The Relation Between Sluggish Cognitive Tempo and DSM-IV ADHD

To test the relation between sluggish cognitive tempo (SCT) and DSM-IV ADHD symptoms, parent and teacher ratings of the 18 DSM-IV ADHD items and five potential SCT items were obtained in a community sample of 8-18 year-old twins that was overselected for ADHD and learning disabilities (n = 296). Confirmatory factor analyses revealed that a three-factor model provided the best fit to the data for both parent and teacher ratings. DSM-IV inattention and hyperactivity-impulsivity symptoms loaded on two factors consistent with the DSM-IV model, and five SCT symptoms loaded primarily on a third factor. The SCT and inattention factors were highly correlated, whereas SCT and hyperactivity-impulsivity were weakly related. Both raters indicated that children meeting symptom criteria for the combined and inattentive subtypes exhibited significantly more SCT symptoms than those meeting symptom criteria for hyperactive-impulsive type and the comparison group without ADHD. Children meeting symptom criteria for the inattentive type exhibited significantly more SCT symptoms than those meeting criteria for the combined type, based on teacher ratings. These results suggest that SCT is an internally consistent construct that is significantly associated with DSM-IV inattention.     

Inattention as a key predictor of tobacco use in adolescence

The authors examined the prediction from inattention to tobacco use among 2 cohorts (ages 7 and 13) of a community sample followed to young adulthood. Changes in self-reported tobacco use were tested with marginal transitional regression models, using parent and teacher ratings of inattention, hyperactivity-impulsivity, and other psychopathology, along with other factors, as predictors. Inattention, but not hyperactivity-impulsivity, significantly predicted adolescent tobacco use and young adult daily tobacco use. Peer substance use, parental substance use, and conduct disorder also predicted increases in tobacco use. African American ethnicity was strongly protective against later tobacco use.     

Structure and Validity of Sluggish Cognitive Tempo Using an Expanded Item Pool in Children with Attention-Deficit/Hyperactivity Disorder

We evaluated the latent structure and validity of an expanded pool of Sluggish Cognitive Tempo (SCT) items. An experimental rating scale with 44 candidate SCT items was administered to parents and teachers of 165 children in grades 2–5 (ages 7–11) recruited for a randomized clinical trial of a psychosocial intervention for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type. Exploratory factor analyses (EFA) were used to extract items with high loadings (>0.59) on primary factors of SCT and low cross-loadings (0.30 or lower) on other SCT factors and on the Inattention factor of ADHD. Items were required to meet these criteria for both informants. This procedure reduced the pool to 15 items. Generally, items representing slowness and low initiative failed these criteria. SCT factors (termed Daydreaming, Working Memory Problems, and Sleepy/Tired) showed good convergent and discriminant validity in EFA and in a confirmatory model with ADHD factors. Simultaneous regressions of impairment and comorbidity on SCT and ADHD factors found that Daydreams was associated with global impairment, and Sleepy/Tired was associated with organizational problems and depression ratings, across both informants. For teachers, Daydreams also predicted ODD (inversely); Sleepy/Tired also predicted poor academic behavior, low social skills, and problem social behavior; and Working Memory Problems predicted organizational problems and anxiety. When depression, rather than ADHD, was included among the predictors, the only SCT-related associations rendered insignificant were the teacher-reported associations of Daydreams with ODD; Working Memory Problems with anxiety, and Sleepy/Tired with poor social skills. SCT appears to be meaningfully associated with impairment, even when controlling for depression. Common behaviors resembling Working Memory problems may represent a previously undescribed factor of SCT.     

The Association Between Sluggish Cognitive Tempo and Academic Functioning in Youth with Attention-Deficit/Hyperactivity Disorder (ADHD)

The purpose of the study was to evaluate the relation between Sluggish Cognitive Tempo (SCT) and academic functioning in a sample of 52 adolescents (40 males, 12 females) with Attention-Deficit/Hyperactivity Disorder (ADHD; M _age?=?13.75). This study builds on prior work by utilizing an empirically-based and psychometrically validated measure of SCT, collecting ratings of SCT from both parents and teachers, and examining associations with multiple domains of academic functioning from both the parent and teacher perspective as well as grade point average (GPA). Both SCT and DSM-IV symptoms of inattention were significantly correlated with domains of academic functioning. Multiple regression analyses demonstrated that the parent-rated SCT Slow subscale predicted overall academic functioning, organizational skills impairment, and homework problems above and beyond ADHD symptoms and child and demographic characteristics known to be associated with academics, including intelligence, academic achievement, and family income. The teacher-rated SCT Low Initiation/Persistence subscale also predicted homework problems and was the only SCT variable to predict school grades above and beyond ADHD symptoms and relevant covariates. Both the SCT Slow and Low Initiation/Persistence subscales include items related to youth seeming apathetic, unmotivated, and lacking initiative, behaviors that are strongly related to ADHD symptoms of inattention but not currently captured by the DSM-IV. Implications of these findings towards supporting the external validity of the SCT construct are discussed along with potential implications for intervention.     

Dimensions and Correlates of Attention Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo

The present study examined Sluggish Cognitive Tempo (SCT) in relation to ADHD symptoms, clinical diagnosis, and multiple aspects of adjustment in a clinical sample. Parent and teacher reports were gathered for 322 children and adolescents evaluated for behavioral, emotional, and/or learning problems at a university clinic. Confirmatory factor analyses (CFA) supported the presence of three separate, but correlated factors (SCT, inattention, and hyperactivity/impulsivity) in both parent and teacher ratings. As expected, SCT symptoms were greatest in youth with ADHD Inattentive type, but were also found in non-ADHD clinical groups. SCT symptoms were related to inattention, internalizing, and social problems across both parent and teacher informants; for parent reports, SCT was also related to more externalizing problems. Findings support the statistical validity of the SCT construct, but its clinical utility is still unclear.     

Longitudinal Predictors of School-Age Academic Achievement: Unique Contributions of Toddler-Age Aggression, Oppositionality, Inattention, and Hyperactivity

This project examined the unique predictive validity of parent ratings of toddler-age aggression, oppositionality, inattention, and hyperactivity-impulsivity to academic achievement at school-age in a sample of 566 high-risk children and families. The study also investigated potential indirect effects of the Family Check-Up on school-age academic achievement through changes in child behavior problems. The results demonstrated that toddler-age aggression was most consistently associated with school-age academic achievement, albeit modestly. Moreover, findings showed that the intervention predicted greater decreases in aggression from ages 2–3 to 4–5 compared to controls. The results suggest that in high-risk toddler-aged children, aggression may be a more consistent predictor of school-age academic achievement than other externalizing dimensions, which has implications for early identification and efforts to promote children’s adaptation.     

The Internal and External Validity of Sluggish Cognitive Tempo and its Relation with DSM–IV ADHD

Studies of subtypes of DSM-IV attention-deficit/hyperactivity disorder (ADHD) have provided inconsistent support for the discriminant validity of the combined type (ADHD-C) and predominantly inattentive type (ADHD-I). A large sample of children and adolescents with ADHD (N?=?410) and a comparison group without ADHD (N?=?311) were used to test the internal and external validity of sluggish cognitive tempo (SCT), a dimension characterized by low energy and sleepy and sluggish behavior. SCT scores were then incorporated in analyses of ADHD subtypes to test whether the discriminant validity of ADHD-C and ADHD-I could be improved by including SCT symptoms as part of the criteria for ADHD-I. Factor analyses of parent and teacher ratings indicated that six SCT items loaded on a factor separate from symptoms of ADHD and other psychopathology, providing important support for the internal validity of SCT. The external validity of SCT was supported by significant associations between SCT and measures of functional impairment and neuropsychological functioning when symptoms of ADHD and other psychopathology were controlled. However, contrary to initial predictions, high levels of SCT did not identify a subgroup of ADHD-I that was clearly distinct from ADHD-C. Instead, the current results suggest that DSM-IV inattention and SCT are separate but correlated symptom dimensions that are each independently associated with important aspects of functional impairment and neuropsychological functioning.     

A rating measure of ADHD-related neuropsychological impairment in children and adolescents: Data from the Cognition and Motivation in Everyday Life (CAMEL) Scale from population and clinical samples

A new parent-completed questionnaire, the Cognition and Motivation in Everyday Life (CAMEL) scale, was developed to provide a comprehensive assessment of neuropsychological impairment in children related to attention-deficit/hyperactivity disorder (ADHD) across diverse cognitive, motivational and energetic domains. Its psychometric properties were investigated. A total of 60 items were generated to cover a wide range of putative ADHD-related neuropsychological processes. A clinical (n = 142) and community (n = 810) sample of parents with children between 6 and 16 years of age completed the questionnaire. Data on ADHD symptoms were also collected with a commonly-used, validated parent rating scale to explore the associations between CAMEL scores and dimensional measures of child ADHD and conduct problems. Factor analysis identified six factors which we labeled (i) Cognition, (ii) Self-Direction and Organization, (iii) Effort Engagement, (iv) Arousal Regulation, (v) Motivational Responsiveness, and (vi) Cautiousness. Self-Direction and Organization and Arousal Regulation were the strongest predictors for ADHD symptomatology. Self-Direction and Organization was strongly associated with inattention and Arousal Regulation with hyperactivity-impulsivity symptoms. Parents distinguished between broad neuropsychological domains in reliable and plausible ways, making distinctions between key aspects of functioning. However, the boundaries between these domains did not map directly onto the distinctions drawn within traditional models of ADHD deficits. Further research is required to examine the predictive validity and cost-effectiveness of the CAMEL scale compared to direct objective testing using laboratory measures in predicting prognosis and treatment outcome.     

Are sluggish cognitive tempo symptoms associated with executive functioning in preschoolers?

The aim of this study is to investigate whether sluggish cognitive tempo (SCT) symptoms are associated with neurocognitive task performance and ratings of real-world executive functioning (EF) in preschoolers at risk for attention-deficit/hyperactivity disorder (ADHD). The associations between parent- and teacher-rated SCT symptoms and neuropsychological task performance and ratings of EF in 61 4-year-old preschool children (51 boys, 10 girls) with self-regulation difficulties were examined, with regression analyses controlling for the effects of ADHD inattention symptoms. In the study sample, higher teacher-rated SCT symptoms are significantly associated with poorer performance on tasks of visual-perceptual abilities, auditory and visual attention, sustained and selective attention, inhibitory control, pre-numerical/numerical concepts, and slower processing speed, but SCT symptoms are not significantly associated with working memory, attention shifting or cognitive flexibility when controlling for ADHD inattention. Higher parent-rated SCT symptoms are significantly associated with visual-perceptual abilities. ADHD inattention symptoms are more strongly associated than SCT with daily life EF ratings; neither parent- nor teacher-rated SCT symptoms are significantly associated with daily life ratings of inhibition, working memory, or planning/organization after controlling for ADHD inattention. This study suggests that SCT symptoms contribute to EF deficits at least on neurocognitive tasks assessing visual-perceptual/spatial abilities, attention to detail and processing speed, as observed in this sample of young children at risk for ADHD, and may be an important intervention target.     

DSM-IV-Defined Inattention and Sluggish Cognitive Tempo: Independent and Interactive Relations to Neuropsychological Factors and Comorbidity

The aim of the present study was to investigate the independent relations of DSM-IV-defined inattention and behaviors characteristic of sluggish cognitive tempo (SCT) to neuropsychological factors and problem behaviors often comorbid with attention deficit/hyperactivity disorder (ADHD). By controlling for symptoms of DSM-IV-defined inattention, unique relations to SCT could be ascertained. Additionally, interactive relations of DSM-IV-defined inattention and SCT were of interest. A community-based sample of school children (N = 209; the higher end of the ADHD-symptom range was oversampled) completed neuropsychological tasks designed to measure executive function (EF), sustained attention, and state regulation. Behavioral symptoms were measured using parental and teacher ratings of the DSM-IV criteria for ADHD and Oppositional Defiant Disorder (ODD). The results showed that these two domains of inattention, DSM-IV-defined inattention and SCT, have neuropsychological processes and comorbid behavioral problems in common. However, when controlling for the overlap, DSM-IV-defined inattention was uniquely related to EF and state regulation, while SCT was uniquely related to sustained attention. In addition, the results showed an interactive relation of DSM-IV-defined inattention and SCT to ODD. Findings from the present study support the notion that DSM-IV-defined inattention constitutes a somewhat heterogeneous condition. Such results can further our theoretical understanding of the neuropsychological impairments and comorbid behavioral problems associated with ADHD symptoms.     

The Separation of ADHD Inattention and Hyperactivity-Impulsivity Symptoms: Pathways from Genetic Effects to Cognitive Impairments and Symptoms

Both shared and unique genetic risk factors underlie the two symptom domains of attention deficit hyperactivity disorder (ADHD): inattention and hyperactivity-impulsivity. The developmental course and relationship to co-occurring disorders differs across the two symptom domains, highlighting the importance of their partially distinct etiologies. Familial cognitive impairment factors have been identified in ADHD, but whether they show specificity in relation to the two ADHD symptom domains remains poorly understood. We aimed to investigate whether different cognitive impairments are genetically linked to the ADHD symptom domains of inattention versus hyperactivity-impulsivity. We conducted multivariate genetic model fitting analyses on ADHD symptom scores and cognitive data, from go/no-go and fast tasks, collected on a population twin sample of 1,312 children aged 7–10. Reaction time variability (RTV) showed substantial genetic overlap with inattention, as observed in an additive genetic correlation of 0.64, compared to an additive genetic correlation of 0.31 with hyperactivity-impulsivity. Commission errors (CE) showed low additive genetic correlations with both hyperactivity-impulsivity and inattention (genetic correlations of 0.17 and 0.11, respectively). The additive genetic correlation between RTV and CE was also low and non-significant at ?0.10, consistent with the etiological separation between the two indices of cognitive impairments. Overall, two key cognitive impairments phenotypically associated with ADHD symptoms, captured by RTV and CE, showed different genetic relationships to the two ADHD symptom domains. The findings extend a previous model of two familial cognitive impairment factors in combined subtype ADHD by separating pathways underlying inattention and hyperactivity-impulsivity symptoms.     

Social and Academic Impairment in Youth with ADHD, Predominately Inattentive Type and Sluggish Cognitive Tempo

Sluggish cognitive tempo (SCT) was originally identified as a construct that characterized the inattention problems of some children with attention deficit disorder (ADD). Research has indicated that using SCT symptoms to identify a subset of youth with attention-deficit/hyperactivity disorder, predominately inattentive type (ADHD-IT) may elucidate distinct patterns of impairment and thereby improve the external validity of ADHD subtypes. The objective of the current study was to investigate whether youth with clinically-assessed ADHD-IT and high levels of SCT exhibit unique social and academic impairments. In a clinic-referred sample of youth (N?=?209; 23 % female) aged 6 to 17 years, participants who met criteria for three different groups were identified: ADHD, Combined Type (ADHD-CT; n?=?80), ADHD-IT with low SCT symptoms (n?=?74), and ADHD-IT with high SCT symptoms (n?=?55). These groups were compared on indicators of social and academic functioning while considering the effects of co-occurring internalizing and disruptive behavior disorders. Youth with ADHD-IT high in SCT exhibited uniquely elevated withdrawal, as well as low leadership and low peer-directed relational and overt aggression, which were not accounted for by co-occurring disorders. This high-SCT group was also the only group to have more homework problems than the ADHD-CT group, but only when other disruptive behavior disorders were absent. The distinctiveness of the high-SCT group, which was primarily evident in social as opposed to academic functioning, provides partial support for the external validity and clinical utility of SCT.     

Internal and External Validity of Self-Report and Parent-Report Measures of Sluggish Cognitive Tempo in South Korean Adolescents

This study evaluated the internal and external validity of self-report and parent-report measures of sluggish cognitive tempo (SCT) in South Korean adolescents. Adolescents (N =?469, ages 13–17 years; 50.2% boys) completed self-report measures of SCT and attention-deficit/hyperactivity disorder inattention (ADHD-IN) in addition to measures of internalizing and externalizing psychopathology, social problems, and grades. Parents rated adolescents on SCT, ADHD-IN, internalizing and externalizing psychopathology, and social problems. Using adolescent self-report, 11 of 15 SCT symptoms showed convergent and discriminant validity with ADHD-IN. Using parent-report, all 15 SCT symptoms showed convergent and discriminant validity with ADHD-IN. For within source analyses, SCT showed unique and stronger associations than ADHD-IN with internalizing psychopathology whereas ADHD-IN showed unique and stronger associations than SCT with externalizing psychopathology. SCT and ADHD-IN showed similar unique associations with social problems, whereas ADHD-IN was more strongly related than SCT to grades. Across source analyses also supported the differential unique associations of SCT and ADHD-IN with internalizing and externalizing psychopathologies. This study provides initial evidence for the internal and external validity of SCT with South Korean adolescents, extending support for the transcultural validity of SCT to the important developmental period of adolescence.

     

Internal and External Validity of Sluggish Cognitive Tempo and ADHD Inattention Dimensions with Teacher Ratings of Nepali Children

The objective was to evaluate the validity of sluggish cognitive tempo (SCT) and ADHD-inattention (IN) symptoms in children from Nepal. Teachers rated SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), anxiety, depression, academic impairment, social impairment, and peer rejection dimensions in 366 children (50 % girls) in first through sixth grades (M _age?=?9.35, SD _age?=?1.96) on two separate occasions separated by 4-weeks. Seven of the eight SCT symptoms and all nine ADHD-IN symptoms showed convergent validity (substantial loadings on their respective factors) and discriminant validity (higher loadings on their respective factor than the alternative factor) at both time-points. Across all three separate analyses (assessment 1, assessment 2, and from assessment 1 to assessment 2), higher SCT scores were associated with lower ADHD-HI scores and higher depression, academic impairment, and social impairment scores after controlling for ADHD-IN while higher ADHD-IN scores were associated with higher ADHD-HI, ODD, academic impairment, and peer rejection scores after controlling for SCT. Also, as hypothesized, SCT scores were not related to ODD scores after controlling for ADHD-IN. The study provides the first evidence for the internal and external validity of the SCT dimension relative to the ADHD-IN dimension with teacher ratings of children from Nepal, thereby increasing the validity of the SCT construct beyond North America, Western Europe, South America, and South Korea.     

Sluggish Cognitive Tempo Symptoms Contribute to Heterogeneity in Adult Attention-Deficit Hyperactivity Disorder

Attention-deficit hyperactivity disorder (ADHD) persists into adulthood in over 50% of cases, although its associated symptom profiles, comorbid problems, and neuropsychological deficits change substantially across development. Sluggish cognitive tempo (SCT) symptoms may contribute to associations between ADHD and comorbid problems and may partially explain the substantial heterogeneity observed in its correlates. 349 adults aged 18–38 years (M = 23.2, SD = 4.5, 54.7% male, 61.03% with ADHD) completed a multi-informant diagnostic procedure and a comprehensive neuropsychological battery. Adults with ADHD (n = 213) were retained for analyses. Latent class analyses (LCA) revealed three profiles of SCT symptoms among those with ADHD, which we classified as minimal, moderate, or severe SCT. Multiple analysis of covariance (MANCOVA) revealed significant differences among these profiles, which remained when controlling for persistence of ADHD symptoms and sex. In general, adults with ADHD combined with SCT symptoms (moderate and severe) had significantly more symptoms of anxiety, depression, and persistent inattention, and had more severe professional and relational impairment compared to ADHD adults without SCT. Compared to those with moderate or minimal SCT symptoms, the severe SCT group had the most symptoms of depression and internalizing disorders, and the most impairment in the domain of daily responsibility. No significant differences based on externalizing symptoms emerged when controlling for sex and persistence of inattention symptoms, suggesting the moderate and severe SCT groups do not simply reflect more symptoms. Moreover, follow-up mediation analyses revealed that SCT might at least partially explain the heterogeneity in ADHD. Findings have implications for refinement of etiological conceptualization, assessment methods, and intervention strategies.     

Disentangling the impact of low cognitive ability and inattention on social behavior and peer relationships. Conduct Problems Prevention Re search Group

Examined the shared and unique contributions of low cognitive ability and inattention to the development of social behavior problems and peer relationships of children at the time of school entry. Kindergarten and first-grade assessments of cognitive ability, inattention and prosocial and aggressive behavior were collected for a multisite, normative sample. Sociometric assessments of peer relationships were collected at the end of first grade. Cognitive ability and inattention both contributed to the prediction of social behavior and peer relationships. Low cognitive ability was particularly predictive of prosocial skill deficits, and social behavior mediated the relation between cognitive ability and social preference. Inattention predicted both prosocial skill deficits and elevated aggressive-disruptive behavior problems. Behavior problems partially mediated the relation between inattention and social preference. Identified subgroups of children with elevated levels of inattention or low cognitive ability showed different patterns of peer problems, with low acceptance characteristic of the low cognitive ability (only) group and high dislike ratings characteristic of the inattentive and inattentive/low-ability group. Implications are discussed for the design of early intervention and prevention programs.     

Cognitive predictors of parent-rated inattention in very preterm children: The role of working memory and processing speed

Inattention is one of the most common neurobehavioral problems following very preterm birth. Attention problems can persist into adulthood and are associated with negative socio-emotional and educational outcomes. This study aimed to determine whether the cognitive processes associated with inattention differ between term-born and very preterm children. Sixty-five children born very preterm (<33+0 weeks’ gestation) aged 8–11 years were recruited alongside 48 term-born controls (?37 20 +0 weeks’ gestation). Both groups included children with a wide spectrum of parent-rated inattention (above average attention to severe inattention) measured as a continuous dimension using the Strengths and Weaknesses of ADHD and Normal-Behavior (SWAN) scale. The children completed tests to assess basic cognitive processes and executive function. A hierarchical multiple regression analysis was implemented to assess which neurocognitive processes explained variance in parent-rated inattention and whether these differed between preterm and term-born children. In both groups, poorer verbal and visuospatial short-term memory and poorer visuospatial working memory independently explained variance in parent-rated inattention. Slower motor processing speed explained variance in inattention among very preterm children only. The cognitive mechanisms associated with parent-rated inattention were predominantly overlapping between groups, but relationships between motor processing speed and inattention were unique to very preterm children. These associations may reflect risk factors for inattention in term and very preterm children. Future research should assess the efficacy of these cognitive processes as potential targets for intervention     

The Genetic Association Between ADHD Symptoms and Reading Difficulties: The Role of Inattentiveness and IQ

Previous studies have documented the primarily genetic aetiology for the stronger phenotypic covariance between reading disability and ADHD inattention symptoms, compared to hyperactivity-impulsivity symptoms. In this study, we examined to what extent this covariation could be attributed to “generalist genes” shared with general cognitive ability or to “specialist” genes which may specifically underlie processes linking inattention symptoms and reading difficulties. We used multivariate structural equation modeling on IQ, parent and teacher ADHD ratings and parent ratings on reading difficulties from a general population sample of 1312 twins aged 7.9–10.9 years. The covariance between reading difficulties and ADHD inattention symptoms was largely driven by genetic (45%) and child-specific environment (21%) factors not shared with IQ and hyperactivity-impulsivity; only 11% of the covariance was due to genetic effects common with IQ. Aetiological influences shared among all phenotypes explained 47% of the variance in reading difficulties. The current study, using a general population sample, extends previous findings by showing, first, that the shared genetic variability between reading difficulties and ADHD inattention symptoms is largely independent from genes contributing to general cognitive ability and, second, that child-specific environment factors, independent from IQ, also contribute to the covariation between reading difficulties and inattention symptoms.     

Emotional/Behavioral Problems and Functional Impairment in Clinic- and Community-Based Children with Attention-Deficit/Hyperactivity Disorder in Taiwan

Using a sample of 268 patients and 137 community-based children with DSM-IV ADHD, and 268 school controls, aged 6–15, this study aimed to compare the emotional/behavioral problems and functional impairment between clinic- and community-based children with ADHD. Children’s ADHD-related symptoms, a wide range of emotional/behavioral problems, and functional impairments were assessed by the psychiatric interviews and self-, parent- and teacher-reported questionnaires. Both ADHD groups scored higher in parent- and teacher-reported ADHD-related symptoms, wide-ranging emotional/behavioral problems, and impairments in the school, peer, family, and leisure time domains than school controls. However, clinic-based children with ADHD had more physical/developmental problems, more severe functional impairments and teacher-reported hyperactivity/impulsivity symptoms, and higher family burdens than their community counterparts. Our findings suggest that a higher maternal educational level, parent’s perceived child functional impairment, teacher’s perceived impaired peer relationship and hyperactivity-impulsivity, and child physical and developmental problems may be related to the psychiatric referrals of children with ADHD.     

Efficacy of Adderall for Attention-Deficit/Hyperactivity Disorder: a meta-analysis

Stimulant medication has, for many years, been the pharmacological treatment of choice for children and adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Several studies have shown Adderall , to be efficacious for measures of inattention, hyperactivity-impulsivity, aggression, disruptive behavior, and academic productivity. Although these studies provide useful information for clinicians treating ADHD children and adults, the variability in efficacy among the different types of measures used within each study has not been comprehensively examined. Thus, to provide a clearer picture of what conclusions can be drawn from these studies, we performed a meta-analysis. Data from the six available studies of standard release Adderall show it to be efficacious for symptoms of inattention, hyperactivity-impulsivity, and aggression, as well as global ratings. Its efficacy was significant for clinician, parent, and teacher ratings, and for both fixed- and best-dose designs.