Parent-Based Therapies for Preschool Attention-Deficit/Hyperactivity Disorder: A Randomized, Controlled Trial With a Community Sample

Few studies have examined the impact of childhood attention deficit hyperactivity disorder (ADHD) symptoms on adult ADHD functional outcomes. To address this issue dimensionally, ADHD symptoms in childhood and adulthood and their relation to educational deficits and work disability are studied in a clinical sample of adult patients with previously untreated ADHD. About 250 adults diagnosed systematically with ADHD according to DSM-IV were prospectively recruited. Primary outcomes were high school dropout and being out of the work last year. Childhood ADHD symptoms, sex differences, comorbidities of other mental disorders, and adult ADHD symptoms were examined by historical data, clinician interviews, and questionnaires. High levels of ADHD symptom severity in childhood were related to dropping out of high school [odds ratio (OR) = 3.0], as were higher numbers of hyperactive–impulsive symptoms in childhood. Significantly, more women than men were long-term work disabled (OR = 2.0). After adjusting for age and gender, persisting high levels of ADHD inattention symptoms in adulthood (OR = 2.5), number of comorbid disorders, and particularly anxiety disorders were significantly related to long-term work disability. Childhood hyperactive–impulsive symptoms and overall severity of childhood ADHD symptoms were associated with high school dropout rates; however, persisting ADHD inattention symptoms and comorbid mental disorders in adulthood were more correlated to occupational impairment. These findings underline proposals for studies on early recognition and interventions for ADHD and psychiatric comorbidity. They further suggest that inattentive symptoms be a focus of adult ADHD treatment and that workplace interventions be considered to prevent long-term work disability.

ABSTRACTObjectives: To investigate the prevalence of attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) symptoms in adult patients with primary restless legs syndrome (RLS) and to determine the iron biological correlates of these comorbidities. Participants and Methods: We obtained demographic and clinical data from consecutive 105 outpatients with idiopathic RLS who answered validated questionnaires designed to assess the presence of ADHD and OCD symptoms. In these patients, iron blood parameters were routinely checked. Results: Of the total sample, 42.86% of the patients with RLS showed symptoms reminiscent either of ADHD or OCD. Prevalence of ADHD and OCD symptoms was 27.62% and 7.62%, respectively. Compared to other groups, a significantly higher percentage of RLS patients with ADHD symptoms was on antidepressant (p = 0.012); and women with ADHD symptoms, either alone or combined with OCD symptoms, showed significant reduced ferritin concentrations compared to men with either isolated ADHD symptoms or with combined ADHD and OCD symptoms (p = 0.028 and p = 0.025, respectively). Conclusions: Our findings highlight the high prevalence of ADHD and OCD symptoms in adult patients with primary RLS and independently of serum iron stores decrease, except for women with ADHD symptoms either alone or in combination with OCD symptoms. This may suggest an overlapping neurobiological dopaminergic and serotoninergic dysfunction in ADHD, OCD, and RLS, and question the expression of different RLS phenotypes. The efficacy of dopamine agonists in these groups of patients should be questioned in future studies.

We found no certain evidence that IR methylphenidate compared with placebo or lithium can reduce symptoms of ADHD in adults (low- and very low-certainty evidence). Adults treated with IR methylphenidate are at increased risk of gastrointestinal and metabolic-related harms compared with placebo. Clinicians should consider whether it is appropriate to prescribe IR methylphenidate, given its limited efficacy and increased risk of harms. Future RCTs should explore the long-term efficacy and risks of IR methylphenidate, and the influence of conflicts of interest on reported effects.

Objective: The aim of this study was to examine how attention-deficit hyperactivity disorder (ADHD) symptoms play an interaction effect on the association between psychosocial work environments and health (psychological distress/work engagement) among workers.Methods: This is a cross-sectional study of 2,693 employees at a pharmaceutical company using a self-administered questionnaire evaluating ADHD symptoms (Adult ADHD Self-Report Scale Screener), psychosocial work environments (job demands, job control and social support), and health outcomes (psychological distress; K6, and work engagement; Utrecht Work Engagement Scale). Multiple regression analyses were applied to assess the interaction between ADHD symptoms and psychosocial work environments on health outcomes.Results: The prevalence of workers with ADHD symptoms was 5.9% (n = 159). Significant interaction effects of ADHD symptoms × job control and ADHD symptoms × social support were observed (β = −0.067, p < 0.01 and β = −0.052, p < 0.01, respectively) on psychological distress after adjustment of age, sex, occupation and education. The interaction effect of ADHD symptoms × each psychosocial work environment was not observed on work engagement.Conclusions: Job control and social support were more influential factors that were related to psychological distress in accordance with ADHD symptoms. This study also found no difference of the interaction between psychosocial work environments and ADHD symptoms on work engagement. To the best of our knowledge, this study was first to clarify the effect of ADHD symptoms on the association between psychosocial work environments and health outcomes (psychological distress/work engagement). These findings can aid employers how to arrange better work environments for workers with ADHD symptoms.

The Relationship Between Maternal Stress and Boys' ADHD Symptoms and Quality of Life: An Australian Prospective Cohort Study

Background: Parent management training (PMT) is a recognized intervention for managing attention deficit hyperactivity disorder (ADHD) in children. Objectives: The present study aims to bridge this gap by investigating the comparative effectiveness of in-person versus videoconference PMT. Methods: Ninety parents with diagnosed ADHD children participated in this parallel-design, randomized clinical trial. Parents were recruited from a community outpatient clinic and randomly assigned (block randomization) to either a videoconference or in-person PMT group. The ADHD children between the ages of 3 and 12 who met the diagnostic and statistical manual of mental disorders (DSM-5) standards for ADHD diagnosis were included, as long as the child did not have oppositional defiant disorder (ODD) or conduct problem. The primary outcome measure was parent-reported ADHD symptoms, assessed using the Conners’ Parent Rating Scale (CPRS-48) at baseline, post-treatment, and 2-month follow-up. The Swanson, Nolan, and Pelham (SNAP-IV) Questionnaire was also used as a secondary outcome measure. Statistical analyses included Independent samples t-test and mixed ANOVA, with effect sizes reported as Cohen’s d. Results: Both in-person and videoconference PMT significantly improved core ADHD symptoms (attention deficit, hyperactivity, and overall ADHD) (all P &lt; 0.001 except videoconference PMT at follow-up for ADHD, P = 0.01) and conduct problems (P &lt; 0.001). However, in-person PMT showed additional benefits for social and psychosomatic problems, with medium to large effect sizes. Specifically, the effect size for in-person PMT in improving conduct problems was 0.48, while the effect size for the superiority of in-person PMT over videoconference PMT in improving social problems was 0.55. These findings suggest that while both delivery methods are effective for core ADHD symptoms, in-person PMT may offer more comprehensive benefits, particularly in addressing social and psychosomatic issues. Conclusions: Videoconference PMT can be a viable alternative for improving core ADHD symptoms, particularly when in-person delivery is impractical. However, in-person PMT might be the preferred approach for addressing social and psychosomatic difficulties. These findings have implications for clinical practice and future research in expanding access to PMT.

Plasma homovanillic acid correlates inversely with history of learning problems in healthy volunteer and personality disordered subjects

To review evidence on the association between restless legs syndrome (RLS) and attention-deficit/hyperactivity disorder (ADHD), to discuss the hypothetical mechanisms underlying this association, and to consider the potential interest for common pharmacologic treatments of RLS and ADHD when co-occurring. A PubMed search. In clinical samples, up to 44% of subjects with ADHD have been found to have RLS or RLS symptoms, and up to 26% of subjects with RLS have been found to have ADHD or ADHD symptoms. Several mechanisms may explain this association. Sleep disruption associated with RLS might lead to inattentiveness, moodiness, and paradoxical overactivity. Diurnal manifestations of RLS, such as restlessness and inattention, might mimic ADHD symptoms. Alternatively, RLS might be comorbid with idiopathic ADHD. Subjects with RLS and a subset of subjects with ADHD might share a common dopamine dysfunction. Limited evidence suggests that some dopaminergic agents, such as levodopa/carbidopa, pergolide, and ropinirole, may be effective in children with RLS associated with ADHD symptoms. Although still limited, evidence from clinical studies demonstrates an association between RLS and ADHD or ADHD symptoms. Further clinical studies using standard criteria and procedures are needed to better estimate the degree of association. Epidemiologic studies are required to assess the relationship between ADHD and RLS symptoms in nonclinical samples. Further investigations should address the mechanisms underlying the relationship between RLS and ADHD. Several dopaminergic agents seem to be promising treatment for RLS associated with ADHD symptoms. To date, however, the absence of randomized and blinded controlled studies does not allow evidence-based recommendations.

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.

Effectiveness of pharmacological interventions for managing ADHD symptoms in individuals with autism spectrum disorder: A systematic review and meta-analysis

The current diagnostic manuals, DSM-IV-TR and ICD-10, do not allow the diagnosis of ADHD to be made separately in the presence of autism (pervasive developmental disorder). However, the characteristics of ADHD are very common in autism, occurring in around 30 to 70%. Surveys of children with ADHD also reveal a high proportion of features of Autism Spectrum Disorder (ASD). Furthermore, treatment of ADHD in the presence of autism is of benefit in a large proportion. The inconsistency in the diagnostic manuals should be resolved in the forthcoming DSM-5 and ICD-11. The results of twin studies have been consistent with the sharing of genetic influences between autism and ADHD symptoms. Genome-wide studies have also shown shared chromosomal regions of interest for susceptibility sites for both conditions. There is an overlap between the executive function deficits in both conditions, although the details of the dysfunction may be different. There is evidence that all the standard treatments for ADHD can be effective in the presence of autism (though to a lesser extent than in pure ADHD): methylphenidate, amphetamines, atomoxetine, clonidine and guanfacine. Atypical antipsychotics such as risperidone and aripiprazole may be of specific importance in managing ASD with irritability, aggression and hyperactivity. The idea that ADHD cannot be diagnosed or treated successfully in those with ASD is a myth that should be dispelled; many of those who have both autism spectrum disorder and ADHD can benefit greatly from the treatment of the ADHD.

Meta-Analysis: Treatment of Attention-Deficit/Hyperactivity Disorder in Children With Comorbid Tic Disorders

Living with symptoms of Attention Deficit-Hyperactivity Disorder (ADHD) in adulthood: a systematic review protocol of qualitative evidence

BackgroundSymptoms of attention deficit hyperactivity disorder (ADHD) are commonly comorbid with depression This study aimed to examine the relationship between ADHD symptoms and depression through perceived family support and to explore whether the magnitude of the relationship depended on the type of family climate of medical students.MethodsThis cross-sectional study was conducted among 124 first year medical students in Thailand. Participants completed questionnaires on ADHD symptoms, depression, perceived family support, and 9 types of family climate. The questionnaires included the Adult ADHD Self-Report Scale Screener, Patient Health Questionnaire-9, and revised Thai Multidimensional Scale of Perceived Social Support. Mediational analysis was adopted to examine the mediating role of perceived family support in the relationship between ADHD symptoms and depression, while moderation analysis was applied to examine the extent of the relationship depending on family climate.ResultsThe relationship between ADHD symptoms and depression was moderate. Perceived family support partially mediated this relationship after controlling for age and sex. Among the types of family climate, only helpful family climate was a significant moderator of perceived family support and depression. The moderated mediation model increased the variance in depression from 17% by the mediation model to 21%. However, follow-up conditional mediational analysis showed that the indirect effect of ADHD symptoms on depression via perceived family support was not significant and that this effect did not vary linearly as a function of helpful family climate.ConclusionThe findings of the study revealed that poor family support might be one risk of developing depression in the context of ADHD symptoms. Further study on providing intervention concerning family support among those with ADHD symptoms should be warranted. In addition, a study on helpful family climate in a larger sample size, in other populations, and in a longitudinal fashion for a more robust conclusion is encouraged.

To investigate the presence of symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) in university students using validated and translated psychological assessment tools in Brazil. A cross-sectional study was conducted, evaluating 433 students through online questionnaires: the Adult Self-Report Scale (ASRS-18) for ADHD and the Autism Spectrum Quotient - 10 items (AQ-10) for ASD. Analysis of 433 questionnaires identified ADHD symptoms in 62.4% and ASD symptoms in 15.7% of the students. Common ASD symptoms included difficulties in attention to details and communication, while ADHD symptoms primarily involved inattention. Significant associations were also found between ADHD and ASD symptoms and treatment for depression and/or anxiety. Therefore, it was concluded that symptoms of ADHD and ASD significantly impact personal relationships and academic profiles of students, as these psychological disorders are strongly linked to human performance in both social and professional contexts.