Sequential treatment of ADHD in mother and child (AIMAC study): importance of the treatment phases for intervention success in a randomized trial

Background: The efficacy of parent-child training (PCT) regarding child symptoms may be reduced if the mother has attention-deficit/hyperactivity disorder (ADHD). The AIMAC study (ADHD in Mothers and Children) aimed to compensate for the deteriorating effect of parental psychopathology by treating the mother (Step 1) before the beginning of PCT (Step 2). This secondary analysis was particularly concerned with the additional effect of the Step 2 PCT on child symptoms after the Step 1 treatment. Methods: The analysis included 143 mothers and children (aged 6–12 years) both diagnosed with ADHD. The study design was a two-stage, two-arm parallel group trial (Step 1 treatment group [TG]: intensive treatment of the mother including psychotherapy and pharmacotherapy; Step 1 control group [CG]: supportive counseling only for mother; Step 2 TG and CG: PCT). Single- and multi-group analyses with piecewise linear latent growth curve models were applied to test for the effects of group and phase. Child symptoms (e.g., ADHD symptoms, disruptive behavior) were rated by three informants (blinded clinician, mother, teacher). Results: Children in the TG showed a stronger improvement of their disruptive behavior as rated by mothers than those in the CG during Step 1 (Step 1: TG vs. CG). In the CG, according to reports of the blinded clinician and the mother, the reduction of children’s disruptive behavior was stronger during Step 2 than during Step 1 (CG: Step 1 vs. Step 2). In the TG, improvement of child outcome did not differ across treatment steps (TG: Step 1 vs. Step 2). Conclusions: Intensive treatment of the mother including pharmacotherapy and psychotherapy may have small positive effects on the child’s disruptive behavior. PCT may be a valid treatment option for children with ADHD regarding disruptive behavior, even if mothers are not intensively treated beforehand. Trial registration: ISRCTN registry ISRCTN73911400. Registered: 29 March 2007

Abnormal Distracter Processing in Adults with Attention-Deficit-Hyperactivity Disorder

Background: Subjects with Attention-Deficit Hyperactivity Disorder (ADHD) are overdistractible by stimuli out of the intended focus of attention. This control deficit could be due to primarily reduced attentional capacities or, e. g., to overshooting orienting to unexpected events. Here, we aimed at identifying disease-related abnormalities of novelty processing and, therefore, studied event-related potentials (ERP) to respective stimuli in adult ADHD patients compared to healthy subjects. Methods: Fifteen unmedicated subjects with ADHD and fifteen matched controls engaged in a visual oddball task (OT) under simultaneous EEG recordings. A target stimulus, upon which a motor response was required, and non-target stimuli, which did not demand a specific reaction, were presented in random order. Target and most non-target stimuli were presented repeatedly, but some non-target stimuli occurred only once (‘novels’). These unique stimuli were either ‘relative novels ’ with which a meaning could be associated, or ‘complete novels’, if no association was available. Results: In frontal recordings, a positive component with a peak latency of some 400 ms became maximal after novels. In healthy subjects, this novelty-P3 (or ‘orienting response’) was of higher magnitude after complete than after relative novels, in contrast to the patients with an undifferentially high frontal responsivity. Instead, ADHD patients tended to smaller centro-parietal P3 responses after target signals and, on a behavioural level, responded slower than controls

ERP peak latencies.

<p>Mean peak-latencies in milliseconds (± SD) for the frontal novelty-P3 and the centro-parietal oddball-P3 for controls and patients.</p

Familiarity effect on parietal P3.

<p>Grand-average of ERP from parietal electrodes (P8, P4, Pz, P3, P7) upon familiar (bold line) and unfamiliar novels (dotted line) in controls (A1) and patients (A2).</p

Modified oddball task.

<p>Altogether 460 target, non-target and novel (non-target) symbols were presented to each subject in the current modified oddball task. Meaning-wise, novels were either familiar (relative novel) or non-familiar (complete novel). The symbols appeared at intervals of 2 seconds in randomised order.</p

Study Cohorts.

<p>Demographic data and clinical specifics of patients and controls as assessed by the Wender Utah Rating Scale (WURS-K), ADHD-checklist, Beck Depression Inventory (BDI).</p

Categorisation of novel stimuli.

<p>Categorisation of the stimuli strongly overlapped between groups. This can be deduced from the present description, in which the sixty novel stimuli were ordered according to semantic familiarity scores in the control cohort: First and second columns provide scores per group, the highest familiarity being 15 (meaning that all group members could associate a meaning with the given stimulus), the lowest 0 (meaning that none of the group members could associate a meaning with the given stimulus). In the third column, between-group differences for stimuli with the indicated rating constellation are presented, expressed as the rating score of controls minus that of patients. In the last column, the number of stimuli with the between-group rating-constellation, specified in the respective row, is indicated.</p

Statistical comparison of novelty P3.

<p>Columns indicate mean novelty-P3 amplitude to familiar and unfamiliar novels, bars show the respective standard errors of mean (ns = not significant, * indicates P<.05).</p

Familiarity effect on frontal P3.

<p>Grand-average of ERP from frontal electrodes (F8, F4, Fz, F3, F7) upon familiar (bold line) and unfamiliar novels (dotted line) in controls (A1) and patients (A2). B1 shows ERP-differences for familiar, B2 for unfamiliar novels between controls (dotted line) and ADHD-patients (bold line).</p

Comparing Dimensional Models Assessing Personality Traits and Personality Pathology Among Adult ADHD and Borderline Personality Disorder

Objective: This pilot study was a comparison of dimensional models assessing personality traits and personality pathology in a clinical sample of adults diagnosed with ADHD and adults diagnosed with borderline personality disorder (BPD), and a nonclinical control sample of healthy adults. Method: Personality traits were assessed using the NEO-Personality Inventory-Revised (NEO-PI-R) and dimensional personality pathology with the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). Results: Adults with ADHD and BPD produced higher Emotional Dysregulation/Neuroticism and Dissocial Behavior scores than controls. For the Extraversion/Inhibitedness scale, adults with BPD produced significantly lower scores than adults with ADHD and controls. On the Conscientiousness/Compulsivity domains, Conscientiousness scores were lower for both disorders, whereas low Compulsivity values were specific to adult ADHD. Conclusion: Our results suggest that patients with adult ADHD and BPD have distinguishable profiles of personality traits and personality pathology