Young Adults with Attention Deficit Hyperactivity Disorder (ADHD): The impact of secondary tasks on driving performance

Abstract Objective: Young adults with Attention Deficit Hyperactivity Disorder (ADHD) are at higher risk for being involved in automobile crashes. Driving simulators have been used in a variety of contexts to categorize a number of deficits in performance exhibited by drivers with ADHD. Recent research focuses on non-distracted driving. However, in-vehicle infotainment and communications systems are known to further contribute to a driver's risk of collision. This paper explores the impact of secondary tasks on the driving performance of individuals with and without ADHD. Methods: Data are drawn from two portions of a validated driving simulation that represent the periods before, during and after participation in a secondary task. Secondary tasks include a cellular phone task administered in a high stimulus setting and a working memory task presented during low stimulus driving. Data from drivers with and without ADHD was compared. Results: When compared to the control group, drivers with ADHD have more difficulty performing the cellular telephone task but fail to modulate their driving in a way that compromises safety. Highway driving performance is impaired in individuals with ADHD. The degree of impairment increases while participating in a working memory task. Conclusions: The results suggest in low stimulus driving, attention to the secondary task substantially impact the performance of ADHD drivers

Family-based association study of the BDNF, COMT and serotonin transporter genes and DSM-IV bipolar-I disorder in children

Background: Over the past decade pediatric bipolar disorder has gained recognition as a potentially more severe and heritable form of the disorder. In this report we test for association with genes coding brain-derived neurotrophic factor (BDNF), the serotonin transporter (SLC6A4), and catechol-O-methyltransferase (COMT). Methods: Bipolar-I affected offspring triads (N = 173) were drawn from 522 individuals with 2 parents in 332 nuclear families recruited for genetic studies of pediatric psychopathology at the Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD at Massachusetts General Hospital. Results: We failed to identify an association with the val66 allele in BDNF (OR = 1.23, p = 0.36), the COMT-l allele (OR = 1.27, p = 0.1), or the HTTLPR short allele (OR = 0.87, p = 0.38). Conclusion: Our study suggests that the markers examined thus far in COMT and SLC6A4 are not associated with pediatric bipolar disorder and that if the val66met marker in BDNF is associated with pediatric bipolar disorder the magnitude of the association is much smaller than first reported

The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder

Brain; Diagnosis; GeneticsCerebro; Diagnóstico; GenéticaCervell; Diagnòstic; GenèticaBackground Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. Methods We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. Results We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. Conclusions Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma

Efficacy of atomoxetine in adult attention-Deficit/Hyperactivity Disorder: a drug-placebo response curve analysis

BACKGROUND: The objective of this study was to evaluate the efficacy of atomoxetine, a new and highly selective inhibitor of the norepinephrine transporter, in reducing symptoms of attention-deficit/hyperactivity disorder (ADHD) among adults by using drug-placebo response curve methods. METHODS: We analyzed data from two double-blind, placebo-controlled, parallel design studies of adult patients (Study I, N = 280; Study II, N = 256) with DSM-IV-defined ADHD who were recruited by referral and advertising. Subjects were randomized to 10 weeks of treatment with atomoxetine or placebo, and were assessed with the Conners Adult ADHD Rating Scales and the Clinical Global Impression of ADHD Severity scale before and after treatment. RESULTS: Those treated with atomoxetine were more likely to show a reduction in ADHD symptoms than those receiving placebo. Across all measures, the likelihood that an atomoxetine-treated subject improved to a greater extent than a placebo-treated subject was approximately 0.60. Furthermore, atomoxetine prevented worsening of most symptom classes. CONCLUSION: From these findings, we conclude that atomoxetine is an effective treatment for ADHD among adults when evaluated using several criteria

How Prevalent Are Autistic Traits Among Children With Attention-Deficit/Hyperactivity Disorder? A Qualitative Review of the Literature

Twin, family, and linkage studies have indicated that attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs) share a portion of their heritable etiology. This suggests that individuals with ADHD may manifest different forms of ASDs that may range from fully developed syndromic forms of the disorder to milder manifestations of ASD symptomatology, which will henceforth be referred to as autistic traits.The main purpose of this study was to conduct a literature search to examine the current body of knowledge regarding the prevalence of autistic traits (operationalized as the presence of autistic symptoms in the absence of a diagnosis of ASD) among children with ADHD and the associated morbidity of such traits.A systematic literature search in PubMed was conducted to discover all controlled studies published in the English language that systematically assessed the presence of autistic traits in children with ADHD who did not meet the criteria for ASDs. Three articles met our inclusion and exclusion criteria and were included in this qualitative review.Only three scientific papers that met our a priori inclusion and exclusion criteria were identified. These articles described findings obtained from clinical samples and identified a prevalence of autistic traits among children with ADHD that ranged from 7% to 60%. As compared with children with ADHD without these traits, the presence of autistic traits in children with ADHD was associated with more severe dysfunction in a wide range of non-overlapping domains and in the social and communication domains in particular.Although this study was limited by the small amount of available literature about this subject, these findings suggest that a sizeable subset of children with ADHD manifest autistic traits and that the presence of these traits is associated with increased dysfunction and social and communication deficits

Efficacy of Atomoxetine in Adult Attention-Deficit/Hyperactivity Disorder: A Drug-placebo Response Curve Analysis

Background: The objective of this study was to evaluate the efficacy of atomoxetine, a new and highly selective inhibitor of the norepinephrine transporter, in reducing symptoms of attention-deficit/hyperactivity disorder (ADHD) among adults by using drug-placebo response curve methods. Methods: We analyzed data from two double-blind, placebo-controlled, parallel design studies of adult patients (Study I, N = 280; Study II, N = 256) with DSM-IV-defined ADHD who were recruited by referral and advertising. Subjects were randomized to 10 weeks of treatment with atomoxetine or placebo, and were assessed with the Conners Adult ADHD Rating Scales and the Clinical Global Impression of ADHD Severity scale before and after treatment. Results: Those treated with atomoxetine were more likely to show a reduction in ADHD symptoms than those receiving placebo. Across all measures, the likelihood that an atomoxetine-treated subject improved to a greater extent than a placebo-treated subject was approximately 0.60. Furthermore, atomoxetine prevented worsening of most symptom classes. Conclusion: From these findings, we conclude that atomoxetine is an effective treatment for ADHD among adults when evaluated using several criteria

Are Autistic Traits in Youth Meaningful? A Replication study in Non-referred Siblings of Youth with and without Attention-Deficit/Hyperactivity Disorder

Background: We previously described the high prevalence and burden of significant autistic traits (ATs) in youth with attention-deficit/hyperactivity disorder (ADHD). These traits are associated with significantly greater impairment in psychopathological, interpersonal, educational, and neuropsychological functioning. Because the sample consisted of referred ADHD youth, uncertainty remained regarding whether these findings are generalizable to non-referred populations of youths with and without ADHD. Objective: The aim of the current study was to assess the prevalence and implications of ATs in a non-referred population of siblings of probands with and without ADHD. Method: Participants were non-referred siblings of probands with ADHD (N = 257) and control probands (N = 234) of longitudinal, case-control family studies conducted at Massachusetts General Hospital. Assessments included measures of psychiatric, psychosocial, educational, and cognitive functioning. The presence of significant ATs was operationalized using the Child Behavior Checklist AT profile, which consists of combined aggregate T-scores of ≥ 195 on the Withdrawn, Social, and Thought Problems subscales. Results: ATs were significantly more prevalent among the siblings of probands with ADHD as compared with siblings of control probands (6% vs. 1%; P = .02). Siblings of probands with ADHD with a positive AT profile (N = 15) were significantly more impaired than those without an AT profile (N = 242) with regard to psychopathological, interpersonal, educational, and neuropsychological functioning. Conclusions: The current study reports a higher-than-expected prevalence of ATs in a non-referred sample of siblings of youth with ADHD, which is consistent with previous findings regarding ATs in a referred sample of youth with ADHD. The presence of ATs is associated with higher levels of morbidity and dysfunction

Longitudinal Course of Deficient Emotional Self-Regulation CBCL Profile in Youth with ADHD: Prospective Controlled Study

Background: While symptoms of deficient emotional self-regulation (DESR) have been long associated with attention-deficit/hyperactivity disorder (ADHD), there has been limited investigation of this aspect of the clinical picture of the disorder. The main aim of this study was to examine the predictive utility of DESR in moderating the course of ADHD children into adolescence. Methods: Subjects comprised 177 children with and 204 children without ADHD followed for an average of 4 years (aged 6–18 years at baseline, 54% male). Subjects were assessed with structured diagnostic interviews and measures of psychosocial functioning. DESR was defined by the presence (n = 79) or absence (n = 98) of Child Behavior Checklist (CBCL)-DESR profile (score ≥ 180 < 210 total of Attention, Aggression, and Anxious/Depressed subscales) at the baseline assessment. Results: Of subjects with DESR at baseline, 57% had DESR at follow-up. Persistent ADHD was significantly associated with DESR at follow-up (x$^{2}$$_{(1)}$ = 15.37, P < 0.001). At follow-up, ADHD + DESR subjects had significantly more comorbidities (z = 2.55, P = 0.01), a higher prevalence of oppositional defiant disorder (z = 3.01, P = 0.003), and more impaired CBCL social problems t-score (t$_{(227)}$ = 2.41, P = 0.02) versus ADHD subjects. Conclusion: This work suggests that a positive CBCL-DESR profile predicts subsequent psychopathology and functional impairments in children with ADHD suggesting that it has the potential to help identify children with ADHD at high risk for compromised outcomes

Brain differences between persistent and remitted attention deficit hyperactivity disorder

Previous resting state studies examining the brain basis of attention deficit hyperactivity disorder have not distinguished between patients who persist versus those who remit from the diagnosis as adults. To characterize the neurobiological differences and similarities of persistence and remittance, we performed resting state functional magnetic resonance imaging in individuals who had been longitudinally and uniformly characterized as having or not having attention deficit hyperactivity disorder in childhood and again in adulthood (16 years after baseline assessment). Intrinsic functional brain organization was measured in patients who had a persistent diagnosis in childhood and adulthood (n = 13), in patients who met diagnosis in childhood but not in adulthood (n = 22), and in control participants who never had attention deficit hyperactivity disorder (n = 17). A positive functional correlation between posterior cingulate and medial prefrontal cortices, major components of the default-mode network, was reduced only in patients whose diagnosis persisted into adulthood. A negative functional correlation between medial and dorsolateral prefrontal cortices was reduced in both persistent and remitted patients. The neurobiological dissociation between the persistence and remittance of attention deficit hyperactivity disorder may provide a framework for the relation between the clinical diagnosis, which indicates the need for treatment, and additional deficits that are common, such as executive dysfunctions.McGovern Institute for Brain Research at MIT (Poitras Center for Affective Disorders Research)Massachusetts General Hospital (Paediatric Psychopharmacology Council Fund

Attention and working memory deficits in a perinatal nicotine exposure mouse model

Background: Cigarette smoking by pregnant women is associated with a significant increase in the risk for cognitive disorders in their children. Preclinical models confirm this risk by showing that exposure of the developing brain to nicotine produces adverse behavioral outcomes. Here we describe behavioral phenotypes resulting from perinatal nicotine exposure in a mouse model, and discuss our findings in the context of findings from previously published studies using preclinical models of developmental nicotine exposure. Methodology/Principal findings Female C57Bl/6 mice received drinking water containing nicotine (100μg/ml) + saccharin (2%) starting 3 weeks prior to breeding and continuing throughout pregnancy, and until 3 weeks postpartum. Over the same period, female mice in two control groups received drinking water containing saccharin (2%) or plain drinking water. Offspring from each group were weaned at 3-weeks of age and subjected to behavioral analyses at 3 months of age. We examined spontaneous locomotor activity, anxiety-like behavior, spatial working memory, object based attention, recognition memory and impulsive-like behavior. We found significant deficits in attention and working memory only in male mice, and no significant changes in the other behavioral phenotypes in male or female mice. Exposure to saccharin alone did not produce significant changes in either sex. Conclusion/Significance The perinatal nicotine exposure produced significant deficits in attention and working memory in a sex-dependent manner in that the male but not female offspring displayed these behaviors. These behavioral phenotypes are associated with attention deficit hyperactivity disorder (ADHD) and have been reported in other studies that used pre- or perinatal nicotine exposure. Therefore, we suggest that preclinical models of developmental nicotine exposure could be useful tools for modeling ADHD and related disorders