Towards an understanding of unique and shared pathways in the psychopathophysiology of AD/HD

Most attention deficit hyperactivity disorder (ADHD) research has compared cases with unaffected controls. This has led to many associations, but uncertainties about their specificity to ADHD in contrast with other disorders. We present a selective review of research, comparing ADHD with other disorders in neuropsychological, neurobiological and genetic correlates. So far, a specific pathophysiologicalpathway has not been identified. ADHD is probably not specifically associated with executive function deficits. It is possible, but not yet established, that ADHD symptoms may be more specifically associated with motivational abnormalities, motor organization and time perception. Recent findings indicating common genetic liabilities of ADHD and other conditions raise questions about diagnostic boundaries. In future research, the delineation of the pathophysiological mechanisms of ADHD needs to match cognitive, imaging and genetic techniques to the challenge of defining more homogenous clinical groups; multi-site collaborative projects are needed. © Blackwell Publishing Ltd

The Stroop revisited: a meta-analysis of interference control in AD/HD

Background: An inhibition deficit, including poor interference control, has been implicated as one of the core deficits in AD/HD. Interference control is clinically measured by the Stroop Colour-Word Task. The aim of this meta-analysis was to investigate the strength of an interference deficit in AD/HD as measured by the Stroop Colour-Word Task and to assess the role of moderating variables that could explain the results. These moderating variables included: methods of calculating the interference score, comorbid reading and psychiatric disorders, AD/HD-subtypes, gender, age, intellectual functioning, medication, and sample size. Methods: Seventeen independent studies were located including 1395 children, adolescents, and young adults, in the age range of 6-27 years. A meta-analysis was conducted to assess the effect sizes for the scores on the word and the colour card as well as the interference score. Results: Children with AD/HD performed more poorly on all three dependent variables. The effect sizes for word reading (d = .49) and colour naming (d = .58) were larger and more homogeneous than the effect size for the interference score (d = .35). The method used to calculate the interference score strongly influenced the findings for this measure. When interference control was calculated as the difference between the score on the colour card minus the score on the colour-word card, no differences were found between AD/HD groups and normal control groups. Discussion: The Stroop Colour-Word Task, in standard form, does not provide strong evidence for a deficit in interference control in AD/HD. However, the Stroop Colour-Word Task may not be a valid measure of interference control in AD/HD and alternative methodologies may be needed to test this aspect of the inhibitory deficit model in AD/HD. © Association for Child Psychology Psychiatry, 2004

Psychosocial Treatment of Children in Foster Care: A Review

A substantial number of children in foster care exhibit psychiatric difficulties. Recent epidemiologi-cal and historical trends in foster care, clinical findings about the adjustment of children in foster care, and adult outcomes are reviewed, followed by a description of current approaches to treatment and extant empirical support. Available interventions for these children can be categorized as either symptom-focused or systemic, with empirical support for specific methods ranging from scant to substantial. Even with treatment, behavioral and emotional problems often persist into adulthood, resulting in poor functional outcomes. We suggest that self-regulation may be an important mediat-ing factor in the appearance of emotional and behavioral disturbance in these children

The relation between sluggish cognitive tempo and DSM-IV ADHD

To test the relation between sluggish cognitive tempo (SCT) and DSM-IV ADHD symptoms, parent and teacher ratings of the 18 DSM-IV ADHD items and five potential SCT items were obtained in a community sample of 8–18 year-old twins that was overselected for ADHD and learning disabilities (n = 296). Confirmatory factor analyses revealed that a three-factor model provided the best fit to the data for both parent and teacher ratings. DSM-IV inattention and hyperactivity–impulsivity symptoms loaded on two factors consistent with the DSM-IV model, and five SCT symptoms loaded primarily on a third factor. The SCT and inattention factors were highly correlated, whereas SCT and hyperactivity–impulsivity were weakly related. Both raters indicated that children meeting symptom criteria for the combined and inattentive subtypes exhibited significantly more SCT symptoms than those meeting symptom criteria for hyperactive–impulsive type and the comparison group without ADHD. Children meeting symptom criteria for the inattentive type exhibited significantly more SCT symptoms than those meeting criteria for the combined type, based on teacher ratings. These results suggest that SCT is an internally consistent construct that is significantly associated with DSM-IV inattention

Links between within‐person fluctuations in hyperactivity/attention problems and subsequent conduct problems

BACKGROUND: The onset of hyperactivity/impulsivity and attention problems (HAP) is typically younger than that of conduct problems (CP), and some research supports a directional relation wherein HAP precedes CP. Studies have tested this theory using between-person and between-group comparisons, with conflicting results. In contrast, prior research has not examined the effects of within-person fluctuations in HAP on CP. METHOD: The current study tested the hypothesis that within-person variation in HAP would positively predict subsequent within-person variation in CP, in two population samples of youth (N=620) who participated in identical methods of assessment over the course of 30 months. Three-level, hierarchical models were used to test for within-person, longitudinal associations between HAP and CP, as well as moderating effects of between-person and between-family demographics. RESULTS: We found a small but significant association in the expected direction for older youth, but the opposite effect in younger and non-Caucasian youth. These results were replicated across both samples. CONCLUSIONS: The process by which early HAP relates to later CP may vary by age and racial identity