Higher Levels Of Attention-deficit/hyperactivity Disorder Symptoms Research Articles

Unraveling the relationship between executive function and mind wandering in childhood ADHD

ABSTRACT Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in children. According to developmental literature findings, there is a link between executive function (EF) and ADHD. Although EF deficits vary across ADHD presentations in children, working memory capacity is commonly associated with attention impairments. Notably, deficits in working memory capacity are also observed in frequent mind wandering reports for typically developing children. Mind wandering is shifting attention away from a current task to an unrelated thought. To explore the relationship between EF and mind wandering in children with ADHD (n = 47) and further compare our current sample to a typically developing (control) group from a previous study (n = 47), all participants completed three EF-related tasks. They concurrently reported if they were on task or mind wandering. Our results indicate better short-term memory capacity predicted lower mind wandering frequency in children who reported high levels of ADHD symptoms. Similar trends were observed for working memory capacity and ADHD symptomatology. Children with ADHD also reported more overall and unintentional mind wandering on questionnaires compared to children without ADHD. However, the relationship between EF and mind wandering did not differ between these groups. The current study suggests memory-related cognitive abilities may inform our understanding and management of mind wandering in children, driving the development of interventions targeting attention regulation.

Are Family Factors Differentially Associated with Externalizing Symptoms Among Youth with Perinatally Acquired HIV?

Youth with perinatally-acquired HIV (PHIV) face unique psychosocial stressors. They are at risk for externalizing problems, including symptoms of oppositional defiant disorder, conduct disorder (CD), and attention-deficit/hyperactivity disorder (ADHD), as well as risk-taking behaviors, such as substance use (SU). Although family factors have been differentially associated with externalizing and SU behaviors based on youth sex in prior research, there is a dearth of literature considering these processes among youth with PHIV. Participants included 314 youth with PHIV (M = 12.88years, SD = 3.08years; 50.80% male; 85.30% Black or Latinx). Boys exhibited higher levels of ADHD symptoms than girls. Among boys, lower levels of consistency in discipline were associated with higher CD symptoms. Lower levels of family cohesion were associated with higher levels of SU among girls, and higher levels of CD symptoms across youth sex. Findings support the need for family-focused behavioral interventions among youth with PHIV.

Triarchic traits as risk versus protective factors for ADHD symptomatology: A prospective longitudinal investigation.

Attention-deficit/hyperactivity disorder (ADHD) symptoms are associated with myriad adverse outcomes, including interpersonal difficulties, but factors that moderate the developmental course and functional impact of ADHD over time are not well understood. The present study evaluated developmental contributions of the triarchic neurobehavioral traits (boldness, meanness, and disinhibition) to ADHD symptomatology and its subdimensions from adolescence to young adulthood. Participants were twins and triplets assessed at ages 14, 17, and 19 (initial N = 1,185, 51.2% female). Path analyses using negative binomial regression revealed that boldness at age 14 was associated with more ADHD symptoms cross-sectionally (especially hyperactivity/impulsivity), but fewer symptoms (especially inattention) at age 19 in the prospective analysis. Notably, inclusion of interpersonal problems at ages 14 and 17 as covariates reduced the latter effect to nonsignificant. Disinhibition concurrently and prospectively predicted higher levels of ADHD symptoms, including both subdimensions, and the prospective effects were partially mediated by greater social impairment at age 17. Meanness prospectively (but not concurrently) predicted higher levels of hyperactivity/impulsivity symptoms. Sex moderated certain associations of meanness and disinhibition with ADHD symptoms. These findings highlight how fundamental neurobehavioral traits shape both psychopathology and adaptive outcomes in the developmental course of ADHD.

34 Attention-Deficit/Hyperactivity Disorder, Emotion Regulation, and Executive Functioning Associated with Educational and Occupational Outcomes in Adults

Objective:While attention-deficit/hyperactivity disorder (ADHD) symptoms, including inattention, hyperactivity, and impulsivity, are normally distributed within the population, features of ADHD have been associated with poor functional outcomes across various domains of life, such as academic achievement and occupational status. However, some individuals with even strong ADHD features show normal or above-average success within these functional domains. Executive dysfunction and emotion regulation abilities are associated with educational attainment and occupational status and may therefore explain some of the heterogeneity in functional outcomes in individuals with mild, moderate, and high levels of ADHD symptoms. In this study, we investigated whether emotion regulation strategy use (i.e., emotion suppression or cognitive reappraisal) and executive function abilities moderate the relationship between ADHD symptoms and occupational status and education attainment in adults.Participants and Methods:Data were collected from 109 adults aged 18 - 85 (M = 38.08, SD = 15.54; 70.6% female) from the Nathan Kline Institute Rockland Sample. All participants completed measures of ADHD symptoms (Conners Adult ADHD Rating Scale), emotion regulation strategy use (Emotion Regulation Questionnaire), and executive functioning (composite scores of inhibition, shifting and fluency from the standardized Delis-Kaplan Executive Function System). In this study, executive function abilities and emotion regulation strategy use were tested as potential moderators of the relationship between ADHD symptoms and functional outcomes using hierarchical regression models.Results:Several two- and three-way interactions predicting occupational status and educational attainment were observed. Education attainment was predicted by hyperactivity and reappraisal (ß = -0.26, p = .006); inattention, shifting, and reappraisal (ß = -0.52, p = .029); inattention, shifting, and suppression (ß = -0.40, p = .049); inattention, fluency, and reappraisal (ß = 0.24, p = .038); hyperactivity, fluency, and reappraisal (ß = 0.27, p = .034); and impulsivity, fluency, and reappraisal (ß = 0.44, p = .004). Occupational status was predicted by inattention and reappraisal, (ß = -0.27, p = .032), hyperactivity and reappraisal (ß = -0.26, p = .004); and impulsivity, fluency, and reappraisal (ß = 0.35, p = .031). Fluency was positively associated with educational attainment when controlling for inattention and impulsivity.Conclusions:Consistent with the hypothesis, the association between ADHD symptoms and both occupational status and educational attainment were moderated by the interaction between emotion regulation strategy use, executive function abilities domains. The observed interactions suggest that both occupational status and educational attainment may depend heavily on one’s intrinsic abilities and traits. Contrary to previous literature, we found no evidence that ADHD symptoms, emotional regulation strategies were independently associated with either educational attainment or occupational status, but this should be validated in a sample with greater representation of adults with clinically significant ADHD.

Evaluation of a pilot physical activity intervention for children with ADHD symptoms and reading difficulties

AbstractPhysical activity (PA) benefits children's cognition, in particular executive functions (EF). Children with Attention Deficit Hyperactivity Disorder (ADHD), Reading Difficulties (RD) and co‐occurring ADHD/RD have low levels of PA and difficulties with EF. This study evaluated a PA programme to determine recruitment, attrition, feasibility (e.g. in‐school or after‐school hours), intensity of PA during the programme and effect sizes. Outcomes evaluated were EF, academic attainment and social and emotional behaviour. Sixty‐nine children (35 males) aged 7–13 years participated in a delayed control design. The sample comprised 15 children with RD, 15 with high levels of ADHD symptoms, 15 with co‐occurring RD and ADHD symptoms and 24 typically developing children. Thirty‐one of the participants took part in a 12 week PA intervention designed to enhance cognition and 38 acted as a control group. The control group subsequently received the intervention and data was combined for analysis. The study was successful in recruiting participants for the intervention; more success was observed for in‐school than after‐school hours. Participants spent 46% (SD = 14) of the intervention in Moderate‐to‐Vigorous intensity PA (MVPA). A significant effect of time‐point (pre‐ vs. post‐intervention) was found for inhibition and visuospatial working memory (η2 = 0.11 and 0.18 respectively). There was no interaction with symptomatology though; all groups had higher scores on EF tasks after the intervention. It is possible to recruit and retain participants with ADHD symptoms and reading difficulties to a school‐based PA programme and adherence to measurements was good. Taking part in the programme may improve inhibition and visuospatial working memory and reduce symptomatology suggesting this is a potential source of remediation which should be explored.

Attention deficit hyperactivity disorder symptoms and lifetime use of psychoactive substances among French university students: A cross-sectional study

In a cross sectional study of 13,837 university students, we aimed to explore the association between attention deficit hyperactivity disorder (ADHD) symptoms and lifetime psychoactive substance use (LPSU) on a wide range of illicit substances. Logistic and Hurdel multivariable regressions were used. ADHD symptoms were significantly associated with the lifetime use of ketamine, magic mushrooms, poppers, and nine other psychoactive substances. There was an association between ADHD symptoms and both LPSU and truncated count of lifetime psychoactive substance use. High levels of ADHD symptoms are associated with the use of a large variety and multiple LPSU.

Adult ADHD and internet addiction among undergraduate medical college students

Attention-deficit /hyperactivity disorder (ADHD) was originally defined in children but is now recognized to persist into adulthood or is independently diagnosed in some adults. It is associated with impairment across multiple domains, including home, college and, work and can lead to excessive internet usage, social withdrawal, substance abuse disorders, fatigue, job loss, mood changes, and distress. To look for adult ADHD and Internet Addiction among undergraduate medical college students. Designed as a cross-sectional study conducted on undergraduate medical college students. This is a cross-sectional study involving 501 undergraduate medical college students between 18-25 years of age. The Adult ADHD Self-report scale (ASRSv1.2) was applied to screen for adult ADHD. Young’s internet addiction scale (IAT) was applied to look for internet addiction. Statistical analysis was done using SPSS version 25. The mean age of the participants was 20.3 years. Most of the participants (54.9%) who screened positive for adult ADHD belonged to the younger age group (20-21 years). Mild internet addiction was seen in 34.5% of the participants, moderate in 6.4%, severe in 0.2 % and 58.9% had no internet addiction. Students who had screened positive for adult ADHD reported more addictive tendencies. Higher levels of ADHD symptoms were associated with increased Internet addiction among undergraduate medical college students. This study shows that adult ADHD can be one of the reasons leading to internet addiction among students. An understanding of the magnitude of the problem is essential for early screening and timely psychiatric intervention for the better functional outcome for the students.

An examination of the effects of ADHD symptoms and sex on the relation between cannabis protective behavioral strategies and cannabis consequences

The risk for cannabis-related problems is elevated among young adults with attention-deficit/hyperactivity disorder (ADHD) symptoms. It is unknown whether the use of cannabis protective behavioral strategies (PBS) mitigates this risk for college students with ADHD. Prior research finds that college students who use alcohol and report high levels of ADHD symptoms particularly benefit from employing alcohol PBS, and these relations are strongest for male students. Thus, this study examined the moderating effects of ADHD symptoms and sex assigned at birth on the relation between cannabis PBS use and cannabis-related problems among college students who use cannabis. Participants were 384 college students (66.9% female, 57.8% white non-Hispanic, Mage = 19.29) from 12 United States universities who reported past-month cannabis use. Participants completed measures of demographics, ADHD symptoms, past-month cannabis frequency and related problems, and cannabis PBS use via an online survey. There was a significant interaction of ADHD hyperactive/impulsive symptoms, PBS use, and sex on cannabis-related problems, controlling for cannabis use frequency. The strength of the negative association between PBS use and problems depended on level of ADHD symptoms for females, but not for males. However, there were no interactive effects for ADHD inattentive symptoms. These results supplement the literature base on relations between PBS use and ADHD symptoms in college students, extending support for their use to cannabis users. Importantly, promoting PBS use to female college students who are high in hyperactive/impulsive ADHD symptoms is recommended.

Exploring the effect of ADHD traits on the moment-to-moment interplay between provocation and aggression: Evidence from dynamic structural equation modeling.

The relation between attention deficit hyperactivity disorder (ADHD) symptoms and aggression is well documented; however, the processes that account for higher levels of aggression associated with ADHD in the course of daily life are little understood. The current study used ecological momentary assessment to explore how ADHD traits relate to individual differences in perceiving provocation from others and the resultant aggressive behaviors; and the strengths of the links between provocation and aggression in the flow of daily life. A dynamic structural equation model was fit using data from a subpopulation of young adults involved in the longitudinal z-proso study (n = 259, median-age 20). Data on provocation and aggression was collected at four quasi-random time periods per day over a 14-day period. Individuals with higher ADHD trait levels reported higher instances of provocation and aggression, with ADHD traits significantly moderating aggression inertia such that those with higher levels of ADHD traits showed greater persistence of aggressive behavior over time. However, ADHD trait levels did not significantly moderate any of the observed cross-lagged effects. Our findings suggest that individuals with higher levels of ADHD traits are at greater risk of exposure to interpersonal interactions involving interpersonal provocation, show higher levels of aggressive behavior in daily life, and find it more difficult to reduce their aggression once triggered. These findings support the importance of targeting factors such as social skills and emotion regulation that may underpin the increased difficulties in interpersonal interactions often experienced by individuals with high levels of ADHD symptoms.

Concordance between the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and Clinical Assessment of Attention Deficit-Adult (CAT-A) over-reporting validity scales for detecting invalid ADHD symptom reporting

This study investigated the relationship between symptom validity scales on the Clinical Assessment of Attention Deficit-Adult (CAT-A) and the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in the context of Attention-Deficit/Hyperactivity Disorder (ADHD) evaluation. The sample comprised 140 consecutive patients referred for a neuropsychological evaluation of ADHD and were administered the CAT-A and the MMPI-2-RF and a battery of performance-based neurocognitive tests. Results indicated CAT-A/MMPI-2-RF symptom validity concordance of 51% between measures, with 38% concordant valid and 13% concordant invalid responses. Among those with discordance symptom validity results, rates of valid CAT-A/invalid MMPI-2-RF responding (41%) were more common than invalid CAT-A/valid MMPI-2-RF responding (8%). Results also indicated higher levels of ADHD symptoms among invalid responding within the CAT-A, whereas the MMPI-2-RF Cognitive Complaints scale did not differ by CAT-A validity status. Finally, symptom validity scales on both the CAT-A and MMPI-2-RF were largely discordant from neuropsychological test validity status per performance validity tests. Findings highlight the need for symptom validity testing when assessing ADHD and indicate that validity indices on broad personality assessments may assess different constructs than embedded validity indices in ADHD-specific measures.

Phasic Versus Tonic Irritability: Differential Associations With Attention-Deficit/Hyperactivity Disorder Symptoms

Irritability is a multifaceted construct in pediatric psychopathology. It has been conceptualized as having a phasic dimension and a tonic dimension. Disruptive mood dysregulation disorder is defined by the presence of both dimensions. Severe irritability, or disruptive mood dysregulation disorder, is highly comorbid with attention-deficit/hyperactivity disorder (ADHD). However, it is unknown whether the presence of ADHD modulates the expression of phasic and tonic irritability. A data-driven, latent variable approach was used to examine irritability and ADHD symptoms in a transdiagnostic pediatric sample (N= 489) with primary disruptive mood dysregulation disorder, ADHD, subclinical irritability symptoms, or no diagnosis. Using latent profile analyses, we identified 4 classes: high levels of both irritability and ADHD symptoms, high levels of irritability and moderate levels of ADHD symptoms, moderate levels of irritability and high levels of ADHD symptoms, and low levels of both irritability and ADHD symptoms. Confirmatory factor analysis operationalized phasic irritability and tonic irritability. As expected, the 2 latent classes characterized by high overall irritability exhibited the highest levels of both phasic and tonic irritability. However, between these 2 high irritability classes, highly comorbid ADHD symptoms were associated with significantly greater phasic irritability than were moderately comorbid ADHD symptoms. In contrast, the 2 high irritability groups did not differ on levels of tonic irritability. These findings suggest that phasic, but not tonic, irritability has a significant association with ADHD symptoms and that phasic and tonic might be distinct, though highly related, irritability dimensions. Future research should investigate potential mechanisms underlying this differential association.

Neurophysiological markers of ADHD symptoms in typically-developing children

Children with attention-deficit/hyperactivity disorder (ADHD) are characterized by symptoms of inattention, impulsivity, and hyperactivity. Neurophysiological correlates of ADHD include changes in the P3 component of event-related brain potentials (ERPs). Motivated by recent advances towards a more dimensional understanding of ADHD, we investigate whether ADHD-related ERP markers relate to continuous variations in attention and executive functioning also in typically-developing children. ERPs were measured while 31 school children (9–11 years) completed an adapted version of the Continuous Performance Task that additionally to inhibitory processes also isolates effects of physical stimulus salience. Children with higher levels of parent-reported ADHD symptoms did not differ in task performance, but exhibited smaller P3 amplitudes related to stimulus salience. Furthermore, ADHD symptoms were associated with the variability of neural responses over time: Children with higher levels of ADHD symptoms demonstrated lower variability in inhibition- and salience-related P3 amplitudes. No effects were observed for ERP latencies and the salience-related N2. By demonstrating that ADHD-associated neurophysiological mechanisms of inhibition and salience processing covary with attention and executive functioning in a children community sample, our study provides neurophysiological support for dimensional models of ADHD. Also, temporal variability in event-related potentials is highlighted as additional indicator of ADHD requiring further investigation.

A comparison of the self-report patterns of analog versus real-world malingerers of attention deficit hyperactivity disorder.

Much of what we know about malingering of attention deficit hyperactivity disorder (ADHD) has been learned from the performance of analog malingerers, typically first-year psychology students given credit for study participation. It is not clear, however, whether their performance is similar to that found in actual clinical settings. Indeed, past research suggests that analog malingerers may overexaggerate deficits relative to real-world malingerers, making them easier to identify in controlled studies. The purpose of the current study was, therefore, to compare the performance of analog malingers to post-secondary students strongly suspected of malingering ADHD on a self-report measure of ADHD symptoms. Their scores were, in turn, compared to those returned by students with genuine ADHD and clinical controls. Results demonstrated that, apart from analog subjects overexaggerating symptoms of hyperactivity, few differences exist between the scores returned by analog malingerers relative to clinical malingerers. While newly devised symptom validity measures show promise in identifying malingered ADHD, neither the analog nor the clinical malingers consistently failed these symptom validity scales. Furthermore, a good portion in both malingering groups failed to endorse high levels of ADHD symptoms in general. Clinical implications are discussed.

Can auditory warning signals normalize eye movements in children with ADHD?

Attenuated baseline arousal has been hypothesized to underlie symptoms of attention deficit/hyperactivity disorder (ADHD). A behavioral signature of reduced baseline arousal is an increased beneficiary effect of warning signals in reaction tasks. This paradoxical effect is believed to be caused by a temporary increase in arousal induced by warning signals. In a preregistered study, we tested the hypothesis that children with high levels of ADHD symptoms would be hyperresponsive to warning signals in a well-established visual attention task (the gap/overlap paradigm). Previous studies using this task have found slower and more variable saccadic reaction times in children with ADHD compared to typically developing children, suggesting that these eye movement metrics are candidate biomarkers. We examined 71 children, of which 1/3 had a diagnosis of ADHD, using both dimensional analyses and group comparisons. Previously reported findings of reduced saccadic latency and increased latency variability were replicated. Importantly, saccadic latency was normalized by auditory warning signals. Analyses of pupil dilation, a physiological index of arousal and locus coeruleus-noradrenergic activity, confirmed that warning signals led to enhanced arousal. Our findings are novel and contribute to our understanding of arousal and attention in ADHD and have implications for treatment and interventions.

Electrophysiological Correlates of Response Time Variability During a Sustained Attention Task.

Individuals with Attention Deficit Hyperactivity Disorder (ADHD) tend to perform cognitive tasks with greater Response Time Variability (RTV). Greater RTV in ADHD may be due to inefficient functional connectivity of the brain during information processing. This study aimed to investigate the relationship between brain connectivity, RTV, and levels of ADHD symptoms. Twenty-eight children aged 9–12 years and 49 adolescents aged 15–18 years performed the Sustained Attention to Response Task (SART) while EEG was recorded. The participants’ levels of ADHD symptoms were measured using self- and parent-rated questionnaires. The ex-Gaussian analysis and The Fast Fourier Transform were used to measure multiple aspects of RTV. Functional connectivity between 64 electrodes was computed during task performance, and global efficiency and modularity were calculated, reflecting integration and segregation of the brain, respectively. There was a positive association between multiple RTV measures and the level of ADHD symptoms, where participants with higher levels of ADHD symptoms showed greater RTV, except for sigma from the ex-Gaussian analysis. More efficient brain network activity, measured by global efficiency, was associated with reduced RTV. Children showed greater RTV and less efficient brain network activity compared with the adolescents. These findings support the view that stable responses are achieved with more integrated (and efficient) brain connectivity.

Relative Age and Attention-Deficit/Hyperactivity Disorder: Data From Three Epidemiological Cohorts and a Meta-analysis

To investigate the effect of relatively younger age on attention-deficit/hyperactivity disorder (ADHD) symptoms and diagnosis through three population-based cohorts and a meta-analysis. This study included participants of three community-based cohorts in Brazil: 1993 Pelotas Cohort (N= 5,249), 2004 Pelotas Cohort (N= 4,231), and Brazilian High-Risk Study for Psychiatric Disorders (HRC study) (N= 2,511). We analyzed the effect of relatively younger age on ADHD symptoms and diagnosis. For the meta-analysis, we searched MEDLINE, PsycINFO, and Web of Science from inception through December 25, 2018. We selected studies that reported measures of association between relative immaturity and an ADHD diagnosis. We followed the Meta-analysis Of Observational Studies in Epidemiology guidelines. The protocol for meta-analysis is available on PROSPERO (CRD42018099966). In the meta-analysis, we identified 1,799 potentially eligible records, from which 25 studies including 8,076,570 subjects (164,049 ADHD cases) were analyzed with their effect estimates. The summarized relative risk of an ADHD diagnosis was 1.34 (95% CI, 1.26-1.43, p< .001) for children born in the first 4 months of the school year (relatively younger). Heterogeneity was high (I2= 96.7%). Relative younger age was associated with higher levels of ADHD symptoms in the 1993 Pelotas Cohort (p= .003), 2004 Pelotas Cohort (p= .046), and HRC study (p= .010). Children and adolescents who are relatively younger compared with their classmates have a higher risk of receiving an ADHD diagnosis. Clinicians should consider the developmental level of young children when evaluating ADHD symptoms.

The relationship between internet addiction, attention deficit hyperactivity symptoms and online activities in adults

AimThe objective of this study was to examine the relationship between Internet Addiction (IA), Attention Deficit Hyperactivity Disorder (ADHD) symptoms and online activities in an adult population. MethodsA sample of 400 individuals aged 18 to 70 completed the Adult ADHD Self-Report Scale (ASRS), Young's Internet Addiction Test, and their preferred online activities. ResultsA moderate association was found between higher levels of ADHD symptoms and IA. The best predictors of IA scores were ADHD symptoms, age, playing online games and spending more time online. ConclusionOur findings further support a positive relationship between ADHD symptoms and excessive internet use.

ADHD Symptoms in Middle Adolescence Predict Exposure to Person-Related Life Stressors in Late Adolescence in 5-HTTLPR S-allele Homozygotes.

Literature suggests that life stressors predict attention-deficit/hyperactivity disorder (ADHD) symptoms and that this relationship is moderated by the serotonin transporter polymorphism (5-HTTLPR). It is less clear whether, on reverse, ADHD symptoms may influence the risk of exposure to life stressors. Furthermore, the role of life stressors may vary across development depending on the type of life stressor. We used threewave longitudinal data of 1,306 adolescents from the general population and clinicreferred cohort of the TRacking Adolescents' Individual Lives Survey. The 5-HTTLPR genotype (SS, LS, LL), parent-reported ADHD symptoms at three time points (T1: Mage = 11.2; T2: Mage = 13.5; T3: Mage = 16.2years), and the number of personrelated ('dependent') and environment-related ('independent') life stressors occurring between measurements (T1-T2, T2-T3) were assessed. Using path analyses, we examined bidirectional relations between exposure to these life stressors and ADHD symptoms between the separate waves moderated by 5-HTTLPR status. Exposure to life stressors did not predict ADHD symptoms. Rather, we found that in 5-HTTLPR Sallele homozygotes, ADHD symptoms in middle adolescence (T2) predicted exposure to the number of person-related life stressors later in adolescence (T2-T3, p = 0.001). There was no relation with environment-related life stressors. Our study suggests that S-allele homozygotes with higher levels of ADHD symptoms in middle adolescence are more vulnerable to becoming exposed to person-related ('dependent') life stressors in late adolescence. Findings emphasize the need to be aware of social-emotional adversities that may occur in genetically vulnerable adolescents with ADHD symptoms in the transition into adulthood.

Increased attention-deficit/hyperactivity symptoms in atopic dermatitis are associated with history of antihistamine use.

Epidemiologic evidence indicates a relevant association between atopic dermatitis (AD) and attention-deficit/hyperactivity disorder (ADHD). Underlying mechanisms and ways to best identify subgroups of AD patients at risk for ADHD are poorly understood. To compare sociodemographic, clinical and psychosocial characteristics of children with AD, ADHD, comorbid AD/ADHD and age-matched healthy controls and to investigate aspects of AD related to ADHD symptoms. Applying a factorial design, we investigated 4 groups of children aged 6-12years: AD-only (ie, without ADHD), ADHD-only (ie, without AD), AD+ADHD and healthy controls (HC; ie, no AD/no ADHD). Using validated instruments, ADHD symptoms and other behavioural problems, quality of life, parenting stress and sleeping problems were compared between groups. In children with AD-only, clinical signs (objective SCORAD), symptoms (POEM, VAS pruritus, VAS sleeping problems) and previous treatment of AD were assessed to investigate disease patterns related to ADHD symptoms. Compared to HC (n=47), children with AD-only (n=42), ADHD-only (n=34) and comorbid AD+ADHD (n=31) had significantly increased behavioural problems and decreased quality of life. Children with AD-only had significantly higher levels of ADHD symptoms than HC. In children with AD-only, previous use of antihistamines was significantly associated with increased ADHD symptoms (OR 1.88; 95% CI 1.04-3.39). Current clinical signs and AD symptoms were unrelated to the level of ADHD symptoms. Even if the clinical diagnosis of ADHD is excluded, children with AD show increased levels of ADHD symptoms. Further investigations need to determine whether early antihistamine exposure is a major risk factor for ADHD or a surrogate for previous AD severity and/or associated sleeping problems.

Do parental ADHD symptoms reduce the efficacy of parent training for preschool ADHD? A secondary analysis of a randomized controlled trial

Previous studies have suggested that children with Attention-Deficit/Hyperactivity Disorder (ADHD) may benefit less from behavioral parent training (BPT) if their parents have high levels of ADHD symptoms. We conducted a secondary analysis of data from a randomized controlled trial to test the hypothesis that parental ADHD symptoms reduce the efficacy of two BPT programs in a sample of preschoolers with ADHD. One intervention was specifically designed for children with ADHD (NFPP: New Forest Parenting Programme) and one was designed for children with Oppositional Defiant Disorder (ODD) (HNC: Helping the Noncompliant Child). Neither intervention was adapted to address parental ADHD symptoms. This secondary analysis included data from 164 parents and their 3-4 year-old children who were randomly assigned to one of the two programs or a waitlist group. Children were compared on ADHD and ODD outcomes at post-intervention and a 6-month follow-up. The presence of parent ADHD symptoms reduced the efficacy of BPT in only one of 16 analyses. Implications and limitations (e.g., low baseline rate of parental ADHD symptoms) of the findings are provided.