Adrenocortical Functioning in Boys with Attention-Deficit/Hyperactivity Disorder: Examining Subtypes of ADHD and Associated Comorbid Conditions

Disruptions to hypothalamic-pituitary-adrenal (HPA) axis function have been associated with varying forms of psychopathology in children. Studies suggesting children with ADHD have blunted HPA function have been complicated by the prevalence of comorbid diagnoses and heterogeneity of ADHD. The goals of this research were to assess the relations between waking and stress–response salivary cortisol levels and comorbid disruptive behavior (DBD) and anxiety (AnxD) disorders and problems in boys with ADHD, and to examine whether cortisol levels varied across ADHD subtypes. One hundred seventy elementary school-age boys with ADHD provided salivary cortisol at waking and in reaction to venipuncture. Parent reports were used to assess boys’ psychiatric diagnoses and severity of behavioral problems. Boys’ comorbid AnxD and anxiety problems were associated with greater cortisol reactivity, whereas boys’ comorbid DBD and oppositional problems predicted diminished adrenocortical activity. Reactive cortisol increases were greatest in boys with ADHD and comorbid AnxD, but without DBD. ADHD subtypes were not differentially associated with waking, pre-stress baseline, or reactive cortisol levels. However, comorbid DBD predicted decreased cortisol reactivity in boys with inattentive and hyperactive subtypes of ADHD, but not in boys with combined subtype of ADHD. The results clarify previous patterns of distinct and divergent dysregulations of HPA function associated with boys’ varying kinds of psychopathology.

How Do Trait Dimensions Map onto ADHD Symptom Domains?

Theories of Attention-Deficit/Hyperactivity Disorder (ADHD) implicate dysfunctional regulation mechanisms that have been conceptually grouped into “top-down” control and “bottom-up” affective/reactive processes. This dual-process account can be invoked in relation to temperament or personality traits and may clarify how traits relate to ADHD. Two samples were examined to illuminate developmental effects. The younger sample was 179 youngsters aged 7 to 12 years (113 boys; 107 with ADHD). The older sample was 184 adolescents (109 boys; 87 with ADHD) aged 13 to 18 years. Structural equation models included parent-rated traits, teacher-rated ADHD symptoms, and laboratory-obtained executive functions. A control or “top-down” factor included cognitive control and conscientiousness/effortful control. A second factor labeled affective or “bottom-up” included neuroticism/negative emotionality, agreeableness, and reactive control. In the younger sample, these two factors were differentially and specifically related to inattention and hyperactivity, respectively. However, in the older sample, the first factor was related to inattention and hyperactivity, whereas the second factor was related to hyperactivity. Personality traits appear to map onto ADHD symptoms in a meaningful manner consistent with a dual-process model of temperament and ADHD. This research was supported by NIH National Institute of Mental Health Grant R01-MH63146, MH59105, and MH70542 to Joel Nigg. Martel was supported by NIH F31 MH075533. We are indebted to the families and staff who made this study possible.     

Multiple Psychological Senses of Community in Afghan Context: Exploring Commitment and Sacrifice in an Underground Resistance Community

The study of positive outcomes associated with strong psychological sense of community (PSOC) has grown worldwide. Yet most research explores PSOC as a uni-dimensional (positive) variable operating in a single referent community. Theoretical and empirical literature has suggested, however, that PSOC can be positive, neutral or negative (Brodsky in J Commun Psychol 24(4):347–363, 1996; Brodsky et al. in Psychological sense of community: Research, applications and implications. Kluwer, New York 2002) and since people live in multiple physical and relational communities, there may be multiple PSOCs (M-PSOC) operating simultaneously and interactively (Brodsky and Marx in J Commun Psychol 29(2):1–18, 2001). This paper explores the operation of M-PSOC in the lives of Afghan women, and male supporters, who belonged to a resistance organization before, during and after the Taliban regime. Decisions to join and stay in this community can be explained, in part, through the differentiation of positive, organizational-level PSOC from negative, macro-community-level PSOC. In addition, M-PSOC suggests unique cultural meanings of the terms “community” and “choice.” Findings have implications for cross-cultural community work and for fostering resilient sub-communities in the face of macro and societal-level risks and oppression.     

A General Factor of Personality in the Millon Clinical Multiaxial Inventory-III, the Dimensional Assessment of Personality Pathology, and the Personality Assessment Inventory

A General Factor of Personality (GFP) occupies the apex of the hierarchy in three prominent personality disorder inventories. On the Millon Clinical Multiaxial Inventory-III, a GFP accounted for 41% of the variance in two second-order factors, 31% of the variance in five first-order factors, and 26% of the variance in all 24 scales. On the Dimensional Assessment of Personality Pathology, a GFP accounted for 61% of the variance in six first-order factors and 36% of the variance in all 18 scales. In a cross-validation study of the Personality Assessment Inventory, a GFP accounted for 65% of the variance in two second-order factors, 47% of the variance in five first-order factors, and 27% of the variance in all 18 scales.     

Community vs. Clinic-Based Modular Treatment of Children with Early-Onset ODD or CD: A Clinical Trial with 3-Year Follow-Up

This study examines the treatment outcomes of 139, 6–11 year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) who were randomly assigned to a modular-based treatment protocol that was applied by research study clinicians either in the community (COMM) or a clinic office (CLINIC). To examine normative comparisons, a matched sample of 69 healthy control children was included. Multiple informants completed diagnostic interviews and self-reports at six assessment timepoints (pretreatment to 3-year follow-up) to evaluate changes in the child’s behavioral and emotional problems, psychopathic features, functional impairment, diagnostic status, and service involvement. Using HLM and logistic regression models, COMM and CLINIC showed significant and comparable improvements on all outcomes. By 3-year follow-up, 36% of COMM and 47% of CLINIC patients no longer met criteria for either ODD or CD, and 48% and 57% of the children in these two respective conditions had levels of parent-rated externalizing behavior problems in the normal range. We discuss the nature and implications of these novel findings regarding the role of treatment context or setting for the treatment and long-term outcome of behavior disorders. This study was supported by grants to the first author from the National Institute of Mental Health (MH 57727) and to the second author by the National Institute of Nursing Research (NR 07615). The fourth author was supported by grant K01 MH078039 from the National Institute of Mental Health. The authors acknowledge the research and clinical staff of the Resources to Enhance the Adjustment of Children (REACH) program, and Drs. David Brent, Tammy Chung, William Gardner, John Lochman, and Wayne Osgood. Reprints may be obtained from Dr. Kolko, WPIC, 3811 O’Hara St., Pittsburgh, PA 15213.     

Inhibitory response capacities of bilateral lower and upper extremities in children with developmental coordination disorder in endogenous and exogenous orienting modes

This study was designed to investigate separately the inhibitory response capacity and the lateralization effect in children with developmental coordination disorder (DCD) in the endogenous and exogenous modes of orienting attention. Children with DCD on the lower extremities (DCD-LEs), along with age-matched controls, completed four tasks that involved various applications of asynchronous stimuli to the feet or hands at various intervals. The results demonstrated that children with DCD-LEs had a significantly longer reaction time than the controls for all tasks, and were not alert to the appearance of the target. However, they displayed a deficit in volitional shifts of attention (endogenous mode), but not in automatic dislocation of attention (exogenous mode), whenever they performed the tasks with either their lower or their upper-limbs-even 6 months after the initial study. These findings confirm the deficit in the inhibitory response capacity in terms of volitional movement of attention by children with DCD. Additionally, the negative effect of lateralization on the bilateral extremities was not present in children with DCD-LEs. Significantly differences in response ability were detected only between the dominant and non-dominant sides of upper-limbs, but not between the lower-limbs, suggesting a future avenue for further experimentation on bilateral extremities.     

Mechanisms of deficit of visuospatial attention shift in children with developmental coordination disorder: A neurophysiological measure of the endogenous Posner paradigm

The purpose of this study was to investigate and compare the mechanisms of brain activity, as revealed by a combination of the visuospatial attention shifting paradigm and event-related potentials (ERP) in children with developmental coordination disorder (DCD) and typically developing children. Twenty-eight DCD children and 26 typically developing children were recorded with regard to their behavioral performance and ERP measures during a variant of the endogenous Posner paradigm, in which they should react to visual targets preceded by spatial cues or presented uncued. Children with DCD showed longer reaction time and a deficit in inhibitory response capacity when compared to typically developing children. The electrophysiological characteristics also showed distinct modulatory effects upon attentional orienting, anticipatory mechanisms, and cognitive-to-motor transfer in children with DCD: longer cue-P3 and target-N1 latency, smaller target-P3 amplitude, an elongated interval between N2 and the motor response (N2-RT), and small areas on contingent negative variation (CNV). The combined analysis of behavioral performance and ERP data suggested that children with DCD had deficits of slower target identification (N1), less ability in interhemispheric (P3) and cognitive-to-motor transfer speed (N2-RT), as well as a less mature anticipatory and executive process (CNV).     

Assessing ADHD-related Family Stressors with the Disruptive Behavior Stress Inventory (DBSI): A Replication and Extension

The Disruptive Behavior Stress Inventory (DBSI) was developed to provide information related to the occurrence and severity of stressors that result from having a child with ADHD. Data provided in the initial 2002 study by Johnson and Reader (Journal of Clinical Psychology in Medical Settings, 9, 51–62) provided good preliminary support for the reliability of the DBSI, as well the ability of the scale scores to differentiate primary caregivers of children with and without a history of ADHD. The present study was an attempt to replicate major findings of the 2002 study using an additional larger sample and extend it by conducting item-level analyses to determine the degree to which individual DBSI items differentiate primary caregivers of children with and without a history of ADHD. Results provided additional support for the reliability and validity of the DBSI by replicating major findings from the 2002 study and further suggesting that a large majority of the 40 items individually differentiate between primary caregivers of children with and without a history of ADHD.     

The effects of total sleep deprivation on recognition memory processes: A study of event-related potential

This study examined the memorization of information after a night of normal sleep and total sleep deprivation (TSD) by means of event-related potentials (ERPs). We expected a disfacilitatory effect of TSD on memory processing. Eighteen subjects were tested twice in a counterbalanced fashion. During the study session, subjects were presented with unfamiliar face stimuli and asked to memorize them for a subsequent memory test. At the test session, the subjects were presented with the studied faces intermixed with “new” faces and asked to indicate the previously presented stimuli. The N100 was used as a covariate to control for the differences in level of vigilance between the two sessions. Sleep deprivation decreased subjects’ ability to discriminate new from previously studied stimuli and decreased the peak amplitude of the early component (N200) to the decrement of performance. In addition, following TSD the amplitude of the late frontal component (LFC), which is thought to reflect contextual processing, was decreased in covariance with the N100 vigilance component. The amplitude of the late posterior component (LPC/P600) was also reduced but was unrelated to the vigilance component of the ERP. Based on prior studies, this LPC reduction can be interpreted to indicate a decrease in information retrieved after TSD. In summary, a night of TSD decreased the amplitude of the ERPs associated with complex episodic memory task stimuli, affected the frontal cortex during episodic retrieval, and prevented the elaboration process. Furthermore, there was an inability to discriminate what is and what is not in memory, possibly due to less local processing of details.