Attention-deficit/hyperactivity Disorder Symptom Severity Research Articles

Electroencephalogram activity in attention-deficit hyperactivity disorder

ObjectiveThe aim of the study was to apply an evidence-based pharmacotherapy on different groups of attention-deficit hyperactivity disorder (ADHD) patients monitored by electroencephalogram (EEG) before and after 6 months of treatment and to estimate the prevalence of ADHD in a sample of Egyptian governorates (Kafr El Sheik and Menoufia neuropsychiatric clinics). It also aimed to detect the neurobiological basis of ADHD children using EEG.BackgroundADHD is one of the most commonly diagnosed and treated psychiatric disorders in childhood.Patients and methodA randomized, clinical trial was conducted on 30 children attending our neuropsychiatric outpatient clinic, screened from 255 children diagnostic through Diagnostic and statistical manual of mental disorders, 5th ed. and Kiddie-Schedule For Affective Disorders And Schizophrenia-Present And Lifetime Version. Psychiatry, Mental Health, (KSADS-PL) scale screening. Then the patients were divided into two equal groups. The first group received the drug Strattera (Eli Lilly Company) at a dose of (0.5: 1.2 mg/kg/day) only. The second group received Concerta (Alza Corporation) at a dose of (18 mg/day). Another 30 children are randomly allocated to control groups (30 children in each). Full history taking and complete clinical examination were done. KSADS-PL rating scale was assessed at baseline and then 6 months after treatment. EEG monitoring of children before and after treatment.ResultsIn this study we found that the score of the KSADS-PL rating scale was significantly decreased in ADHD patients after treatment in both pharmacotherapy groups. In addition, there was no significant difference in EEG between both ADHD children before and after treatment.ConclusionPharmacotherapy using drugs as concerta and stratera has beneficial effects in reducing ADHD symptom severity

The effects of ADHD symptomatology and academic enabling behaviours on undergraduate academic achievement

AbstractUniversity students demonstrating higher levels of Attention‐Deficit Hyperactivity Disorder (ADHD) symptom severity largely experience lower academic achievement. Educational research has found that a group of behaviours (i.e., study skills, interpersonal skills, engagement, and motivation) known as academic enablers (AE) facilitate positive outcomes within a classroom‐based learning environment. The current study recruited 617 undergraduate students to explore whether ADHD symptomatology and AE emerge as significant predictors of academic achievement at the university level, and whether demonstration of AE contribute to predicting achievement above and beyond that of ADHD effects. Results from simple linear regression analysis indicated that higher ADHD symptom severity predicted poorer academic achievement. Greater application of AE—excluding interpersonal skills—predicted greater academic achievement among university students. Exploratory results from hierarchical linear regression analysis suggested that demonstration of engagement, motivation, and especially study skills contribute towards predicting greater academic achievement while controlling for negative effects from ADHD symptom presentation. These findings imply that undergraduate academic outcomes can potentially be improved for students struggling with more severe ADHD symptom presentation if more emphasis is placed by universities to promote academic enabling behaviours within the educational framework and environment.

A Case Study on EEG Analysis: Embedding Entropy Estimations Indicate the Decreased Neuro-Cortical Complexity Levels Mediated by Methylphenidate Treatment in Children with ADHD.

Objective: Complexity analysis is a method employed to understand the activity of the brain. The effect of methylphenidate (MPH) treatment on neuro-cortical complexity changes is still unknown. This study aimed to reveal how MPH treatment affects the brain complexity of children with attention deficit hyperactivity disorder (ADHD) using entropy-based quantitative EEG analysis. Three embedding entropy approaches were applied to short segments of both pre- and post- medication EEG series. EEG signals were recorded for 25 boys with combined type ADHD prior to the administration of MPH and at the end of the first month of the treatment. Results: In comparison to Approximate Entropy (ApEn) and Sample Entropy (SampEn), Permutation Entropy (PermEn) provided the most sensitive estimations in investigating the impact of MPH treatment. In detail, the considerable decrease in EEG complexity levels were observed at six cortical regions (F3, F4, P4, T3, T6, O2) with statistically significant level (p < .05). As well, PermEn provided the most meaningful associations at central lobes as follows: 1) The largeness of EEG complexity levels was moderately related to the severity of ADHD symptom detected at pre-treatment stage. 2) The percentage change in the severity of opposition as the symptom cluster was moderately reduced by the change in entropy. Conclusion: A significant decrease in entropy levels in the frontal region was detected in boys with combined type ADHD undergoing MPH treatment at resting-state mode. The changes in entropy correlated with pre-treatment general symptom severity of ADHD and conduct disorder symptom cluster severity.

Retinal Nerve Fiber Layer Thickness and Its Relationship With Executive Functions in Adult Attention Deficit Hyperactivity Disorder Patients.

ObjectiveThe aim of this study was to compare the thickness of the retinal nerve fiber layer (RNFL) with controls in individuals with attention deficit hyperactivity disorder (ADHD) and to examine the relationship between RNFL thickness and the level of performance in disease severity and executive function tests in ADHD cases. MethodsThe study included 38 volunteer patients diagnosed with ADHD and 30 healthy volunteers. Adult ADHD self-report scale was used for ADHD symptom severity. Executive functions were evaluated by Digit Span Test, Verbal Fluency Test, Stroop Test, and Trail Making Test. RNFL thickness of all participants was evaluated using optical coherence tomography (OCT). ResultsIn the comparison of RNFL values, it was found that right mean, right temporal, right temporal inferior, left mean, left nasal, and left nasal inferior quadrant values were statistically thinner in ADHD cases compared to the control group (p<0.05). There was no statistically significant correlation between the mean RNFL thickness values of the right and left eyes of ADHD cases and the symptom severity and performance levels in executive function tests. ConclusionThis study is a guide in terms of being the first study investigating the relationship between RNFL thickness, symptom severity, and various neuropsychological tests in adults with ADHD.

A dynamic graph convolutional neural network framework reveals new insights into connectome dysfunctions in ADHD

The pathological mechanism of attention deficit hyperactivity disorder (ADHD) is incompletely specified, which leads to difficulty in precise diagnosis. Functional magnetic resonance imaging (fMRI) has emerged as a common neuroimaging technique for studying the brain functional connectome. Most existing methods that have either ignored or simply utilized graph structure, do not fully leverage the potentially important topological information which may be useful in characterizing brain disorders. There is a crucial need for designing novel and efficient approaches which can capture such information. To this end, we propose a new dynamic graph convolutional network (dGCN), which is trained with sparse brain regional connections from dynamically calculated graph features. We also develop a novel convolutional readout layer to improve graph representation. Our extensive experimental analysis demonstrates significantly improved performance of dGCN for ADHD diagnosis compared with existing machine learning and deep learning methods. Visualizations of the salient regions of interest (ROIs) and connectivity based on informative features learned by our model show that the identified functional abnormalities mainly involve brain regions in temporal pole, gyrus rectus, and cerebellar gyri from temporal lobe, frontal lobe, and cerebellum, respectively. A positive correlation was further observed between the identified connectomic abnormalities and ADHD symptom severity. The proposed dGCN model shows great promise in providing a functional network-based precision diagnosis of ADHD and is also broadly applicable to brain connectome-based study of mental disorders.

Actigraphy-Derived Sleep Profiles of Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD) over Two Weeks-Comparison, Precursor Symptoms, and the Chronotype.

Although sleep problems are common in children with ADHD, their extent, preceding risk factors, and the association between neurocognitive performance and neurobiological processes in sleep and ADHD, are still largely unknown. We examined sleep variables in school-aged children with ADHD, addressing their intra-individual variability (IIV) and considering potential precursor symptoms as well as the chronotype. Additionally, in a subgroup of our sample, we investigated associations with neurobehavioral functioning (n = 44). A total of 57 children (6–12 years) with (n = 24) and without ADHD (n = 33) were recruited in one center of the large ESCAlife study to wear actigraphs for two weeks. Actigraphy-derived dependent variables, including IIV, were analyzed using linear mixed models in order to find differences between the groups. A stepwise regression model was used to investigate neuropsychological function. Overall, children with ADHD showed longer sleep onset latency (SOL), higher IIV in SOL, more movements during sleep, lower sleep efficiency, and a slightly larger sleep deficit on school days compared with free days. No group differences were observed for chronotype or sleep onset time. Sleep problems in infancy predicted later SOL and the total number of movements during sleep in children with and without ADHD. No additional effect of sleep problems, beyond ADHD symptom severity, on neuropsychological functioning was found. This study highlights the importance of screening children with ADHD for current and early childhood sleep disturbances in order to prevent long-term sleep problems and offer individualized treatments. Future studies with larger sample sizes should examine possible biological markers to improve our understanding of the underlying mechanisms.

How Are Attention-deficit Hyperactivity and Internet Gaming Disorders Related in Children and Youth?

This review addresses important practical questions facing clinicians regarding internet gaming disorder (IGD) and attention-deficit/hyperactivity disorder (ADHD) in children and youth (C-Y). The authors investigated data concerning the risk that C-Y who have ADHD will develop IGD, whether effective treatment of ADHD positively influences the course of IGD in C-Y who have both, and other findings that might be of benefit to clinicians who treat C-Y with these conditions. We conducted a literature review using 4 databases: PubMed, Scopus, PsychInfo, and Embase. C-Y with ADHD are at greater risk for developing IGD than those without ADHD. A close association exists between the severity of ADHD symptoms and the severity of IGD. It is unknown what proportion of C-Y with ADHD will develop IGD during their developmental trajectory; however, C-Y with IGD are at risk for developing ADHD, and ADHD can also increase the vulnerability of C-Y to IGD. Adolescents with ADHD and IGD have greater deficits in social skills than those with ADHD but no IGD. Lower parental occupational and socioeconomic status and poor family relationships are associated with more severe IGD symptoms. Atomoxetine and methylphenidate are equally effective in alleviating IGD symptoms comorbid with ADHD. C-Y with ADHD are at increased risk for developing IGD compared with C-Y without ADHD, but it has not been determined at what developmental stage IGD is likely to emerge. Since IGD and ADHD are strongly associated, it is imperative to consider ADHD as a significant risk factor for IGD and vice versa, which can help psychiatrists be alert for early signs of IGD and manage them accordingly.

A Controlled Evaluation of a Sport-Specific Performance Optimization Program in an Athlete Diagnosed With Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder Within the Context of COVID-19.

Adolescent athletes with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) experience unique challenges that impact their sport performance, such as making errors due to poor concentration. The current multiple-baseline across behaviors case trial (i.e., positive assertion and negative assertion) is an evaluation of The Optimum Performance Program in Sports in an adolescent athlete diagnosed with ADHD and ODD. Intervention skill sets were targeted sequentially in a virtual format to safeguard against COVID-19 contraction. A battery of psychological measures was administered at baseline, post-intervention, and 1-month follow-up. Results indicated negative and positive assertion skills improved, but only when targeted, and severity of ADHD and ODD symptom severity, general mental health symptoms, and factors interfering with sport performance decreased from pre- to post-intervention and these improvements were maintained at 1-month follow-up. Similar improvements occurred in relationships with coaches, teammates, and family. Treatment integrity and consumer satisfaction were high.

Risk Behaviors in Youth With and Without Tourette Syndrome

BackgroundSpecific health-risk behaviors are present in older adolescents and young adults wtih Tourette syndrome (TS), but little is known about health-risk behaviors in youth with TS. MethodsWe compared responses on the Youth Risk Behavior Surveillance System (YRBS) in youth with TS with those in a concurrent community control group. The YRBS evaluates risk behaviors most closely associated with morbidity and mortality in young people. Tic severity, presence of comorbid attention-deficit/hyperactivity disorder (ADHD), measures of ADHD symptom severity, and whether or not the individual had been bullied in school were also compared between the groups. ResultsData from 52 youth with TS and 48 control youth were included. We did not detect any differences between control youth and youth with TS in the reporting of risky behaviors. Tic severity was not significantly associated with high-risk behavior. However, ADHD was significantly more common in youth with TS (P < 0.0002), and youth with TS who identified themselves as victims of bullying had significantly higher ADHD symptom severity scores (P = 0.04) compared with those who were not bullied. ConclusionsRisk behaviors are not reliably or clinically different in youth with TS compared with control youth. ADHD severity, but not tic severity, was associated with being bullied in youth with TS.

Down Syndrome Survey in South Indian Population- Understanding Inheritance, Perceptions, Interventions and Diagnosis

ABSTRACT Down syndrome (DS) has been prevalent worldwide, for centuries now. Despite the fact that tremendous research has been done on DS ever since the early 1950s, most results obtained, are on the basis of etiological and demographic factors and predominantly of the western data. Every year in India, &gt;30,000 children are born with DS. This survey has been done keeping the Indian population in mind and to analyze the outlook of parents having children with DS, understand the comorbidities and their management. The study was conceptualized to create an exhaustive and comprehensive questionnaire to study the pattern of inheritance of Trisomy 21, analyze influence and correlation of advanced maternal age, sex ratio, order of birth, hypothyroidism, common comorbidities, abortions, Attention deficit hyperactivity disorder (ADHD) and sleeping difficulties in individuals diagnosed with DS. 50 family triads were interviewed. The results showed that incidence of DS was more in males compared to females. The analysis revealed that mean maternal age of 25-28 years showed increased incidence of DS. 2.5 percent showed severe ID and 27.5 percent had severe ADHD symptoms, while 10-13 percent showed mild to moderate ADHD. The most and least prevalent comorbidity seen was the presence of heart disease (45%) and hearing impairment (10 percent) respectively. It was found that about 40 percent of parents strongly agreed to the idea that Genetic Counseling (GC) is helpful and wanted to reinforce it to others who find it difficult to cope up with their DS child.

Evaluation of Children with Attention Deficit Hyperactivity Disorder on the Wechsler Intelligence Scale for Children-IV

Objective: The aim of this study was to evaluate the cognitive performance and clinical characteristics of children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) who had attended a tertiary center. Method: Fifty-six children and adolescents aged 7-16 years with ADHD who had been admitted to the Child and Adolescent Psychiatry clinic between June 2020 and March 2021 were retrospectively included in the study. A semi-structured interview form for the Affective Disorders and Schizophrenia Interview Schedule-Present Version for School-Age Children was used to determine mental disorders. The Clinical Global Impression Scale (CGIS) was completed to assess the severity of ADHD symptoms. The Wechsler Intelligence Scale for Children-IV (WISC-IV) was used in the assessment of cognitive skills. Results: The median age of the participants was 13 and 71.4% of them were male. The Working memory index (s=83.3) and Full-Scale IQ (FSIQ) (s=84) were found to be the lowest scores. According to the comparisons between CGIS, the FSIQ score (χ2 =0.736; p=0.947), verbal comprehension index (χ2 =2.882; p=0.578), perceptual reasoning index (χ2 =1.412; p=0.842), working memory index (χ2 =1.980; p=0.739), processing speed index (χ2 =1.673; p=0.796) were not found to be statistically different between the groups. Conclusion: The WISC-IV scale, which is increasingly preferred in the clinic use, could help to obtain information about cognitive performance in children with ADHD, regardless of the severity of ADHD symptoms.

Attention-deficit hyperactivity disorder symptoms and quality of life in female patients with fibromyalgia

Background/aim The present study aimed to determine the association between attention-deficit hyperactivity disorder (ADHD) symptoms severity, fibromyalgia (FM) severity, and QoL.Materials and methodsWhile the FM group consisted of 113 (74%) patients, the control group consisted of 40 (26%) individuals. FM symptom severity, ADHD symptom severity, and QoL were evaluated using the fibromyalgia impact questionnaire (FIQ), adult ADHD self-report scale (ASRS), and World Health Organization quality of life scale-brief version (WHOQOL-BREF), respectively. ResultsIt was found that the FM group had significantly higher scores on the ASRS than the control group (p < 0.05). There was a significant difference in FIQ scores and three WHOQOL-BREF domain scores between the FM alone and comorbid FM/high probability of ADHD groups (p < 0.05). We found a negative correlation between ASRS total scores and all other scale scores (except for the social relationships domain score of the WHOQOL-BREF) and a positive correlation between ASRS total scores and FIQ scores in FM patients. ADHD scores would mediate the relationship between depression severity and QoL.ConclusionsOur findings indicated that the presence of ADHD symptoms was related to greater FM symptom severity and poorer QoL. Also, ADHD scores would mediate the relationship between depression severity and QoL.

Altered cortical activation associated with mirror overflow driven by non-dominant hand movement in attention-deficit/hyperactivity disorder

Mirror overflow is involuntary movement that accompanies unilateral voluntary movement on the opposite side of the body, and is commonly seen in Attention-Deficit/Hyperactivity Disorder (ADHD). Children with ADHD show asymmetry in mirror overflow between dominant and non-dominant hand, yet there are competing mechanistic accounts of why this occurs. Using EEG during a sequential, unimanual finger-tapping task, we found that children with ADHD exhibited significantly more mirror overflow than typically developing (TD) controls, especially during the tapping of the non-dominant hand. Furthermore, source-level EEG oscillation analysis revealed that children with ADHD showed decreased alpha (8–12 Hz) event-related desynchronization (ERD) compared with controls in both hemispheres, but only during tapping of the non-dominant hand. Moreover, only the ERD ipsilateral to the mirror overflow during non-dominant hand movement correlated with both magnitude of overflow movements and higher ADHD symptom severity (Conners ADHD Hyperactivity/Impulsiveness scale) in children with ADHD. TD controls did not show these relationships. Our findings suggest that EEG differences in finger-tapping in ADHD are related primarily to voluntary movement in the non-dominant hand. Our results are also consistent with the Ipsilateral Corticospinal Tract (CST) Hypothesis, which posits that the atypical persistence of mirror overflow in ADHD may originate in the sensorimotor areas ipsilateral to mirror overflow and be transmitted via non-decussating CST fibers.

Placebo Response and Its Predictors in Attention Deficit Hyperactivity Disorder: A Meta-Analysis and Comparison of Meta-Regression and MetaForest.

BackgroundHigh placebo response in attention deficit hyperactivity disorder (ADHD) can reduce medication–placebo differences, jeopardizing the development of new medicines. This research aims to (1) determine placebo response in ADHD, (2) compare the accuracy of meta-regression and MetaForest in predicting placebo response, and (3) determine the covariates associated with placebo response.MethodsA systematic review with meta-analysis of randomized, placebo-controlled clinical trial investigating pharmacological interventions for ADHD was performed. Placebo response was defined as the change from baseline in ADHD symptom severity assessed according to the 18-item, clinician-rated, DSM-based rating scale. The effect of study design–, intervention–, and patient–related covariates in predicting placebo response was studied by means of meta-regression and MetaForest.ResultsNinety-four studies including 6614 patients randomized to placebo were analyzed. Overall, placebo response was −8.9 points, representing a 23.1% reduction in the severity of ADHD symptoms. Cross-validated accuracy metrics for meta-regression were R2 = 0.0012 and root mean squared error = 3.3219 for meta-regression and 0.0382 and 3.2599 for MetaForest. Placebo response among ADHD patients increased by 63% between 2001 and 2020 and was larger in the United States than in other regions of the world.ConclusionsStrong placebo response was found in ADHD patients. Both meta-regression and MetaForest showed poor performance in predicting placebo response. ADHD symptom improvement with placebo has markedly increased over the last 2 decades and is greater in the United States than the rest of the world.

Bidirectional Associations Between Maternal Mental Health and Child Sleep Problems in Children With ADHD: A Longitudinal Study

Background: Children with attention-deficit/hyperactivity disorder (ADHD) experience more sleep problems than their typically developing peers. In addition, their parents experience higher rates of mental health difficulties relative to parents of children without ADHD. Cross-sectional studies have reported associations; however, longitudinal studies have not yet been conducted. This study aimed to investigate potential bidirectional relationships between sleep problems in children with ADHD and maternal mental health difficulties (i.e. overall mental health, depression, anxiety, stress) over a 12-month period. Methods: Female caregivers of 379 children with ADHD (5–13 years) reported on their child’s sleep (Children’s Sleep Habits Questionnaire) and their own mental health (Depression Anxiety Stress Scale) at three time points over a 12-month period (baseline, 6-months, and 12-months). Autoregressive cross-lagged panel analyses were used to analyze the data, controlling for child age, child sex, ADHD symptom severity, ADHD medication use, comorbidities (autism spectrum disorder, internalizing disorders, and externalizing disorders), caregiver age, and socioeconomic disadvantage. Results: Child sleep problems and maternal mental health difficulties were highly stable across the 12-month period. In addition, longitudinal relationships were evident, with child sleep problems at 6-months predicting both overall maternal mental health difficulties and maternal anxiety at 12-months. However, child sleep problems at 6-months did not predict maternal depression or maternal stress at 12-months. There was little evidence that maternal mental health difficulties predicted child sleep problems over the 12-month period. Conclusion: This study demonstrates that despite the stability in child sleep problems and maternal mental health difficulties over time, sleep problems in children with ADHD contribute to later maternal mental health difficulties. This suggests that sleep interventions to improve child sleep may lead to an improvement in maternal mental health over time. It also suggests a need to be aware of the potential mental health difficulties being experienced by mothers who have children with sleep problems.

Etiological Networks of Attention-Deficit/Hyperactivity Disorder during Childhood and Adolescence

ABSTRACT Objective The purpose of the current study was to use network analysis techniques to parse relations between attention-deficit/hyperactivity disorder (ADHD) symptom domains, domains of executive function, and temperament traits. Methods Participants were 420 children aged 6–17 years (55% boys). The majority of the participants were Caucasian (72.86%) and 50% of the sample met diagnostic criteria for ADHD. Both parents and teachers provided ratings of participants’ ADHD symptom severity. Parents completed questionnaires pertaining to participants’ temperament traits, and participants completed well-validated laboratory measures of executive function. Results Results suggested effortful control as demonstrating the strongest relations with ADHD, particularly the parent-reported inattentive symptom domain. Additionally, negative effects appeared to demonstrate weaker but still notable relations primarily with the parent-reported hyperactive/impulsive symptom domain. Measures of executive function did not appear to demonstrate relations with any measures of ADHD symptoms or temperament traits. The results were generally replicated in a distinct sample (n = 732, 7–13 years, 63% boys, 81% White), although differences emerged pertaining to the role of surgency (i.e., related to the hyperactive/impulsive symptom domain in the replication but not the primary sample). Conclusions Overall, findings provided support for the primary role of effortful control, as well as secondary roles for negative affect and surgency, as key risk markers for the characterization of ADHD. Additional exploration of the overlap between temperament and executive function, as pertaining to ADHD, may help clarify heterogeneity in phenotypes and suggest priorities for targeted interventions outside of traditional symptoms.

Inhibitory control in youth with Tourette's Disorder, attention-deficit/hyperactivity disorder and their combination and predictors of objective tic suppressibility

The present study investigated inhibitory control deficits in Tourette's Disorder (TD)-only, Attention Deficit/Hyperactivity Disorder (ADHD)-only, and TD+ADHD and explored the degree to which measures of inhibitory control, and tic and ADHD severity predicted objective tic suppressibility. Participants were youth ages 9 to 14 (M = 11.15) with TD-only (n = 24), TD+ADHD (n = 19), ADHD-only (n = 139), and typically-developing controls (n = 59) drawn from a larger study. Groups were compared on computer-based and paper and pencil neurocognitive inhibitory control tasks. Among youth with TD, neurocognitive measures of inhibitory control, subjective tic-suppressibility (Premonitory Urge for Tics Scale, item 10), and ADHD symptom severity were evaluated as predictors of objective tic suppressibility (i.e., laboratory-based tic suppression task), controlling for total tic severity. There were significant group differences on Color-Word inhibition/switching performance, though post-hoc comparisons yielded no significant pairwise group contrasts. Subjective tic suppressibility was the only significant predictor of objective tic suppressibility. The evident intact neurocognitive inhibitory control among youth with TD suggests that individuals with TD may use compensatory neural mechanisms to support typical speed and accuracy of response. The role of cognitive flexibility in mechanisms of tic suppression should also be further explored.

Predicting the Adult Clinical and Academic Outcomes in Boys With ADHD: A 7- to 10-Year Follow-Up Study in China.

Background: Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood and causes adverse effects on social functioning. The present study aimed to widely investigate the predictors, particularly childhood intelligence quotient (IQ) and family environment factors, on adult clinical and academic outcomes in boys with ADHD.Methods: A total of 101 boys with ADHD in a Chinese Han ADHD cohort were followed up 7–10 years later. Baseline ADHD symptoms were evaluated using the parent version of the ADHD Rating Scale-IV (ADHD-RS-IV) and the Chinese version of the Conners' Parent Rating Scale-Revised (CPRS-48). The intelligence of the child was tested by the China-Wechsler Intelligence Scale for Children (C-WISC), and family function was assessed by the Family Environment Scale-Chinese Edition (FES-CV). Adult ADHD persistence was defined using DSM-IV criteria for ADHD, and academic outcome fell into two categories: higher academic level group (studying in senior middle school or above) and lower academic level group (studying in vocational secondary schools or below).Results: Stepwise multiple logistic regression analysis revealed that the father's character, impulsive–hyperactive index as measured by the CPRS-48, and intellectual–cultural index as measured by the FES-CV independently predicted clinical outcomes in adults, with an AUC of 0.770 (p < 0.001, 95% CI = 0.678–0.863). The corresponding sensitivity and specificity were 0.743 and 0.727, respectively. The father's education level, family economic level, and verbal IQ (VIQ) on the C-WISC independently predicted adult academic outcomes, with an AUC of 0.870 (p < 0.001, 95% CI = 0.796–0.944). The corresponding sensitivity and specificity were 0.813 and 0.783, respectively.Conclusion: Initial ADHD symptom severity and IQ, father's character and education level, and family atmosphere and function affect adult clinical and academic outcomes. Addressing these areas early may help to improve the prognosis of ADHD into adulthood.

Contributions of Friends’ Problem Behaviors to Friendship Quality in a Sample of Children with ADHD

ABSTRACT Objective It is often assumed that children with attention-deficit/hyperactivity disorder (ADHD) experience friendship difficulties because of their own problem behaviors. However, friendships are dyadic relationships between two children. This study sought to understand the incremental contributions of friends’ problem behaviors to dyadic friendship quality in a clinically diagnosed sample of children with ADHD. Method One hundred and sixty-five dyads consisting of a target child with ADHD and social impairment (age 6–11; 67% male; 72% white) and a reciprocated, real-life friend were recruited. Parents and teachers rated the ADHD symptom severity, externalizing problems, and callous-unemotional (CU) traits of target children and friends. Friendship quality in the dyad was measured with: (a) questionnaires independently completed by target children, their parents, their friends, and the parents of their friends; and (b) observations of child-friend interactions. Results The severity of ADHD symptoms and externalizing problems (but not CU traits) in target children was associated with more negative friendship quality reported on questionnaires. Adjusting for the corresponding problem behavior in target children, each type of friends’ problem behaviors incrementally predicted less positive friendship quality (on questionnaires). Friends’ ADHD symptoms and CU traits also incrementally predicted more negative friendship quality (on questionnaires and observations). Conclusions Considering problem behaviors in friends of children with ADHD (in addition to those in children with ADHD) may be important for identifying dyads at risk for lower quality friendships. These findings could possibly lead to new directions when designing and evaluating treatments targeting the friendship problems of children with ADHD.

Impact of Parental Impulsivity on Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder: Do Mothers' Attitudes Predict Symptom Severity in Children?

Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder that occurs early in school-aged children, and it is highly comorbid with oppositional defiant disorder (ODD). Parents of children with ADHD frequently show mental problems related to impulsivity. The aim of this study was to examine the relationship between impulsivity of the mothers and the symptom patterns and severity of children. A total of 85 children between the ages of 6 and 12 and their mothers participated. Conners' Parent and Teacher Scales, Structured Clinical Interview for DSM-IV Personality Disorders, and ıowa gambling task were applied. We found a positive correlation between the impulsivity of the mothers and the total symptom severity of ADHD and ODD in children. During the treatment process of ADHD, the evaluation of impulsivity in mothers of children with ODD comorbidity and treatment of impulsivity in the mother would be beneficial. In future studies, examining the effects after treatment of impulsivity may contribute to the literature.