Elevated ADHD Symptoms Research Articles

Self-rated costs and benefits of conventional and alternative adult ADHD treatments.

Conventional treatments offered by healthcare providers for adult ADHD include pharmacological and non-pharmacological approaches or a combination of both. Both treatment types may have downsides like side effects or low efficacy, potentially leading to treatment dissatisfaction. Also, adults with ADHD explore non-prescribed, complementary and/or alternative medicine (CAM) on their initiative, including substances such as dietary supplements and activities such as physical exercise. This survey study aimed to investigate the types of conventional and CAM treatments adults with ADHD use and their self-rated effectiveness. Also, lifetime experience of negative effects across all treatment types and the motives to use CAM were explored. In total, 227 adults diagnosed with ADHD or reporting clinically elevated ADHD symptoms (without official ADHD diagnosis) were included in the analyses. Both lifetime and current use and experiencing negative effects were highest for conventional pharmacological treatments, followed by CAM activities, CAM substances, and conventional non-pharmacological approaches. The most common reason for using CAM was overall well-being. Conventional treatments were rated more effective in influencing cognition than CAM, but their self-rated effectiveness did not differ in other assessed domains. CAM activities were rated more effective than CAM substances in all assessed domains. This study highlights the high prevalence of CAM use by adults with ADHD, implying that some patients find value in such alternative treatments. Future studies should consider investigating alternative and/or complementary treatments for adult ADHD, alone or in combination with conventional treatments.

Can a mindfulness programme in schools for students with ADHD symptoms improve emotional well-being?

Abstract Background This study employs a cluster randomized controlled trial to investigate the effectiveness of a universal mindfulness-based intervention (MBI) in classrooms in improving emotional well-being and emotion regulation among adolescents with elevated ADHD symptoms. Methods The study comprised 342 students: 164 in an MBI group, 128 in a relaxation control group, and 47 in an inactive control group. Positive and negative emotional states and the emotion regulation strategies of rumination, acceptance, catastrophizing, positive reappraisal, and self-kindness were measured at the pre- (T0) and post-intervention (T9) and the 26-week follow-up (T26). Linear mixed models were used to analyze the intervention effects among all participants and separately by gender and ADHD symptom type. Results The results showed that compared to the controls, there was a beneficial effect on the MBI group concerning acceptance at T9; acceptance remained at the baseline level in the MBI group but decreased in the inactive control group. In contrast, in the inactive control group, rumination decreased at T9, and positive reappraisal increased at T26 compared to the MBI group. The MBI had no detectable effects on self-kindness, catastrophizing, or positive/negative emotional states. Findings on the emotion regulation strategies varied by gender. In boys, the MBI increased acceptance at T9 compared to the inactive control group, whereas in girls, the programme reduced catastrophizing at T9 and T26 compared to the active control group. Contrary in boys, MBI group exhibited less reduction in catastrophizing at T9 compared to the inactive control group. Conclusions Universal MBIs may have some beneficial effects on emotion regulation in adolescents with elevated ADHD symptoms. Both girls and boys might be responsive to universal MBIs as part of the school curriculum, however not all consequences are positive (especially in boys). Key messages • Universal MBIs in classrooms may have some beneficial effects on emotion regulation among adolescent with elevated ADHD symptoms; however, the results are contradictory and more research is needed. • Even though, universal MBIs may have some benefits, they may require modifications to lead to more beneficial effects on emotional well-being when used with this subgroup of students.

Exploring bi-directional impacts of Lisdexamfetamine dimesylate on psychological comorbidities and quality of life in people with Binge Eating Disorder

BackgroundLisdexamfetamine dimesylate (LDX) has demonstrated safety and efficacy for treatment of Binge Eating Disorder (BED). However, to date, trials have not included participants with co-occurring psychiatric disorders. This study explores how LDX affects eating disorder psychopathology, symptoms of common psychiatric comorbidities of BED (ADHD, depression, anxiety), and psychological quality of life, in people with moderate to severe BED.MethodsThese are secondary analyses of an open-label LDX trial conducted in 41 adults (18–40 years) over eight-weeks. Participants received LDX titrated to 50 or 70 mg. Clinical assessments and self-report questionnaires were conducted at baseline and 8-week follow-up.ResultsEating disorder psychopathology and psychological quality of life improved after 8-weeks of LDX. No significant group-level changes in depression, anxiety or ADHD severity scores were observed. However, the majority within the small subsets with elevated depression and ADHD symptoms experienced reduced depressive and inattentive symptom severity, respectively.ConclusionsWe provide proof-of-concept evidence that LDX may provide broader psychological benefits to individuals with BED, beyond reducing their BE frequency. Effects of LDX on anxiety should be monitored closely by clinicians. Early indications suggest that LDX may be effectively used in people with BED, with and without co-occurring psychiatric conditions, however tolerability may be lower in highly complex cases.Trial registration: Australian and New Zealand Clinical Trials Registry (anzctr.org.au) #ACTRN12618000623291.

Sensory Processing in Children and Adolescents with Neurofibromatosis Type 1.

Despite the evidence of elevated autistic behaviors and co-occurring neurodevelopmental difficulties in many children with neurofibromatosis type 1 (NF1), we have a limited understanding of the sensory processing challenges that may occur with the condition. This study examined the sensory profile of children and adolescents with NF1 and investigated the relationships between the sensory profiles and patient characteristics and neuropsychological functioning. The parent/caregivers of 152 children with NF1 and 96 typically developing children completed the Sensory Profile 2 (SP2), along with standardized questionnaires assessing autistic behaviors, ADHD symptoms, internalizing symptoms, adaptive functioning, and social skills. Intellectual functioning was also assessed. The SP2 data indicated elevated sensory processing problems in children with NF1 compared to typically developing children. Over 40% of children with NF1 displayed differences in sensory registration (missing sensory input) and were unusually sensitive to and unusually avoidant of sensory stimuli. Sixty percent of children with NF1 displayed difficulties in one or more sensory modalities. Elevated autistic behaviors and ADHD symptoms were associated with more severe sensory processing difficulties. This first detailed assessment of sensory processing, alongside other clinical features, in a relatively large cohort of children and adolescents with NF1 demonstrates the relationships between sensory processing differences and adaptive skills and behavior, as well as psychological well-being. Our characterization of the sensory profile within a genetic syndrome may help facilitate more targeted interventions to support overall functioning.

Brief Report: Sensory Features Associated with Autism After Controlling for ADHD Symptoms.

Sensory processing differences are reported bothin children with ADHD and in children with autism. Given the substantial overlap between autism and ADHD, the current study examined which sensory features were uniquely predictive of autistic traits after controlling for ADHD symptoms, age, IQ, and sex in a sample of children and adolescents with autism aged 6-17 years. The sample included 61 children and adolescents with autism. The Sensory Profile was used to examine Dunn's quadrant model (seeking, sensitivity, avoiding, registration), ADHD symptoms were measured using hyperactivity and attention problems BASC-2 T-scores, and autistic traits were measured using the AQ. After controlling for age, IQ, sex, and ADHD symptoms, Dunn's sensitivity quadrant predicted autistic traits. Findings provide insight into the phenotype of autism and ADHD. Sensory sensitivity may be unique to autism over and above elevated ADHD symptoms that are commonly seen in this population.

Indirect effect of ADHD on parenting stress through increased child anxiety and decreased emotional regulatory coping.

Parents of children with ADHD experience significantly more parenting stress in comparison to parents of typically developing children due to the emotional and behavioral difficulties related to ADHD. Additionally, approximately 30% of children with ADHD experience co-occurring anxiety. Parents of children with co-occurring anxiety and ADHD report increased stress due to role restriction and isolation compared to parents of children with ADHD alone. Poor emotional regulatory coping in children with ADHD has been linked to elevated negative affect and irritability, which also contributes to increased stress among parents. The present study examined the direct and indirect associations of child anxiety symptoms and emotional regulatory coping on elevated ADHD symptoms and parenting stress. Participants were 203 children aged 7-12-years-old and their parents. Parents completed a self-report measure of parenting stress and measures of their child's ADHD symptoms, anxiety, and emotional regulatory coping. Additionally, children completed self-report measures of emotional regulatory coping. Model testing indicated that the overall model demonstrated excellent fit to the data. Parameter testing supported an indirect effect of child ADHD symptoms on parenting stress through child anxiety symptoms and an indirect effect of child ADHD symptoms on parenting stress through child emotional regulatory coping. These results suggest that child anxiety and emotion dysregulation in children with ADHD have a negative impact on parental stress. The current study adds to the understanding of the important roles emotional regulatory coping and anxiety play in children with ADHD to contribute to increased parenting stress.

Retrospective Report of Academic Motivation Among College Students With Elevated ADHD Symptoms

Objective: Children with ADHD exhibit deficits in academic motivation compared to their peers. Yet conceptualizations of motivation according to prominent motivation theories connected to achievement have not been studied in college-bound youth with ADHD symptoms. Method: This study examined motivation according to these theories, differences in motivation by ADHD symptoms, and how the cross-sectional association between motivation and achievement varies by ADHD symptoms. The sample included 461 first-year college students retrospectively reporting their motivation and achievement in their last year of high school. Results: Results indicated differences in motivation by ADHD symptoms. Mastery achievement goal orientation was uniquely associated with achievement and exerted beneficial effects on achievement at moderate to high ADHD symptom levels. Conclusion: Motivation may operate differently in association with achievement for college-bound youth with ADHD symptoms compared to youth with no to low symptoms.

Low standards yet disappointed: ADHD symptoms and experiential avoidance in college students

The literature suggests that ADHD symptoms are associated with experiential avoidance (EA), but little is known about factors that explain this relation. The present study examined indirect effects of ADHD symptoms on EA via perfectionism in a sample of 3720 undergraduates who completed an online survey. Results showed that perfectionism partially explained the relation between ADHD symptoms and EA, yet the direction of findings differed when examining different elements of perfectionism. Specifically, ADHD symptoms predicted higher Discrepancy scores, but lower Standards and Order scores. This suggests that undergraduates with elevated ADHD symptoms do not strive towards orderliness or hold themselves to overly high standards, yet judge themselves harshly for falling short of their expectations. Targeting this harsh judgment through the use of cognitive-behavioral, or acceptance and commitment therapy may be beneficial for undergraduates with elevated symptoms of ADHD.

Antecedents and Consequences of Child Externalizing Problems: Differences in Dynamic Parent–Child Processes

Given that noncompliance is the most common externalizing problem during middle childhood and reliably predicts significant conduct problems, innovations in elucidating its etiology are sorely needed. Evaluation of in-the-moment antecedents and consequences of child noncompliance improves traction on this goal, given that multiple theories contend that child noncompliance and parent behavior mutually influence each other through negative reciprocation as well as contingent praise processes. Among a sample of 140 families (child age: 6–10 years; 32.1% female), the present study capitalized on intensive repeated measures of observed child noncompliance and parent negative talk and praise objectively coded during three unique tasks. We employed dynamic structural equation modeling to evaluate within-dyad parent–child behavioral dynamics and between-dyad differences therein. Results provided mixed support for hypotheses and suggested that antecedents and consequences of child noncompliance differed according to task demands and child ADHD symptoms. Contrary to models of coercive cycles, during child-led play, parent negative talk was more likely following prior child noncompliance, but child noncompliance was less likely following prior parent negative talk. As expected, during parent-led play, parent praise was less likely following prior child noncompliance, which was also less likely following prior parent praise. Relative to youth with fewer symptoms, for children with elevated ADHD symptoms, during a challenging clean-up task, child noncompliance was less stable and less contingent on prior parent negative talk. Results are discussed in terms of their implications of real-time parent–child interactions for typical and atypical development of externalizing problems.

A Dynamical Systems Investigation of the Co-regulation between Perceived Daily Parental Warmth and Adolescent Attention-deficit/hyperactivity Disorder Symptoms.

Longitudinal research demonstrates that child ADHD symptoms and behaviors exhibit reciprocal associations with parenting behaviors over time. However, minimal research has investigated these associations and their dynamic links at the daily level. Intensive longitudinal data can disentangle stable between-person differences from within-person fluctuations and reveal nuanced short-term family dynamics on a micro timescale. Using 30-day daily diary data from a community sample of 86 adolescents (Mage = 14.5, 55% female, 56% White, 22% Asian) and latent differential equation modeling, this study examined the links between perceived daily parental warmth and ADHD symptoms as coupled dynamical systems. The results show that the magnitude of fluctuations in perceived daily parental warmth generally remains stable, while elevated ADHD symptoms return to their normal level over time. Perceived parental warmth is sensitive to change in ADHD symptoms such that adolescents feel that their parents will fine-tune their warmth with gradual changes when adolescents demonstrate heightened symptoms. There are substantial between-family differences in these regulating system dynamics. Among families with more baseline parental non-harsh discipline, both perceived parental warmth and ADHD symptoms tend to be more stable and fluctuate less often. Intensive longitudinal data and dynamical systems approaches offer a new lens to uncover short-term family dynamics and adolescent adjustment at a refined micro level. Future research should explore antecedents and consequences of between-family differences in these short-term family dynamics on multiple timescales.

3.52 Hyperfocus or Flow? Attentional Strengths in ASD

ASD is associated with elevated ADHD traits and symptoms as well as strengths in attention. In the ASD literature, attentional strengths have been described as maladaptive (eg, hyperfocus) in contrast with positive portrayals in the typically developing (TD) population (eg, flow). The objectives of this study were to: 1) compare profiles of attentional strengths and weaknesses in ASD and ADHD; and 2) determine whether attentional strengths in ASD are associated with impairment, difficulties with task switching, and perseveration/perfectionism.

Training inhibitory control in adolescents with elevated attention deficit hyperactivity disorder traits: a randomised controlled trial of the Alfi Virtual Reality programme

IntroductionAttention deficit hyperactivity disorder (ADHD) is characterised by significant deficits in attention and inhibition. These deficits are associated with negative sequelae that emerge in childhood and often continue throughout adolescence....

Does Child Anxiety Exacerbate or Protect Against Parent-Child Relationship Difficulties in Children with Elevated ADHD Symptoms?

Pediatric ADHD is associated with parent–child relationship difficulties. However, the extent to which these relations are attributable to specific ADHD symptom clusters (i.e., inattentive vs. hyperactive/impulsive), and the extent to which child anxiety symptoms may exacerbate or protect against these difficulties, remains unclear. To address these gaps in the literature, the current study combined multi-informant measures (parent, teacher, child) with a clinically-evaluated and carefully-phenotyped sample of 188 children with and without ADHD and anxiety (ages 8–13; 63 girls). Results indicated that child-reported anxiety (β = .46) and teacher-reported inattentive (β = .71) symptoms, and their interaction (β = -1.06), along with child age and IQ (β = -.14 to -.15), predict the extent to which parents perceive themselves as confident and competent parents (all p < .05). In contrast, only comorbid oppositional-defiant disorder conferred risk for increased parent-reported relational frustration, and we were unable to detect any reliable child-level demographic, diagnostic, or behavioral predictors of parent-reported discipline practices. These findings were robust to control for child demographic characteristics, clinical diagnoses, and intellectual functioning, with sensitivity analyses highlighting the importance of assessing ADHD inattentive vs. hyperactive/impulsive symptoms separately for understanding parenting outcomes. Taken together, the current findings suggest that child ADHD and anxiety symptoms may influence specific rather than broad-based aspects of the parent–child relationship, and produce differently valenced outcomes in the presence vs. absence of the other condition. Interestingly, it appears that the combination of greater child inattention and anxiety, rather than elevations in either symptom domain independently, predict adverse parenting outcomes in terms of reduced parental confidence.

Examining the effects of ADHD symptoms and parental involvement on children’s academic achievement

ObjectiveOur understanding of the role of parental involvement in academic outcomes for children with ADHD is limited, with mixed evidence suggesting a positive association between parental involvement and academic achievement for pediatric ADHD but limited evidence regarding how this varies based on ADHD symptom severity, ADHD symptom domains, or co-occurring ODD symptoms. In this context, the present study aimed to examine the effects of parental involvement, ADHD symptoms, and comorbid ODD on children’s overall, reading, and math achievement. MethodA well-characterized clinically-evaluated sample of 162 children recruited through a university-based children’s learning/behavioral health clinic and community resources (ages 8–13; 50 girls; 69% Caucasian/Non-Hispanic) were administered standardized academic achievement tests, with parents and teachers completing measures of parental involvement and ADHD symptoms, respectively. ResultsInattention, but not hyperactivity-impulsivity, was associated with lower academic achievement in all tested models (β= -.16 to -.22, all p < .03). Surprisingly, parental involvement had significant negative associations with math and overall academic achievement (β= -.13 to -.26, both p< .05) and did not moderate the relations between ADHD symptoms and academic achievement in any tested model. Comorbid ODD symptoms did not significantly predict academic achievement or interact with parental involvement in any tested model. These findings were robust to control for child IQ, age, sex, SES, anxiety, and depression. ConclusionParental involvement may not serve as a protective factor against academic underachievement for children with clinically elevated ADHD symptoms, and may predict lower rather than higher academic achievement for clinically evaluated children in general.

How effective is fine motor training in children with ADHD? A scoping review

BackgroundMotor deficiencies are observed in a large number of children with ADHD. Especially fine motor impairments can lead to academic underachievement, low self-esteem and frustration in affected children. Despite these far-reaching consequences, fine motor deficiencies have remained widely undertreated in the ADHD population. The aim of this review was to systematically map the evidence on existing training programs for remediating fine motor impairments in children with ADHD and to assess their effectiveness.MethodsThe scoping review followed the PRISMA-ScR guidelines. In March 2020, PsycINFO, MEDLINE (PubMed), Web of Science, Google Scholar and The Cochrane Database of Systematic Reviews were searched for evidence. The eligibility criteria and the data charting process followed the PICO framework, complemented by study design. The investigated population included children with a formal ADHD diagnosis (either subtype) or elevated ADHD symptoms aged between 4 and 12 years, both on and off medication. All training interventions aiming at improving fine motor skills, having a fine motor component or fine motor improvements as a secondary outcome were assessed for eligibility; no comparators were specified.ResultsTwelve articles were included in the final report, comprising observational and experimental studies as well as a review. Both offline and online or virtual training interventions were reported, often accompanied by physical activity and supplemented by training sessions at home. The training programs varied in length and intensity, but generally comprised several weeks and single or multiple training sessions per week. All interventions including more than one session were effective in the treatment of fine motor deficiencies in children with ADHD and had a wide range of additional positive outcomes. The effects could be maintained at follow-up.ConclusionsFine motor training in children with ADHD can be very effective and multiple approaches including specific fine motor and cognitive training components, some kind of physical activity, feedback mechanisms, or multimodal treatments can be successful. Training programs need to be tailored to the specific characteristics of the ADHD population. A mHealth approach using serious games could be promising in this context due to its strong motivational components.

Temperament Traits Mark Liability for Coexisting Psychiatric Symptoms in Children With Elevated ADHD Symptoms

Objective: Among children with ADHD, coexisting psychiatric disorders are common and associated with greater impairment and symptom persistence. Given that temperament traits are easily measured, developmentally stable, and variable among youth with ADHD, temperament profiles may be clinically useful for predicting liability for coexisting psychiatric symptoms in this population. Methods: Eighty-three children with ADHD symptoms participated. Caregivers rated their child’s surgency, negative emotionality, and effortful control, as well as severity of internalizing and externalizing psychiatric symptoms. Hierarchical linear regressions were conducted to estimate associations between temperament traits and psychiatric symptoms, controlling for severity of ADHD. Results: Temperament ratings explained significant variance in psychiatric symptoms above and beyond ADHD symptoms alone. Symptoms of each coexisting psychiatric disorder was associated with a distinct temperament and ADHD symptom profile. Conclusion: Temperament ratings appear to have clinical utility for predicting coexisting psychiatric symptoms in children with elevated ADHD symptoms.

The Differential Effect of Anxiety and ADHD Symptoms on Inhibitory Control and Sustained Attention for Threat Stimuli: A Go/No-Go Eye-Movement Study

Objective: This study examined the synergistic effects of ADHD and anxiety symptoms on attention and inhibitory control depending on the emotional content of the stimuli. Method: Fifty-four typically developing individuals (27 children/adolescents and 27 adults) completed an eye-movement based emotional Go/No-Go task, using centrally presented (happy, angry) faces and neutral/symbolic stimuli. Sustained attention was measured through saccade latencies and saccadic omission errors (Go trials), and inhibitory control through saccadic commission errors (No-Go trials). ADHD and anxiety were assessed dimensionally. Results: Elevated ADHD symptoms were associated with more commission errors and slower saccade latencies for angry (vs. happy) faces. In contrast, angry faces were linked to faster saccade onsets when anxiety symptoms were high, and this effect prevailed when both anxiety and ADHD symptoms were high. Conclusion: Social threat impacted performance in individuals with sub-clinical anxiety and ADHD differently. The effects of anxiety on threat processing prevailed when both symptoms were high.

Do ADHD Symptoms and Relationship Quality With Mothers and Best Friends Across High School Predict Depressive Symptoms for Adolescents?

Objective: Symptoms of ADHD place adolescents at increased risk for depression. The transition from middle to high school may magnify depression risk. This study examined whether changes in adolescents’ negative relationship quality with their mothers and best friends from eighth to 12th grades mediated the longitudinal relations between ADHD and depressive symptoms. Method: 368 adolescents (48.5% male) were initially recruited. Results: Boys with elevated ADHD symptoms in the eighth grade reported steeper increases in negative relationship quality with their mothers relative to girls, and that this trajectory mediated the relation between ADHD and depressive symptoms. ADHD symptoms were also associated with increases in negative friendship quality across high school for boys; however, this did not mediate the relation between ADHD and depressive symptoms for either sex. Conclusion: Growth in mother–adolescent negative relationship quality may be one mechanism that explains the development of depressive symptoms in adolescent boys with elevated ADHD symptoms.

Cognition, ADHD Symptoms, and Functional Impairment in Children and Adolescents With Neurofibromatosis Type 1

Objective: We examined the contribution of attention and executive cognitive processes to ADHD symptomatology in NF1, as well as the relationships between cognition and ADHD symptoms with functional outcomes. Methods: The study sample consisted of 141 children and adolescents with NF1. Children were administered neuropsychological tests that assessed attention and executive function, from which latent cognitive variables were derived. ADHD symptomatology, adaptive skills, and quality of life (QoL) were assessed using parent-rated questionnaires. Path analyses were conducted to test relationships among cognitive functioning, ADHD symptomatology, and functional outcomes. Results: Significant deficits were observed on all outcome variables. Cognitive variables did not predict ADHD symptomatology. Neither did they predict functional outcomes. However, elevated ADHD symptomatology significantly predicted functional outcomes. Conclusion: Irrespective of cognitive deficits, elevated ADHD symptoms in children with NF1 negatively impact daily functioning and emphasize the importance of interventions aimed at minimizing ADHD symptoms in NF1.

Factors Associated with Parental Treatment Attitudes and Information-Seeking Behaviors for Childhood ADHD

Objective: Despite the association between childhood ADHD and long-term negative outcomes, there is a significant delay to treatment and a low rate of lifetime treatment contact for individuals with ADHD. Method: The current study examined (a) variables associated with parental treatment-seeking attitudes and information-seeking behaviors and (b) the relationship between these attitudes and behaviors in 87 non–treatment-seeking parents whose children had elevated ADHD symptoms. Results: Regressions indicated that attitudes toward ADHD treatment were associated with ADHD knowledge and misconceptions (ps < .01), susceptibility to ADHD stigma (p < .001), and satisfaction with past providers (ps < .01). Experience with past providers was significantly associated with information-seeking behavior (ps < .01). Conclusion: Parental knowledge of ADHD, low levels of stigma, and positive experiences with past providers were the strongest predictors of positive attitudes about ADHD treatment. Experience with past providers was the only factor related to treatment-seeking behavior. These results offer avenues to decreasing barriers to treatment in pediatric ADHD.