Co-occurring Attention Deficit Hyperactivity Disorder Research Articles

Coping styles in substance use disorder (SUD) patients with and without co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD).

BackgroundPatients with a substance use disorder (SUD) and co-occurring attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) often start using substances in an attempt to cope with the stress related to their ADHD or ASD. To improve treatment for these patient groups, it is important to identify and compare the various coping styles between SUD patients with and without ADHD or ASD and with subjects from a general population sample.MethodsCross-sectional study using the Utrecht Coping List (UCL) in 50 SUD patients, 41 SUD + ADHD patients, 31 SUD + ASD patients and 1,200 railway employees.ResultsCompared with the reference group, all three SUD groups showed a significant higher mean on the Palliative reaction, Avoidance, and Passive reaction subscales of the UCL. The scores for all UCL subscales of the SUD and the SUD + ADHD groups were very similar. However, the SUD + ASD group scored higher on Passive reaction and lower on Reassuring thoughts than the SUD and the SUD + ADHD groups and lower on Expression of emotions subscale in comparison with the SUD + ADHD group.ConclusionsRegardless of the presence of a co-occurring disorder, SUD patients reported more palliative, avoidant and passive coping when confronted than people in the general population. In addition, SUD patients with co-occurring ASD were different from other SUD patients in their coping and professionals should take this into account when working on more adaptive coping strategies with these patients.

Aberrant Behaviors and Co-occurring Conditions as Predictors of Psychotropic Polypharmacy among Children with Autism Spectrum Disorders.

The purpose of this study was to identify rates and predictors of psychotropic medication polypharmacy among Medicaid-eligible children in South Carolina with autism spectrum disorder (ASD) from 2000 to 2008. Population-based surveillance data were linked with state Medicaid records to obtain a detailed demographic, behavioral, educational, clinical, and diagnostic data set for all Medicaid-eligible 8-year-old children (n=629) who were identified and diagnosed with ASD using standardized criteria. Polypharmacy was defined as having interclass psychotropic medication claims overlapping for ≥30 consecutive days at any time during the 2-year study period. Multivariable logistic regression was used to model predictors of any polypharmacy, and for the three most common combinations. Overall, 60% (n=377) used any psychotropic medication, and 41% (n=153) of those had interclass polypharmacy. Common combinations were attention-deficit/hyperactivity disorder (ADHD) medications with an antidepressant (A/AD), antipsychotic (A/AP) or a mood stabilizer (A/MS). Black children had lower odds of any polypharmacy, as did those eligible for Medicaid because of income or being foster care versus those eligible because of disability. There were no significant associations between polypharmacy and social deficits in ASD for any combination, although children with communication deficits diagnostic of ASD had lower odds of any polypharmacy and A/AP polypharmacy. Children with argumentative, aggressive, hyperactive/impulsive, or self-injurious aberrant behaviors had higher odds of polypharmacy, as did children with diagnosed co-occurring ADHD, anxiety or mood disorders, or conduct/oppositional defiant disorder (ODD) in Medicaid records. Future research is warranted to investigate how child-level factors impact combination psychotropic medication prescribing practices and outcomes in ASD.

Children With Conduct Problems and Co-occurring ADHD: Behavioral Improvements Following Parent Management Training

To scale up evidence-based treatment of conduct problems, parent management training, Oregon model (PMTO) has been disseminated throughout Norway. This study examined whether Attention Deficit Hyperactivity Disorder (ADHD) predicted the outcomes of PMTO. Of 253 children and families, 97 were reported to have an ADHD diagnosis. Although different at intake, the groups with and without ADHD had close to an equal change in behavioral status following treatment. Maternal depression and family income predicted the combined group's behavior following PMTO. The study indicates that reductions in conduct problems following PMTO are of the same magnitude in children with or without ADHD. However, some characteristics may differentially predict outcomes for children with combined problems.

Everyday life consequences of substance use in adult patients with a substance use disorder (SUD) and co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD): a patient's perspective.

BackgroundAlthough the prevalence of substance use disorder (SUD) with co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) is relatively high in adult patients, there is hardly any knowledge about these dual diagnoses. A recent study reported met- and unmet needs for several life domains regarding these patient groups. To improve treatment, it is necessary to identify the everyday life consequences of SUD and co-occurring ADHD or ASD in adult patients.MethodsQualitative study using in-depth interviews. 11 SUD + ADHD and 12 SUD + ASD patients participated in the study. The interview transcripts were coded and analysed according to the seven steps for descriptive phenomenology by Colaizzi.ResultsBoth patients with ADHD and patients with ASD can get caught in a jumble of thoughts and emotions which can often lead to agitation and impulsivity in the case of ADHD or passivity and melancholia in the case of ASD with co-occurring SUD in both cases. Initially substance use ameliorates the symptoms and related problems, but both patient groups can later experience even greater problems: difficulties with the structuring of daily life due to a lack of planning (SUD + ADHD) or due to a lack of initiative (SUD + ASD). Both groups indicate that structure helps them function better. They also recognize that substance use disorganizes their lives and that an absence of structure contributes to substance use in what becomes a vicious circle which needs to be broken for effective treatment and care.ConclusionsThis study provides insight into the daily life consequences of SUD with a co-occurring ADHD or ASD. Substance use is reported to solve some ADHD- or ASD-related problems in the short run but have negative consequences in the long run (i.e., contribute to already impaired cognitive functioning). Insight is provided into what clinicians can do to break this vicious circle and thus help ADHD patients to refrain from action and ASD patients to take action.

Continuity in features of anxiety and attention deficit/hyperactivity disorder in young preschool children

Anxiety disorders and attention deficit/hyperactivity disorder (ADHD) develop before school age, but little is known about early developmental pathways. Here we test two hypotheses: first, that early signs of anxiety and ADHD at 18 months predict symptoms of anxiety and ADHD at age 3½ years; second, that emotional dysregulation at 18 months predicts the outcome of co-occurring anxiety and ADHD at age 3½ years. The study was part of the prospective Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. The 628 participants were clinically assessed at 3½ years. Questionnaire data collected at 18 months were categorized into early behavioural scales of anxiety, ADHD, and emotional dysregulation. We investigated continuity in features of anxiety and ADHD from 18 months to 3½ years of age through logistic regression analyses. Anxiety symptoms at 3½ years were predicted by early signs of anxiety (Odds ratio (OR) = 1.41, CI = 1.15–1.73) and emotional dysregulation (OR = 1.33, CI = 1.15–1.54). ADHD symptoms at 3½ years were predicted by early signs of ADHD (OR = 1.51, CI = 1.30–1.76) and emotional dysregulation (OR = 1.31, CI = 1.13–1.51). Co-occurring anxiety and ADHD symptoms at 3½ years were predicted by early signs of anxiety (OR = 1.43, CI = 1.13–1.84), ADHD (OR = 1.30, CI = 1.11–1.54), and emotional dysregulation (OR = 1.34, CI = 1.13–1.58). We conclude that there were modest continuities in features of anxiety and ADHD through early preschool years, while emotional dysregulation at age 18 months was associated with symptoms of anxiety, ADHD, and co-occurring anxiety and ADHD at age 3½ years.

Need for Care and Life Satisfaction in Adult Substance Use Disorder Patients With and Without Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD)

To identify care needs of adult substance use disorder (SUD) patients with and without co-occurring attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). An exploratory study using the European Addiction Severity Index, the Camberwell Assessment of Needs, and the Manchester Short Assessment of Quality of Life to assess and compare care needs and perceived quality of life. All patients are dissatisfied with parts of their existence. SUD patients have fewer care needs than SUD patients with co-occurring ADHD or ASD. The SUD and SUD + ADHD groups report needs in similar domains. The SUD + ASD group shows a greater number of and more extensive care needs. Differences in the care needs of adult SUD patients with and without ADHD or ASD should be taken into account when developing evidence-based nursing care interventions.

A meta-analysis of behavior therapy for Tourette Syndrome

Individual randomized controlled trials (RCTs) of habit reversal training and a Comprehensive Behavioral Intervention for Tics (collectively referred to as behavior therapy, BT) have demonstrated efficacy in reducing tic severity for individuals with Tourette Syndrome and Chronic Tic Disorders (collectively referred to as TS), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified eight RCTs that met inclusion criteria, and produced a total sample of 438 participants. A random effects meta-analysis found a medium to large ES for BT relative to comparison conditions. Participant mean age, average number of therapy sessions, and the percentage of participants with co-occurring attention deficit hyperactivity disorder (ADHD) were found to moderate treatment effects. Participants receiving BT were more likely to exhibit a treatment response compared to control interventions, and identified a number needed to treat (NNT) of three. Sensitivity analyses failed to identify publication bias. Overall, BT trials yield medium to large effects for TS that are comparable to treatment effects identified by meta-analyses of antipsychotic medication RCTs. Larger treatment effects may be observed among BT trials with older participants, more therapeutic contact, and less co-occurring ADHD.

ADHD Symptoms Moderate the Relation Between ASD Status and Internalizing Symptoms in 3–6-Year-Old Children

The current study sought to understand the relation between diagnostic status (autism spectrum disorders [ASD] versus typically developing) and internalizing problems in children with and without co-occurring attention deficit hyperactivity disorder (ADHD) symptoms. Participants were 88 children, ages 3:0-6:11, their parents and teachers. Findings indicated that ADHD symptoms moderated the relation between diagnostic status and depressive and somatic symptoms. High ADHD symptoms in children with ASD were associated with increased depressive and somatic symptoms compared to children with typical development. Findings suggest poor prognostic outcomes for children with ASD and co-occurring ADHD symptoms and highlight the need for early identification and targeted intervention.

Evaluation of a Mindfulness-based Intervention for Adolescents with Learning Disabilities and Co-occurring ADHD and Anxiety

The current study evaluated the impact of a 20-week mindfulness training program on executive function (EF), internalizing and externalizing behavior and social skills in a clinical sample of adolescent boys with learning disabilities (LD). Integra Mindfulness Martial Arts (MMA) is a manualized group treatment program incorporating elements of mindfulness meditation, cognitive behavioral therapy (CBT), behavior modification and mixed martial arts. Adolescents (ages 12–18; n = 60) with LD were assigned to the MMA or wait list control group (WL). Adolescents and their parents completed standardized questionnaires before and after training. Subgroup analyses were conducted to investigate the impact of the intervention on youth with co-occurring attention deficit/hyperactivity disorder (ADHD) or anxiety. Compared to the WL group, MMA participants with co-occurring ADHD (14 MMA, 14 WL) improved on parent-rated externalizing behavior, oppositional defiant problems and conduct problems. Boys with elevated hyperactive/impulsive symptoms (12 MMA, 17 WL) improved on parent-rated social problems and monitoring skills. Boys with elevated inattentive symptoms (15 MMA, 18 WL) improved on parent-rated social problems. Boys with elevated anxiety (12 MMA, 17 WL) reported decreased anxiety. MMA shows promise as an alternative treatment option for youth with LD and co-occurring difficulties.

Impact of attention-deficit/hyperactivity disorder on health-related quality-of-life of specific learning disability children

To evaluate the impact of co-occurring attention-deficit/hyperactivity disorder (ADHD) on the health-related quality of life (HRQOL) of children with newly diagnosed specific learning disability (SpLD). From September 2005 to March 2006, 150 parents (either mother or father) of children consecutively diagnosed as having SpLD were enrolled. The Child Health Questionnaire-Parent Form 50 (CHQ-PF50) was used to measure parent-reported HRQOL. CHQ-PF50 mean domain and summary scores computed for "SpLD/ADHD" and "SpLD only" children groups were compared using Independent Samples t-test. HRQOL of "SpLD/ADHD" children was significantly poorer in four domains: emotional impact on parents (mean difference: -11.0; 95% CI: -18.75--3.25; P = 0.006), general behavior (-9.61; 95% CI: -15.44--3.78; P = 0.002), time impact on parents (-9.51; 95% CI: -18.42--0.60; P = 0.038), and, self esteem (-7.62; 95% CI: -13.98--1.26; P = 0.020); and in overall psychosocial functioning (-5.34; 95% CI: -8.49--2.19; P = 0.001). Co-occurring ADHD adversely impacts the HRQOL of children with newly diagnosed SpLD especially in domains related to their psychosocial functioning.

Methods of Recruiting Adolescents with Psychiatric and Substance Use Disorders for a Clinical Trial

Background: The present article reports on recruiting strategies in a 16-week, multi-site trial of osmotic-release methylphenidate combined with cognitive-behavioral therapy in adolescents with co-occurring attention deficit hyperactivity disorder and substance use disorder. Methods: A multifaceted recruiting strategy was employed that targeted multiple referral sources, used incentives, involved numerous staff members, emphasized the therapeutic alliance during prescreening, and utilized data to modify strategies based on results. Overall, 303 adolescents were randomized from 1,333 total referrals across 11 participating sites. Results: Overall, existing treatment program sources, including treatment program staff, social services, the juvenile justice system, and mental health clinics provided a majority of referrals for pre-screening and randomization. Conclusions and Scientific Significance: These results support the feasibility of recruiting dually-diagnosed adolescents utilizing a multifaceted approach involving the entire study team.

Twelve-Month Outcome of Adolescents With Bipolar Disorder Following First Hospitalization for a Manic or Mixed Episode

Objective: Although adolescent-onset bipolar disorder is associated with significant morbidity, there have been few prospective outcome studies of this population. The aim of this study was to examine the 12-month outcome of bipolar adolescents following an initial hospitalization for a manic or mixed episode. Method: Bipolar adolescents (N=71) were recruited during their first hospitalization for a manic or mixed episode and were evaluated using diagnostic, symptomatic, and functional assessments. Patients were also evaluated at 1, 4, 8, and 12 months after hospitalization to assess syndromic, symptomatic, and functional outcomes. Predictors of each type of outcome were identified. Results: Kaplan-Meier estimates of the cumulative probabilities of syndromal, symptomatic, and functional recovery and syndromic recurrence during the first 12 months following initial hospitalization were 0.86, 0.43, 0.41, and 0.54, respectively. Only 35% of bipolar adolescents reported full medication adherence. Individual predictors of poor syndromic recovery included co-occurring attention deficit hyperactivity disorder (ADHD), anxiety disorders, and disruptive behavior disorders as well as nonadherence to psychotropic medication and lower socioeconomic levels. Co-occurring alcohol use disorders, treatment with antidepressants, and the absence of psychotherapeutic intervention predicted syndromic recurrence. Boys were more than twice as likely as girls to experience symptomatic recovery. Conclusions: Most bipolar adolescents experienced syndromic recovery following their first hospitalization. However, rates of symptomatic and functional recoveries were much lower. Future studies examining effective pharmacological and nonpharmacological treatment strategies for bipolar youth with co-occurring disorders and investigating factors that contribute to the development of substance use disorders and treatment adherence in bipolar youth are necessary to improve outcome.

Twelve-Month Outcome of Adolescents With Bipolar Disorder Following First Hospitalization for a Manic or Mixed Episode

Although adolescent-onset bipolar disorder is associated with significant morbidity, there have been few prospective outcome studies of this population. The aim of this study was to examine the 12-month outcome of bipolar adolescents following an initial hospitalization for a manic or mixed episode. Bipolar adolescents (N=71) were recruited during their first hospitalization for a manic or mixed episode and were evaluated using diagnostic, symptomatic, and functional assessments. Patients were also evaluated at 1, 4, 8, and 12 months after hospitalization to assess syndromic, symptomatic, and functional outcomes. Predictors of each type of outcome were identified. Kaplan-Meier estimates of the cumulative probabilities of syndromal, symptomatic, and functional recovery and syndromic recurrence during the first 12 months following initial hospitalization were 0.86, 0.43, 0.41, and 0.54, respectively. Only 35% of bipolar adolescents reported full medication adherence. Individual predictors of poor syndromic recovery included co-occurring attention deficit hyperactivity disorder (ADHD), anxiety disorders, and disruptive behavior disorders as well as nonadherence to psychotropic medication and lower socioeconomic levels. Co-occurring alcohol use disorders, treatment with antidepressants, and the absence of psychotherapeutic intervention predicted syndromic recurrence. Boys were more than twice as likely as girls to experience symptomatic recovery. Most bipolar adolescents experienced syndromic recovery following their first hospitalization. However, rates of symptomatic and functional recoveries were much lower. Future studies examining effective pharmacological and nonpharmacological treatment strategies for bipolar youth with co-occurring disorders and investigating factors that contribute to the development of substance use disorders and treatment adherence in bipolar youth are necessary to improve outcome.