness score of 75 corresponded to the minimum marginal probability change averaged across the outcomes of interest. DiscussionThis paper describes a previously unknown association between mindfulness and risky driving in a vulnerable population which is at higher risk of injury and death from motor vehicle crashes. The strength of the associations across a range of behaviors suggests mindfulness could be a general protective factor for adolescents’ driving behaviors and suggests that mindfulness training may be a promising safety intervention for adolescents. A mindfulness score of 75 could be a potential target for mindfulness training interventions aiming to reduce risky driving behaviors and crashes among teenage drivers.Abbreviations: ADHD, Attention Deficit Hyperactivity Disorder; CI, Confidence Interval; MAAS, Mindful Attention Awareness Scale; NORC, University of Chicago’s National Opinion Research Center; YRBS, Youth Risk Behavior Survey.