Hyperactivity-impulsivity Subscale Research Articles

Are congenital heart defects connected to more severe attention-deficit/hyperactivity disorder?: A systematic review and meta-analysis.

Congenital heart defects (CHDs) are the most common cause of birth defect-related infant morbidity and mortality, affecting 1% of 40,000 births per year in the United States. On the other side, the etiology of attention-deficit/hyperactivity disorder (ADHD) is multifactorial. Multiple studies have found that cardiac surgery patients have higher morbidity of having this disorder. Many studies have investigated the prevalence of ADHD in different subtypes of CHD, but few have focused on the severity of ADHD symptoms. Thus, we conducted this systematic review and meta-analysis to investigate the severity of ADHD symptoms in CHD patients. We searched PubMed, Embase, Scopus, and Web of Science were searched from inception to March 6, 2023 without any restrictions. We included observational studies published in English language that evaluated burden of symptom of ADHD in CHD patients. Moreover, the standardized mean difference (SMD) for continuous outcomes with 95% confidence interval (CI) was pooled. P-values <.05 are considered as significant, and we performed all statistical analyses using RevMan software Version 5.4.1. Eight studies were included in our review with a total number of 120,158 patients. CHD was associated with a statistically significant increase in both ADHD index T score and ADHD Hyperactivity-Impulsivity Subscale (informant) with (SMD = 0.65, 95% CI [0.40, 0.90], P < .00001, I2 = 81%) and (SMD = 0.16, 95% CI [0.04, 0.28], P = .008, I2 = 0%). Regarding ADHD Inattention Subscale (informant), the pooled data showed that a significant increase of this score in the CHD group (SMD = 0.25, 95% CI [0.13, 0.37], P < .001, I2 = 0%), and ADHD Combined Score (informant) showed a significant increase of this score in the CHD group (SMD = 0.23, 95% CI [0.11, 0.35], P = .0002, I2 = 0%). Our study revealed a strong association between CHD and not only ADHD, but also the severity of ADHD, making early diagnosis of ADHD in children with CHD a mandatory step in the clinical evaluation practice to improve these children on both clinical and psychological aspects.

Prevalence of attention deficit/hyperactivity disorder (ADHD) in congenital heart diseases (CHD), a systematic review and meta-analysis

Abstract Introduction Neuropsychiatric disorders are well-established in patients with congenital heart defects (CHD); moreover, patients with CHD have higher three to four times risk for inattention and hyperactivity. Several published studies have investigated the prevalence of attention deficit/hyperactivity disorder (ADHD) among patients with CHD, thus we conducted our meta-analysis in an attempt to further investigate the role of CHD in increasing the incidence of ADHD. Methods Electronic databases were systematically searched to identify any observational or interventional studies that compared the effects of congenital heart disease on the incidence or progression of ADHD. Pooled mean difference (MD) and their 95% confidence intervals (CI) were calculated using inverse variance and fixed effect models Results We identified eight studies with 120187 patients with a mean age of 15.8 years. Patients with CHD compared to healthy population have statistically significant higher scores in ADHD inattention subscale, ADHD hyperactivity-impulsivity subscale, ADHD combined scale (Fig. 1) with MD of 0.25 [95% CI 0.13, 0.37, p&amp;lt;0.0001], 0.16 [95% CI 0.04, 0.28, p=0.008], 0.23 [95% CI 0.11, 0.35, p=0.0002], respectively. Furthermore, ADHD index T score (Fig. 2) for both self-reported and informant report showed a statistically significant increase in CHD with MD of 0.42 [95% CI 0.26, 0.58, p&amp;lt;0.00001] and 0.86 [95% CI 0.52, 1.19, p&amp;lt;0.00001]. Conclusion CHD showed an associated increased risk for the development of ADHD which was confirmed with several ADHD scales. Funding Acknowledgement Type of funding sources: None.

Tattooing and piercing are associated with symptoms of ADHD: A cross-sectional study of non-clinical adults

IntroductionPrevious studies suggest that individuals with tattoos and piercings exhibit higher impulsive personality traits compared to peers without body modifications. No studies on body modifications and core-symptoms of ADHD are available.ObjectivesThis study aimed to compare self-reported ADHD symptoms between non-clinical adults with and without body modifications.MethodsA non-clinical adult Swedish population (n=815) completed the Adult ADHD self-report scale (ASRS-v1.1) and answered questions concerning body modification. ADHD diagnosis served as exclusion criterion. Three grouping variables were analysed separately; tattoo status, piercing status and a combination of having both tattoo and piercing. Linear regression compared mean ASRS total- and subscale scores between individuals with and without body modification according to each grouping variable, while adjusting for candidate covariates age and sex.ResultsThe prevalence of each body modification variable was; 30% for tattoo, 18% for piercing other than earlobe and 12% for combination of tattoo and piercing. Any combination of body modification was associated with significantly higher ASRS total- and subscale scores compared to no body modification. The most pronounced differences between groups were for the combination of tattoo and piercing, and on the hyperactivity/impulsivity (HI) subscale; revealing adjusted mean differences of 4.3 points (range 0-72) on the ASRS-total score (p &lt;0.001) and 2.6 points (range 0-36) on the ASRS HI subscale (p &lt;0.001).ConclusionsBody modification was associated with more pronounced ADHD core symptoms amongst non-clinical adults. Although statistically significant, the clinical significance is uncertain. The prevalence rates of body modifications in our cohort indicate that they are becoming cultural normal.DisclosureNo significant relationships.

Outcomes of a 12-week ecologically valid observational study of first treatment with methylphenidate in a representative clinical sample of drug naïve children with ADHD.

Randomized placebo-controlled trials have reported efficacy of methylphenidate (MPH) for Attention-deficit/hyperactivity disorder (ADHD); however, selection biases due to strict entry criteria may limit the generalizability of the findings. Few ecologically valid studies have investigated effectiveness of MPH in representative clinical populations of children. This independently funded study aims to describe treatment responses and their predictors during the first 12 weeks of MPH treatment using repeated measurements of symptoms and adverse reactions (ARs) to treatment in 207 children recently diagnosed with ADHD. The children were consecutively included from the Child and Adolescent Mental Health Centre, Mental Health Services, The Capital Region of Denmark. The children (mean age, 9.6 years [range 7-12], 75.4% males) were titrated with MPH, based on weekly assessments of symptoms (18-item ADHD-rating scale scores, ADHD-RS-C) and ARs. At study-end 187 (90.8%) children reached a mean end-dose of 1.0 mg/kg/day. A normalisation/borderline normalisation on ADHD-RS-C was achieved for 168 (81.2%) children on the Inattention and/or the Hyperactivity-Impulsivity subscale in week 12, and 31 (15.0%) children were nonresponders, which was defined as absence of normalisation/borderline normalisation (n = 19) or discontinuation due to ARs (n = 12), and eight (3.8%) children dropped out from follow-up. Nonresponders were characterised by more severe symptoms of Hyperactivity-Impulsivity and global impairment before the treatment. ARs were few; the most prominent were appetite reduction and weight loss. A decrease in AR-like symptoms during the treatment period questions the validity of currently available standard instruments designed to measure ARs of MPH. This ecologically valid observational study supports prior randomized placebo-controlled trials; 81.2% of the children responded favourably in multiple domains with few harmful effects to carefully titrated MPH. Clinical trial registration: ClinicalTrials.gov with registration number NCT04366609.

Associations between the Mismatch-negativity Potential and Symptom Severity in Medication-naïve Children and Adolescents with Symptoms of Attention Deficit/hyperactivity Disorder.

ObjectiveThe mismatch negativity (MMN) event-related potential is an index of the pre-attentive stage of neural auditory information processing and an electrophysiological signal indicative of the integrity of auditory information processing with regard to the attention deficit symptom of attention deficit hyperactivity disorder (ADHD). We investigated the association between the MMN amplitude and latency in frontal brain regions and symptom severity in children with ADHD and subclinical ADHD symptoms.MethodsThis study included 29 children: 16 (10 boys; mean age, 13.06 ± 3.67 years) with ADHD (ADHD group) and 13 (eight boys; mean age, 13.40 ± 3.31 years) with sub-clinical ADHD symptoms (subclinical ADHD group). We performed the following assessments: Korean ADHD rating scale-IV (K-ARS-IV), children depression inventory, state/trait anxiety inventory for children, and MMN (measured at Fz, FCz, Cz, and CPz).ResultsThere were no sex or mean age differences between the groups (c2 = −0.01, p = 0.958; Z = −1.88, p = 0.060, respectively). The ADHD group had a significantly higher mean K-ARS-IV score (26.13 ± 9.56 vs. 17.15 ± 11.73, Z = −2.11, p = 0.035). Significant differences were found according to symptom severity in the MMN amplitude at FCz (Z = −2.11, p = 0.035) and MMN latency at Fz and FCz (Z = −2.48, p = 0.013; Z = −2.57, p = 0.010). The K-ARS-IV, K-ARS inattention subscale, and K-ARS hyperactivity-impulsivity subscale scores in the ADHD group correlated significantly with the MMN amplitude at Cz and CPz.ConclusionThis study found differences in the MMN amplitude and latency according to the severity of ADHD symptoms and identified MMN as a potential adjunct to the diagnosis of ADHD.

Screening with an ADHD-specific rating scale in preschoolers: A cross-cultural comparison of the Early Childhood Inventory-4.

The Early Childhood Inventory-4 (ECI-4) Hyperactivity-Impulsivity (HI) and Inattention (IA) subscales are screeners for attention-deficit/hyperactivity disorder (ADHD). There have been few studies of the screening properties of these subscales, particularly outside the United States. We investigated the classification accuracy of the parent and teacher versions of the HI and IA subscales and the cross-cultural validity of the cutoff values based on norms from a United States sample. The present study was part of the Norwegian Mother and Child Cohort Study. Parents and teachers rated boys (n = 332) and girls (n = 319) with the ECI-4 (mean Age 3.5 years). Interviewers who were blind to the ratings used the Preschool Age Psychiatric Assessment Interview to assign ADHD diagnoses. The ECI-4 HI and IA subscales showed acceptable accuracy in identifying ADHD in boys and girls (areas under the curve ranged from .67 to .85). In a multivariate regression analysis, the parent and teacher HI subscale scores significantly contributed to ADHD identification, but not the IA subscale scores. To achieve the necessary sensitivity to detect children with ADHD, lower cutoff levels than those specified by the United States ECI-4 norms were needed. For screening purposes, the parent and teacher ECI-4 showed acceptable accuracy in identifying preschoolers at risk for ADHD, and it may be sufficient to use the HI subscale scores. The suggested cutoff values provided by the United States ECI-4 norms had limited cross-cultural validity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Attention-Deficit/Hyperactivity Disorder Symptom Characteristics in Korean Elementary School Children: Comparison with US Population.

ObjectiveAttention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in elementary school children. The present study investigated the characteristics of ADHD in Korean elementary school children using the Korean version of the ADHD Rating Scale (K-ARS). The data was compared with those obtained from a comparable American population. MethodsParticipants included 29,914 elementary school children, aged 6–12 years, from a medium-sized city. The parents completed the home version of the K-ARS. The total and subscale-specific normative data and sex- and age-related mean score differences were analyzed. These data were compared with those obtained from the American population using independent t-tests. ResultsMean total and subscale K-ARS scores were significantly higher among boys (vs. girls) and younger children aged equal to or less than 8 years old (vs. older children). Mean scores on the hyperactivity-impulsivity subscale were lower than those of American children, but similar to another Korean sample. ConclusionOur data characterized ADHD symptoms in Korean children. However, further studies are needed to identify the cultural differences underlying ratings of ADHD symptom severity.

Attention-deficit hyperactivity disorder and impulsivity in female patients with fibromyalgia.

ObjectiveData which indicate a greater role of the central nervous system in the etiology of fibromyalgia are increasing. The goal of the present study is to determine the link between fibromyalgia and attention-deficit hyperactivity disorder (ADHD) and, in addition, to reveal the relevance of impulsivity dimension.MethodsThe study included 78 females with fibromyalgia who applied to a physical medicine and rehabilitation polyclinic in Ceyhan State Hospital and 54 healthy females. The diagnosis of fibromyalgia was made by an experienced specialist of physical medicine and rehabilitation based on the American Rheumatology Association Diagnostic Criteria (2010). The diagnosis of ADHD was by an experienced psychiatrist using Diagnostic and Statistical Manual of Mental Disorders-5. The following inventories were used: adult ADHD self-report scale, Wender Utah rating scale, and Barratt impulsivity scale short form.ResultsAdult ADHD was detected in 29.5% of the fibromyalgia group and 7.4% of the control group; childhood and adolescent attention hyperactivity disorder ratios in these groups were 33.3% and 11.1%, respectively. The differences were statistically significant (P=0.002, P=0.003). Scores of the fibromyalgia group on the Wender Utah rating scale, adult ADHD self-report scale, attention subscale, hyperactivity–impulsivity subscale, and the Barratt impulsivity scale for non-planning and attentional impulsivity were found to be significantly higher than the control group (P<0.05, P<0.01, P<0.01, P<0.05, P<0.01, P<0.05, respectively).ConclusionThe present study has shown that both adult and childhood ADHD are quite common in female fibromyalgia patients. There was a link between fibromyalgia and impulsivity. Certain subtypes of fibromyalgia and attention-deficit hyperactivity deficit disorder could be sharing the common etiological pathways.

Effect of an Ecological Executive Skill Training Program for School-aged Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Clinical Trial.

Background:As medication does not normalize outcomes of children with attention deficit hyperactivity disorder (ADHD), especially in real-life functioning, nonpharmacological methods are important to target this field. This randomized controlled clinical trial was designed to evaluate the effects of a comprehensive executive skill training program for school-aged children with ADHD in a relatively large sample.Methods:The children (aged 6–12 years) with ADHD were randomized to the intervention or waitlist groups. A healthy control group was composed of gender- and age-matched healthy children. The intervention group received a 12-session training program for multiple executive skills. Executive function (EF), ADHD symptoms, and social functioning in the intervention and waitlist groups were evaluated at baseline and the end of the final training session. The healthy controls (HCs) were only assessed once at baseline. Repeated measures analyses of variance were used to compare EF, ADHD symptoms, and social function between intervention and waitlist groups.Results:Thirty-eight children with ADHD in intervention group, 30 in waitlist group, and 23 healthy children in healthy control group were included in final analysis. At posttreatment, intervention group showed significantly lower Behavior Rating Inventory of Executive Function (BRIEF) total score (135.89 ± 16.80 vs. 146.09 ± 23.92, P = 0.04) and monitoring score (18.05 ± 2.67 vs. 19.77 ± 3.10, P = 0.02), ADHD-IV overall score (41.11 ± 7.48 vs. 47.20 ± 8.47, P < 0.01), hyperactivity-impulsivity (HI) subscale score (18.92 ± 5.09 vs. 21.93 ± 4.93, P = 0.02), and inattentive subscale score (22.18 ± 3.56 vs. 25.27 ± 5.06, P < 0.01), compared with the waitlist group. Repeated measures analyses of variance revealed significant interactions between time and group on the BRIEF inhibition subscale (F = 5.06, P = 0.03), working memory (F = 4.48, P = 0.04), ADHD-IV overall score (F = 21.72, P < 0.01), HI subscale score (F = 19.08, P < 0.01), and inattentive subscale score (F = 12.40, P < 0.01). Multiple-way analysis of variance showed significant differences on all variables of BRIEF, ADHD-rating scale-IV, and WEISS Functional Impairment Scale-Parent form (WFIRS-P) among the intervention and waitlist groups at posttreatment and HCs at baseline.Conclusions:This randomized controlled study on executive skill training in a relatively large sample provided some evidences that the training could improve EF deficits, reduce problematic symptoms, and potentially enhance the social functioning in school-aged children with ADHD.Clinical Trial Registration:http://www.clinicaltrials.gov; NCT02327585.

Subclinical ADHD-Symptoms Are Associated with Executive-Functioning and Externalizing Problems in College Students without ADHD-Diagnoses

&lt;p&gt;This study investigated whether problem behaviors,&lt;strong&gt; &lt;/strong&gt;typically associated with a clinical diagnosis of ADHD, would also be associated with subclinical ADHD symptoms within a non-clinical college sample. These are symptoms characteristic of ADHD, which are insufficient to warrant a DSM-IV diagnosis of ADHD. Self-ratings of behaviors known to be comorbid with ADHD (Oppositional-Defiant Disorder (ODD) behaviors, risk-taking, and Executive-Functioning (EF) problems) were examined as predictors of self-ratings of ADHD symptoms. Measures of ODD symptoms, risk-taking, and EF behavioral problems (related to poor management of time) significantly predicted ADHD symptoms, as measured by Barkley’s ADHD Combined Subscale. These predictors accounted for 26% of the variance. The same measures predicted symptoms of ADHD, Inattentive type, as measured by Barkley’s Inattentiveness (IA) Subscale, and accounted for 30% of the variance. For the Hyperactivity-Impulsivity Subscale (HI), the ODD measure significantly entered the equation, while the other two measures were borderline significant, accounting altogether for 10% of the variance. As hypothesized, the EF measure was the strongest predictor for IA, and the ODD measure was the strongest predictor for HI. In conclusion, problem behaviors comorbid with a formal clinical ADHD diagnosis were found to be significantly associated with subclinical ADHD symptoms within a non-clinical sample of college students, as indicated by the substantial proportion of the variance they accounted for in predicting the Barkley’s’ Combined and Inattentiveness Subscales, and to a lessor extent for the Hyperactivity/Impulsivity Subscale. This indicates that college students with ADHD symptoms may have substantial problems not only with their ADHD symptoms, but also with executive functioning and externalizing behaviors associated with these symptoms.&lt;/p&gt;

Bifactor latent structure of ADHD/ODD symptoms: predictions of dual-pathway/trait-impulsivity etiological models of ADHD.

To determine if ADHD/ODD symptoms are better represented by a bifactor model of disruptive behavior [general disruptive behavior factor along with specific inattention (IN), specific hyperactivity/impulsivity (HI), and specific oppositional defiant disorder (ODD) factors] than an ADHD-IN, ADHD-HI, and ODD three-factor model. Mothers' and fathers' ratings of ADHD-IN, ADHD-HI, and ODD symptoms in a community sample of 4,658 children and adolescents (53% female) from Brazil, Thailand, and the US were used to evaluate the measurement models. The bifactor model of disruptive behavior provided a better fit than the three factor model. The bifactor model also occurred with mothers' and fathers' ratings of male and female children and adolescents. Consistent with predictions derived from recently articulated dual-pathway and trait-impulsivity models of externalizing liability, and from behavioral genetics studies indicating near complete overlap in vulnerability to ADHD and ODD, ADHD and ODD symptoms arose from a single, general disruptive behavior factor, which accounted for all of the variance in HI subscale scores and over half of the variance IN and ODD subscales. Thus, IN, HI, and ODD subscale scores strongly reflect a general disruptive behavior factor – not the specific content of their respective constructs.

Long-Term Treatment with Atomoxetine for Attention-Deficit/Hyperactivity Disorder Symptoms in Children and Adolescents with Autism Spectrum Disorder: An Open-Label Extension Study

The efficacy and tolerability of long-term treatment with atomoxetine for symptoms of attention-deficit/hyperactivity disorder (ADHD) in children with autism spectrum disorder (ASD) has not been established. In this study, 88 patients 6-17 years of age, with ADHD and ASD, were treated with 1.2 mg/kg/day atomoxetine for 20 weeks as follow-up of an 8 week double-blind placebo-controlled period. Primary endpoint was the ADHD Rating Scale (ADHD-RS). After 8 weeks of initial treatment, the mean total, inattention, and hyperactivity-impulsivity ADHD-RS further decreased significantly from 34.9 to 27.0 for the total ADHD-RS, from 18.3 to 14.5 for the ADHD-RS inattention subscale, and from 16.5 to 12.6 for the hyperactivity-impulsivity subscale. Adverse events were mild and tended to diminish over time during continued treatment, especially regarding nausea and fatigue. There were no serious adverse events. The results of the present analysis suggest that continued treatment with atomoxetine up to 28 weeks further improve ADHD symptoms in children and adolescents with ASD, while adverse events tend to subside. Future studies investigating the long-term efficacy of atomoxetine in children and adolescents with ASD should be randomized and placebo controlled. This study has been registered in ClinicalTrials.gov ( www.clinicaltrials.gov ) under registration number NCT00380692.

Low self-awareness of ADHD in adults using a self-report screening questionnaire

IntroductionAwareness of attention deficit hyperactivity disorder (ADHD) in adults has been growing over the last decade. One of the most interesting issues related to this topic is these adults’ self-awareness of their ADHD symptoms and their estimation of their own impairments. Our hypothesis while studying young adult ADHD populations was that there would be a significant difference between their self-report and their clinical assessment. MethodOne hundred and three students volunteered for this study. In order to validate our ADHD screening questionnaire (ADHD-SQ), and to assess the level of awareness they have of their own symptoms, participants underwent a complete clinical assessment for ADHD. They were divided into a control group (n=24), and an ADHD study group (n=79), which in turn was composed of two sub-groups, one comprising 24 ADHD predominantly inattentive (ADHD-I) and the other 55 ADHD combined type (ADHD-C). ResultsFactor analysis yielded two factors explaining 41% of the variance. The Inattention (IA) subscale score tended to be higher in both ADHD sub-groups as compared to the control group (6.5±2.1 vs. 2.34±2.3 with P<0.001), with no significant difference between the two ADHD sub-groups. Hyperactivity Impulsivity (HI) subscale was significantly higher for the ADHD-C sub-group than in the ADHD-I sub-group, whose score was similar to that of the control group (control: 1.6±2.1; ADHD-I: 1.55±1.0; ADHD-C: 4.5±2.6, P<0.0001). Receiver Operating Characteristics (ROC) analysis showed similar results. The area under the curve (AUC) of IA subscale score was 0.90 (95% confidence: 0.83–0.96) and for HI subscale score was 0.75, (95% confidence: 0.63–0.86). Classification into groups used a cut-off point of 3+ items out of nine, in the SQ and 6+ items out of nine in the clinical assessment. These two classifications showed 68% agreement (46% sensitivity and 95% specificity). In both ADHD sub-groups, the self-reported average number of positive symptoms per student was relatively low for both clusters; this phenomenon was pronounced in the specific subtypes. The self-rated HI cluster score was considerably low in the ADHD-C sub-group (4.5±2.6), and the IA one was particularly low in the ADHD-IADHD-I sub-group (5.9±1.9). ConclusionThis study's results indicate that ADHD symptoms are under-reported for both inattentive and hyperactive-impulsive clusters, indicating that adults with ADHD tend to under-estimate their own ADHD-related impairments. We suggest that this questionnaire may be used both in research and academic settings to help counsellors and students to obtain early indication of ADHD and to refer students suspected of having ADHD to full clinical assessment.

Standardized Observational Assessment of Attention Deficit Hyperactivity Disorder Combined and Predominantly Inattentive Subtypes. II. Classroom Observations

.Trained classroom observers used the Direct Observation Form (DOF; McConaughy & Achenbach, 2009) to rate observations of 163 6- to 11-year-old children in their school classrooms. Participants were assigned to four groups based on a parent diagnostic interview and parent and teacher rating scales: Attention Deficit Hyperactivity Disorder (ADHD)—Combined type (n = 64); ADHD—Inattentive type (n = 22); clinically referred without ADHD (n = 51); and nonreferred control children (n = 26). The ADHD—Combined group scored significantly higher than the referred without ADHD group and controls on the DOF Intrusive and Oppositional syndromes, Attention Deficit Hyperactivity Problems scale, Hyperactivity-Impulsivity subscale, and Total Problems; and significantly lower on the DOF On-Task score. The ADHD—Inattentive group scored significantly higher than controls on the DOF Sluggish Cognitive Tempo and Attention Problems syndromes, Inattention subscale, and Total Problems; and significantly lower on the DOF On-Task score. Implications are discussed regarding the discriminative validity of standardized classroom observations for identifying children with ADHD and differentiating between the two ADHD subtypes.

Standardized Observational Assessment of Attention Deficit Hyperactivity Disorder Combined and Predominantly Inattentive Subtypes. I. Test Session Observations

.Test examiners used the Test Observation Form (McConaughy & Achenbach, 2004) to rate test session behavior of 177 6- to 11-year-old children during administration of the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV) and Wechsler Individual Achievement Tests—Second Edition (WIAT-II). Participants were assigned to four groups based on a parent diagnostic interview and parent and teacher rating scales: attention deficit hyperactivity disorder (ADHD)—Combined type (n = 74); ADHD—Inattentive type (n = 25); clinically referred without ADHD (n = 52); and controls (n = 26). The ADHD—Combined type group scored significantly higher than the other three groups on six Test Observation Form scales: (1) Attention Problems; (2) Oppositional; (3) Attention Deficit/Hyperactivity Problems scale; (4) Inattention subscale; (5) Hyperactivity-Impulsivity subscale; and (6) Externalizing. The two ADHD groups also scored significantly lower than controls on all WISC-IV and WIAT-II composites and lower than those clinically referred without ADHD on WISC-IV Working Memory Index and Full Scale Intelligence Quotient. Implications are discussed regarding the discriminative validity of standardized test session observations for identifying children with ADHD and differentiating between the two ADHD subtypes.

Association of the Adrenergic α2A Receptor Gene With Methylphenidate Improvement of Inattentive Symptoms in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

Preclinical studies have demonstrated the relevance of adrenergic alpha2A receptor on the attentional process and the mechanism of action of methylphenidate hydrochloride. Several molecular genetic investigations suggest a role for the adrenergic alpha2A receptor gene (ADRA2A) in attention-deficit/hyperactivity disorder (ADHD), especially in the inattentive dimension. However, the effect of ADRA2A in the response to methylphenidate in humans has not been previously investigated, to our knowledge. To evaluate the association between the ADRA2A -1291 C>G polymorphism and the clinical response to methylphenidate treatment in children and adolescents with ADHD. A pharmacogenomic study was undertaken between November 1, 2002, and May 1, 2004, using a nonrandom assignment, quasi-experimental design. An ADHD outpatient program at a university hospital in Brazil. Patients One hundred six patients consecutively diagnosed as having ADHD were genotyped for the ADRA2A -1291 C>G polymorphism and were included in the analyses. Intervention Short-acting methylphenidate administered in increasing dosages until no further clinical improvement was detected or until limited adverse effects occurred. The primary outcome measure was the parent-rated inattentive subscale of the Swanson, Nolan, and Pelham Scale version IV. Secondary outcome measures included the Barkley Side Effect Rating Scale and the parent-rated hyperactivity-impulsivity subscale of the Swanson, Nolan, and Pelham Scale version IV. Scales were applied by child psychiatrists blinded to genotype at baseline and at 1 and 3 months of treatment. A significant interaction effect between the presence of the G allele and treatment with methylphenidate over time on inattentive scores was detected during the 3 months of treatment (n = 106; F(2,198) = 4.30; P = .02). We documented the effect of the G allele at the ADRA2A -1291 C>G polymorphism on the improvement of inattentive symptoms with methylphenidate treatment in children and adolescents with ADHD. Our findings provide clinical evidence for the involvement of the noradrenergic system in the modulation of methylphenidate action.