The relationship of compliance with inattention and hyperactivity/impulsivity

The aim of the study was to investigate the relationship between Attention Deficit Hyperactivity Disorder (ADHD) inattention and hyperactivity/impulsivity symptoms in predicting compliance. It was hypothesised that inattention symptoms are a better predictor of compliance than hyperactivity/impulsivity. There were two different groups of participants: 367 college students (both males and females) and 89 male prisoners. All participants had completed the Gudjonsson Compliance Scale (GCS) and the DSM-IV-TR (Screening) Checklist for adult ADHD symptoms. Significant correlations emerged between compliance and ADHD symptoms, but the correlations were higher for inattention than hyperactivity/impulsivity among both samples. This was confirmed by multiple regression analyses (hierarchical), which showed that the variance in compliance explained by ADHD inattention versus hyperactivity/impulsivity symptoms increased from 2% to 8% for college students and 8% to 24% for prisoners after entering inattention into the model (hyperactivity/impulsivity was entered first in the regression models). The findings suggest that inattention is a more powerful predictor of compliance than hyperactivity/impulsivity. This is a novel and an important finding.     

Cognitive Behavioral Therapy for Attention-Deficit/Hyperactivity Disorder in College Students: A Review of the Literature

The current review presents a theory-guided review of the existing cognitive behavioral therapy (CBT) interventions for attention-deficit/hyperactivity disorder (ADHD) in college students. Across the eight studies that investigated this topic, moderate reductions were shown in inattentive symptoms but little to no change was reported in hyperactive/impulsive symptoms. Results indicated a moderate treatment effect on self-reported quality of life and school/work functioning, yet less of an impact on GPA, response inhibition, social functioning, and executive functioning. Methodological and statistical problems and inconsistencies were noted. Since college students are emerging adults, it is likely that the optimum CBT intervention for college students with ADHD lies somewhere in between the existing clinic-based adult ADHD CBT interventions as well as the school-based adolescent ADHD psychosocial interventions. Directions for future research and recommendations for clinicians in university settings are provided in an attempt to further develop the existing college students CBT clinical research evidence base.     

Big five dimensions and ADHD symptoms: links between personality traits and clinical symptoms

Attention-deficit/hyperactivity disorder (ADHD) in adulthood is conceptualized as originating in childhood. Despite considerable theoretical interest, little is known about how ADHD symptoms relate to normal personality traits in adults. In 6 studies, the Big Five personality dimensions were related to ADHD symptoms that adults both recalled from childhood and reported concurrently (total N = 1,620). Substantial effects emerged that were replicated across samples. First, the ADHD symptom cluster of inattention-disorganization was substantially related to low Conscientiousness and, to a lesser extent, Neuroticism. Second, ADHD symptom clusters of hyperactivity-impulsivity and oppositional childhood and adult behaviors were associated with low Agreeableness. Results were replicated with self-reports and observer reports of personality in community and clinical samples. Findings support theoretical connections between personality traits and ADHD symptoms.     

A review of adult ADHD: a neuropsychological and neuroimaging perspective

Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder which effects an estimated 3% to 5% of children. Despite estimates that ADHD persists in 30% to 70% of adults having had the disorder in childhood, ADHD in adulthood remains controversial. This report summarizes current thinking in the diagnosis and etiology of adult ADHD. Most theories posit that ADHD is related to anomalies in frontal lobe function and dopaminergic transmission. However, there is debate as to whether ADHD is a unitary disorder with different manifestations, a syndrome, or multiple disorders. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, classifies ADHD into inattention, hyperactivity-impulsivity, and combined subtypes. Although problems with cognition are core ADHD symptoms, self-reporting has not been a reliable predictor of neuropsychological test performance. Nevertheless, we suggest that a performance-based diagnosis, including empirically derived, age-sensitive neuropsychological tests, provides the best hope of dissociating ADHD from psychiatric disorders with similar symptoms. We also describe the promise of new neuroimaging technologies, such as functional magnetic resonance imaging, in elucidating the pathophysiology of ADHD and similar psychiatric disorders.     

成人注意缺陷多动障碍在内外源冲突时的表现:眼动的证据

在注意定向与维持上,注意缺陷多动障碍(ADHD)个体更容易受到外部刺激的干扰而导致目标任务加工进程受阻,表现出了注意定向反应的缺陷,但导致任务失败的原因是由于对突然出现的外部无关刺激的过度兴奋还是对内源性目标刺激的持续维持能力减弱,尚不清楚。研究采用反向眼跳范式、记忆导向眼跳范式和视觉导向眼跳范式,来探索成人ADHD内外源注意定向反应的情况,以及当二者发生冲突时,成人ADHD失败的可能机制。结果发现,在反向眼跳任务上,成人注意缺陷多动障碍组错误率更高,并且差异性显著。但在记忆导向眼跳任务中,成人注意缺陷多动障碍组与正常组的差异不显著。在视觉导向眼跳任务中,成人注意缺陷多动障碍组的正确眼跳潜伏期比正常组要短,且二者之间的差异显著。这说明,在内外源刺激反应的冲突导致的情境中,成人注意缺陷多动障碍的反应明显落后于正常个体,这种缺陷并非由于其维持内源性注意产生定向反应落后所导致的,而是与其外源注意定向反应过强有关。     

Evidence for a general factor model of ADHD in adults

Objective: To examine factor structures of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) symptoms of ADHD in adults. Method: Two sets of models were tested: (a) models with inattention and hyperactivity/impulsivity as separate but correlated latent constructs and (b) hierarchical general factor models with a general factor for all symptoms and separate specific factors for inattention and hyperactivity/impulsivity. Participants were 751 adults with ADHD. Two models with correlated factors and two general factor models of ADHD symptoms were tested. Results: The general factor model provided a better fit of the data than the correlated models. The general factor model with one general and three (inattention, motoric, and verbal hyperactivity/impulsivity) specific factors best accounted for the adults' symptoms. Conclusion: These results suggest a unitary component to ADHD symptoms as well as dimensional specific factors. The replication of a general factor in adults suggests continuity of symptom presentation from childhood into adulthood. Clinical implications are discussed.     

Developmental change in the relation between executive functions and symptoms of ADHD and co‐occurring behaviour problems

In a sample of 92 children aged 6–13 years this study investigates the normal developmental change in the relation between executive functioning (EF) and the core behavioural symptoms associated with attention deficit hyperactivity disorder (ADHD) (hyperactivity/impulsivity and inattention) as well as symptoms often co‐occurring with childhood hyperactivity (conduct‐ and internalizing problems). EF was assessed by using multiple tests grouped through prior factor analysis, resulting in cognitive measures relating to disinhibition, speed/arousal, verbal working memory, non‐verbal working memory, and fluency. The results showed that although disinhibition was positively related to hyperactivity/impulsivity and inattention mainly for the youngest age group, there were no significant age effects for these relations. Instead, age effects were found for the relations between speed/arousal and inattention as well as for the relations between verbal working memory/fluency and inattention. In the oldest age group poor performance on these cognitive measures was associated with high ratings of inattention. For the total sample a relation was obtained between disinhibition and hyperactivity/impulsivity as well as between both working memory measures and internalizing problems. In conclusion, the results from this study suggest that poor inhibition is most clearly associated with ADHD symptoms for younger children, whereas poor functioning with regard to later developing and more complex executive functions such as working memory and fluency is associated with ADHD symptoms for older children. Copyright © 2006 John Wiley & Sons, Ltd.     

Parenting Behavior and Cognitions in a Community Sample of Mothers with and without Symptoms of Attention-deficit/Hyperactivity Disorder

Although attention-deficit/hyperactivity disorder (ADHD) in adults has recently emerged as an important area of research, little attention has been given to the family functioning of women with ADHD, particularly in their role as mothers. We examined parenting self-esteem, locus of control, and disciplinary styles in a community sample of mothers with varying levels of ADHD symptoms. Women with high levels of ADHD symptoms reported more occupational and psychiatric problems than women with lower levels of ADHD symptoms. They also reported lower parenting self-esteem, a more external parenting locus of control, and less effective disciplinary styles. The findings suggest that women with ADHD symptoms may face a number of difficulties within the parenting domain.     

Retrospective ratings of ADHD symptoms made at young adulthood by clinic-referred boys with ADHD-related problems, their brothers without ADHD, and control participants

Retrospective childhood attention-deficit/hyperactivity disorder (ADHD) symptoms are required to diagnosis adult ADHD, but the validity of self-rated symptoms across time is questionable. Here, boys with ADHD-related problems, their brothers without ADHD, and former schoolmates rated themselves during young adulthood for ages 9, 14, and 19. Brothers rated probands retrospectively at the same ages. The young adults referred as children for ADHD (a) acknowledged childhood symptoms; (b) described improvement over time; (c) did not differ from brothers or controls on most self-ratings of young adult symptoms; (d) rated themselves as more symptomatic at age 9, but less symptomatic at age 19, than their brothers rated them; and (e) agreed only to some degree with brothers' ratings of probands' aggression (median correlation = .22). Probands' ratings showed limited agreement with judges' symptom ratings (median correlation = .16) and young adult follow-up examiners' ratings (median correlation = .14). These findings are not accounted for solely by changes in informants, nor by the course of ADHD psychopathology. They suggest some stability but limited internal consistency and validity for retrospective ADHD ratings by probands and brothers.     

Attention deficit hyperactivity disorder among inmates in Bergen Prison

The aim of this study was to investigate whether clinical findings are consistent with research indicating a high prevalence of attention deficit hyperactivity disorder (ADHD) among prison inmates. Forty‐three male inmates who were referred for ADHD assessment at the health service in Bergen prison participated. Although most of them reported symptoms in accordance with ADHD both in childhood and adulthood, only 35% of the referred inmates fulfilled the criteria for ADHD when a comprehensive assessment was conducted. The results emphasize the importance of a comprehensive assessment when diagnosing ADHD among prison inmates.     

Aggression Among Children with ADHD,Anxiety, or Co-occurring Symptoms: Competing Exacerbation and Attenuation Hypotheses

Competing hypotheses for explaining the role of anxiety in the relation between attention-deficit/hyperactivity disorder (ADHD) symptoms and childhood aggression were evaluated. Two studies tested whether anxiety exacerbated, attenuated, or had no effect on the relation between ADHD and aggression subtypes among psychiatrically hospitalized children. In Study 1 (N = 99), children who scored above clinical cut-off levels for anxiety only, ADHD only, and co-occurring ADHD and anxiety were compared on aggression subtypes (i.e., reactive, proactive, overt, and relational aggression). In Study 2, the moderating role of anxiety on the relation between ADHD and aggression subtypes was examined with a larger sample (N = 265) and with continuous variables. No support was found for either the attenuation or exacerbation hypothesis, and results remained consistent when separately examining hyperactivity/impulsivity and inattention symptoms of ADHD. Although ADHD symptoms were significantly associated with all aggression subtypes, this association did not remain when including symptoms of oppositional defiant disorder.     

Reported prevalence of attentional difficulties in a general sample of college students

The present study investigated the self-reported prevalence of attention-deficit hyperactivity disorder (ADHD)symptoms in 770 college students using the Adult Rating Scale and the Wender Utah Rating Scale. Psychometric properties of these scales were explored. The study also investigated the performance of students with ADHD symptoms, relative to students without ADHD symptoms, on a battery of neuropsychological tasks. Results revealed that 7 and 8% of the students reported significant symptoms (i.e., 1.5 SD above the mean) on the Adult Rating Scale and the Wender Utah Rating scale, respectively, and 2.5% reported significant symptoms on both the Adult Rating Scale and the Wender Utah Rating Scale. Using more stringent criteria (two standard deviations), fewer (i.e, 4, 3.8%, and 0.5%) subjects reported significant symptoms associated with ADHD. Between-group differences were found on one of the neuropsychological tasks. The construct validity of the rating scales was supported. Limitations and implications for future research are advanced.Presented at the International Neuropsychological Society's Sixteenth European Conference, Angers, France, June 1994, and the Annual Convention of the American Psychological Association, Los Angeles, CA, August 1994.     

Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD

Children diagnosed with attention-deficit/hyperactivity disorder (ADHD; n = 142) were prospectively monitored into adolescence (13-18 years old) to evaluate their risk for elevated substance use relative to same-aged adolescents without ADHD (n = 100). Probands reported higher levels of alcohol, tobacco, and illicit drug use than did controls. Group differences were apparent for alcohol symptom scores but not for alcohol or marijuana disorder diagnoses. Within probands, severity of childhood inattention symptoms predicted multiple substance use outcomes: childhood oppositional defiant disorder/conduct disorder (ODD/CD) symptoms predicted illicit drug use and CD symptoms. Persistence of ADHD and adolescent CD were each associated with elevated substance use behaviors relative to controls. Further study of the mediating mechanisms that explain risk for early substance use and abuse in children with ADHD is warranted.     

Examining Anxiety and Depression as Moderators of the Associations Between ADHD Symptoms and Academic and Social Problems in Hispanic Adolescents

The effects of attention-deficit/hyperactivity disorder (ADHD) symptoms on the psychosocial functioning of Hispanic youth have been understudied. It also remains unclear if the well-established associations between ADHD symptoms and academic and social impairment are exacerbated by co-occurring internalizing symptoms. The purposes of the present study were to (1) examine whether ADHD symptoms would be associated with academic and social problems while also controlling for oppositional defiant disorder (ODD) symptoms, and (2) test the hypothesis that anxious and depressive symptoms would moderate the relations between ADHD symptoms and academic and social problems. Participants were 142 at-risk Hispanic adolescents (54 % male, ages 14–19) who reported on their anxious and depressive symptoms, as well as their teachers who reported on adolescents’ ADHD symptoms, ODD symptoms, academic problems, and social problems. When the psychopathology variables were included simultaneously in a path model, ADHD was the only domain significantly positively associated with academic problems. In contrast, ODD and depressive symptoms were the only domains significantly positively associated with social problems when all of the psychopathology variables were included in the path model. No moderation effects were found in relation to academic problems, although a significant ADHD × depression interaction was found in relation to social problems. Specifically, ADHD symptoms were not associated with social problems among adolescents who reported low levels of depressive symptoms, but the association between ADHD symptoms and social problems was significant at higher levels of depression. In addition to targeting oppositionality, attending to the combined presence of ADHD and depressive symptoms will be important for reducing the social impairments among Hispanic adolescents.     

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.     

Concordance of self- and informant ratings of adults' current and childhood attention-deficit/hyperactivity disorder symptoms

Self-informant rating concordance for attention-deficit/hyperactivity disorder (ADHD) symptoms was assessed in 281 adults at the subscale (Inattention, Hyperactivity-Impulsivity) and individual symptom levels. Potential demographic, diagnostic, and informant identity moderators were also investigated. Concordance levels were similar for current and childhood symptoms. Although moderate positive correlations were found between self- and informant ratings on both subscales, informants endorsed more significant inattentive symptom severity. Kappa coefficients were variable, suggesting low concordance for certain symptoms. Sex and ADHD diagnosis moderated concordance, although effect sizes were small. These results have implications for the use of behavior rating scales in diagnosing ADHD, raise questions about the validity of self- and informant ratings, and support the need to investigate individual-differences variables that may impact concordance.     

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.     

The Association between Self-Regulation and Symptoms of Autism Spectrum Disorder in Preschoolers with Externalizing Behavior Problems

The purpose of the current study was to examine the role of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) symptoms in predicting deficits in self-regulation across the domains of executive functioning and emotion regulation. Parents of 40 preschoolers with externalizing behavior problems reported on children’s ADHD and ASD symptoms, and emotion regulation. Children completed a standardized executive functioning battery. Results indicated that 28% of parents and 53% of teachers rated children above the subclinical range on ASD symptoms. An interaction emerged such that higher ASD symptoms were only associated with poorer executive functioning for children with lower ADHD symptoms. However, ASD symptoms were predictive of poorer emotion regulation independent of ADHD symptoms. Findings revealed clinically significant ASD symptoms, which aided in explaining heterogeneity in self-regulation deficits.     

Distinguishing sluggish cognitive tempo from attention-deficit/hyperactivity disorder in adults

Researchers who study subtypes of attention-deficit/hyperactivity disorder (ADHD) in children have identified a subset having a sluggish cognitive tempo (SCT) typified by symptoms of daydreaming, mental confusion, sluggish-lethargic behavior, and hypoactivity, among others who differ in many respects from ADHD. No studies have examined the nature and correlates of SCT in adults. This study sought to do so using a general population sample in which those having high levels of SCT symptoms were identified (≥95th percentile) and compared to adults having high levels of ADHD symptoms and adults having both SCT and ADHD symptoms. From a representative sample of 1,249 U.S. adults 18-96 years four groups were created: (a) high levels of SCT but not ADHD (N = 33), (b) high levels of ADHD but not SCT (N = 46), (c) high levels of both SCT and ADHD (N = 39), and (d) the remaining adults as a control group (N = 1,131). As in children, SCT formed a distinct dimension from ADHD symptoms that was unrelated to age, sex, or ethnicity. Adults in both ADHD groups were younger than those with SCT only or control adults. The SCT-only group had less education than the control group, whereas both SCT groups earned less annual income than the control or ADHD-only group. More individuals in the combined group were out of work on disability. In their EF, both SCT groups reported greater difficulties with self-organization and problem solving than controls or the ADHD-only group. Otherwise, the SCT + ADHD group reported significantly greater problems with all other domains of EF than the other groups. But both the SCT-only and ADHD-only groups had significantly more EF difficulties than controls though not differing from each other. A similar pattern was evident on most ratings of psychosocial impairment, except in work and education where SCT was more impairing than ADHD alone and in driving where ADHD was more impairing. SCT contributed unique variance to EF deficits and psychosocial impairment apart from ADHD inattention and hyperactive-impulsive symptoms. Results further suggested that a symptom threshold of 5 or more out of 9 along with a requirement of impairment would result in 5.1% of the population as having SCT. It is concluded that SCT may be a separate disorder from ADHD yet with comorbidity occurring in approximately half of all cases of each. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder

The authors investigated prospectively assessed eating pathology (body image dissatisfaction and bulimia nervosa symptoms) among an ethnically and socioeconomically diverse sample of adolescent girls with attention-deficit/hyperactivity disorder-combined type (ADHD-C; n=93), ADHD-inattentive type (ADHD-I; n=47), and a comparison group (n=88). The sample, initially ages 6-12 years, participated in a 5-year longitudinal study (92% retention rate). After statistical control of relevant covariates, girls with ADHD-C at baseline showed more eating pathology at follow-up than did comparison girls; girls with ADHD-I were intermediate between these two groups. Baseline impulsivity symptoms, as opposed to hyperactivity and inattention, best predicted adolescent eating pathology. With statistical control of ADHD, baseline peer rejection and parent- child relationship problems also predicted adolescent eating pathology. The association between punitive parenting in childhood and pathological eating behaviors in adolescence was stronger for girls with ADHD than for comparison girls. Results are discussed in terms of the expansion of longitudinal research on ADHD to include female-relevant domains of impairment, such as eating pathology.