What is the prevalence of adult ADHD? Results of a population screen of 966 adults

To provide a better estimate of the prevalence of ADHD in adulthood, the authors complete a telephone survey of 966 randomly selected adults. They compute two diagnoses from the survey data. Participants meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for both childhood and adulthood are defined as narrow ADHD. Broad ADHD adds to that definition those meeting subthreshold criteria. Cronbach's alpha is .90 for the 18 DSM-IV symptoms in childhood and .88 when rated for current symptoms in adulthood. No one item unduly influences the reliability of the total score. The authors find similar results in separate analyses of hyperactive-impulsive and inattentive symptoms. They estimate prevalences of 2.9% for Narrow ADHD and 16.4% for Broad ADHD. Having ADHD is associated with lower levels of education and employment status. These findings suggest that adult ADHD is a common disorder associated with impaired functioning.     

Using data augmentation to obtain standard errors and conduct hypothesis tests in latent class and latent transition analysis

Latent class analysis (LCA) provides a means of identifying a mixture of subgroups in a population measured by multiple categorical indicators. Latent transition analysis (LTA) is a type of LCA that facilitates addressing research questions concerning stage-sequential change over time in longitudinal data. Both approaches have been used with increasing frequency in the social sciences. The objective of this article is to illustrate data augmentation (DA), a Markov chain Monte Carlo procedure that can be used to obtain parameter estimates and standard errors for LCA and LTA models. By use of DA it is possible to construct hypothesis tests concerning not only standard model parameters but also combinations of parameters, affording tremendous flexibility. DA is demonstrated with an example involving tests of ethnic differences, gender differences, and an Ethnicity x Gender interaction in the development of adolescent problem behavior.     

A laboratory school comparison of mixed amphetamine salts extended release (Adderall XR) and atomoxetine (Strattera) in school-aged children with attention deficit/hyperactivity disorder

Mixed amphetamine salts extended release (MAS XR; Adderall XR) and atomoxetine (Strattera) were compared in children 6 to 12 years old with attention deficit/hyperactivity disorder (ADHD) combined or hyperactive/impulsive type in a randomized, double-blind, multicenter, parallel-group, forced-dose-escalation laboratory school study. Primary efficacy measure was the SKAMP (Swanson, Kotkin, Agler, M-Flynn, and Pelham) behavioral rating scale. Changes in mean SKAMP deportment scores from baseline were significantly greater for MAS XR (n = 102) than for atomoxetine (n = 101) overall (-0.56 and -0.13, respectively; p < .0001) and at each week (p < .001). Adverse events were similar for both treatment groups. The extended time course of action and greater therapeutic efficacy of MAS XR suggests that it is more effective than atomoxetine in children with ADHD.     

Dimensions of impulsivity and aggression associated with suicide attempts among bipolar patients: a preliminary study

Impulsivity and hostility are often thought to be interrelated among depressed patients with suicidal behavior, but few studies have examined this relationship empirically. In this study, we assessed trait impulsivity and hostility among 52 DSM-IV bipolar subjects with and without histories of suicide attempts. Impulsivity and hostility were correlated among attempters (r = .41, p = .03) but not non-attempters (r = .22, p = .28). As compared to non-attempters, attempters had significantly higher levels of overall hostility, more extensive subcomponents of hostility, and a trend toward higher overall impulsivity. Associations between lifetime suicide attempts and overall hostility were significant while controlling for current depression severity and lifetime illness duration. Aggression and impulsivity appear linked among bipolar patients with lifetime suicide attempts but may be independent constructs among non-attempters. The presence of both factors may elevate risk for suicidal behavior.     

Extinction-induced immobility in the water maze and its neurochemical concomitants in aged and adult rats: a possible model for depression?

Extinction of escape behavior in the water maze due to the removal of the platform, was hypothesized to induce a negative state, including the development of immobility, which is held to reflect a state of "despair" when measured in the forced swimming test. 27 aged and 8 adult animals (26 and 3 months old Wistar rats, respectively) were tested in the water maze during nine days with a platform hidden, followed by 7 days of extinction trials with the platform absent. As expected, both age groups developed immobility over the extinction trials, with the aged showing more than the adults. To examine whether the age difference in immobility was related to performance differences during acquisition, the aged were subdivided into superior, intermediate and inferior learners (n = 9 per group) on the basis of overall times to platform during acquisition, and compared with each other and the adults. Results showed that the aged inferior learners displayed the highest levels of immobility among the aged. Immobility scores were then correlated with post-mortem neurotransmitter contents in the hippocampus and ventral striatum. In the ventral striatum, levels of immobility were correlated with levels of acetylcholine, dopamine and the metabolite dihydroxyphenylacetic acid in the aged, and with norepinephrine in the adults. The data support the hypothesis that multiple extinction trials in the water maze result in immobility that may indicate "behavioral despair," and that striatal neurotransmitter systems correlate with the degree of its expression. The concept of extinction-induced despair is held to provide the promise of a conceptual and empirical model of human depression that is the consequence of loss of reinforcers.     

Potential noradrenergic targets for cognitive enhancement in schizophrenia

Substantial evidence suggests that alterations in noradrenergic function contribute to the cognitive impairments of schizophrenia. Activation of post-junctional alpha 2a-adrenergic receptors in the prefrontal cortex by the alpha 2a-selective agonist guanfacine has demonstrated some preliminary benefit in subjects with schizophrenia treated with atypical antipsychotics. alpha 1-adrenergic receptor activity may be less important in mediating the cognitive impairments of schizophrenia. beta-adrenergic receptors may serve as another potential target for cognitive remediation in schizophrenia. However, the potential increase in memory consolidation in schizophrenia patients produced by beta-adrenergic agonists may be outweighed by the impairment in cognitive flexibility and executive functioning produced by beta-adrenergic agonists. Finally, norepinephrine reuptake inhibitors, such as atomoxetine, hold promise as potential cognitive enhancers in schizophrenia because of their ability to indirectly but selectively increase extracellular dopamine concentrations in the prefrontal cortex.     

Cortical regions associated with different aspects of object recognition performance

In the present object recognition study, we examined the relationship between brain activation and four behavioral measures: error rate, reaction time, observer sensitivity, and response bias. Subjects perceptually matched object pairs in which structural similarity (SS), an index of structural differentiation, and exposure duration (DUR), an index of task difficulty, were manipulated. The SS manipulation affected the fMRI signal in the left anterior fusiform and parietal cortices, which in turn reflected a bias to respond same. Conversely, an SS-modulated fMRI signal in the right middle frontal gyrus reflected a bias to respond different. The DUR manipulation affected the fMRI signal in occipital and posterior fusiform regions, which in turn reflected greater sensitivity, longer reaction times, and greater accuracy. These findings demonstrate that the regions most strongly implicated in processing object shape (SS-modulated regions) are associated with response bias, whereas regions that are not directly involved in shape processing are associated with successful recognition performance.     

Applications of computer-based instruction: using specialized software to aid letter-name and letter-sound recognition

We evaluated computerized training and testing programs with children who were having difficulties learning prereading skills. The programs were derived from equivalence research and were written in authoring software designed for educators. After learning to match uppercase and lowercase printed letters to the corresponding letter names (Tasks 1 and 2), the children matched the letters to one another (Tasks 4 and 5). Then, after learning to match uppercase letters to sounds (Task 3), they also matched lowercase letters to sounds (Task 6) and matched printed to spoken words (Tasks 7 and 8). The results recommend equivalence-based protocols and user-friendly software in further development of prereading instruction.