Attention-deficit/hyperactivity disorder (ADHD) is proposed to be a neuropsychologically heterogeneous disorder that encompasses two distinct sub-groups, one with executive function (EF) deficits and ...one with delay aversion (DA). However, such claims have often been based on studies that have operationalized neuropsychological deficits using a categorical approach - using intuitive but rather arbitrary, clinical cut-offs. The current study applied an alternative empirical approach to sub-grouping in ADHD, latent profile analysis (LPA), and attempted to validate emerging subgroups through clinically relevant correlates.
One-hundred medication-naïve children with ADHD and 96 typically developing children (6-14 years) completed nine EF and three DA tasks as well as an odor identification test. Parents and teachers provided reports of the children's behavior (ADHD and EF). Models of the latent structure of scores on EF and DA tests were contrasted using confirmatory factor analysis (CFA). LPA was carried out based on factor scores from the CFA and sub-groups were compared in terms of odor identification and behavior.
A model with one DA and two EF factors best fit the data. LPA resulted in four sub-groups that differed in terms of general level of neuropsychological performance (ranging from high to very low), odor identification, and behavior. The sub-groups did not differ in terms of the relative EF and DA performance. Results in the ADHD group were replicated in the control group.
While EF and DA appear to be dissociable constructs; they do not yield distinct sub-groups when sub-grouping is based on a statistical approach such as LPA.
To reconcile the strong secular persistence of attention-deficit/hyperactivity disorder (ADHD) despite its impairing effects, ADHD traits have been postulated to offer an evolutionary advantage. It ...has been proposed that such advantages should in particular be observable under time-critical, novel, and resource-depleted conditions requiring response-readiness and high levels of scanning and exploration/foraging. Our objective was to provide the first behavioral test of this hypothesis. Schoolchildren from the general population with no/few (
n
= 56), mild (
n
= 50), moderate (
n
= 48), and severe (
n
= 48) ADHD traits, defined according to their ADHD-Rating Scale IV (ADHD-RS-IV) total score, participated in an exploratory foraging and response-readiness laboratory test. Here, children searched for coins hidden in locations of varying obscurity in an unfamiliar room for 1 min. Test-performance (number of coins found) adjusted for age, sex, and estimated IQ was analyzed categorically using multiple linear regression analyses and dimensionally by fitting a regression model including the ADHD-RS-IV score as a continuous measure. There were no differences in the mean number of coins between the No/Few (Mean = 7.82), Mild (Mean = 7.76), Moderate (Mean = 7.58), and Severe (Mean = 7.88) groups
F
(3,195) = 0.24,
p
= 0.871. Furthermore, excluding children with functional impairment, adjusting for verbal working memory and response inhibition, and stratifying for sex did not change these findings. Finally, continuous ADHD traits were not found to be related to test-performance
F
(3,195) = 0.73,
p
= 0.536. While our results do generally not support the evolutionary advantage theory (i.e., ADHD traits neither conferred an advantage nor a disadvantage), this does not disprove that ADHD traits may have offered advantages via other mechanisms.
Children with ADHD are reported to have sleep problems and neuropsychological deficits, but studies examining a potential association between the two are scarce and the use of varying methodology can ...complicate conclusions.
A clinical sample of 59 medication-naïve children with ADHD between the ages of 6 and 14 years (71% male).
Children underwent polysomnography and multiple sleep latency test, and parent rated sleep habits on the Children's Sleep Habits Questionnaire. Children also completed an extensive neuropsychological battery of executive function and delay aversion tasks, and parents and teachers rated executive function behavior on the Behavior Rating Inventory of Executive Function. Linear regression analyses were conducted with each of the neuropsychological outcomes included as the outcome variable and the sleep parameters as the predictor variables.
The correlations between sleep and neuropsychological outcomes were generally modest, but some sleep parameters (primarily sleep stages and sleep latencies) were associated with objectively and subjectively measured executive function and delay aversion.
Using objective and subjective gold standard assessment procedures this study supports a (modest) association between sleep and neuropsychological function in children with ADHD.
Functional impairment rating scales are few in numbers and have mainly been examined in clinical populations. The Weiss Functional Impairment Rating Scale—Parent report (WFIRS-P) is a case in point. ...We tested the psychometric properties of the WFIRS-P in the largest general population study to date and for the first time examined the factor structure of the scale in a general population setting. Participants were 2,027 schoolchildren aged 6 to 11. Parents/caregivers completed the WFIRS-P and criterion measures of quality of life, attention-deficit/hyperactivity disorder, and behavioral/emotional symptoms. Confirmatory factor analysis and convergent/divergent validity analyses supported a six-factor structure: family, life skills, self-concept, social activities, and the separation of the school domain into two smaller domains covering school learning and school behavior. Children with and without a history of referral differed significantly on all six domains supporting the external validity. In conclusion, the WFIRS-P was found to generate valid scores in a general population sample.
A 44-year-old man with Trisomy 21 and Eisenmenger's syndrome underwent surgery due to a life-threatening scrotal hernia, containing the bladder, bilateral hydroceles and part of the sigmoid colon. ...Joint venture plastic and urologic surgery was performed with reposition of the bladder and sigmoid colon into the abdominal cavity, bilateral inguinal hernial mesh repair, left sided orchiectomy, excision of bilateral hydroceles and excision of a major part of the scrotum and recreation of the original anatomy of the penis and scrotum. This Case presents a successful outcome achieved as the patient after one-step-surgery was left to normal condition.
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.
The Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) assesses ADHD symptoms in children and adolescents. The original United States norms comprise percentiles. Yet, no Nordic ...percentile norms exist, and only T-scores, which (often falsely) assume normally distributed data, are currently available. Here, we for the first time provide Danish percentile norms for children aged 6-9 based on parent/caregiver-reports, and illustrate the potential consequences of T-scores when derived based on the expected skewed distribution of an ADHD scale in the population.OBJECTIVEThe Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) assesses ADHD symptoms in children and adolescents. The original United States norms comprise percentiles. Yet, no Nordic percentile norms exist, and only T-scores, which (often falsely) assume normally distributed data, are currently available. Here, we for the first time provide Danish percentile norms for children aged 6-9 based on parent/caregiver-reports, and illustrate the potential consequences of T-scores when derived based on the expected skewed distribution of an ADHD scale in the population.The sample comprised 1895 Danish schoolchildren (879 girls and 1016 boys) in 1st, 2nd, or 3rd grade from the general population. Their parents/caregivers completed the ADHD-RS-IV. Sex and age differences were investigated, percentiles were derived based on the observed score distributions, and for comparison, T-scores > 70 were estimated, which are expected to identify the top 2.3% under the assumption of normality.MATERIALS AND METHODSThe sample comprised 1895 Danish schoolchildren (879 girls and 1016 boys) in 1st, 2nd, or 3rd grade from the general population. Their parents/caregivers completed the ADHD-RS-IV. Sex and age differences were investigated, percentiles were derived based on the observed score distributions, and for comparison, T-scores > 70 were estimated, which are expected to identify the top 2.3% under the assumption of normality.Boys were rated to have higher ADHD-RS-IV scores than girls except on the impulsivity score. No age effects were found on the majority of scores. Sex-stratified and unisex percentiles (80, 90, 93, 98) were reported. The distribution of ADHD-RS-IV scores were highly skewed. T-score cutoffs identified a significantly higher proportion of and about twice as many children as having elevated ADHD symptoms than expected (4.3-5.2% vs. 2.3%).RESULTSBoys were rated to have higher ADHD-RS-IV scores than girls except on the impulsivity score. No age effects were found on the majority of scores. Sex-stratified and unisex percentiles (80, 90, 93, 98) were reported. The distribution of ADHD-RS-IV scores were highly skewed. T-score cutoffs identified a significantly higher proportion of and about twice as many children as having elevated ADHD symptoms than expected (4.3-5.2% vs. 2.3%).ADHD-RS-IV (parent/caregiver-report) percentile norms for young Danish schoolchildren are now available for future reference. The use of percentiles is considered appropriate given the skewed score distribution and since T-scores appear to over-identify children as having clinically elevated ADHD symptoms.CONCLUSIONSADHD-RS-IV (parent/caregiver-report) percentile norms for young Danish schoolchildren are now available for future reference. The use of percentiles is considered appropriate given the skewed score distribution and since T-scores appear to over-identify children as having clinically elevated ADHD symptoms.
Objective: Little systematic information is available regarding how sleep problems influence daytime functioning in children with ADHD, as the role of ADHD presentations and comorbidity is unclear. ...Method: In total, 397 children were assessed with the Children’s Sleep Habits Questionnaire, the Weiss Functional Impairment Rating Scale, and the ADHD Rating Scale. Results: We found a moderate, positive correlation between sleep problems and impaired functioning in both children with ADHD and in typically developed children. ADHD presentations did not differ significantly with respect to sleep problem profile, but having a comorbid internalizing or autistic disorder lead to higher sleep problem score. Conclusion: Sleep problems and impaired daily functioning were more common in children with ADHD, but the overall association between sleep problems and impaired daily functioning was similar in clinical and nonclinical children. Internalizing or autistic comorbid disorders added significantly to the sleep problems.
Objective:
The question of whether attention-deficit/hyperactivity disorder (ADHD) is a discrete category or a continuous dimension remains clinically relevant. We report the first examination of ...this question from the viewpoint of the relationship between ADHD traits and psychosocial quality of life (QoL), and whether the level of QoL declines markedly around a certain high ADHD trait range suggestive of a categorical boundary.
Methods:
Parents/caregivers of 1,967 schoolchildren aged 6 to 11 from the general population completed the Pediatric Quality of Life Inventory and the ADHD-Rating Scale IV. Piecewise linear and non-linear regression analyses were performed.
Results:
No evidence for a non-linear association or an abrupt change in the rate of decrease in QoL was observed in the high end of the ADHD traits continuum. Instead, the relationship was consistent with linearity.
Conclusion:
Psychosocial QoL gradually declines in a linear manner as ADHD trait levels increase providing further support for a dimensional model.
Most studies support a bifactor model of childhood ADHD with two specific factors. However, several studies have not compared this model with a bifactor model with three specific factors, few have ...tested the actual strength of the factors, and none have examined whether “talks excessively” should be treated as a hyperactivity versus impulsivity symptom in children with ADHD.
To examine the factor structure of ADHD symptoms and evaluate the relative strength of potential factors.
Parent-reports on the ADHD-Rating Scale (ADHD-RS-IV) were collected for 2044 schoolchildren from the general population and 147 children with ADHD from a clinical sample. Single-, two- and three-(correlated and bi-)factor models were tested using confirmatory factor analysis.
Most models had a satisfactory fit. However, a correlated three-factor model where “talks excessively” was included as an indicator of impulsivity, and especially a bifactor model with one strong, well-defined general and two/three (ICD-10 defined) weak specific factors fit the data slightly better than the remaining models.
The factor structure is best characterized by a bifactor model with a strong general factor and two/three weaker specific factors. Therefore, we suggest emphasizing the ADHD-RS-IV total score rather than the subscale scores in clinical practice.
•A bifactor model of ADHD with one general and two/three specific factors is supported.•“Talks excessively” is part of the impulsivity and not the hyperactivity construct.•The specific inattention, hyperactivity, and impulsivity factors are relatively weak.•Most variance in ADHD-RS-IV items is captured by a strong, well-defined general factor.•Using the total ADHD-RS-IV score instead of relying on the subscales is recommended.
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