Maternal Functioning Differences Based on ADHD Subtype

Objective: Maternal functioning differences in parenting stress, parental efficacy, and parenting behaviors were examined for mothers of children with ADHD. Method: Participants included 29 mothers of children with ADHD, Predominantly Inattentive Type (ADHD-I) and 38 mothers of children with ADHD, Predominantly Hyperactive-Impulsive or Combined Type (ADHD-HI/C). Results: Findings suggest that mothers of children with ADHD-HI/C reported significantly greater parenting stress and engaged in more negative parenting behaviors than mothers of children with ADHD-I. Conclusion: This study suggests that tailoring behavioral parent training based on ADHD subtype may be particularly helpful for parents of children with ADHD-HI/C

High loading of polygenic risk for ADHD in children with comorbid aggression

Objective: Although attention deficit hyperactivity disorder (ADHD) is highly heritable, genome-wide association studies (GWAS) have not yet identified any common genetic variants that contribute to risk. There is evidence that aggression or conduct disorder in children with ADHD indexes higher genetic loading and clinical severity. The authors examine whether common genetic variants considered en masse as polygenic scores for ADHD are especially enriched in children with comorbid conduct disorder. Method: Polygenic scores derived from an ADHD GWAS meta-analysis were calculated in an independent ADHD sample (452 case subjects, 5,081 comparison subjects). Multivariate logistic regression analyses were employed to compare polygenic scores in the ADHD and comparison groups and test for higher scores in ADHD case subjects with comorbid conduct disorder relative to comparison subjects and relative to those without comorbid conduct disorder. Association with symptom scores was tested using linear regression. Results: Polygenic risk for ADD, derived from the meta-analysis, was higher in the independent ADHD group than in the comparison group. Polygenic score was significantly higher in ADHD case subjects with conduct disorder relative to ADHD case subjects without conduct disorder. ADHD polygenic score showed significant association with comorbid conduct disorder symptoms. This relationship was explained by,the aggression items. Conclusions: Common genetic variation is relevant to ADHD, especially in individuals with comorbid aggression. The findings suggest that the previously published ADHD GWAS meta-analysis contains weak but true associations with common variants, support for which falls below genome-wide significance levels. The findings also highlight the fact that aggression in ADHD indexes genetic as well as clinical severity

College Student Perceptions of ADHD: Links Between Prior Knowledge and Stigma

Attention deficit hyperactivity disorder (ADHD) is characterized by persistent inattention, which might or might not accompany hyperactivity and impulsivity, that noticeably interferes with functioning and development in at least two settings. It is a commonly diagnosed childhood mental health disorder. Public knowledge and attitudes towards ADHD are an important consideration for those who are going to potentially be working with that population. Research has shown older children and parents may attribute ADHD behavior to poor social skills or immaturity. Teachers often report feeling unprepared to have a student with ADHD and would like more training. Some research has shown the perpetuation of common misconceptions of ADHD by parents and teachers. This research sought to determine if there was a correlation between knowledge of ADHD and stigma towards individuals with ADHD and to determine if students majoring in psychology differed from their peers on knowledge about ADHD or attitudes towards individuals with ADHD. After surveying 131 students from a faith-based, private university in Virginia, it was found that those majoring in psychology did not have significant differences in knowledge of ADHD or stigma towards people with ADHD when compared to students in other majors. Both knowledge and stigma scores were high across groups and no significant correlation between knowledge and attitudes was found. Findings have implications for university students diagnosed with ADHD and administrators working to reduce the stigma of ADHD on campus

Attention-deficit/hyperactivity disorder medication and seizures

OBJECTIVE: Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of seizures, but there is uncertainty about whether ADHD medication treatment increases risk among patients with and without preexisting seizures. METHODS: We followed a sample of 801,838 patients with ADHD who had prescribed drug claims from the Truven Health MarketScan Commercial Claims and Encounters databases to examine whether ADHD medication increases the likelihood of seizures among ADHD patients with and without a history of seizures. First, we assessed overall risk of seizures among patients with ADHD. Second, within-individual concurrent analyses assessed odds of seizure events during months when a patient with ADHD received ADHD medication compared with when the same individual did not, while adjusting for antiepileptic medications. Third, within-individual long-term analyses examined odds of seizure events in relation to the duration of months over the previous 2 years patients received medication. RESULTS: Patients with ADHD were at higher odds for any seizure compared with non-ADHD controls (odds ratio [OR] = 2.33, 95% confidence interval [CI] = 2.24-2.42 males; OR = 2.31, 95% CI = 2.22-2.42 females). In adjusted within-individual comparisons, ADHD medication was associated with lower odds of seizures among patients with (OR = 0.71, 95% CI = 0.60-0.85) and without (OR = 0.71, 95% CI = 0.62-0.82) prior seizures. Long-term within-individual comparisons suggested no evidence of an association between medication use and seizures among individuals with (OR = 0.87, 95% CI = 0.59-1.30) and without (OR = 1.01, 95% CI = 0.80-1.28) a seizure history. CONCLUSIONS: Results reaffirm that patients with ADHD are at higher risk of seizures. However, ADHD medication was associated with lower risk of seizures within individuals while they were dispensed medication, which is not consistent with the hypothesis that ADHD medication increases risk of seizures

ADHD : from childhood into adulthood

This is an overview of the some of the most recent and seminal research done on Attention Deficit Hyperactivity Disorders (ADHD). ADHD is currently one of the most common reasons for referral to child mental health services and still is under-recognised both in children (5.29%) and adults (2.5%). ADHD is a highly heritable disorder with a mulitifactorial pattern of inheritance. Parents, siblings and parents of a child with ADHD are 4-5 times more likely to have ADHD. Environmental factors also play a role in elucidating this disorder. Untreated ADHD leads to numerous co-morbidities, and longer term morbidity. Methylphenidate is suggested as the first line pharmacological treatment. ADHD is easy to treat, 80% of correctly diagnosed patients (children or adults) respond favourably to methylphenidate. All child and general adult psychiatrists should be aware of this disorder, comfortable with making the diagnosis and treating adults with ADHD. The purpose of the overview is to cover the epidemiology, aetiology, diagnostic criteria and different managements of ADHD.peer-reviewe

What do general practitioners know about ADHD? Attitudes and knowledge among first-contact gatekeepers: systematic narrative review

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood disorder with international prevalence estimates of 5 % in childhood, yet significant evidence exists that far fewer children receive ADHD services. In many countries, ADHD is assessed and diagnosed in specialist mental health or neuro-developmental paediatric clinics, to which referral by General (Family) Practitioners (GPs) is required. In such ‘gatekeeper’ settings, where GPs act as a filter to diagnosis and treatment, GPs may either not recognise potential ADHD cases, or may be reluctant to refer. This study systematically reviews the literature regarding GPs’ views of ADHD in such settings. Methods: A search of nine major databases was conducted, with wide search parameters; 3776 records were initially retrieved. Studies were included if they were from settings where GPs are typically gatekeepers to ADHD services; if they addressed GPs’ ADHD attitudes and knowledge; if methods were clearly described; and if results for GPs were reported separately from those of other health professionals. Results: Few studies specifically addressed GP attitudes to ADHD. Only 11 papers (10 studies), spanning 2000–2010, met inclusion criteria, predominantly from the UK, Europe and Australia. As studies varied methodologically, findings are reported as a thematic narrative, under the following themes: Recognition rate; ADHD controversy (medicalisation, stigma, labelling); Causes of ADHD; GPs and ADHD diagnosis; GPs and ADHD treatment; GP ADHD training and sources of information; and Age, sex differences in knowledge and attitudes. Conclusions: Across times and settings, GPs practising in first-contact gatekeeper settings had mixed and often unhelpful attitudes regarding the validity of ADHD as a construct, the role of medication and how parenting contributed to presentation. A paucity of training was identified, alongside a reluctance of GPs to become involved in shared care practice. If access to services is to be improved for possible ADHD cases, there needs to be a focused and collaborative approach to training

An examination of the effects of stimulant medication on response inhibition: A comparison between children with and without attention deficit hyperactivity disorder

This study investigated whether methylphenidate is effective in improving response inhibition in children with Attention Deficit Hyperactivity Disorder (ADHD). Children with ADHD were compared with normally developing children on measures of response inhibition. Participants with ADHD were compared across two conditions--medicated and unmedicated. There was no significant difference between the inhibitory control of children with and without ADHD. Children with ADHD showed significant improvements in inhibitory control following methylphenidate. The findings of the present study contrast with previous studies which document reduced inhibitory control in ADHD, compared with normally developing children. Reports of methylphenidate improving functioning in children with ADHD are supported. Limitation and implications of the study are discussed

Standardizing the Process for Diagnosing Attention Deficit Hyperactivity Disorder (ADHD) in the Primary Care Setting

Standardizing the Process for Diagnosing Attention Deficit Hyperactivity Disorder (ADHD) in the Primary Care Setting Louise Moon Rosales, MSN, APRN Purpose. Attention deficit hyperactivity disorder (ADHD) is a common problem that primary care providers diagnose and treat. Yet, there is a current lack of standardization to diagnose ADHD in many primary care settings. This purpose of this project was to standardize the process of diagnosing ADHD through introduction of screening instruments. Objectives included: assessment of clinician knowledge and attitudes about ADHD, implementation of a clinician-directed educational intervention, and development of a work flow procedure to standardize the diagnostic process. Methods. Clinicians at a family practice participated in a project to standardize the ADHD diagnostic process. Knowledge and attitude assessments via informal interviews and pre-intervention surveys were conducted with the five practice clinicians; three physicians and two nurse practitioners. An ADHD educational intervention was implemented followed by post-intervention surveys. A work flow procedure was implemented to assist in diagnosing ADHD through the use of psychometrically proven instruments embedded into the electronic health record (EHR). The scales used were the Vanderbilt ADHD Assessment Scale and Wender Utah Rating Scale. To measure clinician and subsequent patient outcomes, a data collection plan was created. Results. All five clinicians completed the pre and post knowledge and attitudinal surveys. The results demonstrated increased provider knowledge and confidence in diagnosing ADHD. A standardized process to diagnose ADHD was successfully developed, and scales to aid in the diagnosis of ADHD were embedded into the EHR. A data collection plan to monitor ongoing clinician and patient outcomes was implemented. Conclusions. An educational intervention and standardized workflow procedure by which to diagnose ADHD were successfully implemented in a family practice, thereby laying the foundation for continued quality improvement in the diagnosis of ADHD. To refine the process and gain a better appreciation of the impact of the intervention on clinicians and patients, data collection on established outcome measures continues. Keywords. Attention deficit hyperactivity disorder, ADHD, diagnosis, rating scales, primary care

Comorbid depressive disorders in ADHD. the role of ADHD severity, subtypes and familial psychiatric disorders

ObjectiveaaTo evaluate the presence of Major Depressive Disorder (MDD) and Dysthymic Disorder (DD) in a sample of Italian children with Attention Deficit Hyperactivity Disorder (ADHD) and to explore specific features of comorbid depressive disorders in ADHD. MethodsaaThree hundred and sixty-six consecutive, drug-naïve Caucasian Italian outpatients with ADHD were recruited and comorbid disorders were evaluated using DSM-IV-TR criteria. To evaluate ADHD severity, parents of all children filled out the ADHD Rating Scale. Thirty-seven children with comorbid MDD or DD were compared with 118 children with comorbid conduct disorder and 122 without comorbidity for age, sex, IQ level, family psychiatric history, and ADHD subtypes and severity. Resultsaa42 of the ADHD children displayed comorbid depressive disorders: 16 exhibited MDD, 21 DD, and 5 both MDD and DD. The frequency of hyperactive-impulsive subtypes was significantly lower in ADHD children with depressive disorders, than in those without any comorbidity. ADHD children with depressive disorders showed a higher number of familial psychiatric disorders and higher score in the Inattentive scale of the ADHD Rating Scale, than children without any comorbidity. No differences were found for age, sex and IQ level between the three groups. Conclusions: Consistent with previous studies in other countries, depressive disorders affect a significant proportion of ADHD children in Italy. Patient assessment and subsequent treatment should take into consideration the possible presence of this comorbidity, which could specifically increase the severity of ADHD attention problems

Incremental Clinical Utility of ADHD Assessment Measures with Latino Families

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common disorder beginning in childhood, with related symptoms and impairment across settings often persisting into adolescence and adulthood if effective treatment is not provided (Bernardi et al., 2012). Therefore, the early and accurate assessment and diagnosis of ADHD is critical. While the prevalence of ADHD symptomatology has been found to be consistent between Latinos and European Americans (Morgan, Hillemeir, Farkas, & Maczuga, 2014), there is little research on the best practices for assessing ADHD in Latinos. The current study sought to examine the incremental clinical utility of two parent- and teacher-report measures of ADHD symptomatology and functional impairment used to assess ADHD in a sample of Latino children. A sample of Latino schoolchildren (N=53) was recruited to participate in the current study, along with their primary parents and teachers; a comprehensive ADHD assessment was conducted for each participant. Results suggest that teachers in the current sample had a higher rate of agreement with final clinical judgment than did parents in the current sample. Additionally, results suggest that parent- and teacher-reports of functional impairment did not add incremental utility in predicting ADHD diagnostic status, beyond that of parent- and teacher-reports of ADHD symptomatology; follow-up analyses suggest why this may be the case. Lastly, results suggest that teacher-reports of ADHD symptoms and functional impairment added incremental utility in predicting ADHD diagnostic status, beyond parent-reports of ADHD symptoms and functional impairment. Clinical implications of these findings will be discussed