Attention Deficit Hyperactivity Disorder Research Articles

Effect of Digital-Based Cognitive Rehabilitation on Executive Functions in Children with Attention Deficit/Hyperactivity Disorder

Background: Attention deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by deficits in executive functions. Objectives: This study aimed to evaluate the effect of digital-based cognitive rehabilitation (DBCR) on executive functions, behavioral regulation, and metacognition in children with ADHD. Methods: A total of thirty male participants, aged 6 - 12 years, who met predetermined inclusion criteria, were selected through a random sampling method. Their parents completed the Behavior Rating Inventory of Executive Function (BRIEF) to assess executive functions. The children were divided into experimental and control groups, with the experimental group undergoing 10 DBCR sessions, while the control group participated in generic computer game sessions. Parents completed the BRIEF after the intervention and again five weeks later. The data were analyzed using SPSS 25. Results: Following DBCR, significant improvements were observed in the total score of executive functions and the Metacognition Index (MI) in children with ADHD. The effect sizes for DBCR on the global executive composite (GEC) and MI were 47% and 37%, respectively, while the effect size for the intervention targeting the Behavior Regulation Index (BRI) was approximately 11%. Conclusions: The study suggests that DBCR positively impacts the GEC and MI in children with ADHD, potentially preventing deficits in these areas. Further research is needed to determine the effectiveness of DBCR on the BRI in children with ADHD.

Comparison of Cold and Cool Cognition in Children With and Without Attention Deficit-Hyperactivity Disorder (ADHD)

ABSTRACT Children with ADHD suffer from impaired attentional, executive, and emotional processing. This study aimed to compare attentional and executive processing using (non)emotional stimuli in children with and without ADHD. Eighty-five children with ADHD and 72 matched typically developing children performed the Stroop, continuous performance, and Go/No-Go tasks using (non)emotional stimuli. Greater performance in selective attention, inhibitory control, and sustained attention was found in emotional stimuli compared to non-emotional stimuli in both groups. Emotional stimuli facilitated attentional and executive functions in children with and without ADHD. Impaired attentional and executive functions in children with ADHD are not valence-sensitive.

Inclusive practice: a study exploring community pharmacists' perspectives, knowledge, and training of Neurodiversity (ND) and the effects on their practice

Abstract Introduction An estimated 1 in 7 people in the UK are neurodivergent, a term encompassing conditions such as autism, attention deficit hyperactivity disorder (ADHD), and other learning differences.1 Neurodivergent individuals have poorer health outcomes, increased risk of premature mortality and reduced access to healthcare.2 The Oliver McGowan case highlighted the need for raising awareness of neurodiversity and mandatory training.2 CPs are uniquely positioned to implement simple adjustments, e.g., adapting communication methods and inclusive pharmacy spaces, consequently reducing health inequalities. CPs’ knowledge, cultural perspectives and current accommodations in their practice for neurodiverse patients must be determined. Aim To explore community pharmacists' perspectives, knowledge and training of neurodiversity and the effects on their practice. Methods A mixed-methods approach was used following ethical approval from Kingston University Ethics Committee. After a pilot study, using random sampling, paper questionnaires comprising 26 mixed-style questions were distributed and collected in person to community pharmacists in East London boroughs within a two-month period. Survey participants were invited for an optional in-person or remote semi-structured interview, conducted using a validated interview guide. The minimum sample size was 129 pharmacists (Raosoft online calculator; 95% confidence interval). Data was analysed using descriptive and inferential statistics, using Microsoft Excel alongside thematic analysis for interview responses. Results Response rate was 80% (n=103/129) and 6 pharmacists participated in interviews. 53% (n=55) were Asian, 21% (n=22) Black, and 19% (n=20) White ethnicity. 52% (n=54) identified as male and 47% (n=48) as female. There was a statistically significant correlation between ethnicity and perception of neurodiversity, with conditions taken less seriously in Asian and Black cultures compared to White culture (p<0.001). White participants were statistically more likely to rate their knowledge as good or above in comparison to Asian or Black participants (p=0.01), with 70% (n=14/20) White participants rating their knowledge as good in comparison to 18% (n=4/22) Black and 29% (n=16/55) Asian participants. 100% (n=103/103) and 94% (n=97/103) participants were able to identify autism and ADHD respectively as neurodiverse conditions but only 20% (n=21/103) and 21% (n=22/103) respectively identified dyspraxia and dyscalculia. 94% (n=97/103) stated no changes were made to accommodate neurodiverse patients with only 3% (n=3/103) offering large-print labels or poster formats and 2% (n=2/103) offering quiet areas. Thematic analysis demonstrated the absence of interventions and awareness was commonly due to systemic barriers and lack of specific training. Participants described diverse cultural attitudes and attached stigma to neurodiversity. Discussion/Conclusion There are significant gaps in knowledge about neurodiversity, possibly linked to a lack of formal training opportunities for CPs. Consequently, minimal adjustments are made to accommodate neurodiverse patients. Changes to pharmacy education and training are needed to develop general understanding, with tools that can be incorporated in pharmacies to aid neurodiverse patients and improve health literacy.2 Simple measures such as ‘quiet hours’ or large-text labels can greatly impact a person’s healthcare experience. However, improvements are required in infrastructure and resources within pharmacies, as well as shifts in cultural attitudes to encourage patients to share their status.3 Study limitations included time constraints and a small but diverse geographical area.

Psychotic-like Experiences and Underlying Mechanisms: An Integrative Model of ADHD Symptoms, Rumination, Negative Affect, and Trauma Experience

Background: Psychotic-like experiences (PLEs) are low-intensity subclinical phenomena, often transient in nature. The etiology of PLEs primarily involves neurodevelopmental changes, trauma exposure, and maladaptive coping styles. Attention-Deficit/Hyperactivity Disorder (ADHD) is considered to be one of the factors that increase the risk of future psychosis. Furthermore, ADHD symptoms predict a heightened incidence of traumatic experiences, ruminative thoughts, and negative affect (NA). This present study examines whether rumination and NA mediate the relationship between ADHD symptoms and PLEs and whether trauma experiences moderate these pathways. Methods: A total of 188 participants (72% female) aged 18–35 completed questionnaires assessing ADHD symptoms and traumatic experiences and took part in a seven-day experience sampling method (ESM) procedure, completing ratings of PLEs experiences, the intensity of ruminations, and NA. Results: Correlation analysis showed significant relationships between all tested variables. Serial mediation analysis revealed a significant indirect effect of rumination and NA in the link between ADHD symptoms and PLEs. There was no significant impact of trauma experience in this relationship. Conclusions: Our study underscores the important role of rumination and NA in the co-development of ADHD symptoms and PLEs. Future research should consider investigating the intra-individual dynamics of ADHD and trauma using ecologically valid research methods in the context of PLEs to better understand these complex relationships.

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.

Attention Deficit Hyperactivity Disorder among Youth at Clinical High Risk of Psychosis

Abstract Background Attention Deficit Hyperactivity Disorder (ADHD) affects a significant proportion of the population and is associated with numerous adverse outcomes including lower educational attainment, occupational challenges, increased substance use, and various mental health issues including psychosis. This study examined the demographic, clinical, cognitive, social cognitive and functional differences between youth at clinical high-risk (CHR) for psychosis with and without co-morbid ADHD. Method Data was drawn from the North American Prodrome Longitudinal Studies (NAPLS2 and NAPLS3), which included 764 and 710 CHR individuals, respectively. After applying exclusion criteria, the sample consisted of 271 CHR participants with ADHD and 1118 without ADHD. All data was examined cross-sectionally. Results Compared to the non-ADHD group, the ADHD group was younger, had more difficulties with role functioning, premorbid functioning, social cognition, were more likely to have a co-morbid learning disorder and reported less depression symptoms. There were no significant differences between the groups on positive or negative psychotic symptoms, transition rates, adverse events, or other co-morbid disorders including substance use and depression. Discussion Co-morbid ADHD is likely not a significant predictor of transition to psychosis among CHR youth, however those CHR with ADHD may experience symptoms at a younger age than those without and present with a distinct clinical profile.

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.

Methylphenidate and Atomoxetine in Pregnancy and Possible Adverse Fetal Outcomes

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.

Change in striatal functional connectivity networks across 2 years due to stimulant exposure in childhood ADHD: results from the ABCD sample.

Widely prescribed for Attention-Deficit/Hyperactivity Disorder (ADHD), stimulants (e.g., methylphenidate) have been studied for their chronic effects on the brain in prospective designs controlling dosage and adherence. While controlled approaches are essential, they do not approximate real-world stimulant exposure contexts where medication interruptions, dosage non-compliance, and polypharmacy are common. Brain changes in real-world conditions are largely unexplored. To fill this gap, we capitalized on the observational design of the Adolescent Brain Cognitive Development (ABCD) study to examine effects of stimulants on large-scale bilateral cortical networks' resting-state functional connectivity (rs-FC) with 6 striatal regions (left and right caudate, putamen, and nucleus accumbens) across two years in children with ADHD. Bayesian hierarchical regressions revealed associations between stimulant exposure and change in rs-FC of multiple striatal-cortical networks, affiliated with executive and visuo-motor control, which were not driven by general psychotropic medication. Of these connections, three were selective to stimulants versus stimulant naive: reduced rs-FC between caudate and frontoparietal network, and between putamen and frontoparietal and visual networks. Comparison with typically developing children in the ABCD sample revealed stronger rs-FC reduction in stimulant-exposed children for putamen and frontoparietal and visual networks, suggesting a normalizing effect of stimulants. 14% of stimulant-exposed children demonstrated reliable reduction in ADHD symptoms, and were distinguished by stronger rs-FC reduction between right putamen and visual network. Thus, stimulant exposure for a two-year period under real-world conditions modulated striatal-cortical functional networks broadly, had a normalizing effect on a subset of networks, and was associated with potential therapeutic effects involving visual attentional control.

Bioequivalence of lisdexamfetamine dimesylate hard capsules formulations

Lisdexamfetamine (LDX), an inactive prodrug of dexamphetamine, is used as a second-line treatment for attention deficit hyperactivity disorder (ADHD) and for moderate to severe binge eating disorder (BED). The objective of this study is to evaluate the bioequivalence of two LDX formulations, including the reference product manufactured by Patheon Pharmaceuticals (Venvanse® 70 mg) versus a formulation manufactured by Eurofarma Laboratórios S/A. A randomized, crossover, open-label study was conducted with two treatments, two periods, two sequences, and 48 healthy participants of both sexes who received oral administration of the medications. A total of 24 blood samples were collected from each participant, from T0 (before taking the medication) to 10 hours later. The plasma concentration of LDX was quantified using liquid chromatography coupled with mass spectrometry (LC-MS/MS). Both formulations were well tolerated, and no serious adverse events were reported. Cmax and AUC0-t were compared: the ratio between the test and reference formulations for Cmax was 106.22% with a 95% confidence interval (CI) of 97.72% - 116.66% and a power of 98.75%. The ratio between the test and reference formulations for AUC0-t was 106.28%, CI (100.68% - 112.19%), with a power of 100.00%. The ratio between the test and reference formulations for AUC0-inf was 106.29%, CI (100.71% - 112.17%), with a power of 100.00%. The formulations were shown to be statistically bioequivalent in terms of their rate and extent of absorption, based on criteria established by the Brazilian Health Regulatory Agency (ANVISA).

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

BackgroundThe 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.MethodsData 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.ResultsThe 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.ConclusionA 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.

Smart Health Monitoring Approach to Diagnose Attention-Deficit Hyperactivity Disorderbased on Real-Time Activity and Heart Rate Variability using Boosting Models

Introduction: Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent chronic mental health condition that significantly impacts the psychological and physical wellbeing of millions of adolescents. Early detection and accurate diagnosis are crucial for effective treatment and mitigating the disorder's adverse effects. Despite extensive research efforts, current methods often fall short in simultaneously accounting for daily motor activity and heart rate variability in ADHD detection. Method: Addressing these gaps, this paper introduces a histogram-based gradient-boosting classifier for analyzing real-time activity and heart-rate variability data to automate ADHD diagnosis. By extracting twelve key features from the data and selecting the most significant ones with the extra tree model, we evaluate these features using various classifiers, including histogram-based gradient boosting, light gradient boosting machine, extreme gradient boosting, gradient boosting, and adaptive boosting. Results: The histogram-based gradient-boosting model, validated through ten-fold crossvalidation, outperforms other classifiers with an accuracy of 99.12%, an F1 measure of 99.12%, and a sensitivity of 99.13%. Additionally, it achieves a specificity of 99.1%, an AUC of 0.9995, and a minimal FDR of 0.88%. These results demonstrate that the proposed approach offers a highly effective and precise solution for automated ADHD diagnosis. Conclusion: The implications of these findings suggest that integrating real-time activity and heart-rate variability data into diagnostic processes can significantly enhance the accuracy and efficiency of ADHD assessment, potentially leading to earlier and more reliable diagnoses, improved patient outcomes, and more tailored treatment strategies.

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