Sensory-motor deficits in children with developmental coordination disorder, attention deficit hyperactivity disorder and autistic disorder

Children who have been diagnosed with any one developmental disorder are very likely to meet diagnostic criteria for some other developmental disorder. Although comorbidity has long been acknowledged in childhood disorders, little is understood about the mechanisms that are responsible for the high level of comorbidity. In a series of studies, we have investigated the link between sensory-motor deficits and developmental disorders. Poor sensory-motor integration has long been implicated as a cause of motor problems in developmental disorders such as developmental coordination disorder (DCD), and our recent research has also investigated sensory-motor deficits in children with attention deficit hyperactivity disorder (ADHD) and autistic disorder. Based on a critical examination of relevant literature and some of our recent research findings, we argue that the importance of poor sensory-motor functioning in discriminating children with different disorders has been underestimated. Poor sensory-motor coordination appears to be linked to DCD, but not ADHD. Also, sensory-motor deficits in children with DCD and autistic disorder may provide insight into some of the social difficulties found in these groups of children. This research will increase our understanding of why children with one developmental disorder typically also have problems in other areas.     

Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Jugendalter

Attention deficit–hyperactivity disorder (ADHD) in children and adolescents is a common and severe psychiatric disorder with a prevalence between 2 and 6%. In a high percentage of cases, there is a positive family history. In almost all sufferers, persistent functional limitations that impact everyday life are observed. The prognosis for untreated ADHD is very poor, being associated with social decline, drug addiction, and delinquency. Diagnosis is complex. Typical symptoms are often “hidden”. They are age specific and are mainly associated with inattention, impulsiveness associated with aggression and delinquency, and dangerous risk-taking behavior. More than half of patients also have additional comorbid disorders. The treatment concept always includes nonpharmacological interventions, which are often supplemented with drugs.     

Developmental aspects of delinquency and internalizing problems and their association with persistent juvenile substance use between ages 7 and 18.

Analyzed longitudinal data from 3 samples of the Pittsburgh Youth Study on boys ages 7 to 18 to examine the co-occurrence of persistent substance use with other problem behaviors, including attention deficit hyperactivity disorder (ADHD), persistent delinquency, and persistent internalizing problems (i.e., depressed mood, anxiety, shy or withdrawn behavior). In preadolescence, persistent substance users also tended to be persistent delinquents, and half of this group displayed persistent internalizing problems as well. In adolescence, a third of the persistent substance users did not manifest other persistent problems. Across the samples, the least common substance users were those who manifested persistent internalizing problems only. Logistic regression analyses showed that persistent substance use in preadolescence was predicted by persistent delinquency and internalizing problems and in adolescence by persistent delinquency only. The combination of persistent substance use and delinquency was predicted by oppositional defiant disorder in middle childhood and by persistent internalizing problems in middle to late childhood. ADHD was not a predictor of persistent substance use (and delinquency) in any of the analyses. Results are discussed in terms of developmental models of multiproblem youth with an eye on improving early interventions.     

Family factors associated with attention deficit hyperactivity disorder and emotional disorders in children

Few well-controlled studies have identified psychosocial profiles of families of boys with ADHD and boys with emotional disorders compared with normal controls. However, the clinical and theoretical literature pinpoints four domains in which distinctive profiles would be expected to occur. In this study, twenty-two mothers and thirteen fathers of twenty-two boys with ADHD; twenty mothers and fifteen fathers of twenty boys with a mood or anxiety disorder; and twenty-six mothers and sixteen fathers of twenty-seven normal controls were compared on: (1) stress, support and quality of life; (2) current family functioning; (3) parenting style and satisfaction in the family of origin and current family; and (4) current and past parental functioning. The two clinical groups showed higher levels of stress and lower levels of both social support and quality of life than did normal controls. Both clinical groups showed deficits in current family functioning, but contrary to expectations the ADHD and emotional disorder group did not show distinctly different profiles. Parents of ADHD children reported higher levels of authoritarian parenting styles, and parents from both clinical groups reported less parenting satisfaction than did normal controls in both their current families and their families of origin. Parents of children with ADHD and emotional disorders reported greater parenting satisfaction in their families of origin than in their current families. This discrepancy was greatest for parents of ADHD children. Parents of children with ADHD and emotional disorders reported greater psychological health problems and more childhood ADHD symptomatology than did normal controls. Parents of children with ADHD and emotional disorders have significant psychosocial difficulties in family and personal functioning. Family intervention is highly appropriate for families with children who are referred for help with both types of difficulties.     

Die Bedeutung der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung für die Entstehung und Prognose von Störungen des Sozialverhaltens im Kindes- und Jugendalter

Attention Deficit/Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) are two of the most common neurobehavioral disorders of childhood. Despite of their high comorbidity rate both disorders can be reliably differentiated. Especially the comorbid condition is associated with a poor outcome and some of the affected children develop an Antisocial Personality Disorder. This article summarizes diagnostic criteria and epidemiological data of both disorders and emphasises the role of ADHD in the aetiology and pathogenesis of antisocial behavior. ADHD seems to have a negative impact particular in children of the early-starter subtype of CD. Findings from genetic, psychophysiological and neuroimaging studies emphasise the relevance of biological risk factors in the etiological models and developmental pathways of antisocial behavior. We present so far unpublished data of children with ADHD and ADHD/disruptive behavior disorders which indicate group-specific neurocognitive impairments in the comorbid condition. ADHD and CD seem to constitute a synergistic and interactive relationship in that each disorder aggravates the other. Recent findings point to a “true hybrid” of ADHD/CD. Considering the negative outcome of the comorbid condition, several findings suggest that high-quality treatments may have considerable impact on restoring ADHD children to better functioning.     

Screening for ADHD in an adult social phobia sample

Objective: Recent studies have suggested a link between a primary anxiety disorder and ADHD. Method: A total of 39 participants with a primary diagnosis of social phobia were compared with 178 patients with ADHD and 88 patients with other psychiatric disorders on measures for childhood and adult ADHD (the Wender Utah Rating Scale and the Adult ADHD Self-Report Scale). Results: Childhood symptoms of ADHD were reported by 7.8% of the social phobia participants, and 5.1% scored within the range of adult ADHD. The social phobia group reported significantly fewer ADHD symptoms than both of the comparison groups, who frequently reported social anxiety. Conclusion: Participants with social phobia recruited from the general population are less likely to suffer from ADHD. In contrast, patients with ADHD and patients with other psychiatric disorders appear to be likely to suffer from social anxiety.     

Methylphenidate in treatment of adults with Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) can persist into adulthood with a continuation of the pattern of childhood psychopathology, cognition and functioning. Adult comorbidities include substance use disorders, antisocial personality disorder, anxiety, and depression. Studies have shown that as in children, methylphenidate treatment for adults can lead to a robust, dose-dependent improvement in ADHD symptoms. Future research is needed to evaluate the safety and efficacy of long-term treatment with methylphenidate (MPH).     

The Delinquency Outcomes of Boys with ADHD with and Without Comorbidity

This study examined the association between childhood ADHD and juvenile delinquency by examining data from the Pittsburgh ADHD Longitudinal Study (PALS), a follow-up study of individuals diagnosed with ADHD in childhood (ages 5–12) and recontacted in adolescence and young adulthood for yearly follow-up (age at first follow-up interview M = 17.26, SD = 3.17). Participants were 288 males with childhood ADHD and 209 demographically similar males without ADHD who were recruited into the follow-up study. Delinquency information gathered yearly during the second through eighth follow-up provided a comprehensive history of juvenile delinquency for all participants. Four childhood diagnostic groups [ADHD-only (N = 47), ADHD + ODD (N = 135), ADHD + CD (N = 106), and comparison (N = 209)] were used to examine group differences on delinquency outcomes. Analyses were conducted across three dimensions of delinquency (i.e., severity, age of initiation, and variety). Individuals with childhood ADHD + CD displayed significantly worse delinquency outcomes than the other three groups, across almost all indices of offending. When compared to comparison participants, boys with ADHD-only and ADHD + ODD in childhood displayed earlier ages of delinquency initiation, a greater variety of offending, and higher prevalence of severe delinquency. These findings suggest that although childhood ADHD + CD creates the greatest risk for delinquency, boys with ADHD-only and ADHD + ODD also appear at a higher risk for later offending. The patterns of offending that emerged from the PALS are discussed in the context of the relationship between ADHD, comorbidity, and delinquency.     

Women with Childhood ADHD: Comparisons by Diagnostic Group and Gender

This study compared adult women with childhood ADHD to adult women without childhood ADHD and to adult men with childhood ADHD. The participants, all from a larger longitudinal study, included 30 women and 30 men (approximately age 23 to 24) with childhood ADHD, and 27 women without ADHD. Women with childhood ADHD were matched to comparison women on age, ethnicity, and parental education, and to men with childhood ADHD on age, ethnicity, and IQ. Self- and parent-reports of internalizing, interpersonal, academic, and job impairment, as well as substance use and delinquency indicated group differences on measures of self-esteem, interpersonal and vocational functioning, as well as substance use. Follow-up planned comparison tests revealed that almost all of these differences emerged by diagnostic status, and not by gender. This study adds to research on the negative adult outcomes of ADHD and demonstrates that the outcomes of men and women with childhood ADHD are relatively similar.     

Clinical,Sociobiological, and Cognitive Predictors of ADHD Persistence in Children Followed Prospectively Over Time

With increasing awareness that ADHD is chronically disabling, a burgeoning literature has examined childhood clinical indicators of ADHD persistence. This study investigates whether childhood factors reflecting biological risk and cognitive reserve have additive predictive value for the persistence of ADHD that is unique beyond childhood indicators of disorder severity. One-hundred thirty children with ADHD (mean age = 8.9 years, 75 % male) were followed into adolescence (mean age = 14.0 years). Childhood ADHD and co-morbidities were assessed via interviews with parents and teachers; parental psychopathology was assessed via parent interview; exposure to neurobiological and psychosocial adversity were indexed by parent questionnaire; and cognitive reserve was evaluated through children’s performance on measures of IQ and executive functioning. Univariate analyses identified childhood inattention and hyperactivity-impulsivity, co-morbid oppositional defiant disorder, overall impairment, and paternal anxiety and depression as more prevalent amongst adolescents with persistent compared with remitted ADHD. Only child-level predictors remained significant in a final multivariate model. These results suggest that children who are most likely to experience persistent ADHD have a more severe clinical presentation in childhood, reflected by increased levels of inattention, oppositional behavior, and impairment. They also are more likely to have fathers with internalizing concerns, but these concerns do not uniquely predict ADHD persistence beyond child-level factors. Contrary to expectations, childhood adversity and cognitive functioning did not predict the course of ADHD.     

The Role of Neuropsychological Assessment in the Functional Outcomes of Children with ADHD

The value of evidence-based services is now recognized both within clinical communities and by the public at large. Increasingly, neuropsychologists must justify the necessity of often costly and time-consuming neuropsychological assessments in the diagnosis and treatment of common childhood disorders, such as Attention-deficit/Hyperactivity Disorder (ADHD). Published medical guidelines and prominent researchers, however, have argued against the need for formal neuropsychological assessment of ADHD. The present review examines the literature on developmental outcomes in childhood ADHD, with emphasis on the utility of formal neuropsychological assessment among children diagnosed and treated in primary care settings. The review yields three central findings: 1) adherence to published diagnostic guidelines for ADHD is poor among pediatric and primary care physicians; 2) ADHD most often co-exists with other disorders, thus diagnoses made without formal psychometric assessment can be incomplete or incorrect, ultimately increasing treatment costs; and, 3) untreated children with ADHD, and those who have untreated comorbidities, are at greater risk for poor outcomes in social, academic, vocational, and practical settings. The available literature suggests that neuropsychological assessment provides information that can potentially reduce risks for poor outcomes and improve quality of life among children with ADHD. Controlled studies directly examining the impact of neuropsychological assessments in improving outcomes among children with ADHD are needed.     

Linkages between childhood executive functioning and adolescent social functioning and psychopathology in girls with ADHD

We followed an ethnically and socioeconomically diverse sample of preadolescent girls with ADHD (n = 140) and matched comparison girls (n = 88) over a period of 5 years, from middle childhood through early/midadolescence, with the aim of determining whether childhood levels of executive function (EF) would predict adolescent multi-informant outcomes of social functioning and psychopathology, including comorbidity between externalizing and internalizing symptomatology. Predictors were well-established measures of planning, response inhibition, and working memory, along with a control measure of fine motor control. Independent of ADHD versus comparison group status, (a) childhood planning and response inhibition predicted adolescent social functioning and (b) childhood planning predicted comorbid internalizing/externalizing disorders in adolescence. Subgroup status (ADHD-Combined, ADHD-Inattentive, and comparison) moderated the relationship between childhood planning and adolescent internalizing/externalizing comorbidity, with the combined type revealing particularly strong associations between baseline planning and adolescent comorbidity. Mediation analyses indicated that adolescent social functioning mediated the prediction from childhood EF to comorbidity at follow-up; in turn, in the girls with ADHD, adolescent comorbidity mediated the prediction from childhood EF to social functioning at follow-up. We conclude that childhood interventions should target EF impairments in addition to behavioral symptoms.     

Attention-Deficit Hyperactivity Disorder: The Medicalization of Misbehavior

During the past decade, there has been an increase in the diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD). This syndrome, typically diagnosed in childhood, is characterized by inattention, hyperactive motor behavior, and distractibility. Current prevalence rates obtained in various countries generally exceed the 3–5% reported by DSM-IV. Reasons for increased ADHD prevalence include changes in diagnostic standards, overlap between ADHD and other externalizing disorders, nonspecific behavioral criteria, and the rapid effects of stimulant medication on cognitive functioning. However, social, cultural, and economic factors may also contribute to increased diagnosis. ADHD has become a common topic in the lay media. Popular discussions of ADHD may serve as a metaphoric expression of social anxieties, particularly with respect to children. At the same time, ADHD has rapidly become incorporated into a medical model, with emphasis on pharmacological treatment. Reductions in mental health and educational services, as well as economic pressures of managed care, may also contribute to medicalization of behavioral problems. Collaboration between psychologists and primary care physicians can lead to more accurate diagnosis and appropriate treatment of ADHD and related disorders.     

Does comorbid attention-deficit/hyperactivity disorder impact the clinical expression of pediatric obsessive-compulsive disorder?

What is the impact of attention-deficit/hyperactivity disorder (ADHD) on the phenotypic expression of pediatric obsessive-compulsive disorder (OCD). We examined phenotypic features, and functional and clinical correlates in youths with OCD, with and without comorbid ADHD, from a large sample of consecutively referred pediatric psychiatry patients. Although comorbid ADHD had no meaningful impact on the phenotypic expression or clinical correlates of OCD, it was associated with higher rates of compromised educational functioning compared with other OCD youths. Our findings suggest that the OCD phenotype runs true and is not impacted by comorbid ADHD in youths diagnosed with both OCD and ADHD. In such affected youths, both disorders contribute to morbid dysfunction and require treatment. More work is needed to determine whether OCD plus ADHD represents a developmentally and etiologically distinct form of the OCD syndrome.     

Sluggish cognitive tempo in children and adolescents with higher functioning autism spectrum disorders: Social impairments and internalizing symptoms

Sluggish cognitive tempo (SCT) was introduced in 1980s in the field of attention deficit hyperactivity disorder (ADHD). Studies indicate that symptoms of SCT are separate from symptoms of ADHD and independently associated with multiple domains of functioning in clinical groups and in typical development. We assessed whether similar pattern would apply to higher functioning autism spectrum disorders (ASD). Children with higher functioning ASD (N = 55; 5?15 years) were divided into the ASD+High SCT (n = 17), the ASD+Medium SCT (n = 18) and the ASD+Low SCT (n = 20) groups based on parent‐rated daydreaming and slowness on the Five to Fifteen questionnaire (FTF). The groups were compared on SCT‐related impairments found in previous studies: social skills, academic functioning, psychiatric symptoms, and processing speed. Assessment methods were the FTF, the Development and Well‐Being Assessment, and the Coding subtest of the WISC‐III. The ADHD symptoms were statistically controlled due to the overlap between SCT and ADHD. The ASD+High SCT and ASD+Medium SCT groups were significantly more likely to have the most pronounced social impairments, and the ASD+High SCT group had significantly higher rate of internalizing disorders compared to the ASD+Low SCT group. Our results suggest that children with higher functioning ASD and high or medium levels of SCT symptoms could be at higher risk for psychosocial impairments than children with higher functioning ASD with low levels of SCT symptoms. Co‐occurring ADHD symptoms do not explain the finding. Recognizing SCT symptoms in higher functioning ASD would be important to targeting preventive support.     

Substance use and delinquency among adolescents with childhood ADHD: The protective role of parenting

Several domains of parenting have been identified as important for adolescent well-being. Whether these same domains are equally beneficial for adolescents with ADHD histories remains an empirical and clinically important question. This study examined whether parental knowledge of their teen's activities and whereabouts, consistency, support, and parent-adolescent conflict are associated with substance use and delinquency similarly for adolescents with and without a diagnosis of ADHD in childhood. A sample of 242 adolescents, 142 diagnosed with ADHD in childhood and prospectively followed into adolescence, and 100 without ADHD in childhood, were the focus of study. The relations between adolescent-reported outcomes (i.e., substance use and delinquency) and parenting behaviors were tested using latent variable modeling to determine both the effects of general (common) and specific (unique) parenting behaviors for participants with and without a history of ADHD. Adolescents' report of parental knowledge was a significant correlate of delinquency and substance use above and beyond other parenting variables and the variance in common across the parenting variables. More knowledge was associated with less delinquency and substance use for all participants, but parental knowledge was more strongly associated with alcohol use for adolescents with versus without childhood ADHD. These correlational findings suggest that, despite the increased difficulty of parenting youths with ADHD histories, actions taken by parents and youth to increase parental awareness may provide some protection against behavioral transgressions known to be elevated in this population. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Adult ADHD and/or Sleep Apnea? Differential Diagnostic Considerations with Six Case Studies

An increased interest in the persistence of attention-deficit hyperactivity disorder (ADHD) into adulthood brings concern that adult ADHD may become overdiagnosed. As with ADHD in childhood, various other adult psychological and medical disorders may be associated with ADHD in adulthood, and these related disorders may be mislabeled and mistreated as simple ADHD. One such medical condition is sleep apnea. This paper reviews similarities and differences between ADHD and sleep apnea and presents case histories of six adult patients diagnosed with ADHD who were subsequently found to have at least comorbid obstructive sleep apnea (OSA). Clinicians who diagnose and treat patients with ADHD are advised to become familiar with sleep apnea as a life-threatening condition that presents with overlapping symptoms.     

Factors Associated with Healthy and Impaired Social Functioning in Young Adolescents with ADHD

There is variability in the extent to which adolescents with attention-deficit/hyperactivity disorder (ADHD) exhibit social impairment, as the same diagnosis does not necessarily entail impairment in the same area(s) of functioning. The current study entailed a cross-sectional examination of enhancers to healthy social functioning and risk factors to parent- and self-rated social impairment in 324 middle school youth (ages 10–14 years) with ADHD. A series of binary logistic regression analyses were conducted to evaluate a risk-resilience model for social functioning, including testing compensatory (i.e., main; buffering) and protective (i.e., interaction) effects of enhancers in the presence of identified risk factors. Youth conduct problems, youth depression, and negative parenting emerged as risk factors. Self-rated social acceptance, activity participation (breadth and intensity), and parent involvement were enhancers of healthy social functioning. Of these enhancers, activity participation (breadth and intensity) and parent involvement showed buffering effects against the negative impact of the risk factors on social functioning. None of the enhancers displayed protective effects. The findings of this study enhance our understanding of the social functioning of young adolescents with ADHD, who comprise an understudied population relative to younger children with similar problems.     

ADHD in college students

OBJECTIVE: According to the American Psychiatric Association, 3% to 7% of the school-age population has ADHD and many children continue to display significant symptoms throughout adolescences and adulthood. Relative to the childhood literature, less is known about ADHD in adults, especially college students with ADHD. The principle purpose of this review articles is to summarize the major research findings concerning ADHD in the college student population with regard to prevalence of symptoms, neuropsychological and psychological functioning. Overall, findings suggest that college students with ADHD are at greater risk for academic and psychological difficulties, and they perform similar to non-ADHD controls on many neuropsychological tasks. These findings are preliminary, however, and are tempered by the small number of studies that have been conducted as well as the methodological limitations of these studies. CONCLUSION: Future research using larger sample sizes, rigorous assessment criteria, and a longitudinal design is needed to better understand the psychological, academic, and neuropsychological functioning of college students with ADHD. Studies are also needed to elucidate the effects of pharmacological and nonpharmacological effects of treatment on the functioning of college students with this disorder.     

Comorbid ADHD: Implications for the Treatment of Anxiety Disorders in Children and Adolescents

Despite high comorbidity rates and potential clinical implications, the influence of co-occurring attention-deficit/hyperactivity disorder (ADHD) on outcomes of cognitive-behavioral treatment (CBT) for anxious youth remains poorly understood. In this qualitative review, the current literature on the influence of comorbid ADHD on CBT of youth with diverse anxiety disorders is explored. Peer-reviewed studies examining ADHD, at the diagnostic and symptom level, received highest priority. In addition, inasmuch as some studies did not isolate the effects of ADHD from other disruptive behavior disorders (DBDs: oppositional defiant disorder, conduct disorders), studies with the three DBDs were explored as well. Ten studies met our specified methodological criteria. Findings are discussed in relation to the following two factors: type of anxiety disorder and measurement of ADHD (diagnostic or symptom level) in these studies. There was evidence that youth with a variety of anxiety disorders and with co-occurring ADHD fared worse than their counterparts without ADHD. Additionally, grouping ADHD with other DBDs tended to obscure the negative impact of ADHD on treatment outcomes. Additional research is needed to delineate the influence of comorbid ADHD specifically on treatment outcomes for the various anxiety disorders. Clinical implications of treating anxious youth with comorbid ADHD are explored.