Ratings Of Attention-deficit/hyperactivity Disorder Symptoms Research Articles

Facial emotion recognition in children with or without Attention Deficit/Hyperactivity Disorder: Impact of comorbidity

ObjectivesThis study sought to assess facial emotion recognition deficit in children with Attention Deficit/Hyperactivity Disorder (ADHD) and to test the hypothesis that it is increased by comorbid features. MethodForty children diagnosed with ADHD were compared with 40 typically developing children, all aged from 7 to 11years old, on a computerized facial emotion recognition task (based on the Pictures of Facial Affect). Data from parents’ ratings of ADHD and comorbid symptoms (on the Conners’ Revised Parent Rating Scale) were also collected. ResultsChildren with ADHD had significantly fewer correct answer scores than typically developing controls on the emotional task while they performed similarly on the control task. Recognition of sadness was especially impaired in children with ADHD. While ADHD symptoms were slightly related to facial emotion recognition deficit, oppositional symptoms were related to a decrease in the number of correct answers on sadness and surprise recognition. ConclusionFacial emotion recognition deficit in children with ADHD might be related to an impaired emotional process during childhood. Moreover, Oppositional Defiant Disorder seems to be a risk factor for difficulties in emotion recognition especially in children with ADHD.

Cross-Informant Disagreement on Behavioral Symptoms in Adolescent Attention-Deficit/Hyperactivity Disorder and Its Impact on Treatment Effects

Abstract. In assessing adolescent behavior difficulties, parents, teachers, and the adolescents themselves are key informants. However, substantial disagreement has been found between informants. Specifically, children with attention-deficit/hyperactivity disorder (ADHD) tend to overestimate their competencies, also known as “positive (illusionary) bias.” This study compared parent, teacher, and adolescent ratings of ADHD and other behavioral symptoms in a sample of 114 adolescents with ADHD. Further, the effect of cross-informant disagreement (CID) on treatment outcomes was investigated in a subsample of 54 adolescents who had undergone a training and coaching intervention. Overall, there was moderate agreement among informants. Parent and adolescent ratings were more strongly correlated with each other than with teacher ratings. The strongest discrepancy was found between teacher and adolescent ratings on prosocial behavior. This discrepancy explained 12% of the variance in parent-rated ADHD symptom severity after the intervention. The treatment was less effective in participants with high teacher-adolescent disagreement on prosocial behavior (d = 0.41) than with low disagreement (d = 0.98). These findings suggest that professionals working with adolescents with ADHD should consider multiple sources of information before initiating treatment and pay attention to cross-informant disagreements because these may indicate a risk of diminished treatment effects.

Model-Based Approach for Optimizing Study Design and Clinical Drug Performances of Extended-Release Formulations of Methylphenidate for the Treatment of ADHD.

Methylphenidate (MPH) is currently used to treat children with attention deficit hyperactivity disorder (ADHD). Several extended-release (ER) formulations characterized by a dual release process were developed to improve efficacy over an extended duration. In this study, a model-based approach using literature data was developed to: 1) evaluate the most efficient pharmacokinetic (PK) model to characterize the complex PK profile of MPH ER formulations; 2) provide PK endpoint metrics for comparing ER formulations; 3) define criteria for optimizing development of ER formulations using a convolution-based model linking in vitro release, in vivo release, and hour-by-hour behavioral ratings of ADHD symptoms; and 4) define an optimized trial design for assessing the activity of MPH in pediatric populations. The convolution-based model accurately described the complex PK profiles of a variety of ER MPH products, providing a natural framework for establishing an in vitro/in vivo correlation and for defining criteria for assessing comparative bioequivalence of MPH ER products.

Developing ADHD in preschool: Testing the dual pathway model of temperament

ABSTRACTThe dual pathway model of Attention Deficit Hyperactivity Disorder (ADHD) suggests that effortful control and positive approach, or surgency, are independent pathways leading to ADHD. This model has been proven on the basis of temperament in school children, however not in preschool children. In this study we tested whether the dual pathway model of ADHD can be replicated in preschool children using temperamental measures. One hundred and nineteen children (59 girls, M-age = 4.97 years, SD = 0.96) participated in a study. Parents rated temperament on the Child Behavior Questionnaire (CBQ) and parents and teachers rated ADHD symptoms (SDQ). We found that effortful control and surgency independently predicted preschool ADHD symptoms but there were no moderations or mediations. Our findings support the dual pathway model of temperament but not compensatory models of ADHD. Ratings of temperament might be an important predictor of which child is at risk to develop clinical ADHD later on and therefore an important part of prevention.

Does a child\u2019s language ability affect the correspondence between parent and teacher ratings of ADHD symptoms?

BackgroundRating scales are often used to identify children with potential Attention-Deficit/Hyperactivity Disorder (ADHD), yet there are frequently discrepancies between informants which may be moderated by child characteristics. The current study asked whether correspondence between parent and teacher ratings on the Strengths and Weakness of ADHD symptoms and Normal behaviour scale (SWAN) varied systematically with child language ability.MethodParent and teacher SWAN questionnaires were returned for 200 children (aged 61–81 months); 106 had low language ability (LL) and 94 had typically developing language (TL). After exploring informant correspondence (using Pearson correlation) and the discrepancy between raters, we report inter-class correlation coefficients, to assess inter-rater reliability, and Cohen’s kappa, to assess agreement regarding possible ADHD caseness.ResultsCorrelations between informant ratings on the SWAN were moderate. Children with LL were rated as having increased inattention and hyperactivity relative to children with TL; teachers, however, rated children with LL as having more inattention than parents. Inter-rater reliability of the SWAN was good and there were no systematic differences between the LL and TL groups. Case agreement between parent and teachers was fair; this varied by language group with poorer case agreement for children with LL.ConclusionChildren’s language abilities affect the discrepancy between informant ratings of ADHD symptomatology and the agreement between parents and teachers regarding potential ADHD caseness. The assessment of children’s core language ability would be a beneficial addition to the ADHD diagnostic process.

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.

Impact of Mental Health Comorbidities on the Community-Based Pediatric Treatment and Outcomes of Children with Attention Deficit Hyperactivity Disorder.

Children with attention deficit hyperactivity disorder (ADHD) often exhibit psychiatric comorbidities, which may impact illness presentation, diagnosis, and treatment outcomes. Guidelines exist for dealing with these complex cases but little is known about how comorbidities are being handled in community pediatric settings. The purpose of this study was to evaluate how mental health comorbidities affect community physicians' ADHD care practices and patients' symptom trajectories. Medical charts of 319 children presenting at primary care clinics for ADHD-related concerns were reviewed. Physician assessment and treatment behaviors were extracted and parents rated ADHD symptoms at the time of diagnosis and at 3, 6, and 12 months. Baseline ratings were used to group children, as no comorbid mental health condition, internalizing, or externalizing comorbid condition. Multilevel analyses compared community physician care behaviors and ADHD symptom trajectories across groups. Approximately, 50 percent of the sample met screening criteria for a comorbid mental health condition. For children diagnosed with ADHD and treated with medication, community physician care largely did not differ across groups, but children with internalizing comorbidities made significantly smaller improvements in inattentive and hyperactive/impulsive symptoms compared with children with no comorbidities. Children with ADHD and mental health comorbidities, particularly internalizing disorders, exhibit less robust response to ADHD medication and may require additional testing before starting medication and/or alternative treatment approaches. Potential barriers to conducting comprehensive assessments and to providing multi-modal treatment are discussed.

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.

Equivalence of mother and father ratings of ADHD in children

ABSTRACTObtaining data from multiple informants provides a more comprehensive diagnostic picture in the assessment of attention deficit hyperactivity disorder (ADHD). Differences in symptom ratings have been observed between parent- and teacher-report scales, though less information is available regarding differences between mothers and fathers. To address this gap, this study examines the rater agreement between mothers and fathers on the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) ADHD Symptom Rating Scale (DSM-ADHD-SRS). The participants consisted of 337 children diagnosed with ADHD who underwent comprehensive neuropsychological assessment. Confirmatory factor analysis indicates that a three-factor model comprising inattention, hyperactivity, and impulsivity symptoms provides the best fit for both mothers’ and fathers’ ratings. Mothers provided higher mean ratings for the inattention scale. These results suggest that the factor structure for the DSM-ADHD-SRS is the same, regardless of parent gender. However, symptoms of inattention may vary depending upon which parent completes the ratings. This discrepancy could lead to differences in diagnostic impressions in clinical evaluations.

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.

Psychometrically Informed Approach to Integration of Multiple Informant Ratings in Adult ADHD in a Community-Recruited Sample.

Although Diagnostic and Statistical Manual of Mental Disorders-Fifth edition requires that attention-deficit/hyperactivity disorder (ADHD) symptoms are apparent across settings, assessed by multiple informants, there remains no standardized approach to integration of multiple sources in adult ADHD diagnosis. The goal of the study was to evaluate informant effects on adult ADHD symptom ratings. Participants were 406 adults, ages 18 to 37, and identified second reporters, recruited from the community, and completing a comprehensive diagnostic and cognitive assessment, including a clinician-administered diagnostic interview and self- and other-report questionnaires of ADHD symptoms. Structural equation modeling indicated good fit for a trifactor model of ADHD, including general ADHD, specific inattention and hyperactivity-impulsivity, and self- and other-perspective factors. Yet there were a number of symptoms on the specific hyperactive-impulsive and self-factors that exhibited nonsignificant loadings. Significant differential item functioning across self-ratings and informant ratings was also noted. The external validation indices of laboratory executive function and diagnostic team-rated impairment was significantly correlated with the specific inattentive factor. While executive function was marginally significantly correlated with the other perspective factor, impairment was associated with the self-perspective factor. Overall, inattentive symptoms may be more sensitive measures of adult ADHD, and other and self-ratings may provide different information in relation to external criteria.

Clinical Utility and Predictive Validity of Parent and College Student Symptom Ratings in Predicting an ADHD Diagnosis.

This study examined several questions about the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in a young adult college student population. The primary goal was to examine the clinical utility and predictive validity of college student and parent ratings for predicting a diagnostic status of ADHD. In the present study, 86 college students and their parents completed a comprehensive ADHD evaluation including structured diagnostic interviews to determine an ADHD diagnosis (n = 59 with ADHD diagnosis). We collected ratings of childhood and current ADHD symptoms and examined the clinical utility and predictive validity of both parent and student ratings for predicting the presence or absence of an ADHD diagnosis. Regression analyses revealed that above and beyond student ratings, parent ratings of childhood ADHD symptoms of inattention were the strongest predictors of current diagnostic status of ADHD. In the clinical utility analyses, only parent ratings of ADHD symptoms met acceptable thresholds for confirming and ruling out a diagnosis of ADHD. These results fill an important gap in the literature. Overall, results suggest that rating scales can be used effectively to evaluate ADHD on college campuses as long as both parent and student ratings of childhood symptoms are collected. Importantly, collecting parent ratings protects against possible student malingering to obtain ADHD medications or accommodations. Additional research with larger samples and across multiple universities is needed to establish best practices in the diagnosis of ADHD.

A Multi-method Examination of the Links Between ADHD and Personality Disorder.

An existing relationship between attention-deficit/hyperactivity disorder (ADHD) and personality disorder (PD) has been well documented, yet research has been limited by possible selection and self-report biases as well as PD models of questionable validity. This study examined the relationship of ADHD with adult personality traits and disorders in a sample that included individuals prescreened for elevated childhood ADHD symptoms. Four hundred thirty-nine undergraduates completed retrospective reports of childhood ADHD symptoms as well as current ratings of ADHD symptoms, traditional PD categories, and the DSM-5 alternative PD trait model. To overcome potential biases in self-report, 161 parents of the participants provided ratings of childhood and current functioning. Results suggest that while self-report of ADHD was significantly correlated with several PDs, parent reports obtained somewhat more specific links with adult dependent, borderline, and paranoid PDs. Most importantly, the DSM-5 Section III dimensional trait model provided greater specificity, as the trait of distractibility consistently emerged as a unique predictor, and thus appeared more useful for understanding the developmental pathways of ADHD.

Language Impairment in the Attention-Deficit/Hyperactivity Disorder Context.

Attention-deficit/hyperactivity disorder (ADHD) is a ubiquitous designation that affects the identification, assessment, treatment, and study of pediatric language impairments (LIs). Current literature is reviewed in 4 areas: (a) the capacity of psycholinguistic, neuropsychological, and socioemotional behavioral indices to differentiate cases of LI from ADHD; (b) the impact of co-occurring ADHD on children's LI; (c) cross-etiology comparisons of the nonlinguistic abilities of children with ADHD and specific LI (SLI); and (d) the extent to which ADHD contributes to educational and health disparities among individuals with LI. Evidence is presented demonstrating the value of using adjusted parent ratings of ADHD symptoms and targeted assessments of children's tense marking, nonword repetition, and sentence recall for differential diagnosis and the identification of comorbidity. Reports suggest that the presence of ADHD does not aggravate children's LI. The potential value of cross-etiology comparisons testing the necessity and sufficiency of proposed nonlinguistic contributors to the etiology of SLI is demonstrated through key studies. Reports suggest that children with comorbid ADHD+LI receive speech-language services at a higher rate than children with SLI. The ADHD context is multifaceted and provides the management and study of LI with both opportunities and obstacles.

Parent and teacher ratings of attention-deficit/hyperactivity disorder symptoms: Factor structure and normative data.

Comprehensive assessment of attention-deficit/hyperactivity disorder (ADHD) symptoms includes parent and teacher questionnaires. The ADHD Rating Scale-5 was developed to incorporate changes for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). This study examined the fit of a correlated, 2-factor structure of ADHD (i.e., DSM-5 conceptual model) and alternative models; determined whether ADHD symptom ratings varied across teacher and child demographic characteristics; and presented normative data. Two samples were included: (a) 2,079 parents and guardians (1,131 female, 948 male) completed ADHD symptom ratings for children (N = 2,079; 1,037 males, 1,042 females) between 5 and 17 years old (M = 10.68; SD = 3.75) and (b) 1,070 teachers (766 female, 304 male) completed ADHD symptom ratings for students (N = 2,140; 1,070 males, 1,070 females) between 5 and 17 years old (M = 11.53; SD = 3.54) who attended kindergarten through 12th grade. The 2-factor structure was confirmed for both parent and teacher ratings and was invariant across child gender, age, informant, informant gender, and language. In general, boys were higher in symptom frequency than girls; older children were rated lower than younger children, especially for hyperactivity-impulsivity; and non-Hispanic children were rated higher than Hispanic children. Teachers also rated non-Hispanic African American children higher than non-Hispanic White, Asian, and Hispanic children. Non-Hispanic White teachers provided lower hyperactivity-impulsivity ratings than non-Hispanic, African American, and Hispanic teachers. Normative data are reported separately for parent and teacher ratings by child gender and age. The merits of using the ADHD Rating Scale-5 in a multimodal assessment protocol are discussed. (PsycINFO Database Record

Training Problem Solving and Organizational Skills in Adolescents With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial

Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent psychiatric disorder in adolescence and results severe impairment. Few psychosocial interventions aim at ADHD in adolescence and are rarely evaluated in randomized controlled trials (RCTs). Therefore, an intervention combining adolescent-directed problem-solving and organizational skills training with behavioral parent and teacher training has been developed. Its efficacy in comparison to waiting list and active controls is reported.One hundred thirteen adolescents (mean age = 13.99 years) with ADHD were randomly assigned to the training, a waiting list or an active control condition (progressive muscle relaxation [PMR]). Parents and teachers rated ADHD symptoms, academic enablers, and comorbid problems before and after. Results: The training significantly reduced ADHS symptoms and parent- and teacher-rated internalizing problems and increased teacher rated academic enablers compared to waiting list controls. Compared to active controls, results were in the range of small nonsignificant effects. A skills training is an efficacious treatment for adolescent ADHD, however, not significantly superior to PMR. Contrasts between both interventions need to be further investigated.

The Moderating Effect of Physical Activity on the Association Between ADHD Symptoms and Peer Victimization in Middle Childhood.

Previous research has demonstrated that symptoms of attention-deficit/hyperactivity disorder (ADHD) are associated with higher levels of victimization, but little is known about protective factors. The purpose of the study was to examine whether physical activity attenuated the associations among ADHD symptoms and physical and relational victimization 1.5years later. Participants included 168s through fourth grade students (M age=8.43; 52.4% boys) who completed self-reports of physical activity and victimization; teachers provided ratings of ADHD symptoms. ADHD symptoms predicted subsequent increases in physical, but not relational, victimization among children who reported engaging in moderate/high levels of physical activity, especially out of the school context (moderate: β=.26, p=.03; high: β=.55, p<.001). Findings suggest that children with ADHD symptoms may benefit from being taught the skills necessary to appropriately engage in physical activity and from being monitored while engaging in activity in order to limit physical victimization that they might experience.

Factor structure of symptom dimensions in attention-deficit/hyperactivity disorder (ADHD).

There is disagreement on whether attention-deficit/hyperactivity disorder (ADHD) symptoms are best characterized along two dimensions consisting of inattention and hyperactivity/impulsivity or three dimensions where hyperactivity and impulsivity are separate. To address this, the current study investigated the underlying symptom dimensions of ADHD by examining two- and three-factor models of ADHD symptom ratings in 400 children and adolescents diagnosed with ADHD. ADHD symptom ratings for each of the 18 DSM-IV Criteria A symptoms were obtained from mothers using a standardized symptom rating scale. Confirmatory factor analysis (CFA) was used to examine whether the 18 symptoms were best explained by two or three latent constructs. Results of the CFA demonstrated that a three-factor model was superior to a two-factor model. Findings support three distinct symptom dimensions that are consistent with previous research demonstrating unique clinical presentations of inattention, hyperactivity, and impulsivity. Differentiating between these three domains may aid in predicting behavioral outcomes in children with ADHD.

Methylphenidate for attention-deficit/hyperactivity disorder in children and adolescents: Cochrane systematic review with meta-analyses and trial sequential analyses of randomised clinical trials

Study question Is methylphenidate beneficial or harmful for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents?Methods Electronic databases were searched up to February 2015 for parallel and crossover...

Attention-Deficit/Hyperactivity Disorder (ADHD) in Adulthood: Concordance and Differences between Self- and Informant Perspectives on Symptoms and Functional Impairment.

Attention-deficit/hyperactivity disorder (ADHD) is a severe mental illness, associated with major impairment and a high comorbidity rate. Particularly undiagnosed ADHD in adulthood has serious consequences. Thus, a valid diagnosis is important. In adulthood, the diagnostic process for ADHD is complicated: symptoms may overlap with comorbid disorders, and the onset and progression of the disorder must be reconstructed retrospectively. Guidelines for the diagnostic process recommend the inclusion of additional informant ratings. Research into the relation between self- and informant ratings shows extremely heterogeneous results. The levels of agreement range from low to high. The focus of this study is the concordance and differences between self- and informant ratings on ADHD symptoms and impairments. In this regard, two possible influencing factors (gender and relationship type) are also examined. 114 people participated in this study, 77 with an ADHD diagnosis and 37 without a diagnosis. For all participants, either parents or partners also rated ADHD symptoms and impairments. Small to moderate concordance was found between self- and informant ratings, with females being slightly more concordant than males, particularly for ratings of problems with self-concept. Examination of the consistency within a particular perspective showed that people with ADHD seemed to be unaware of the causal relation between ADHD symptoms and their impairments. A close investigation found almost no influence of gender and relationship type on differences within perspectives. Based on these results, the implications for the diagnostic process are that additional informant information is clearly necessary and helpful.