Parent-rated Attention-deficit/hyperactivity Disorder Symptoms Research Articles

Placebo-related improvement with methylphenidate treatment in children with ADHD.

Non-specific effects of methylphenidate treatment, including expectancy and regression to the mean effects, contribute to the overall effect of methylphenidate on attention-deficit/hyperactivity disorder (ADHD) symptoms. Knowledge on the extent to which non-specific effects contribute to the overall effect and whether regression to the mean explains part of the non-specific effects, is currently lacking. A double-blind, randomized, placebo-controlled, cross-over trial was used to compare parent and teacher ratings of child ADHD symptoms at baseline and during treatment with placebo and 5, 10, 15 and 20mg of methylphenidate, twice daily. Participants were 5-13-year-old children with a DSM-5 diagnosis of ADHD (N = 45). The extent to which non-specific effects contributed to the effects of methylphenidate was determined by ADHD symptom reductions observed with placebo versus reductions observed with active doses of methylphenidate. The influence of regression to the mean was examined by estimating the contribution of baseline ADHD symptom severity to the effects observed with placebo treatment. Data were analyzed using multilevel analyses. We observed significant non-specific effects of methylphenidate for parent-rated ADHD symptoms, but not for teacher-rated symptoms. For parent reported hyperactive/impulsive symptoms, higher baseline symptoms predicted larger effects with placebo, indicating regression to the mean effects. For parent-reports, a significant part of the overall effect of methylphenidate treatment is explained by non-specific effects. Our findings stress the importance of taking non-specific effects into account when evaluating methylphenidate treatment, by including teacher-reports and using a double baseline assessment during titration. Comparing active medication with a placebo in the titration trial has the potential to identify non-specific effects.

Relative Age Effects on Attention-Deficit/Hyperactivity Disorder Symptoms and Educational Achievement: A Longitudinal UK Cohort Study

Being among the youngest in a school class increases the risk for worse educational outcomes and attention-deficit/hyperactivity disorder (ADHD) symptoms, but questions remain about the nature and persistence of such effects. We investigated this "relative age effect" on educational achievement at age 15 to 16 years and on ADHD symptoms from age 7 to age 21 years. Furthermore, we examined whether being young-in-class is linked to a greater reduction in ADHD symptoms from childhood to adulthood and a lower genetic propensity to ADHD. We identified 3,928 young-in-class and 4,580 old-in-class participants from the Twins' Early Development Study. Educational achievement was measured with mathematics and English examination grades at age 15 to 16 years, and ADHD symptoms were measured using 2 different scales and different raters, from age 7 to 21 years, with effects tested using regression. A relative age effect emerged for English but not mathematics examination grades, and for the majority of parent and teacher ratings on ADHD symptoms, most consistently in middle childhood. Being young-in-class was associated with a greater reduction in parent-rated ADHD symptoms from childhood to adulthood when measured with a brief scale, but the comparable result from a longer scale was non-significant (after multiple testing correction). No interaction emerged between relative age and ADHD polygenic scores. Our results emphasise the need to improve support for the children who start school younger than most, and to ensure that developmental comparisons take children's precise age into account. Future research would benefit from in-depth analyses of individual trajectories and their variability among the young-in-class children.

1 Sluggish Cognitive Tempo in Children and Adolescents with Fetal Alcohol Spectrum Disorders: Associations with Executive Function and Subcortical Volumes

Objective:Fetal alcohol spectrum disorder (FASD) is a common neurodevelopmental condition associated with deficits in cognitive functioning (executive functioning [EF], attention, working memory, etc.), behavioral impairments, and abnormalities in brain structure including cortical and subcortical volumes. Rates of comorbid attention-deficit/hyperactivity disorder (ADHD) are high in children with FASD and contribute to significant functional impairments. Sluggish cognitive tempo (SCT) includes a cluster of symptoms (e.g. underactive/slow-moving, confusion, fogginess, daydreaming) found to be related to but distinct from ADHD, and previous research suggests that it may be common in FASD. We explored SCT by examining the relationship between SCT and both brain volumes (corpus callosum, caudate, and hippocampus) and objective EF measures in children with FASD vs. typically developing controls.Participants and Methods:This is a secondary analysis of a larger longitudinal CIFASD study that consisted of 35 children with prenatal alcohol exposure (PAE) and 30 controls between the ages of 9 to 18 at follow-up. Children completed a set of cognitive assessments (WISC-IV, DKEFS, & NIH Toolbox) and an MRI scan, while parents completed the Child Behavior Checklist (CBCL), which includes a SCT scale. We examined group differences between PAE and controls in relation to SCT symptoms, EF scores, and subcortical volumes. Then, we performed within-and between-group comparisons with and without controlling for total intracranial volume, age, attention problems, and ADHD problems between SCT and subcortical brain volumes. Finally, we performed correlations between SCT and EF measures for both groups.Results:Compared to controls, participants with PAE showed significantly more SCT symptoms on the CBCL (t [57] = 3.66, p = 0.0006), more parent-rated attention problems and ADHD symptoms, lower scores across several EF measures (DKEFS Trail-Making and Verbal Fluency; WISC-IV Digit Span, Symbol Search, and Coding; effect sizes ranging from 0.44 to 1.16), and smaller regional volumes in the caudate, hippocampus, and posterior areas of the corpus callosum. In the PAE group, a smaller hippocampus was associated with more SCT symptoms (controlling for parent-rated attention problems and ADHD problems, age, and intracranial volume). However, in the control group, a larger mid posterior and posterior corpus callosum were significantly associated with more SCT symptoms (controlling for parent-rated attention problems, intracranial volume, and age; r [24] = 0.499, p = 0.009; r [24] = 0.517, p = 0.007). In terms of executive functioning, children in the PAE group with more SCT symptoms performed worse on letter sequencing of the Trail-Making subtest (controlling attention problems & ADHD symptoms). In comparison, those in the control group with more SCT symptoms performed better on letter sequencing and combined number letter sequencing of the Trail-Making subtest (controlling attention problems).Conclusions:Findings suggest that children with FASD experience elevated SCT symptoms compared to typically developing controls, which may be associated with worse performance on EF tasks and smaller subcortical volumes (hippocampus) when taking attention difficulties and ADHD symptoms into account. Additional research into the underlying causes and correlates of SCT in FASD could result in improved tailoring of interventions for this population.

Analyzing the network of parent-rated ADHD symptoms before and 2 weeks after the onset of pharmaceutical treatment.

Via a network analysis approach, following 2 weeks of the medication Ritalin, the present study investigated the quality of symptom interactions and the pattern of behavior changes to identify locations of functional weaknesses in the network interactions of symptomology. Ritalin® prescribed for 112 children (aged 4-14) with attention deficit hyperactivity disorder (ADHD) as diagnosed by five child and adolescent psychiatrists. Their parents completed Swanson, Nolan, and Pelham-IV questionnaire (SNAP-IV) before and after Ritalin® onset as the pre and post-test, respectively. Then, the network analysis approach was used to discover the pattern of changes in symptom interactions. The results indicated that in 2 weeks following its initiation, Ritalin significantly reduced restlessness and interactions between symptoms of impulsivity. "Inability to follow instructions" and "difficulty waiting their turn" symptoms were the most central symptoms of strength. Three symptoms, "Often has difficulty waiting their turn," "runs and climbs in situations where it is inappropriate" and "does not follow through on instructions," had the most expected influence. In the 14-day period of investigation, Ritalin® was effective in breaking some interactions and components of ADHD, but no significant mitigation of other components of the detected symptomatology network. Follow-up investigations using network analysis can clarify the dynamics of the network changes after initiation of medications.

Mediators of psychosocial treatment for adolescent ADHD.

Almost no studies identify mediators of psychosocial interventions for attention deficit/hyperactivity disorder (ADHD)-largely due to design limitations. Understanding mediators can promote streamlined interventions in usual care (UC) settings. When individual studies are insufficient to pursue complex questions, integrative data analysis (IDA) allows researchers to pool raw data from multiple studies to produce cumulative scientific knowledge. We leveraged IDA to pool and harmonize data from four randomized controlled trials of ADHD psychosocial treatment (N = 854) with three time points. Linear growth curve analyses examined the impact of four psychosocial treatment conditions on ADHD symptom outcomes and five candidate mediators (compared to no treatment). To test mediation, we examined whether treatment condition predicted linear growth in the mediator at posttreatment, and if the mediator predicted linear growth in the outcome at follow-up. Compared to no treatment, engagement-focused parent-teen treatment (d = .43-.72; Supporting Teens' Autonomy Daily [STAND]) and community-based usual care (d = .54-.99) led to greatest reductions in parent-rated ADHD symptoms, followed by the Summer Treatment Program-Adolescent (d = .29-.30; STP-A) and standard behavioral parent training + organization skills training (d = .26-.31; BPT/OST). Improvements in organization, time management, and planning skills mediated outcome for all treatments. BPT/OST and STP-A prevented deterioration of social skills, in turn mitigating escalation of ADHD symptoms. Improvements in parent-teen communication skills mediated outcome for STAND, BPT/OST, and the STP-A. Parent contingency management and disruptive classroom behavior were not treatment mediators. Psychosocial treatments for adolescent ADHD primarily improve ADHD symptoms through development of teen organization, time management (OTP), and parent-teen communication skills, as well as slowing deterioration of social skills. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Two-Factor Structure of the Parent Cognitive Error Questionnaire: A Measure of Parental Cognitive Errors in Relation to Child Problems.

This study evaluated the factor structure of the scores from a parent rating scale, the Parent Cognitive Error Questionnaire (PCEQ), which measures parents' attributions of child misbehavior and problems. The factor structure of the scores of the PCEQ was examined among 199 children (ages 7-11; mean age: 8.64 years, 58.30% boys, 53.80% White) with Attention-Deficit/Hyperactivity Disorder (ADHD), Predominantly Inattentive Presentation. Reliability and validity of the factors were assessed. Two factors emerged from this sample: (1) parent-specific cognitive errors (self-blame for child problems), and (2) child-specific cognitive errors (child-blame for child problems). Both were related to parent-rated parental depression, parenting satisfaction, parenting self-efficacy, and child ADHD and Oppositional Defiant Disorder (ODD) symptoms. After adjusting for child-specific cognitive errors, parent-specific errors were related to parent-rated parent depressive symptoms, and after adjustment for parent-specific cognitive errors, child-specific cognitive errors were related to parent-rated child ADHD and ODD symptoms. A two-factor structure for the PCEQ scores from this sample was found with evidence of reliability and validity of factors, showing promise for measuring sources of parental attributions regarding child problems.

Frontal interhemispheric structural connectivity, attention, and executive function in children with perinatal stroke.

Perinatal stroke affects ∼1 in 1000 births and concomitant cognitive impairments are common but poorly understood. Rates of Attention Deficit/Hyperactivity Disorder (ADHD) are increased 5–10× and executive dysfunction can be disabling. We used diffusion imaging to investigate whether stroke‐related differences in frontal white matter (WM) relate to cognitive impairments. Anterior forceps were isolated using tractography and sampled along the tract. Resulting metrics quantified frontal WM microstructure. Associations between WM metrics and parent ratings of ADHD symptoms (ADHD‐5 rating scale) and executive functioning (Behavior Rating Inventory of Executive Function (BRIEF)) were explored. Eighty‐three children were recruited (arterial ischemic stroke [AIS] n = 26; periventricular venous infarction [PVI] n = 26; controls n = 31). WM metrics were altered for stroke groups compared to controls. Along‐tract analyses showed differences in WM metrics in areas approximating the lesion as well as more remote differences at midline and in the nonlesioned hemisphere. WM metrics correlated with parental ratings of ADHD and executive function such that higher diffusivity values were associated with poorer function. These findings suggest that underlying microstructure of frontal white matter quantified via tractography may provide a relevant biomarker associated with cognition and behavior in children with perinatal stroke.

The association between polygenic scores for attention-deficit/hyperactivity disorder and school performance: The role of attention-deficit/hyperactivity disorder symptoms, polygenic scores for educational attainment, and shared familial factors.

Polygenic scores (PGS) for attention-deficit/hyperactivity disorder (ADHD) negatively predicts educational attainment (EA), but it remains unclear how ADHD symptoms, PGS for EA, and shared familiar factors influence the associations between PGS for ADHD and school performance. We combined survey data on ADHD symptoms, PGS, and register-based, objective measures of compulsory school performance at age 16 for 6049 twins in the Child and Adolescent Twin Study in Sweden. Linear and instrumental variable (IV) regression models were used to estimate the association between PGS for ADHD and grade point average (GPA), overall and by natural science, humanities, and practically oriented (e.g., sports, arts, music) subject categories. The models were adjusted for parent-rated ADHD symptoms, PGS for EA, and shared familial factors (dizygotic twin comparisons) to examine how these factors influenced the associations between PGS for ADHD and school performance. PGS for ADHD were negatively associated with school performance; β=-0.12, 95% confidence interval = (-0.15, -0.09) for overall GPA with minor differences by subject category. Adjustment for ADHD symptoms attenuated these associations to a small degree compared to PGS for EA, and shared familial factors respectively. Stronger associations were observed using IV regressions compared to linear regression. However, in the IV regression analyses, most associations between PGS for ADHD and GPA in the practically oriented subject category were not significant. Associations between PGS for ADHD and school performance are to a small degree influenced by ADHD symptoms, compared to PGS for EA and shared familial factors. These results highlight important considerations for research using PGS for ADHD to control for genetic factors, and for future clinical applications aiming to determine genetic liability towards ADHD.

Cost-Effectiveness of a Training Intervention for Adolescents with ADHD

ABSTRACT Objective The aim of this study was to examine the costs and cost-effectiveness of a school-based training intervention delivered at varying levels of intensity with adolescents with attention-deficit/hyperactivity disorder (ADHD). Costs were examined in relation to post-treatment and 6-month follow-up effects of the Challenging Horizons Program (CHP), a training intervention for adolescents with ADHD. Method A total of 326 middle-school students (71% male; 77% White) with ADHD were randomized to an after-school version of the CHP (CHP-AS), a less-intensive mentoring version (CHP-M), or routine community care. Detailed time logs were maintained throughout the study and were used to estimate costs associated with each condition. Student grade point average (GPA) and parent-rated ADHD symptoms and organization skills were collected at post-treatment and 6-month follow-up. Results The cost analysis revealed that CHP-AS was more costly per student than CHP-M, both in terms of overall costs and direct expenses to the school. However, CHP-AS was less costly per hour of intervention provided to the youth than CHP-M. Incremental cost-effectiveness ratios revealed that CHP-M may be the more cost-effective option for post-treatment effects, yet CHP-AS may be the more cost-effective option in the long term for sustained gains in organization skills and GPA. Conclusions This study provides stakeholders important information to make decisions regarding allocation of finite monetary resources to meet their prioritized goals.

Actigraph-Measured Movement Correlates of Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in Young People with Tuberous Sclerosis Complex (TSC) with and without Intellectual Disability and Autism Spectrum Disorder (ASD).

Actigraphy, an objective measure of motor activity, reliably indexes increased movement levels in attention-deficit/hyperactivity disorder (ADHD) and may be useful for diagnosis and treatment-monitoring. However, actigraphy has not been examined in complex neurodevelopmental conditions. This study used actigraphy to objectively measure movement levels in individuals with a complex neurodevelopmental genetic disorder, tuberous sclerosis (TSC). Thirty participants with TSC (11–21 years, 20 females, IQ = 35–108) underwent brief (approximately 1 h) daytime actigraph assessment during two settings: movie viewing and cognitive testing. Multiple linear regressions were used to test associations between movement measurements and parent-rated ADHD symptoms. Correlations were used to examine associations between actigraph measures and parent-rated ADHD symptoms and other characteristics of TSC (symptoms of autism spectrum disorder (ASD), intellectual ability (IQ), epilepsy severity, cortical tuber count). Higher movement levels during movies were associated with higher parent-rated ADHD symptoms. Higher ADHD symptoms and actigraph-measured movement levels during movies were positively associated with ASD symptoms and negatively associated with IQ. Inter-individual variability of movement during movies was not associated with parent-rated hyperactivity or IQ but was negatively associated with ASD symptoms. There were no associations with tuber count or epilepsy. Our findings suggest that actigraph-measured movement provides a useful correlate of ADHD in TSC.

High prevalence of ADHD symptoms in unmedicated youths with post-H1N1 narcolepsy type 1

ObjectivesTo characterize attention deficit-hyperactivity disorder (ADHD) symptoms in unmedicated post-H1N1 narcolepsy type 1 (NT1) youths, and explore associations between ADHD symptoms and the narcolepsy phenotype. MethodsA total of 50 consecutively enrolled post-H1N1 NT1 youths (7–20 years, 62% females, 98% HLA-DQB1∗06:02-positive, 98% CSF hypocretin-1 deficient, 88% vaccinated) were assessed after two weeks off medication for ADHD (ADHD diagnosis pre/post-narcolepsy, parent-rated ADHD symptoms) and narcolepsy-phenotyped (semi-structured interview, Stanford Sleep Questionnaire, Epworth Sleepiness Scale, polysomnography (PSG), Multiple Sleep Latency Test (MSLT)). ResultsIn sum, 26 (52%) and 15 (30%) of participants had ADHD symptoms above and below the clinical significant cut-off, respectively, while 9 (18%) had no ADHD symptoms. High values were found for ADHD total score (mean (SD), 17.9 (9.5)) and ADHD subscores (inattentive score, 11.0 (6.3); hyperactive/impulsivity score, 6.9 (4.7)). These were significantly higher than previously reported in a mainly medicated narcolepsy cohort (p < 0.0001). Age, gender and disease duration did not influence scores. Two participants (4%) had ADHD diagnosis prior to narcolepsy onset. ADHD symptoms were correlated with parent-rated, but not with patient rated ESS scores, objective sleepiness (mean sleep latency), sleep fragmentation (sleep stage shift index, awakening index), or CSF hypocretin-1 level. ConclusionComorbid ADHD symptoms were more prevalent in unmedicated post-H1N1 NT1 youths than previously reported in mainly medicated pediatric narcolepsy cohorts. The high prevalence was not due to pre-existing ADHD and generally not correlated with core narcolepsy sleep/wake phenotype characteristics, indicating that the ADHD symptoms were not a direct consequence of disturbed sleep or daytime sleepiness.

Increased prevalence of parent ratings of ADHD symptoms among children with bilateral congenital cataracts.

To investigate the behavioral and psychological disorders and the prevalence of parent ratings of attention deficit hyperactivity disorder (ADHD) symptoms among children with bilateral congenital cataracts (CCs). This cross-sectional study investigated children with bilateral CC aged 3-8y (CC group) using Conners' Parent Rating Scale-48 (CPRS-48) from July to December 2016. The abnormal rates of psychological symptoms in CC children and normal vision (NV) children were compared using the Chi-square test. The scores of CC children were compared with those of NV children and the Chinese urban norm using the independent samples t-test and one-sample t-test, respectively. A total of 262 valid questionnaires were collected. The ratio of CC children to NV children was 119:143. The overall rate of psychological symptoms in CC children was 2.28 times higher than that in NV children (46.22% vs 20.28%, Pearson's χ 2=20.062; P<0.001). CC children showed higher scores for conduct problems, learning problems, impulsiveness/hyperactivity, anxiety, and hyperactivity index than NV children and the Chinese urban norm, particularly between the ages of 3 and 5y. Furthermore, male children aged between 6 and 8y showed a higher impulsive/hyperactive score than females of the same age (t=6.083, P<0.001). Children with bilateral CCs have a higher rate of ADHD symptoms than children with NV. This study provides clinical evidence that screening for psychological symptoms and particularly for ADHD symptoms in children with bilateral CC are recommended for an early diagnosis and timely treatment.

Contribution of the Behavioral Observation of Students in Schools to ADHD Assessment

Classroom observations have long been considered a necessary component of Attention-Deficit/Hyperactivity Disorder (ADHD) evaluations. Yet, research evaluating the utility of observational ratings in ADHD assessment is limited. This study examined the contributions of the Behavioral Observation of Students in Schools (BOSS) to ADHD assessment by investigating associations between BOSS scores with ADHD symptom clusters and symptoms of frequently co-occurring externalizing and internalizing disorders. The utility of BOSS scores in predicting future ADHD-related impairment beyond standard parent and teacher ratings was also examined. One hundred and thirty-five children in grades 2–5 across 23 public schools participated in a randomized controlled trial examining a psychosocial treatment for ADHD. BOSS ratings were collected at baseline. Parent and teacher ratings of child symptoms and impairment were collected at baseline, post-treatment (3–4 months later), and follow-up (8–12 months later). Multiple regressions investigated the associations between the BOSS subscale of Task Engagement (TE) and parent and teacher ratings of ADHD symptoms and related disorders. Multi-level modeling accounted for school cluster effects. Results showed that lower BOSS TE was related to higher teacher-rated inattention but not hyperactivity/impulsivity symptoms. Lower BOSS TE was also associated with higher teacher-rated Oppositional Defiant Disorder (ODD) and depression symptoms, but not anxiety symptoms. Further, BOSS TE predicted higher future impairment beyond baseline teacher and parent ratings of ADHD symptoms and impairment, controlling for treatment. The BOSS appears sensitive to symptoms of child inattention, ODD, and depression, and may have utility in informing future impairment beyond standard informant ratings of ADHD.

Parent Training for Preschool ADHD in Routine, Specialist Care: A Randomized Controlled Trial

Parent training is recommended for attention-deficit/hyperactivity disorder (ADHD) in preschool children. Evidence-based interventions are important, but only if they produce better outcomes than usual care. The authors conducted a multicenter, 2-arm, parallel-group, randomized controlled trial in routine specialist ADHD clinics in the Danish Child and Adolescent Mental Health Services. Children (N= 164, 3-7 years old) with ADHD received a well-established parent training program (New Forest Parenting Programme; n= 88) or treatment as usual (n= 76). The primary outcome was parent ratings of child ADHD symptoms. Secondary outcomes included teacher ratings and direct observations of ADHD symptoms. Outcomes were measured at baseline, after treatment, and at follow-up (36 weeks later). Representativeness of participants was evaluated against the total national cohort of children (N= 1,378, 3-7 years old) diagnosed with ADHD during the same period using the Danish Civil Registration System. Statistical analysis used a repeated measure model. After treatment, the parent training program was superior to treatment as usual on parent-rated ADHD symptoms (p= .009; effect size d=0.30) and on parenting self-efficacy and family strain. Effects persisted to 36 weeks after treatment. There were no effects on teacher ratings or direct observations of ADHD or on ratings of conduct problems or parenting. The clinical sample was similar to the national cohort of young children with ADHD. Evidence-based parent training has value as an intervention for preschool ADHD in routine clinical settings. As in previous trials, effects were restricted to parent-reported outcomes. Surprisingly, there were no effects on child conduct problems. A Controlled Study of Parent Training in the Treatment of ADHD in Young Children (D'SNAPP). http://clinicaltrial.gov/;NCT01684644.

Invariance of ADHD Symptoms Across Sex and Age: a Latent Analysis of ADHD and Impairment Ratings from Early Childhood into Adolescence.

A population-based longitudinal sample of 489 twin pairs was assessed at six time points over ten years to examine the measurement invariance and stability of attention-deficit/hyperactivity disorder (ADHD) symptoms, as well as the developmental relations between inattention (IN), hyperactivity-impulsivity (HI), and multiple aspects of functional impairment. Parent ratings of ADHD symptoms and functional impairment were obtained in preschool and after the completion of kindergarten, first, second, fourth, and ninth grades. Results of the temporal and sex invariance models indicated that parent ratings of the 18 ADHD symptoms function in the same manner for females and males from early childhood into adolescence. In addition to establishing this prerequisite condition for the interpretation of longitudinal and between-sex differences in the IN and HI symptom dimensions, cross-lagged models indicated that both IN and HI were associated with increased risk for both concurrent and future overall, social, and recreational impairment, whereas only IN was uniquely associated with later academic impairment. Taken together, the current results demonstrate that IN and HI are highly stable from preschool through ninth grade, invariant between females and males, and indicative of risk for impairment in multiple areas, thereby providing strong support for the validity of the symptom dimensions among both sexes.

High versus Low Intensity Summer Treatment for ADHD Delivered at Secondary School Transitions

Spikes in symptom severity are noted for adolescents with attention deficit/hyperactivity disorder (ADHD) at the transitions to middle and high school that are attributed to developmental maladjustment. This study evaluated the effectiveness of high-intensity (HI; 412 hr, $4,373 per participant) versus low-intensity (LI; 24 hr, $97 per participant) skills-based summer intervention delivered to adolescents with ADHD by local school district staff. Participants were 325 ethnically diverse rising sixth and ninth graders with ADHD randomized to HI versus LI (n = 218) or recruited into an untreated comparison group (n = 107). Group × Time 1-year outcome trajectories were compared using linear mixed models. Both interventions possessed high fidelity and were viewed by families as enjoyable and beneficial. Youth attendance was higher for HI (~80%) versus LI (~45%). Parent training attendance was uniform across groups (~50%). Parent and student attendance did not impact trajectories. Primary benefits of HI over LI were to note taking (d = .50), parent contingency management (d = .43), and parent-rated ADHD symptoms (d = .40–.46; ninth grade only). Secondary analyses suggested that HI may produce additional benefits compared to no treatment for home organization skills (HI vs. untreated d = .54), parent–teen conflict (HI vs. untreated d = .39), and grade point average (HI vs. untreated d = .47, ninth grade only). Summer HI treatment was superior to LI in engagement and uptake of certain skills. However, the extent to which these medium benefits on a limited number of outcomes justify high costs compared to LI remains an open question. Delivering treatment during the summer instead of school year may limit generalizability.

Predictive validity of parent- and self-rated ADHD symptoms in adolescence on adverse socioeconomic and health outcomes

There is scarcity of research investigating the validity of self-report of attention deficit hyperactivity disorder (ADHD) symptoms compared to other informants, such as parents. This study aimed to compare the predictive associations of ADHD symptoms rated by parents and their children across adolescence on a range of adverse socioeconomic and health outcomes in early adulthood. Parent- and self-rated ADHD symptoms were assessed in 2960 individuals in early (13–14 years) and late adolescence (16–17 years). Logistic regression analyses were used to compare the associations between parent- and self-rated ADHD symptoms at both time points and adverse life outcomes in young adulthood obtained from Swedish national registries. Both parent- and self-ratings of ADHD symptoms were associated with increased risk for adverse outcomes, although associations of parent-ratings were more often statistically significant and were generally stronger (OR = 1.12–1.49, p < 0.05) than self-ratings (OR = 1.07–1.17, p < 0.05). After controlling for the other informant, parent-ratings of ADHD symptoms in both early and late adolescence significantly predicted academic and occupational failure, criminal convictions and traffic-related injuries, while self-ratings of ADHD symptoms only in late adolescence predicted substance use disorder and academic failure. Our findings suggest that both parent- and self-ratings of ADHD symptoms in adolescence provides valuable information on risk of future adverse socioeconomic and health outcomes, however, self-ratings are not valuable once parent-ratings have been taken into account in predicting most outcomes. Thus, clinicians and researchers should prioritize parent-ratings over self-ratings.

Inattention and Reaction Time Variability Are Linked to Ventromedial Prefrontal Volume in Adolescents

BackgroundNeuroimaging studies of attention-deficit/hyperactivity disorder (ADHD) have most commonly reported volumetric abnormalities in the basal ganglia, cerebellum, and prefrontal cortices. Few studies have examined the relationship between ADHD symptomatology and brain structure in population-based samples. We investigated the relationship between dimensional measures of ADHD symptomatology, brain structure, and reaction time variability—an index of lapses in attention. We also tested for associations between brain structural correlates of ADHD symptomatology and maps of dopaminergic gene expression. MethodsPsychopathology and imaging data were available for 1538 youths. Parent ratings of ADHD symptoms were obtained using the Development and Well-Being Assessment and the Strengths and Difficulties Questionnaire (SDQ). Self-reports of ADHD symptoms were assessed using the youth version of the SDQ. Reaction time variability was available in a subset of participants. For each measure, whole-brain voxelwise regressions with gray matter volume were calculated. ResultsParent ratings of ADHD symptoms (Development and Well-Being Assessment and SDQ), adolescent self-reports of ADHD symptoms on the SDQ, and reaction time variability were each negatively associated with gray matter volume in an overlapping region of the ventromedial prefrontal cortex. Maps of DRD1 and DRD2 gene expression were associated with brain structural correlates of ADHD symptomatology. ConclusionsThis is the first study to reveal relationships between ventromedial prefrontal cortex structure and multi-informant measures of ADHD symptoms in a large population-based sample of adolescents. Our results indicate that ventromedial prefrontal cortex structure is a biomarker for ADHD symptomatology. These findings extend previous research implicating the default mode network and dopaminergic dysfunction in ADHD.

Emotional functioning, ADHD symptoms, and peer problems: A longitudinal investigation of children age 6–9.5 years

AbstractThe aim of the present study was to investigate the interplay between attention deficit hyperactivity disorder (ADHD) symptoms and emotional functioning in relation to peer problems. Parent ratings of ADHD symptoms and regulation/reactivity with regard to four emotions (anger, sadness, fear, and happiness/exuberance) at age six were investigated in relation to sociometric peer nominations 3 years later in a non‐clinical sample (n = 91). Reactivity and regulation were only modestly correlated, and these two aspects of emotional functioning did not show the same relation to peer problems. The main finding was that, it was primarily children with high levels of ADHD symptoms in combination with either high dysregulation or low reactivity with regard to happiness/exuberance who received many negative peer nominations. In addition, high levels of ADHD symptoms in combination with high reactivity with regard to anger were associated with nominations of physical aggression. The modest relation between reactivity and regulation emphasizes the importance of separating these two constructs. The fact that it was primarily happiness/exuberance, as opposed to negative emotions, that was associated with negative peer nominations suggests that future studies are needed to clarify the role of specific emotions in relation to the functional impairments associated with ADHD symptoms.Highlights The present study aimed to investigate the interplay between ADHD symptoms and emotional functioning in relation to peer problems using a longitudinal design (age 6–9 years). Ratings of ADHD symptoms and emotional functioning were investigated in relation to sociometric peer nominations and results showed that it was primarily children with high levels of ADHD symptoms in combination with either high dysregulation or low reactivity with regard to happiness/exuberance who received many negative peer nominations. The fact that it was primarily happiness/exuberance, as opposed to negative emotions, that was associated with negative peer nominations suggests that future studies are needed to clarify the role of specific emotions in relation to the functional impairments associated with ADHD symptoms.

Impact of a Web-Portal Intervention on Community ADHD Care and Outcomes.

The quality of care for children with attention-deficit/hyperactivity disorder (ADHD) delivered in community-based pediatric settings is often poor. Interventions have been developed to improve community-based ADHD care but have not demonstrated that better care results in improved patient outcomes. The objective of this study was to determine whether an ADHD quality improvement (QI) intervention for community-based pediatric practices improves patient outcomes. A cluster randomized controlled trial was conducted in which 50 community-based pediatric primary care practices (213 providers) were randomized either to receive a technology-assisted QI intervention or to a control condition. The intervention consisted of 4 training sessions, office flow modification, guided QI, and an ADHD Internet portal to assist with treatment monitoring. ADHD treatment processes and parent- and teacher-rated ADHD symptoms over the first year of treatment were collected for 577 patients. Intent-to-treat analyses examining outcomes of all children assessed for ADHD were not significant (b = -1.97, P = .08). However, among the 373 children prescribed ADHD medication, there was a significant intervention effect (b = -2.42, P = .04) indicating greater reductions in parent ratings of ADHD symptoms after treatment among patients treated by intervention physicians compared with patients treated at control practices. There were no group differences on teacher ratings of ADHD symptoms. ADHD treatment care around medication was significantly better at intervention practices compared with control practices. A technology-assisted QI intervention improved some ADHD care quality and resulted in additional reductions in parent-rated ADHD symptoms among patients prescribed ADHD medications.