Hyperactive-impulsive Attention-deficit/hyperactivity Disorder Research Articles

Rhinorrhea and watery eyes in infancy and risk of attention-deficit hyperactivity disorder in school-age children.

Increased parasympathetic nervous system (PNS) activity is associated with attention-deficit/hyperactivity disorder (ADHD) inattentive symptoms, but not hyperactive-impulsive symptoms, and may contribute to inattentive subtype etiology. Guided by prior work linking infant rhinorrhea and watery eyes without a cold (RWWC) to PNS dysregulation, we examined associations between infant RWWC and childhood ADHD symptoms in a longitudinal cohort of Black and Latinx children living in the context of economic disadvantage (N=301 youth: 158 females, 143 males). Infant RWWC predicted higher inattentive (relative risk [RR] 2.16, p<.001) but not hyperactive-impulsive (RR 1.53, p=.065) ADHD symptoms (DuPaul scale), administered to caregivers at child age 8-14 years. Stratified analyses revealed that these associations were present in females but not males, who were three times more likely to have higher ADHD current total symptoms if they had infant RWWC than if they did not. Additionally, associations between RWWC and inattention symptoms were observed only in females. RWWC may thus serve as a novel risk marker of ADHD inattentive-type symptoms, especially for females.

Increased risk of attention-deficit/hyperactivity disorder in adolescents with high salivary levels of copper, manganese, and zinc

Exposure to toxic heavy metals has been associated with the development of attention-deficit/hyperactivity disorder (ADHD). However, fewer studies have examined the associations between abnormal levels of essential trace metals and ADHD, and none have done so using saliva. We investigated whether salivary metals were associated with ADHD in adolescents aged 12 from the Family Life Project (FLP) using a nested case–control study design that included 110 adolescents who met diagnostic criteria for inattentive (ADHD-I), hyperactive-impulsive (ADHD-H), or combined type ADHD (ADHD-C) (cases) and 173 children who did not (controls). We used inductively coupled plasma optical emission spectrophotometry to measure chromium, copper, manganese, and zinc in saliva samples. We employed logistic regression models to examine associations between quartile levels of individual metals and ADHD outcomes by subtype. Salivary copper levels were significantly associated with increased odds of any ADHD diagnosis (OR = 3.31, 95% CI: 1.08–10.12; p = 0.04) and with increased odds of ADHD-C diagnosis (OR = 8.44, 95% CI: 1.58–45.12; p = 0.01). Salivary zinc levels were significantly associated with increased odds of ADHD-C diagnosis (OR = 4.06, 95% CI: 1.21–13.69; p = 0.02). Salivary manganese levels were also significantly associated with increased odds of ADHD-C diagnosis (OR = 5.43, 95% CI: 1.08–27.27, p = 0.04). This is the first study using saliva to assess metal exposure and provide a potential link between salivary levels of copper, manganese, and zinc and ADHD diagnoses in adolescents. Public health interventions focused on metal exposures might reduce ADHD incidence in low-income, minority communities.

ADHD and hypersexual behaviors: The role of impulsivity, depressive feelings, hypomaniacal symptoms and psychotic prodromes

IntroductionNumerous studies in the literature correlate hypersexual symptomatology and attention deficit hyperactivity disorder (ADHD). The present study aimed to investigate this correlation and the eventual mediation role of impulsivity. MethodsWe recruited through an online platform a sample of 309 subjects (mean age = 34.5, SD = 15.4; females: 67.31 %); then, a sociodemographic questionnaire, together with validated psychometric scales for assessing hypersexuality, ADHD symptomatology, depression, hypomania, prodromal symptoms of psychosis and impulsivity were administered. ResultsWe found a significant association between ADHD symptomatology and hypersexuality symptoms (β = 0.459; p < 0.001). We found a significant predictive model of hypersexuality related to age, gender, depression, hypomanic symptoms, psychotic prodrome, ADHD symptomatology, and impulsivity (adjusted R2 = 0.311; p < .001). Moreover, we found that impulsivity is a significant mediator of the relationship between ADHD and hypersexuality when we considered only the hyperactive-impulsive ADHD subscale (β = 0.103; p = 0.006). Depression and psychotic prodromes have been shown a more relevant mediator effect on the relationship between ADHD and hypersexuality. ConclusionsOur results clarified the well-known relationship between ADHD and hypersexuality, suggesting a significant mediating role of psychotic prodromes and depression in this association. This finding further reinforces the view of hypersexual symptomatology not as a disorder but rather as a psychopathological manifestation of distress, a maladaptive coping strategy that individuals enact due to increased difficulties experienced in the environment. The role of impulsivity as a predictor has shown mixed results, revealing that difficulties in impulse control may play a more marginal role, compared to depressive symptomatology and psychotic prodromes, in determining hypersexuality.

Compared Profile of Late-Onset Versus Childhood-Onset ADHD: A Case-Control Study Among Treatment-Seeking Adult Patients.

To compare the characteristics of childhood-onset versus late-onset Attention Deficit Hyperactivity Disorder (ADHD) in a sample of treatment-seeking patients. Among total of 101 adult patients who were recently diagnosed for ADHD, using the Diagnostic Interview for Adult ADHD (DIVA 2.0), 56 subjects exhibited childhood-onset ADHD, versus 45 displayed late-onset ADHD. Both groups were compared according to their sociodemographic, clinical, and neuropsychological features, providing crude (OR) and adjusted odds ratios (aOR), and their 95% confidence intervals [95% CI]. Compared to late-onset ADHD, patients with childhood-onset had a lower educational score, (OR = 0.52; 95% CI [0.35, 0.76]), a greater score of impulsivity (aOR = 1.09; 95% CI [1.03, 1.16]), an increased number of hyperactive-impulsive ADHD symptoms (aOR = 1.9; 95% CI [1.46, 2.47]), and higher rates childhood trauma (aOR = 1.07; 95% CI [1.01, 1.13]), cannabis use disorder (aOR = 1.07; 95% CI [1.01, 1.13]), and working memory impairment. No difference was observed concerning age, sex, psychiatric symptoms, quality of life, and autonomy. Childhood-onset adult ADHD displayed a more severe profile, relative to late-onset ADHD.

Error-Related Brain Activity in ADHD: A Systematic Review and Meta-Analysis of Electroencephalography Markers of Cognitive Control Performance

Deviant cognitive control performance is implicated in Attention-Deficit-Hyperactivity-Disorder (ADHD). It is also conjectured to be a potential diagnoser and differentiator between the Inattentive and Hyperactive-Impulsive ADHD types. Reliable measures have not been established due to the variation in published results. We performed a systematic review and meta-analysis of the literature published up to May 2021 with data on electrophysiological correlates, that is, EEG correlates of cognitive control monitoring (error-related negativity, ERN; error positivity, Pe; correct-response negativity, CRN) in ADHD patients and the efficiency of EEG recordings in differentiating between ADHD types. Multiple databases including PubMed, Scopus, Google Scholar, bioRxiv, and medRxiv were searched for eligible literature. Meta-Analyses were performed through statistical tools provided by the open-source metafor package and separately using the Hedge's g standardized mean differences. Meta-Analyses were performed on a shortlisted set of 125 studies involving 7248 participants. To avoid extraneous variables, the sex ratio was maintained at 50:50, and the age groups of participants were equally varied between early teenagers (12-15years), late teenagers (15-18years), young adults (21-25), and middle-aged adults (29-37). The ADHD-afflicted group showed reduced ERN (Hedge's g=-0.58 [CIs: -0.76, -0.35]) and reduced Pe (Hedge's g=-0.65 [CIs: -0.79, -0.44). The Hyperactive-Impulsive ADHD types (2574/7248 participants) showed an increased CRN (Hedge's g=0.68 [CIs: 0.71, 0.29]), while the Inattentive ADHD Types (4674/7248 participants) showed a slightly reduced CRN (Hedge's g=-0.25 [CIs: -0.31, -0.28]. The prevalence of counted task errors was higher in the teenagers' group (12-18years) than the adults' group (21-37years). Results suggest that EEG Pattern Markers (especially Pe and CRN) can act as strong differentiators/diagnosers between the Hyperactive-Impulsive and Inattentive ADHD types. In further development, deep learning classifiers can be built for ADHD types using EEG Markers as Features and statistical values as weights. Pranjali Awasthi is a 14-year-old researcher working on the overlap of neuroimaging and machine learning at the Neural Dynamics of Control Lab, FIU. She is an avid speaker on topics of AI Awareness and Ethics. Here is a recent feature by the Analytics India Magazine: https://analyticsindiamag.com/how-this-15-year-old-created-a-research-career-in-machine-learning. New York Institute of Technology MRGA Committee.

Multimodal intervention improves core symptoms in preschool children with attention-deficit/hyperactivity disorder

I tested the effect of a psychobehavioral intervention combined with electroencephalographic (EEG) biofeedback on the core symptoms of preschool children with attention-deficit/hyperactivity disorder (ADHD). Participants were 42 preschool children with attention-deficit, hyperactive-impulsive, or compound-type ADHD. They were randomly divided into the control group, a psychobehavioral intervention group, an EEG biofeedback intervention group, or a psychobehavioral + EEG biofeedback intervention group (i. e., comprehensive). After 4 months of intervention, I assessed (a) attention concentration time and (b) impulsivity and hyperactivity scores using Conners Parent Symptom Questionnaire. Results show that the multimodal intervention significantly improved participants' concentration time and behavioral hyperactive-impulsive symptoms. The multimodal (vs. single-modal) intervention was more effective in improving core symptoms. My results provide a reference for related research and practical application.

Mobile app-based chatbot to deliver cognitive behavioral therapy and psychoeducation for adults with attention deficit: A development and feasibility/usability study

BackgroundAttention deficit is a growing problem in adults, and early diagnosis and treatment are needed. Previous studies have shown that cognitive behavioral therapy (CBT) is effective in improving attention deficit symptoms. However, many patients are not receiving adequate treatment due to time, space, and cost constraints. Recently, in other mental illnesses, mobile-based chatbots delivering CBT and psychoeducation have been used for symptom mitigation and treatment. ObjectiveThis study aimed to investigate the feasibility and usability of a short-term intervention, specifically a mobile-based interactive chatbot application, in alleviating attention deficit symptoms. MethodsThis was a randomized, non-blind parallel-group pilot study conducted from September 2019 to March 2020. Forty-six individuals with attention deficit aged 19–60 were randomly allocated to the chatbot (n = 23) and information-only control groups (n = 23) for 4 weeks. The former group was instructed to use the chatbot application “Todaki,” while the latter group was provided with a book on managing attention deficit symptoms. Participants were administered questionnaires to assess their symptoms of attention deficit, depression, and anxiety and evaluated at baseline and 4 weeks after the intervention. The post-intervention survey assessed the chatbot’s usability, acceptability, and side effects. ResultsThe average age of the participants was 25.1 years (standard deviation [SD] 7.5 years), and 56.5 % (26/46) participants were female. Intention-to-treat analysis (chatbot, n = 23; control, n = 23) revealed a significant reduction of attention deficit symptoms only in the chatbot group, which is represented by group-by-time interaction in Conner’s Adult ADHD Rating Scale subscales of Diagnostic and Statistical Manual-IV Attention-Deficit/Hyperactivity Disorder (ADHD) Hyperactive-Impulsive symptoms (F = 4.39; p = .04) and ADHD symptoms total (F = 6.74, p = .01). Further, the results of the paired t-test were significant only in the chatbot group. The average number of times the chatbots were used in 4 weeks was 20.32 (SD 12.89). The total average usage time was 1 h 15 min (SD 1 h 20 min). The degree of improvement in the ADHD symptoms total score was correlated with the number of times the psychoeducation program was used. According to the participants, the empathic/friendly character and unnatural flow of conversation were the best and worst features of the chatbot, respectively. ConclusionsThis study identified the feasibility and usability of using the mobile-based chatbot to improve attention deficit and its associated psychiatric symptoms. Using this novel intervention to conduct CBT would provide a useful digital therapeutic tool that allows easy accessibility and self-guided management for people with attention deficit, which should be verified through the large scale randomized controlled trial.

Daily, but not occasional, cannabis use is selectively associated with more impulsive delay discounting and hyperactive ADHD symptoms in binge-drinking young adults.

There is increasing interest inand evidence for the negative impacts of cannabis use in cognitive performance and symptoms of attention-deficit/hyperactivity disorder (ADHD), with age of first cannabis use as a potential amplifier of these associations. However, the existing literature is inconsistent, which may be due to methodological limitations, including small sample sizes. To examine current cannabis use and age of first cannabis use in relation to neurocognitive task performance and ADHD symptoms in a large sample of binge-drinking youngadults. Participants were young adults (N=730, M age=21.44, 52.6% female) assessed for current cannabis use, neurocognitive task performance, and ADHD symptoms. Three-group ANCOVAs compared individuals reporting frequent (daily/multiple times daily), occasional (weekly/monthly), or no cannabis use. Covarying alcohol use, tobacco use, age, sex, income, and education, daily cannabis users exhibited significantly more impulsive delay discounting and hyperactive-impulsive ADHD symptoms compared to both other groups. However, cannabis use was not associated with inattentive ADHD symptoms, verbal intelligence, working memory, probability discounting, short-term verbal memory, or behavioral inhibition. Age of initiation of cannabis use exhibited neither main effects nor interactions in relation to any domains of cognitive performance or ADHD symptomatology. The current findings provide support for a link between cannabis use in relation to immediate reward preference and symptoms of hyperactive-impulsive ADHD in young adults, but only among frequent users. No other neurocognitive domains exhibited associations with cannabis and age of first use was neither independently nor interactively associated with cognitive outcomes.

Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) and neurobehavior in US children through 8 years of age: The HOME study

BackgroundStudies of prenatal per- and polyfluoroalkyl substances (PFAS) and attention deficit hyperactivity disorder (ADHD)-related behaviors in children are inconsistent. ObjectivesTo examine associations between maternal serum PFAS concentrations and child behavior in 241 mother-child dyads within the Health Outcomes and Measures of the Environment (HOME) Study. MethodsWe quantified perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS), and perfluorononanoate (PFNA) in maternal serum collected during pregnancy or at delivery. We evaluated a total of 17 outcomes of child behavior using the Behavioral Assessment System for Children-2 (BASC-2) at 5 and 8 years (n = 240) and ADHD diagnostic symptoms and criteria with the Diagnostic Interview Schedule for Children–Young Child (DISC-YC) at 5 years (n = 190). We used linear mixed models and logistic regression with generalized estimating equations to assess associations between PFAS and continuous or dichotomous “at risk” BASC-2 scores; negative binomial regression to calculate incident rate ratios for counts of ADHD symptoms; and Poisson regression with robust standard errors to calculate relative risks of meeting ADHD diagnostic criteria. ResultsEach ln-unit increase in PFOS, PFHxS, and PFNA was associated with higher BASC-2 scores and increased odds of “at-risk” scores for externalizing behaviors, including hyperactivity (PFOS: odds ratio [OR] 2.7, 95% confidence interval [CI] 1.2, 5.9; PFHxS: OR 2.5, 95% CI 1.5, 4.3; PFNA: OR 3.2, 95% CI 1.3, 8.0). PFHxS was also associated with internalizing problems (OR 2.0, 95% CI 1.1, 3.4) and somatization (OR 2.2, 95% CI 1.2, 4.0). PFOS and PFNA were significantly associated with 50–80% more DISC-YC symptoms and diagnostic criteria related to hyperactive-impulsive type ADHD. Prenatal PFNA was associated with increased risk of any-type ADHD. ConclusionsPrenatal PFOS and PFNA were consistently associated with measures related to hyperactive-impulsive type ADHD across two validated assessment instruments. PFHxS was associated with increased problems with both externalizing and internalizing behaviors. No associations were noted between PFOA and child neurobehavior.

Cannabis use, cognitive performance, and symptoms of attention deficit/hyperactivity disorder in community adults.

There is some evidence that cannabis use is associated with lower cognitive performance and symptoms of attention-deficit/hyperactivity disorder (ADHD), but the existing literature is relatively inconsistent, potentially due to small samples in previous studies. Using a dimensional design, the current study examined cannabis use severity and age of first cannabis use in relation to neurocognitive performance and ADHD symptoms in a large sample of community adults (N = 1,008, Mage = 38.49, 56.0% female). Participants were assessed for cannabis involvement, neurocognitive performance, and ADHD symptoms. Dimensional relationships were investigated using multiple hierarchical regressions. Using a covariate model of age, income, sex, alcohol use, and tobacco use, severity of cannabis involvement was significantly associated with greater endorsement of both hyperactive-impulsive and inattentive ADHD symptoms but not with any other cognitive measures in the full sample. Exploratory analyses found greater cannabis use severity was associated with digit span forward and hyperactive ADHD symptoms in young adults (n = 371) and was associated with greater delay discounting, hyperactive, and impulsive ADHD symptoms in high-risk cannabis users (n = 161). Age of first cannabis use was not significantly associated with any neurocognitive variables or ADHD symptomatology in all analyses. The current findings provide evidence of a link between current cannabis misuse and both hyperactive and inattentive ADHD symptoms in general, and possible links to attention and impulsive delay discounting in subgroups of cannabis users, but no associations in other cognitive domains or implication of earlier initiation of cannabis use in relation to cognitive performance or ADHD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Overexcitabilities and ADHD in Gifted Adolescents in Jordan: Empirical Evidence

ABSTRACT There is no empirical evidence in Jordan that addresses the overlap and coexistence of overexcitability (OE) and attention deficit hyperactivity disorder (ADHD) in gifted students. This study aims to investigate (a) the relationship between characteristics of OE forms and ADHD subtypes and (b) the gender differences in OE profiles among gifted students in Jordan. The participants included 265 gifted adolescents from the Jubilee Institute. They were administered the Jordanian version of the Overexcitability Questionnaire-Two (OEQII) and the Conners ADHD/DSM-V Scales-Adolescent scale. The Canonical Correlation Analysis (CCA) revealed a noteworthy collective relationship between OE and ADHD constructs, and another noteworthy relationship in relation to the gender of gifted adolescents. The findings also revealed small, significant positive correlations between (a) Psychomotor OE and hyperactive-impulsive ADHD, (b) Imaginational OE and ADHD subtypes, and (c) a small significant negative correlation between Intellectual OE and inattentive ADHD scores. Additionally, there was a significant gender difference in the Psychomotor OE in favor of boys and significant differences in the Emotional, Sensual, and Imaginational OEs in favor of girls. No significant gender differences were found in the Intellectual OEs of the participants.

Functional impairment outcomes in clinical trials of different ADHD medications: post hoc responder analyses and baseline subgroup analyses

Several recent phase 3 clinical trials of attention-deficit/hyperactivity disorder (ADHD) medications have used the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P). Here, we assess WFIRS-P response in individual patients in two pivotal trials of lisdexamfetamine dimesylate (LDX) and guanfacine extended release (GXR). We also analysed pooled WFIRS-P data from seven phase 3 studies of ADHD medications to shed light on factors associated with baseline functional impairment. The proportion of patients with a change in WFIRS-P score that exceeded the minimal important difference (MID) criteria for response was greater for LDX than placebo in the Family, Learning and School, and Risky Activities domains, and was greater for GXR than placebo in the Social Activities, Learning and School, and Family domains. Responders had significantly worse baseline scores in all WFIRS-P domains (all p < 0.001) than non-responders. In the pooled analyses, baseline WFIRS-P scores in all domains were significantly worse in participants with oppositional defiant disorder (ODD) than in those without ODD. Having combined type or hyperactive-impulsive type ADHD, being enrolled into a study in Europe, being male and being younger also had modest negative effects on baseline WFIRS-P scores. The present analysis of WFIRS-P response shows that previously reported group-level improvements in WFIRS-P functional impairment score translated into clinically relevant improvements in many individual participants. Functional impairment is a diverse and subjective construct that is influenced by multiple factors. Optimal management of individuals with ADHD should involve monitoring improvements in functioning and quality of life, as well as symptomatic improvement.

Attention Deficit Hyperactivity Disorder (ADHD) Subtypes, Co-Occurring Psychiatric Symptoms and Sexual Risk Behaviors among Adolescents Receiving Substance Abuse Treatment

Background: Adolescents entering substance abuse treatment report clustered psychiatric symptoms and sexual risk behaviors representing differential levels of impairment and risk for maladaptive health outcomes. Objectives: To examine the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) subtypes among adolescents receiving outpatient substance abuse treatment; To document group differences in (a) past-year psychiatric symptom scores and (b) sexual risk behaviors by ADHD subtype and gender. Methods: Self-report data were collected via structured interviews from 394 adolescents (280 males, M = 16.33 years, SD = 1.15 years), enrolled in an HIV/STI risk reduction intervention for adolescents receiving outpatient substance abuse treatment. ADHD diagnostic subtypes and other past-year psychiatric symptoms were assessed using the Brief Michigan Version of the Composite Internal Diagnostic Interview (UM-CIDI). Adolescents provided self-report data on sexual risk behaviors. Results: Multivariate analyses of variance (MANOVAs) documented that Inattentive and Hyperactive-Impulsive ADHD subtypes were significantly associated with higher scores for all past-year psychiatric symptoms. The combined ADHD subtype was significantly associated with higher scores for all psychiatric symptoms except affective disorder. Girls reported significantly higher mean symptoms than boys for alcohol abuse and dependence, anxiety, and affective disorder symptoms. Sexual risk behavior scores were not associated with ADHD status, but girls reported consistently higher scores for multiple risk behavior outcomes. Several psychiatric disorder symptoms were significant covariates of multiple sexual risk behaviors. Conclusion/Importance: Brief screenings for ADHD, other psychiatric disorders and sexual risk behaviors can provide data for tailoring substance abuse services to improve adolescent health outcomes for high-risk subgroups.

Attention-deficit/hyperactivity disorder in children with overactive bladder; a case-control study.

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is the most common childhood psychiatric disorder. This disorder is more prevalent in some chronic diseases. Objectives: To investigate ADHD in children with overactive bladder. Patients and Methods: A number of 92 children with overactive bladder and 92 healthy children without overactive bladder (age range of both groups 5 to 12 years old) were included in this study as case and control groups, respectively. Participants were selected from children who had referred to a pediatric clinic in Arak city, Iran. ADHD types (inattentive, hyperactive-impulsive, and mixed) were diagnosed by Conner’s Parent Rating Scale and Diagnostic and Statistical Manual of Mental Disorders IV-TR (DSM-IV-TR) criteria. Data were analyzed by chi-square and t tests. Results: In both groups, 51 children (27.7%) had ADHD. The prevalence of ADHD in the case group (33 cases, 35.9%) was significantly higher than the control group (18 cases, 19.6%) (P = 0.021). Inattentive ADHD was observed in 22 participants (23.9%) of the case group and nine participants of the control group (9.7%) (P = 0.047). Despite this significant difference, three (3.2%) and four (4.3%) children were affected by hyperactive-impulsive ADHD (P = 0.73), and eight (8.6%) and five (5.4%) children were affected by mixed ADHD (P = 0.42) in the case and control groups, respectively. Conclusion: ADHD bladder is significantly more common in children with overactive bladder than healthy children. The observed correlation between ADHD and overactive bladder makes psychological counseling mandatory in children with overactive bladder.

Adolescent risk taking, dopamine, and cocaine: A vicious cycle

Aims: Attention-Deficit/Hyperactivity Disorder (ADHD) is an independent risk factor for cigarette smoking. Although smokers withADHDdiffer fromnon-ADHDsmokers inmany respects, ADHD is a heterogeneous disorder composed of different subtypes. Given that past research has demonstrated differences between ADHD subtypes, including studies examining nicotine dependence, the aim of the current studywas to assess ADHD subtype differences in the immediate consequences of smoking using ecological momentary assessment (EMA). In particular, we aimed to assess subtype differences in smoking to regulate affect and ADHD symptoms. Methods: Smokers with ADHD (n=17) were subdivided into ADHD Predominately Inattentive (n=9) and ADHD Combined (n=8) subtypes followingadiagnostic assessment. Participants carried an electronic diary for at least 7 days and provided entries for each cigarette they smoked. Results: Both groups did not differ in nicotine dependence severity. 1232 EMA smoking entries were recorded. Participants responded to questions immediately prior to and after each cigarette. The ADHD Combined subtype reported significantly greater reductions in boredom (p= .011), total ADHD symptoms (p= .019), inattentive ADHD symptoms (p= .013), and hyperactiveimpulsive ADHD symptoms (p= .048) than the ADHD Inattentive subtype in a series of ANOVA’s. In addition, the Combined subtype reported a statistically significant improvement in positive affect after smoking (p= .038). Subtypes did not differ in smoking to regulate urge to smoke, negative affect, anxiety, stress, hunger, worry, or general restlessness. Conclusions: These findings have implications for the role of affect and ADHD symptom regulation in smoking maintenance among ADHD subtypes. Particularly, thosewith the Combined subtype may smoke to regulate ADHD symptoms, positive affect, and negative affect, whereas those with the Inattentive subtype may smoke to regulate primarily negative affect. Financial support: This research was supported by Grant R03DA029694 (John T. Mitchell).

Delayed Sleep Timing and Symptoms in Adults With Attention-Deficit/Hyperactivity Disorder: A Controlled Actigraphy Study

Patients with attention-deficit/hyperactivity disorder (ADHD) often exhibit disrupted sleep and circadian rhythms. Determination of whether sleep disturbance and/or circadian disruption are differentially associated with symptom severity is necessary to guide development of future treatment strategies. Therefore, we measured sleep and ADHD symptoms in participants aged 19–65 who met the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) criteria for ADHD and insomnia without psychiatric comorbidities by monitoring actigraphy and daily sleep logs for 2 wks, as well as the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), the ADHD Rating Scale (ADHD-RS), and a clinic-designed sleep behavior questionnaire. Principal components analysis identified correlated circadian- and sleep-related variables in all participants with ADHD who completed the study (n = 24). The identified components were entered into a backwards stepwise linear regression analysis, which indicated that delayed sleep timing and increased sleepiness (ESS) (but not sleep duration or sleep efficiency) significantly predicted greater severity of both hyperactive-impulsive and inattentive ADHD symptoms (p < .05 for partial regression coefficients). In addition, combined subtypes had the most impaired age-adjusted sleep quality (PSQI scores; p < .05 compared with healthy controls; n = 13), and 91.7% of them reported going to bed late due to being “not tired/too keyed up to sleep” compared with 57.2% and 50% of inattentive and symptom-controlled participants, respectively (p < .05). In conclusion, the results of this study suggest that ADHD symptom severity correlates with delayed sleep timing and daytime sleepiness, suggesting that treatment interventions aimed at advancing circadian phase may improve daytime sleepiness. In addition, ADHD adults with combined hyperactive-impulsive and inattentive symptoms have decreased sleep quality as well as the delayed sleep timing of predominately inattentive subtypes. (Author correspondence: rfargason@uab.edu)

Double dissociation between lab measures of inattention and impulsivity and the dopamine transporter gene (DAT1) and dopamine D4 receptor gene (DRD4).

Studies examining the biological and neuropsychological processes underlying attention-deficit/hyperactivity disorder (ADHD) suggest that error indices from the A-X Continuous Performance Test (A-X CPT) might represent useful endophenotypes for ADHD. The current study extended such findings by evaluating the utility of these putative endophenotypes in the context of a molecular genetic study. One hundred and forty-eight clinic-referred ADHD probands and 56 siblings were recruited as part of an ongoing study. Between- and within-family tests of association were conducted to test for relations between polymorphisms in two candidate genes, the dopamine transporter gene (DAT1) and the dopamine D4 receptor gene (DRD4), and indices of inattention and impulsivity derived from the A-X CPT. Association analyses of these polymorphisms with the A-X CPT indices suggested a double dissociation such that an index of inattention was associated with DRD4 but not DAT1, and an index of impulsivity was associated with DAT1 but not DRD4. Further analyses suggested that an A-X CPT index of impulsivity partially mediated previously observed associations between hyperactive-impulsive ADHD symptoms and DAT1. Additionally, an A-X CPT index of inattention moderated the relation between inattentive ADHD symptoms and DRD4 such that children with high levels of the endophenotype showed a stronger association between inattentive symptoms and DRD4. The potential utility of endophenotypes derived from the A-X CPT in molecular genetic studies of ADHD is discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Comorbid Symptom Severity in Attention-Deficit/Hyperactivity Disorder

Although current attention-deficit/hyperactivity disorder (ADHD) diagnostic criteria do not include emotional symptoms, externalizing behavior problems, or aggression, the practicing clinician is often faced with the evaluation and management of these symptoms when assessing and treating patients with ADHD. While much research has focused on comorbid disorders in ADHD, less attention has been directed to comorbid symptoms that may or may not meet syndrome criteria but that influence ADHD treatment planning and outcome. The aim of this study is to describe emotional and behavioral symptoms in children and adolescents with ADHD and compare them with non-ADHD control groups. From 1995 to 2005, clinically referred children and adolescents with the combined subtype of ADHD (n = 175) or the inattentive subtype of ADHD (n = 70) as diagnosed by the primary physician (using DSM-IV criteria) were compared with a non-ADHD psychiatric control group (n = 65) and a non-ADHD community control group (n = 72) on measures that assessed emotional symptoms, externalizing behavior problems, and aggression; comparisons were controlled for age, sex, and family income. Both ADHD groups had depressive symptom severity equal to a non-ADHD psychiatric control group and greater than community control groups. Externalizing behavior problems and aggression were more severe in the ADHD combined subtype group compared with other groups. As ADHD symptom severity increased, externalizing behavior problems and aggression, but not internalizing symptoms, also increased in severity. Family income had an independent relationship with externalizing disorders. High rates of internalizing emotional symptoms, externalizing problem behaviors, and aggression were found in a clinical ADHD sample. Externalizing behavior problems and aggression appeared to be related to the hyperactive-impulsive ADHD symptom domain and to overall ADHD symptom severity. It remains an empirical question as to whether effective treatment of the core symptoms of ADHD will also reduce the presence of associated emotional and behavioral symptoms and improve daily functioning in children and adolescents with ADHD.

Prevalence of ADHD and Its Subtypes in Male and Female Adult Prison Inmates

There are few published studies of attention-deficit/hyperactivity disorder (ADHD) in adult inmates, and even fewer studies that have considered ADHD in adult inmates by gender. The present study examined the prevalence of ADHD, its subtypes, and associated psychological and neuropsychological comorbidity as a function of gender in a sample of 3,962 inmates (3,439 men and 523 women; mean age = 33.6 years, range 17-73) who had completed the 250-item, self-report, Diagnostic and Statistical Manual of Mental Disorders, 4th edition (Text Revision) (DSM-IV-TR)-aligned Coolidge Correctional Inventory (CCI). The overall ADHD prevalence rate found was 10.5%, which is substantially higher than the rate among adults in the general population (2-5%). The female inmate ADHD prevalence rate (15.1%) was higher than the male inmate ADHD rate (9.8%), consistent with some previous studies. The most prevalent ADHD subtype for both genders was the hyperactive-impulsive subtype. The combined and inattentive ADHD subtypes had higher levels of comorbid psychopathology than the hyperactive-impulsive ADHD subtype. As the presence of ADHD and associated gender differentials may impact the success of rehabilitation and educative programs with inmates, the assessment of ADHD and comorbid psychopathology should be a priority in initial inmate screening and evaluation.

Assessing the Role of Attention-Deficit/Hyperactivity Disorder Symptoms in Smokers With and Without Posttraumatic Stress Disorder

Smoking prevalence among individuals with posttraumatic stress disorder (PTSD) is elevated relative to non-PTSD smokers, and there is evidence to suggest that affect regulation may be a motivation for smoking among those with this disorder. Previous studies have also indicated that (a) PTSD is frequently comorbid with attention-deficit/hyperactivity disorder (ADHD), (b) individuals with ADHD smoke at significantly higher rates than the general population, (c) subclinical ADHD symptoms are a risk factor for smoking, and (d) affect regulation is a motivation for smoking in ADHD. The goal of this study was to assess the degree to which ADHD symptoms were uniquely associated with smoking-related affective functioning (SRAF) variables above and beyond the variance already explained by PTSD symptoms. Smokers with (n = 55) and without PTSD (n = 68) completed measures assessing PTSD symptoms, ADHD symptoms, and SRAF. The PTSD group endorsed significantly more severe levels of DSM-IV inattentive and hyperactive-impulsive ADHD symptoms. A series of hierarchical regressions among the entire sample indicated that, after accounting for PTSD symptoms, ADHD symptoms were associated with lower positive affect, higher negative affect, higher emotion dysregulation, higher anxiety sensitivity, and higher urges to smoke to increase positive affect. Taken together, these findings suggest that ADHD symptoms may increase affective dysregulation difficulties already faced by smokers, particularly those with PTSD, which may, in turn, confer increased risk for smoking relapse in those with higher levels of symptomatology of both disorders.