Peer Rejection and Friendships in Children with Attention-Deficit/Hyperactivity Disorder: Contributions to Long-Term Outcomes

Even after evidence-based treatment, Attention- Deficit/Hyperactivity Disorder (ADHD) is associated with poor long-term outcomes. These outcomes may be partly explained by difficulties in peer functioning, which are common among children with ADHD and which do not respond optimally to standard ADHD treatments. We examined whether peer rejection and lack of dyadic friendships experienced by children with ADHD after treatment contribute to long-term emotional and behavioral problems and global impairment, and whether having a reciprocal friend buffers the negative effects of peer rejection. Children with Combined type ADHD (N0300) enrolled in the Multimodal Treatment Study of Children with ADHD (MTA) were followed for 8 years. Peer rejection and dyadic friendships were measured with sociometric assessments after the active treatment period (14 or 24 months after baseline; M ages 9.7 and 10.5 years, respectively). Outcomes included delinquency, depression, anxiety, substance use, and general impairment at 6 and 8 years after baseline (Mean ages 14.9 and 16.8 years, respectively). With inclusion of key covariates, including demographics, symptoms ofADHD, ODD, and CD, and level of the outcome variable at 24 months, peer rejection predicted cigarette smoking, delinquency, anxiety, and global impairment at 6 years and global impairment at 8 years after baseline. Having a reciprocal friend was not, however, uniquely predictive of any outcomes and did not reduce the negative effects of peer rejection. Evaluating and addressing peer rejection in treatment planning may be necessary to improve long-term outcomes in children with ADHD

ADGRL3 (LPHN3) variants are associated with a refined phenotype of ADHD in the MTA study

Background ADHD is the most common neuropsychiatric condition affecting individuals of all ages. Long-term outcomes of affected individuals and association with severe comorbidities as SUD or conduct disorders are the main concern. Genetic associations have been extensively described. Multiple studies show that intronic variants harbored in the ADGRL3 (LPHN3) gene are associated with ADHD, especially associated with poor outcomes. Methods In this study, we evaluated this association in the Multimodal Treatment Study of children with ADHD (MTA), initiated as a 14-month randomized clinical trial of 579 children diagnosed with DSM-IV ADHD-Combined Type (ADHD-C), that transitioned to a 16-year prospective observational follow-up, and 289 classmates added at the 2-year assessment to serve as a local normative comparison group (LNCG). Diagnostic evaluations at entry were based on the Diagnostic Interview Schedule for Children-Parent (DISC-P), which was repeated at several points over the years. For an add-on genetic study, blood samples were collected from 232 in the MTA group and 139 in the LNCG. Results For the 205 MTA participants, 14.6% retained the DISC-P diagnosis of ADHD-C in adolescence. For 127 LNCG participants, 88.2% remained undiagnosed by the DISC-P. We genotyped 15 polymorphic SNP markers harbored in the ADGRL3 gene, and compared allele frequencies for the 30 cases with continued diagnosis of ADHD-C in adolescence to the other participants. Replication of the association of rs2345039 ADGRL3 variant was observed (P value = 0.004, FDR corrected = 0.03; Odds ratio = 2.25, upper CI 1.28–3.97). Conclusion The detection of susceptibility conferred by ADGRL3 variants in the extreme phenotype of continued diagnosis of ADHD-C from childhood to adolescence provides additional support that the association of ADGRL3 and ADHD is not spurious. Exploring genetic effects in longitudinal cohorts, in which refined, age-dependent phenotypes are documented, is crucial to understand the natural history of ADHD

The Transition to Middle School is Associated with Changes in the Developmental Trajectory of ADHD Symptomatology in Young Adolescents with ADHD

The attention deficit hyperactivity disorder (ADHD) symptom presentation of young adolescents with ADHD was examined in association with the transition to middle school. This study used data collected in the Multimodal Treatment Study of ADHD, which included children between 7 and 9 years of age with a diagnosis of ADHD (n=258) and grade- and sex-matched controls (n=112). The trajectory of ADHD symptoms before, during, and after the transition to middle school was modeled using hierarchical linear modeling. A clear developmental reduction in ADHD symptomatology was observed for all three ADHD symptom domains. For young adolescents with ADHD, the transition to middle school was associated with a disruption in the developmental decline of inattention, hyperactivity, and impulsivity symptoms as measured by parent ratings. This effect was also observed for teacher ratings of inattention and hyperactivity. These results support the assertion that the environmental changes associated with transitioning to middle school coincide with a transient reversal in ADHD symptom decline among children with ADHD

Coping Skills and Parent Support Mediate the Association Between Childhood Attention-Deficit/Hyperactivity Disorder and Adolescent Cigarette Use

To examine mediators of the association between childhood attention-deficit/hyperactivity disorder (ADHD) and adolescent cigarette use

Psychotic symptoms in ADHD:an analysis of the MTA database

Objective: To assess the prevalence of psychotic symptoms among youths (age 14-25 years) with a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) combined type. Method: The participants in the Multimodal Treatment Study of Children with ADHD (MTA) and a local normative comparison group (LNCG) were systematically assessed 6, 8, 10, 12, 14, and 16 years after the original enrollment at a mean age of 8.5 years. Trained research assistants administered a psychosis screener, and positive screens were referred to study clinicians to confirm or exclude psychosis. Possible associations between screening positive and alcohol or substance use were assessed. Results: Data were available from 509 MTA participants (88% of the original MTA sample) and 276 LNCG subjects (96% of the original sample), with a mean age of 25.1 and 24.6 years, respectively, at Year 16. Twenty-six MTA subjects (5%, 95% CI: 3, 7) and 11 LNCG (4%, 95% CI: 2, 6) screened positive for at least one psychotic symptom (p=0.60). Most psychotic symptoms were transient. The prevalence of clinician-confirmed psychotic symptoms was 1.1% (95% C.I. 0.2, 2.1) in the MTA and 0.7% (0, 1.7) in the LNCG (p=0.72). Greater cannabis use was reported by those who screened (p<0.05) and were confirmed positive (p<0.01). Conclusions: There was no evidence that ADHD increased the risk for psychotic symptoms. In both the ADHD and normative comparison groups, more frequent cannabis use was associated with greater likelihood of experiencing psychotic symptoms, thus supporting the recommendation that youth should not use cannabis

Childhood ADHD and Growth in Adolescent Alcohol Use: The Roles of Functional Impairments, ADHD Symptom Persistence, and Parental Knowledge

Research on the relation between childhood Attention-Deficit/Hyperactivity Disorder (ADHD) and adolescent alcohol use has found mixed results. Studies are needed that operationalize alcohol use in developmentally appropriate ways and that test theoretically plausible moderators and mediators in a longitudinal framework. The current study tested childhood ADHD as a predictor of alcohol use frequency at age 17, and age-related increases in alcohol use frequency, through adolescence for 163 adolescents with ADHD diagnosed in childhood and 120 adolescents without ADHD histories. Childhood ADHD did not predict either alcohol outcome. However, parental knowledge of the teen’s friendships, activities, and whereabouts moderated the association such that childhood ADHD predicted alcohol use frequency at age 17 when parental knowledge was below median levels for the sample. Mediational pathways that explained this risk included social impairment, persistence of ADHD symptoms, grade point average, and delinquency. Social impairment was positively associated with alcohol use frequency through delinquency; it was negatively associated with alcohol use frequency as a direct effect independent of delinquency. These nuanced moderated-mediation findings help to explain previously inconsistent results for the ADHD-adolescent alcohol use association. The findings also imply that future research and intervention efforts should focus on ADHD-related social and academic impairments as well as symptom persistence and parenting efforts

Evidence, Interpretation, and Qualification From Multiple Reports of Long- Term Outcomes in the Multimodal Treatment Study of Children With ADHD (MTA) Part II: Supporting Details

Objective: To review and provide details about the primary and secondary findings from the Multimodal Treatment study of ADHD (MTA) published during the past decade as three sets of articles. Method: In the second of a two part article, we provide additional background and detail required by the complexity of the MTA to address confusion and controversy about the findings outlined in part I (the Executive Summary). Results: We present details about the gold standard used to produce scientific evidence, the randomized clinical trial (RCT), which we applied to evaluate the long-term effects of two well-established unimodal treatments, Medication Management (MedMGT) and behavior therapy (Beh), the multimodal combination (Comb), and treatment “as usual” in the community (CC). For each of the first three assessment points defined by RCT methods and included in intent-to-treat analyses, we discuss our definition of evidence from the MTA, interpretation of the serial presentations of findings at each assessment point with a different definition of long-term varying from weeks to years, and qualification of the interim conclusions about long-term effects of treatments for ADHD based on many exploratory analyses described in additional published articles. Conclusions: Using a question and answer format, we discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families, clinicians, and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD. (J. of Att. Dis. 2008; 12(1) 15-43

Parent-Reported Homework Problems in the MTA Study: Evidence for Sustained Improvement with Behavioral Treatment

Parent-report of child homework problems was examined as a treatment outcome variable in the MTA-Multimodal Treatment Study of Children with Attention-Deficit/ Hyperactivity Disorder (ADHD). Five hundred seventy-nine children ages 7.0 to 9.9 were randomly assigned to either medication management, behavioral treatment, combination treatment, or routine community care. Results showed that only participants who received behavioral treatment (behavioral and combined treatment) demonstrated sustained improvements in homework problems in comparison to routine community care. The magnitude of the sustained effect at the 10-month follow-up assessment was small to moderate for combined and behavioral treatment over routine community care (d=.37, .40, respectively). Parent ratings of initial ADHD symptom severity was the only variable found to moderate these effects