The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder

This study examined the persistence of attention-deficit/hyperactivity disorder (ADHD) into young adulthood using hyperactive (N = 147) and community control (N = 71) children evaluated at ages 19-25 years. ADHD was rare in both groups (5% vs. 0%) based on self-report but was substantially higher using parent reports (46% vs. 1.4%). Using a developmentally referenced criterion (+2 SD), prevalence remained low for self-reports (12% vs. 10%) but rose further for parent reports (66% vs. 8%). Parent reports were more strongly associated with major life activities than were self-reports. Recollections of childhood ADHD showed moderate correlations with actual parent ratings collected in childd hood, which suggests some validity for such recollections. The authors conclude that previous follow-up studies that relied on self-reports might have substantially underestimated the persistence of ADHD into adulthood.     

Sluggish Cognitive Tempo (Concentration Deficit Disorder?): Current Status, Future Directions, and a Plea to Change the Name

Symptoms of sluggish cognitive tempo (SCT) have been recognized for nearly 30 years as comprising a semi-independent set(s) of symptoms from the inattentive (IN) and hyperactive-impulsive (HI) symptoms involved in attention-deficit/hyperactivity disorder (ADHD). It has only been within the past decade that research focusing specifically on SCT symptoms and on samples of SCT cases chosen independently from ADHD samples has increased so as to address the question of whether SCT is a distinct condition from ADHD or other disorders. All but two of these studies have focused on children but the two extant large scale studies on adults have replicated those findings. This Commentary highlights not only those findings concerning SCT that appear to be relatively robust, but also those patterns that appear to be emerging yet in need of further research to corroborate their association with SCT, as well as those barely or unexplored areas that may deserve more research. Evidence to date, including the many findings in this special issue, is nearing a critical mass that likely supports the conclusion that SCT is a distinct disorder of attention from ADHD, yet one that may overlap with it in about half of all cases. SCT has unique symptom dimensions and comorbidities from ADHD, probably distinct though lesser domains of impairment and demographic correlates, and perhaps unique cognitive deficits, causes and life course risks. These latter areas, however, are in need of substantially more research as is SCT in adults and treatments specifically designed for cases of SCT. Meanwhile, the name of the condition is premature, implying a known cognitive deficit that is as yet unknown, and is proving derogatory and offensive to patients, leading this author to recommend a change to Concentration Deficit Disorder.     

A comparison of objective measures of activity and distractibility in hyperactive and nonhyperactive children

In a 15-minute free-play and a 5-minute test session, 13 measures of activity, distractibility, and parental ratings of activity were obtained on three groups of children, consisting of 16 boys referred to a psychological services center for evaluation of possible hyperactivity, 16 referred to that same center for problems other than hyperactivity, and 20 obtained from the local community. Subjects were boys with average intelligence between the ages of 4 and 12 years. Results indicated that the multiple measures of activity and distractibility had significant but relatively low order correlations among themselves. These relationships varied as a function of the subject group. However, there was no sonsistent relationship between the measures of activity and distractibility. The pattern of relationships obtained suggested that both activity level and distractibility are not homogeneous, unidimensional constructs. Results also indicated that boys referred for hyperactivity displayed greater wrist activity in free play, tended to display greater ankle activity in free play, had significantly correlated wrist and ankle activity, and were rated by their parents as more active than other children. This pattern suggested a global restlessness in children referred for hyperactivity that distinguishes them from other children.     

Correspondence and disparity in the self- and other ratings of current and childhood ADHD symptoms and impairment in adults with ADHD

Experts recommend that clinicians evaluating adults for attention-deficit/hyperactivity disorder (ADHD) obtain information from others who know the patient well. The authors examined correspondence between the self- and other-ratings of ADHD symptoms and impairment using 3 groups of adults recruited on the basis of their severity of ADHD: ADHD diagnosis (n = 146), clinical controls self-referring for ADHD but not diagnosed (n = 97), and community controls (n = 109). The influences of diagnostic group, informant relationship, sex of participant, IQ, and comorbid anxiety and depression on self-informant disparities were also examined. Results indicated moderate to high agreement (.59-.80) between self and others on current functioning and slightly lower levels (.53-.75) between self- and parent ratings of childhood functioning. Examination of difference scores between self- and other ratings revealed small mean disparities (-0.1 to +5.0 points) but substantial variation (SDs = -2.4 to 8.9 points) for both current and childhood ratings. Clinic referrals not diagnosed with ADHD, particularly women, had higher disparities than was evident in the ADHD and community groups. Age, IQ, and education were not associated with disparities in most ratings. Higher anxiety, in contrast, was associated with greater disparities on all current and childhood measures of both ADHD and impairment.     

Accuracy of self-evaluation in adults with ADHD: evidence from a driving study

Research on children with ADHD indicates an association with inaccuracy of self-appraisal. This study examines the accuracy of self-evaluations in clinic-referred adults diagnosed with ADHD. Self-assessments and performance measures of driving in naturalistic settings and on a virtual-reality driving simulator are used to assess accuracy of self-evaluations. The group diagnosed with ADHD (n= 44) has a higher rate of collisions, speeding tickets, and total driving citations in their driving history; report less use of safe driving behaviors in naturalistic settings; and use fewer safe driving behaviors in the simulator than the community comparison group (n= 44). Despite poorer performance, adults with ADHD provide similar driving self-assessments, thereby overestimating in naturalistic settings to a greater degree than the comparison group. These findings extend research in children with ADHD to an adult sample in an important domain of functioning and may relate to findings of executive deficits associated with ADHD.     

A review of psychophysiological research with hyperkinetic children

A number of studies have appeared which focus on the issue of whether hyperactive children are psychophysiologically different from normal children and what impact the stimulant drugs may have on psychophysiological characteristics of these children. The present paper reviews these studies under the type of measures that were employed. In general, the results suggest that hyperactive children are probably not under- or overaroused in their resting levels of autonomic functions, although some children may display resting cortical underarousal. However, the findings of studies on the impact of stimulation on autonomic or central functions intimate that some hyperactive children are probably underreactive to environmental stimulation, or are "underarousable." Indeed, where differences between hyperactive and normal children are found in such evoked-response studies, they are consistently in this direction of "underarousability." Results for the effects of stimulant drugs suggest that these drugs energize or increase the "arousal" of these children and enhance the impact of stimulation on the nervous system. The implications of these results for current theories of hyperactivity and for future research are discussed.