Hyperactive-impulsive Attention-deficit/hyperactivity Disorder Symptoms 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.

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.

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.

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).

Temperament, executive function, and attention-deficit/hyperactivity disorder (ADHD) in adolescents: The mediating role of effortful control

ABSTRACTIntroduction: Temperament dimensions may be related to executive functions (EF) and may be involved in the expression and maintenance of symptoms of attention-deficit/hyperactivity disorder (ADHD). The current study aimed to assess whether effortful control (EC) mediates the relationship between EF and inattentive symptoms, and whether surgency (S) and negative affectivity (NA) mediate the relationships between EF and hyperactive–impulsive ADHD symptoms in adolescents.Method: Working individually, participants aged between 12 and 16 years (N = 118; 75 with ADHD) performed tests of cognitive EF (working memory, planning, flexibility, and inhibition), and parents and teachers completed a multi-informant assessment focusing on measures of ADHD symptoms and temperament dimensions (EC, S, and NA).Results: There were significant differences between ADHD and control participants in EF and temperament dimensions. ADHD participants had lower scores than controls in working memory, planning, and inhibition EF; they also had lower scores in EC and higher scores in S and NA. Structural equation modeling indicated differential associations between EC, S, and NA temperament dimensions, and working memory, planning and inhibition EF, and ADHD symptoms. Mediation analysis suggested that EF exerted indirect effects on the inattentive and hyperactive–impulsive symptoms, via EC; higher EF abilities were related to higher levels of EC, which in turn were related to lower scores of inattentive and hyperactive–impulsive ADHD symptoms. S and NA did not mediate relations among EF and hyperactive–impulsive symptoms.Conclusion: The findings expand on those of previous studies of the complex relationship between temperament dimensions and EF and confirm the differential association between impairments in some EF, low EC, and the expression of inattentive and hyperactive–impulsive symptoms in adolescents, which may account for the ADHD–control group differences.

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).

Ecological Momentary Assessment of Antecedents and Consequences of Smoking in Adults with Attention-Deficit/Hyperactivity Disorder

The current study assessed antecedents and consequences of ad lib cigarette smoking in smokers diagnosed with attention-deficit/hyperactivity disorder (ADHD) using ecological momentary assessment (EMA). Adult smokers with ADHD (n = 17) completed 870 smoking and 622 nonsmoking electronic diary entries over a 7-day observation period of their naturalistic smoking behavior. Data collection occurred from 2011 to 2012. Generalized estimating equations indicated that ADHD smokers were more likely to smoke when urge to smoke, negative affect, boredom, stress, worry, and restlessness were elevated. In addition, participants were more likely to smoke in situations that elicited higher levels of nervousness and frustration. ADHD symptoms, in general, did not differ between smoking and nonsmoking contexts, though hyperactive–impulsive ADHD symptoms were elevated prior to smoking in frustrating situations. Additional situational antecedent variables were associated with smoking, including being in the presence of others smoking, being in a bar or restaurant, while outside, and while consuming caffeinated or alcoholic beverages. Participants also reported a significant improvement in urge to smoke, negative affect, stress, hunger, and ADHD symptoms after smoking a cigarette. Findings suggest certain contextual factors that may maintain ad lib cigarette smoking in smokers with ADHD and identify potential treatment targets in smoking cessation interventions for this at-risk group. Clinical implications and future research directions are discussed. Funding for this study was provided by the National Institute on Drug Abuse.

Longitudinal prediction of the one-year course of preschool ADHD symptoms: Implications for models of temperament–ADHD associations

Despite the fact that Attention-Deficit/Hyperactivity Disorder (ADHD) is often conceptualized as an extreme trait, there remains controversy about the best way to understand associations between temperament traits and ADHD. The current study examines longitudinal associations between temperament traits and ADHD during early childhood in order to critically examine vulnerability and spectrum models of trait–ADHD associations. Study participants were 109 children between the ages of 3 and 6 and their primary caregivers and teachers/daycare providers, community-recruited for ADHD-related problems. Primary caregivers completed the Kiddie Disruptive Behavior Disorders Schedule semi-structured diagnostic interview at the initial appointment and one year later. At the initial appointment, primary caregivers completed the Child Behavior Questionnaire as a measure of child temperament traits. Results from the initial time point indicated that high neuroticism and high surgency were associated with inattentive and hyperactive–impulsive ADHD symptoms, and low effortful control was associated with hyperactive–impulsive ADHD symptoms. However, none of these traits predicted the one-year course of ADHD symptoms. Results are more consistent with a spectrum (vs. vulnerability) model of trait–psychopathology associations, suggesting that traits may not influence longitudinal course during early childhood.

Evidence for shared genetic risk between ADHD symptoms and reduced mathematics ability: a twin study

Attention-deficit/hyperactivity disorder (ADHD) symptoms and mathematics ability are associated, but little is known about the genetic and environmental influences underlying this association. Data came from more than 6,000 twelve-year-old twin pairs from the UK population-representative Twins Early Development Study. Parents rated each twin's behaviour using a DSM-IV-based 18-item questionnaire of inattentive and hyperactive-impulsive ADHD symptoms. Mathematics tests based on the UK National Curriculum were completed by each twin. The twins also completed standardised tests of reading and general cognitive ability. Multivariate twin model fitting was applied. Inattentive and hyperactive-impulsive ADHD symptoms were highly heritable (67% and 73% respectively). Mathematics ability was moderately heritable (46%). Mathematics ability and inattentiveness showed a significantly greater phenotypic correlation (r(p) = -.26) and genetic correlation (r(A) = -.41) than mathematics ability and hyperactivity-impulsivity (r(p) = -.18; r(A) = -.22). The genetic correlation between inattentiveness and mathematics ability was largely independent from hyperactivity-impulsivity, and was only partially accounted for by genetic influences related to reading and general cognitive ability. Results revealed the novel finding that mathematics ability shows significantly stronger phenotypic and genetic associations with inattentiveness than with hyperactivity-impulsivity. Genetic associations between inattentiveness and mathematics ability could only partially be accounted for by hyperactivity-impulsivity, reading and general cognitive ability. Results suggest that mathematics ability is associated with ADHD symptoms largely because it shares genetic risk factors with inattentiveness, and provide further evidence for considering inattentiveness and hyperactivity-impulsivity separately. DNA markers for ADHD symptoms (especially inattentiveness) may also be candidate risk factors for mathematics ability and vice versa.

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).

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.

Biological and psychosocial environmental risk factors influence symptom severity and psychiatric comorbidity in children with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a genetically as well as environmentally determined disorder with a high rate of psychiatric comorbidity. In this study, non-genetic biological and psychosocial risk factors for ADHD symptom severity and comorbid disorders were assessed in 275 children with ADHD, aged 5-13years, mean age 9.7 (SD 1.9). Pre-/perinatal biological and lifetime psychosocial risk factors as well as data on parental ADHD were obtained. A different pattern of risk factors emerged for inattentive and hyperactive-impulsive ADHD symptoms. Inattentive symptoms were strongly influenced by psychosocial risk factors, whereas for hyperactive-impulsive symptoms, predominantly biological risk factors emerged. Hyperactive-impulsive symptoms also were a strong risk factor for comorbid oppositional defiant (ODD) and conduct disorder (CD). Smoking during pregnancy was a risk factor for comorbid CD but not ODD and further differential risk factors were observed for ODD and CD. Comorbid anxiety disorder (AnxD) was not related to ADHD symptoms and additional biological and psychosocial risk factors were observed. This study adds to the body of evidence that non-genetic biological and psychosocial risk factors have an impact on ADHD symptom severity and differentially influence comorbid disorders in ADHD. The findings are relevant to the prevention and treatment of ADHD with or without comorbid disorders.

Behavioral Approach in ADHD

Objective: Etiological models of attention-deficit hyperactivity disorder (ADHD) increasingly support the role of a motivational dysfunction pathway, particularly for hyperactive-impulsive symptoms. Overactive behavioral approach tendencies are implicated among these motivational accounts. However, other externalizing disorder symptoms, such as the psychopathy dimension, are also associated with behavioral approach and frequently co-occur with ADHD. The current study tested the hypothesis that behavioral approach is differentially associated with hyperactive-impulsive ADHD and psychopathy symptoms. Method: A sample of young adults ( n = 220) completed self-report measures assessing behavioral approach and inhibition, ADHD symptoms, and psychopathy symptoms. Results: Structural equation analyses supported the hypothesis that behavioral approach predicts hyperactive-impulsive ADHD symptoms while considering symptom overlap with psychopathy symptoms. Conclusion: These findings support motivational accounts that behavioral approach tendencies are predictive of ADHD symptoms and address concerns about externalizing comorbidity. Implications for ADHD etiology are discussed.

Relations between multi-informant assessments of ADHD symptoms, DAT1, and DRD4.

Researchers conducting candidate gene studies of attention-deficit/hyperactivity disorder (ADHD) typically obtain symptom ratings from multiple informants (i.e., mothers, fathers, and teachers) and use a psychologist's best estimate or a simple algorithm, such as taking the highest symptom ratings across informants, to construct diagnostic phenotypes for estimating association. Nonetheless, these methods have never been empirically validated in the context of a molecular genetic study. In the current study, the authors systematically evaluated several methods of operationalizing phenotypes and the resulting evidence for association between ADHD and the candidate genes: dopamine transporter gene (DAT1) and dopamine D4 receptor gene (DRD4). Use of symptom scores as continuous scales in regression analysis suggested that the combination of mother and teacher ratings yielded the strongest evidence for association between hyperactive-impulsive ADHD symptoms and DAT1 and between inattentive ADHD symptoms and DRD4. Teacher ratings alone were sufficient for evaluating the association between inattentive symptoms and DAT1. Further, this regression-based method consistently yielded stronger evidence for association among ADHD symptoms, DAT1, and DRD4 than did three simple algorithms (i.e., the and, or, and averaging rules). The implications of these results for future molecular genetic studies of ADHD are discussed.

Executive functions and adaptive functioning in young adult attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is associated with impairments in occupational, social, and educational functioning in adults. This study examined relations of adaptive impairment to ADHD symptom domains (inattentive-disorganized and hyperactive-impulsive) and to deficits in executive functioning (EF) in 195 well-characterized adults (105 ADHD, 90 non-ADHD, between ages 18 and 37). Participants completed a battery of EF measures as well as assessments of adaptive functioning. Confirmatory factor analyses were used to validate latent factors for adaptive functioning and EF. In a measurement model, weaker EF was associated with poorer adaptive functioning (r = -.30). When multi-informant composite variables for current inattentive-disorganized and hyperactive-impulsive ADHD symptoms were included in the structural model, EF no longer predicted adaptive functioning. While both symptom composites were similarly related to EF (inattentive-disorganized r = .36; hyperactive-impulsive r = .29), inattentive-disorganized symptoms accounted for more variance in adaptive functioning (67.2% vs. 3.6%). Furthermore, for retrospectively reported childhood symptoms of ADHD, only the inattentive-disorganized symptom domain was related to EF or adaptive impairment. These results suggest that, in adults with ADHD, inattentive-disorganized symptoms may be the primary contributor to key aspects of poorer adaptive function and may be the behavioral path through which EF deficits lead to adaptive impairment.