Background
Children with Attention‐Deficit Hyperactivity Disorder (ADHD) appear to have a higher risk of language problems compared with typically developing children, although the types of language ...problems experienced are less clear. This review aims to establish the types of language problems experienced by children with ADHD according to systematically reviewed literature and determine the empirical evidence for language problems in children with ADHD compared with non‐ADHD controls.
Methods
A standardized search protocol was used on databases: CINAHL, Medline, and PsychINFO. We identified studies with the following inclusion criteria: (a) confirmed ADHD status at the time of the study, (b) inclusion of a non‐ADHD control group, (c) use of a validated language measure, and (d) age ≤ 18. t‐Tests, Pearson's r, and Hedges g effect sizes (ES) were calculated using summary statistics. Random effects meta‐analyses were conducted for the language domain suitable for analysis. Publication bias was investigated using both the trim and fill and p‐curve techniques.
Results
Twenty‐one studies were included in the systematic review (ADHD = 1,209; Control = 1,101), within which 60 of 68 separate analyses found significant differences between the ADHD and control group on the language measures (p < .05). Follow‐up meta‐analyses found evidence for large deficits in the ADHD groups overall (10/11 studies met p < .05; weighted mean ES WMES: 1.04); expressive (10/10 met p < .05; WMES: 1.23); receptive (12/14 met p < .05; WMES: 0.97), and pragmatic language (4/4 studies met p < .05; WMES: 0.98) compared with controls.
Conclusions
This study demonstrates that children with ADHD have poorer performance on measures of overall, expressive, receptive, and pragmatic language compared with controls. A screening of language functioning may be a valuable addition to the assessment of ADHD.
Background
Epidemiologic evidence indicates a relevant association between atopic dermatitis (AD) and attention‐deficit/hyperactivity disorder (ADHD). Underlying mechanisms and ways to best identify ...subgroups of AD patients at risk for ADHD are poorly understood.
Aims of the study
To compare sociodemographic, clinical and psychosocial characteristics of children with AD, ADHD, comorbid AD/ADHD and age‐matched healthy controls and to investigate aspects of AD related to ADHD symptoms.
Methods
Applying a factorial design, we investigated 4 groups of children aged 6‐12 years: AD‐only (ie, without ADHD), ADHD‐only (ie, without AD), AD + ADHD and healthy controls (HC; ie, no AD/no ADHD). Using validated instruments, ADHD symptoms and other behavioural problems, quality of life, parenting stress and sleeping problems were compared between groups. In children with AD‐only, clinical signs (objective SCORAD), symptoms (POEM, VAS pruritus, VAS sleeping problems) and previous treatment of AD were assessed to investigate disease patterns related to ADHD symptoms.
Results
Compared to HC (n = 47), children with AD‐only (n = 42), ADHD‐only (n = 34) and comorbid AD + ADHD (n = 31) had significantly increased behavioural problems and decreased quality of life. Children with AD‐only had significantly higher levels of ADHD symptoms than HC. In children with AD‐only, previous use of antihistamines was significantly associated with increased ADHD symptoms (OR 1.88; 95% CI 1.04‐3.39). Current clinical signs and AD symptoms were unrelated to the level of ADHD symptoms.
Conclusions
Even if the clinical diagnosis of ADHD is excluded, children with AD show increased levels of ADHD symptoms. Further investigations need to determine whether early antihistamine exposure is a major risk factor for ADHD or a surrogate for previous AD severity and/or associated sleeping problems.
Accumulating evidence suggests a higher risk for cardiovascular diseases among individuals with mental disorders, but very little is known about the risk for overall and specific groups of ...cardiovascular diseases in people with attention‐deficit/hyperactivity disorder (ADHD). To fill this knowledge gap, we investigated the prospective associations between ADHD and a wide range of cardiovascular diseases in adults. In a nationwide population‐based cohort study, we identified 5,389,519 adults born between 1941 and 1983, without pre‐existing cardiovascular diseases, from Swedish registers. The study period was from January 1, 2001 to December 31, 2013. Incident cardiovascular disease events were identified according to ICD codes. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox proportional hazards regression model, with ADHD as a time‐varying exposure. After an average 11.80 years of follow‐up, 38.05% of individuals with ADHD versus 23.57% of those without ADHD had at least one diagnosis of cardiovascular disease (p<0.0001). ADHD was significantly associated with increased risk of any cardiovascular disease (HR=2.05, 95% CI: 1.98‐2.13) after adjusting for sex and year of birth. Further adjustments for education level, birth country, type 2 diabetes mellitus, obesity, dyslipidemia, sleep problems and heavy smoking attenuated the association, which however remained significant (HR=1.84, 95% CI: 1.77‐1.91). Further adjustment for psychiatric comorbidities attenuated but could not fully explain the association (HR=1.65, 95% CI: 1.59‐1.71). The strongest associations were found for cardiac arrest (HR=2.28, 95% CI: 1.81‐2.87), hemorrhagic stroke (HR=2.16, 95% CI: 1.68‐2.77), and peripheral vascular disease/arteriosclerosis (HR=2.05, 95% CI: 1.76‐2.38). Stronger associations were observed in males and younger adults, while comparable associations were found among individuals with or without psychotropic medications and family history of cardiovascular diseases. These data suggest that ADHD is an independent risk factor for a wide range of cardiovascular diseases. They highlight the importance of carefully monitoring cardiovascular health and developing age‐appropriate and individualized strategies to reduce the cardiovascular risk in individuals with ADHD.
Background
A diagnosis of attention‐deficit/hyperactivity disorder (ADHD) requires the presence of impairment alongside symptoms above a specific frequency and severity threshold. However, the ...question of whether that symptom threshold represents anything more than an arbitrary cutoff on a continuum of impairment requires further empirical study. Therefore, we present the first study investigating if the relationship between ADHD symptom severity and functional impairment is nonlinear in a way that suggests a discrete, nonarbitrary symptom level threshold associated with a marked step increase in impairment.
Methods
Parent reports on the ADHD‐Rating Scale (ADHD‐RS‐IV), the Weiss Functional Impairment Rating Scale (WFIRS‐P), and the Strengths and Difficulties Questionnaire were collected in a general population sample of 1st, 2nd, and 3rd graders (N = 1,914–2,044).
Results
Piecewise linear regression analyses and nonlinear regression modeling both demonstrated that the relationship between symptom severity (ADHD‐RS‐IV total score) and impairment (WFIRS‐P mean score) was characterized by a gradual linear increase in impairment with higher symptom severity and no apparent step increase or changing rate of increase in impairment at a certain high ADHD‐RS‐IV total score level. Controlling for socioeconomic status, sex, and co‐occurring conduct and emotional symptoms did not alter these results, though comorbid symptoms had a significant effect on impairment.
Conclusions
There was no clear evidence for a discrete, nonarbitrary symptom severity threshold with regard to impairment. The results highlight the continued need to consider both symptoms and impairment in the diagnosis of ADHD.
Objective
Understanding the unmet needs of healthcare consumers with attention‐deficit/hyperactivity disorder (ADHD) (individuals with ADHD and their caregivers) provides critical insight into gaps ...in services, education and research that require focus and funding to improve outcomes. This review examines the unmet needs of ADHD consumers from a consumer perspective.
Methods
A standardised search protocol identified peer‐reviewed studies published between December 2011 and December 2021 focusing on consumer‐identified needs relating to ADHD clinical care or research priorities.
Results
1,624 articles were screened with 23 studies that reviewed examining the needs of ADHD consumers from Europe, the U.K., Hong Kong, Iran, Australia, the U.S.A. and Canada. Consumer‐identified needs related to: treatment that goes beyond medication (12 studies); improved ADHD‐related education/training (17 studies); improved access to clinical services, carer support and financial assistance (14 studies); school accommodations/support (6 studies); and ongoing treatment efficacy research (1 study).
Conclusion
ADHD consumers have substantial unmet needs in clinical, psychosocial and research contexts. Recommendations to address these needs include: improving access to and quality of multimodal care provision; incorporating recovery principles into care provision; fostering ADHD health literacy; and increasing consumer participation in research, service development and ADHD‐related training/education.
Aims
1) To investigate whether genetic liability to attention‐deficit/hyperactivity disorder (ADHD), indexed by polygenic risk scores for ADHD (PRS‐ADHD), is associated with substance use disorders ...(SUD) in individuals with ADHD. 2) To investigate whether other individual‐ or family‐related risk factors for SUD could mediate or confound this association.
Design
Population‐based cohort study
Setting and participants
ADHD cases in the iPSYCH sample (a Danish case‐cohort sample of genotyped cases with specific mental disorders), born in Denmark between 1981 and 2003 (N = 13 116). Register‐based information on hospital diagnoses of SUD was available until December 31, 2016.
Measurements
We estimated odds ratios (ORs) with 95% confidence intervals (CIs) for any SUD as well as for different SUD types (alcohol, cannabis, and other illicit drugs) and severities (use, abuse, and addiction), with effect sizes corresponding to a comparison of the highest PRS‐ADHD decile to the lowest.
Findings
PRS‐ADHD were associated with any SUD (OR = 1.30, 95% CI: 1.11–1.51). Estimates were similar across different types and severity levels of SUD. Other risk factors for SUD (male sex, age at ADHD diagnosis, comorbid conduct problems, and parental factors including SUD, mental disorders, and socio‐economic status) were independently associated with increased risk of SUD. PRS‐ADHD explained a minor proportion of the variance in SUD (0.2% on the liability scale) compared to the other risk factors. The association between PRS‐ADHD and any SUD was slightly attenuated (OR = 1.21, 95% CI: 1.03–1.41) after adjusting for the other risk factors for SUD. Furthermore, associations were nominally higher in females than in males (ORfemales = 1.59, 95% CI: 1.19–2.12, ORmales = 1.18, 95% CI: 0.98–1.42).
Conclusions
A higher genetic liability to attention‐deficit/hyperactivity disorder appears to be associated with higher risks of substance use disorders in individuals with attention‐deficit/hyperactivity disorder.
Background
To assess whether age of onset and duration of stimulant therapy for attention‐deficit/hyperactivity disorder (ADHD) are associated with cocaine, methamphetamine, and prescription ...stimulant misuse during adolescence.
Methods
Nationally representative samples of US 10th and 12th grade students (N = 150,395) from the Monitoring the Future study were surveyed via self‐administered questionnaires from 16 annual surveys (2005–2020).
Results
An estimated 8.2% of youth received stimulant therapy for ADHD during their lifetime (n = 10,937). More than one in 10 of all youth reported past‐year prescription stimulant misuse (10.4%)—past‐year cocaine (4.4%) and methamphetamine (2.0%) use were less prevalent. Youth who initiated early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years) did not have significantly increased adjusted odds of cocaine or methamphetamine use relative to population controls (ie, non‐ADHD and unmedicated ADHD youth). Youth who initiated late stimulant therapy for ADHD (≥10 years old) and for short duration (<1 year) had significantly higher odds of past‐year cocaine or prescription stimulant misuse in adolescence than those initiating early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years). Youth who initiated late stimulant therapy for ADHD (≥10 years) for short duration (<1 year) had significantly higher odds of past‐year cocaine, methamphetamine, and prescription stimulant misuse versus population controls during adolescence. No differences in past‐year cocaine, methamphetamine, and prescription stimulant misuse were found between individuals who only used non‐stimulant therapy for ADHD relative to youth who initiated early stimulant therapy (≤9 years old) and for long duration (≥6 years).
Conclusions
An inverse relationship was found between years of stimulant therapy and illicit and prescription stimulant misuse. Adolescents with later initiation and/or shorter duration of stimulant treatment for ADHD should be monitored for potential illicit and prescription stimulant misuse.
Prominent theoretical accounts of attention-deficit/hyperactivity-disorder (ADHD) hypothesize that reinforcement learning deficits underlie symptoms of ADHD. The Dynamic Developmental Theory and the ...Dopamine Transfer Deficit hypothesis assume impairments in both the acquisition and extinction of behavior, especially when learning occurs under partial (non-continuous) reinforcement, and subsequently the Partial Reinforcement Extinction Effect (PREE). Few studies have evaluated instrumental learning in ADHD and the results are inconsistent. The current study investigates instrumental learning under partial and continuous reinforcement schedules and subsequent behavioral persistence when reinforcement is withheld (extinction) in children with and without ADHD.
Large well-defined samples of children with ADHD (n = 93) and typically developing (TD) children (n = 73) completed a simple instrumental learning task. The children completed acquisition under continuous (100%) or partial (20%) reinforcement, followed by a 4-min extinction phase. Two-way (diagnosis by condition) ANOVAs evaluated responses needed to reach the learning criterion during acquisition, and target and total responses during extinction.
Children with ADHD required more trials to reach criterion compared to TD children under both continuous and partial reinforcement. After partial reinforcement, children with ADHD executed fewer target responses during extinction than TD children. Children with ADHD executed more responses than TD children during extinction, irrespective of learning condition.
The findings demonstrate general difficulties in instrumental learning in ADHD, that is, slower learning irrespective of reinforcement schedule. They also show faster extinction following learning under partial reinforcement in those with ADHD, that is, a diminished PREE. Children with ADHD executed more responses during extinction. Results are theoretically important, with clinical implications for understanding and managing learning difficulties in those with ADHD, as they suggest poorer reinforcement learning and lower behavioral persistence.
In their recent examination of the Monitoring the Future (MTF) data, McCabe et al. (Journal of Child Psychology and Psychiatry, 2023) address the complex, longstanding, and clinically valuable ...questions of whether and how stimulant medication treatment for adolescents with ADHD relates to their risk for substance use. Here, we expand on the authors' interpretations of their nuanced findings of increased risk for illicit stimulant use and non‐prescribed stimulant medication use for youth with later age of medication treatment initiation and shorter treatment duration. We particularly focus on highlighting tangible clinical implications, and we recommend ways future research can build on the authors' findings to further clarify this important issue.
Background
Although multiple cross‐sectional studies have shown symptoms of sluggish cognitive tempo (SCT) and attention‐deficit/hyperactivity disorder (ADHD) to be statistically distinct, studies ...have yet to examine the temporal stability and measurement invariance of SCT in a longitudinal sample. To date, only six studies have assessed SCT longitudinally, with the longest study examining SCT over a 2‐year period. The overall goals of this study were to assess the 10‐year longitudinal stability and interfactor relationships of ADHD and SCT symptoms among a community sample of children.
Methods
Confirmatory factor analysis was used to assess the temporal invariance of ADHD and SCT symptoms in a large population‐based longitudinal sample (International Longitudinal Twin Study of Early Reading Development) that included children assessed at preschool and after kindergarten, first, second, fourth, and ninth grades (n = 489). Latent autoregressive models were then estimated to assess the stability of these constructs.
Results
Results demonstrated invariance of item loadings and intercepts from preschool through ninth grades, as well as invariance of interfactor correlations. Results further indicated that both ADHD and SCT are highly stable across these years of development, that these symptom dimensions are related but also separable, and that hyperactivity/impulsivity and SCT are both more strongly correlated with inattention than with each other and show differential developmental trajectories. Specifically, even in the presence of latent simplex analyses providing support for the developmental stability of these dimensions, linear comparisons indicated that that mean levels of hyperactivity/impulsivity decreased with time, inattentive ratings were generally stable, and SCT tended to increase slightly across development.
Conclusions
This study adds to the current literature by being the first to systematically assess and demonstrate the temporal invariance and stability of ADHD and SCT across a span of 10 years.
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