Transdiagnostic considerations are critical to understanding childhood neurodevelopmental disorders.

Growing dissatisfaction with the current categorical diagnostic systems has led to a movement toward transdiagnostic dimensional approaches to assessment of childhood mental health disorders. We argue that a transdiagnostic approach is especially important and appropriate when screening for neurodevelopmental disorders during early childhood. In the early childhood years, symptoms often appear in the form of developmental delays that could portend a variety of different disorders. Early intervention at this point is critical, even though a final endpoint disorder is not yet apparent. Intervening early has the potential to grow the area of weakness, possibly correcting or at least ameliorating these delays. Early intervention requires a multidisciplinary approach integrating efforts across settings and providers that monitor the development of young children. We argue here that young children's language ability is central to the development of social cognition, and a prerequisite for adequate social functioning. Social deficits are defining features of a subset of neurodevelopmental disorders such as autism spectrum disorder and social (pragmatic) communication disorder. Critically, impairment in social functioning is common in additional neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD), learning disorders, and even motor disorders. For this reason, we argue that, at the earliest sign of a possible neurodevelopmental disorder, children should be screened for language deficits prior to initiating a focused assessment for a specific type of neurodevelopmental disorder such as ADHD. Any detected language deficits should be considered in the design and implementation of the assessment, as well as the ultimate intervention plan.

Do Language-Related Cognitive Capacities Help Predict Adjustment in Children with Attention-Deficit/Hyperactivity Disorder?

The goal of this paper was to examine the role that language-related cognitive capacities (LRCC) might play in explaining adjustment of 7 to 12 year-old children (Mage = 9.24; SDage = 0.91) with and without ADHD. The sample was comprised of 178 children with ADHD and 86 typically-developing children (77.3% male; 81.4% White; 9.5% Black; 1.9% Hispanic; 0.8% Asian; 5.7% multiracial; 0.8% did not report race/ethnicity). Using simultaneous regression, we examined whether LRCC accounted for unique variance in achievement, attention problems, oppositional problems, conduct problems, and internalizing, over and above what standard covariates and ADHD diagnostic status could explain. Finally, we examined LRCC as a mediator of the relation between ADHD diagnostic status and these adjustment measures. Results indicated that LRCC significantly predicted 6 of 7 and partially mediated 5 of 7 measures, suggesting that language-related constructs warrant greater attention in diagnosis and treatment of ADHD.

Language Problems and ADHD Behaviors: Unique and Interactive Associations with School Readiness in a Socioeconomically Disadvantaged Preschool Sample.

This study examined the unique and interactive effects of receptive language ability and ADHD behaviors on six school readiness outcomes, over and above the effects of socioeconomic status, in 49 preschoolers (Mage = 3.98, SDage = .58; 53.06% female) recruited from Head Start-affiliated classrooms. Hierarchical regression analyses revealed unique positive associations between receptive language ability and cognitive and mathematics readiness, and unique negative associations between ADHD behaviors and social-emotional, physical, cognitive, and literacy readiness. Moderation analyses indicated that at higher, but not lower, levels of ADHD behaviors, lower receptive language ability was associated with lower social-emotional readiness. Results highlight that, when considered together, children's receptive language ability and ADHD behaviors vary in how they predict school readiness. Further, results provide preliminary evidence for ADHD behaviors as a risk factor in the association between receptive language deficits and social-emotional school readiness. Educational and clinical practice implications are discussed.

Paths to postsecondary education enrollment among adolescents with and without childhood attention-deficit/hyperactivity disorder (ADHD): A longitudinal analysis of symptom and academic trajectories.

We examined developmental trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary education (PSE; N = 749; 79% boys; 63% White, 17% non-Hispanic Black, 10% Hispanic, and 10% other ethnicities). In a multisite study (recruitment based in New York, North Carolina, Pennsylvania, California, and Quebec), participants were originally enrolled between 1994 and 1998 at ages 7 to 9.9 and followed up through 2012 (Mage = 25 at final follow-up). Adolescents who eventually enrolled in PSE had less severe symptoms, but differences were modest and trajectories were similar over time. For all adolescents, standardized achievement trajectories declined up to two thirds of a standard deviation from ages 9 to 17. By the end of high school, the average GPA of adolescents with ADHD was three quarters of a point higher for those who eventually enrolled in PSE compared to those who did not. Overall, school performance mattered more than academic achievement for understanding eventual enrollment of adolescents with ADHD.

The Developmental Course of Teacher-Rated ADHD Symptom Levels in an Early Childhood Community Sample.

OBJECTIVE: This study examined trajectories of inattention and hyperactivity/impulsivity symptom levels across one preschool year and explored variation in trajectories by age, sex, and end-of-year impairment. METHOD: Participants were 261 preschoolers (87% Head Start; 59% Caucasian; 53% boys; Mage = 3.97 years). Teachers rated ADHD symptom levels four times throughout one academic year. RESULTS: Results showed a course of increasing inattention that decelerated over time and steadily increasing hyperactivity/impulsivity. Group-based finite mixture modeling revealed three trajectories of inattention: stable low (57%), change (32%), and stable high (11%), as well as three trajectories of hyperactivity/impulsivity: stable low (63%), increasing (26%), and stable high (11%). Compared to children with increasing or changing symptoms levels, children with stable high levels were more impaired and children with stable low symptom levels were less impaired. CONCLUSION: Findings suggest a "wait and see" approach to treatment may miss an important opportunity for early intervention.

Meeting a Physical Activity Guideline in Preschool and School Readiness: A Program Evaluation.

This study evaluates if the Kiddie Children and Teachers on the Move physical activity (PA) program improves the proportion of days meeting the Institute of Medicine (IOM) PA guideline, and whether meeting the guideline is correlated with improvement in school readiness. Thirteen Head Start-affiliated pre-kindergarten classrooms participated in this study. Minutes per hour of moderate-to-vigorous physical activity (MVPA) and proportion of days meeting the IOM PA guideline were examined across three types of intervention days: days during a non-intervention period, non-program days during the intervention period, and program days during the intervention period. Children displayed increasingly more MVPA and a greater proportion of days meeting the IOM guideline from non-intervention days to non-program days, and from non-program days to program days. Proportion of days meeting the guideline significantly predicted improvement in school readiness in five of six domains. Examination of program fidelity indicated the program was run with high fidelity.

Moderate-to-vigorous physical activity and processing speed: predicting adaptive change in ADHD levels and related impairments in preschoolers.

BACKGROUND: Preschool ADHD symptoms have predictive utility for later presence of ADHD diagnoses (Harvey, Youngwirth, Thakar, & Errazuriz, 2009, Journal of Consulting and Clinical Psychology, 77, 349; Lahey et al., 2004, American Journal of Psychiatry, 161(11), 2014), yet some level of inattention, hyperactivity, and impulsivity are present even in typically developing preschoolers. Physical activity (PA) is known to have a broad spectrum of positive effects on the brain in school-age typically developing children (Centers for Disease Control and Prevention, 2010, The association between school based physical activity, including physical education, and academic performance. Atlanta, GA: U.S. Department of Health and Human Services), including functions impaired by ADHD (Halperin, Berwid, & O'Neill, 2014, Child and Adolescent Psychiatric Clinics of North America, 23, 899), yet links between PA and ADHD levels and impairments have rarely been studied in either typically developing or at-risk preschool children. Importantly, impaired processing speed (PS), though not a symptom of ADHD, is a robust neuropsychological correlate (Willcutt & Bidwell, 2011, Treating attention deficit hyperactivity disorder: Assessment and intervention in developmental context. Kingston, NJ: Civic Research Institute) that may indicate additional risk for ADHD. Hence, we examined whether baseline PS moderates the association between preschoolers' PA, specifically moderate-to-vigorous PA (MVPA), and changes in ADHD levels and related behaviors. METHOD: Eighty-five preschoolers (49.4% female; Mage  = 4.14, SDage  = .64) were drawn from a larger study of the effects of the Kiddie Children and Teachers (CATs) on the Move PA program on school readiness. The sample was largely Head Start eligible (68.2%) and ethnically diverse. Hierarchical regressions were utilized to examine links between MVPA, averaged over a school year, and changes in inattention (IA), hyperactivity/impulsivity (HI), oppositional behaviors, moodiness, and peer functioning, and whether these associations varied based on baseline PS. RESULTS: Results indicated that for IA, HI, and peer functioning, higher amounts of MVPA were associated with greater adaptive change for those with lower (but not higher) levels of PS. CONCLUSIONS: Preschool MVPA may be a viable method of reducing ADHD levels and impairments for those with lower PS.

Effects of Childhood and Adult Persistent Attention-Deficit/Hyperactivity Disorder on Risk of Motor Vehicle Crashes: Results From the Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: To determine motor vehicle crash (MVC) risk in adults with a history of childhood attention-deficit/hyperactivity disorder (ADHD) and persistent ADHD symptoms. METHOD: Participants with (n = 441) and without (n = 239; local normative comparison group) childhood ADHD from the Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) Study were included. Participants provided self-reports on total number of MVCs they had been involved in and the time of licensure. Driving experience was estimated as the number of months since licensure. Total number of MVCs by adulthood was regressed on baseline ADHD status adjusting for sex, age at follow-up, driving experience, baseline oppositional defiant disorder/conduct disorder comorbidity, baseline household income level, adult oppositional defiant disorder/conduct disorder symptoms, adolescent and adult substance use, and adult antisocial personality disorder symptoms. We repeated the analysis using adult ADHD status (persistent versus desistant versus local normative comparison group) and symptom level as the predictor variables. Results are presented as incidence rate ratio (IRR) and CI. RESULTS: Childhood ADHD was associated with a higher number of MVCs (IRR = 1.45, CI = 1.15-1.82), and adult ADHD symptom persistence was associated with more MVCs than desistance (IRR = 1.46, CI = 1.14-1.86). ADHD desistance was not associated with a significantly increased risk for MVCs compared with the local normative comparison group (IRR = 1.24, CI = 0.96-1.61). Concurrent symptoms of inattention and hyperactivity/impulsivity predicted MVC risk. CONCLUSION: Persistence of ADHD into adulthood is a stronger predictor of MVC risk than childhood-limited ADHD. CLINICAL TRIAL REGISTRATION INFORMATION: Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study; https://clinicaltrials.gov; NCT00000388.

Factors Relating to the Presence and Modifiability of Self-Perceptual Bias Among Children with ADHD.

Past research raises concerns about whether the presence of self-perceptual biases among children with attention-deficit/hyperactivity disorder (ADHD) interferes with accurate assessment and/or diminishes treatment response. Yet, it remains unclear whether self-perceptual bias is a construct that can be modified. The current study examines individual differences in how children with ADHD (n = 178) display and modify their self-perceptions of competence in the presence of an external motivator for self-perceptual accuracy. Participants were grouped based on the presence and modifiability of their self-perceptual biases across three experimental conditions. Results demonstrate that the presence and modifiability of participants' self-perceptual biases across conditions was associated with adjustment (i.e., externalizing and internalizing problems) and cognitive functioning. Findings suggest multiple factors may be associated with self-perceptual bias (e.g., self-protection and cognitive impairment), and that these factors may differ across children. Implications for intervention, including whether assessment and treatment can be improved, are discussed.

Adult substance use as a function of growth in peer use across adolescence and young adulthood in the context of ADHD: Findings from the MTA.

Peer substance use strongly predicts adolescent and young adult substance use, but its role in ADHD-related risk for substance use, especially in adulthood, is unclear. In a sample with (n = 516) and without (n = 249) childhood ADHD from the Multimodal Treatment Study of ADHD, we compared associations between change over time in peer substance use and personal substance use (alcohol, cigarettes, marijuana, illicit drugs) from age 14-26 by ADHD status. Developmentally typical peer substance use trajectories across adolescence and young adulthood coincided with similar changes in personal use - but less so for those with ADHD histories. Concurrent associations between peer and personal use in adolescence and young adulthood were weaker for those with ADHD histories than without for commonly used substances (alcohol, marijuana). Prospectively, escalating peer use during adolescence forecasted adulthood declines for commonly used substances, yet persistently high substance use at age 25, regardless of ADHD history. In the reverse direction, growth in adolescent substance use predicted developmentally normative young adult declines in peer use - but for the ADHD group, adolescent heavy drinking predicted increases in young adult peer use. Findings suggest that individuals with ADHD may have difficulty emulating their peers' developmentally normative declines in substance use, highlighting the importance of social factors when treating young adults affected by ADHD and substance abuse.

Distinct Methods for Assessing Compliance With a Physical Activity Guideline for Children in Preschools.

BACKGROUND: According to the US Institute of Medicine guideline, preschool-aged children should participate in ≥15 minutes of physical activity (PA) per hour or 3 hours per day over 12 hours. Examinations of PA guideline compliance to date averaged time spent in PA over several days; however, children could exceed the guideline on some days and not on others. Therefore, this cross-sectional study examined PA guideline compliance in preschool children based on number of minutes per hour (average method) and percentage of days the guideline was met (everyday method). METHODS: PA was measured by accelerometry during the preschool day for up to 10 days in 177 children (59.3% males, Mage = 4.23). Minutes per hour and percentage of time in light, moderate to vigorous, and total PAs were calculated. Percentage of days in compliance was determined by number of days in compliance (defined as the child active on average ≥15 min/h) divided by total accelerometer days. RESULTS: Children engaged in PA, on average, 17.01 minutes per hour, suggesting that on average, children are meeting the guideline. However, children were only in compliance with the PA guideline 62.41% of assessment days. CONCLUSIONS: Findings demonstrate the importance of examining compliance with both the average and everyday methods to more accurately portray level of Institute of Medicine PA guideline compliance.

Depression and ADHD-Related Risk for Substance Use in Adolescence and Early Adulthood: Concurrent and Prospective Associations in the MTA.

Childhood attention-deficit/hyperactivity disorder (ADHD) is prospectively linked to substance use and disorder. Depression emerging in adolescence is an understudied risk factor that may explain some of this risk. In the present study, we considered mediating and moderating roles of adolescent depression in explaining this association by using longitudinal data from the prospective 16-year follow-up of the Multimodal Treatment Study of ADHD (MTA). Participants were 547 children diagnosed with DSM-IV ADHD Combined Type, and 258 age- and sex-matched comparison children. In adolescence, depressive symptoms did not exacerbate effects of childhood ADHD on any substance use. For both groups, time-varying and average depressive symptoms were associated with more frequent use of all substances. Prospectively, we found no evidence of depression mediation to adult substance use. However, adolescent depression moderated the association between childhood ADHD and adult marijuana use. Although adults without ADHD histories used marijuana more frequently if they had elevated depressive symptoms in adolescence, marijuana use by adults with ADHD histories was independent of their adolescent depression. In adulthood, depression diagnoses and ADHD persistence continued to operate as independent, additive correlates of substance use risk. Our findings suggest a circumscribed role for depression in substance use risk that adds to, but does not alter or explain, ADHD-related risk.

Does a social self-perceptual bias mask internalizing symptoms in children with attention-deficit/hyperactivity disorder?

BACKGROUND: Children with attention-deficit/hyperactivity disorder (ADHD) often present with additional psychiatric conditions. Comorbidity is associated with poorer long-term outcomes, highlighting the need for effective assessment and intervention. However, self-perceptual biases may mask the presence of symptoms for a subgroup of children with ADHD. This study examined the role of social self-perceptual biases in children with ADHD versus control children on self-reports of loneliness, and depressive and anxious symptoms. METHODS: The research question was examined in two samples. Sample 1 consisted of 7.7-12.8-year-old boys with ADHD (n = 199) and control boys (n = 74); Sample 2 consisted of 7.7-11.4-year-old boys and girls with ADHD (n = 178) and control children (n = 86). Across samples, children reported social competence and symptoms of anxiety and depression. Child-reported loneliness was examined in Sample 1. A social competence discrepancy score (difference between self-report and teacher-report) was used as an indicator of social self-perceptual bias. RESULTS: Hierarchical multiple regression analyses tested social self-perceptual bias as a suppressor variable. The magnitude of the associations between ADHD and self-reported feelings of depression, anxiety and loneliness was greater when social self-perceptual bias was included in models as compared to models that did not include social self-perceptual bias (ΔR2 s range = 0.04-0.19). CONCLUSIONS: Findings across both samples suggest that social self-perceptual biases may mask internalizing symptom severity on self-reports for individuals who overestimate their social competence. More research is needed to determine the best approach to assessing internalizing problems among children with ADHD.

Cigarette Smoking Progression Among Young Adults Diagnosed With ADHD in Childhood: A 16-year Longitudinal Study of Children With and Without ADHD.

INTRODUCTION: Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for smoking cigarettes, but there is little longitudinal research on the array of smoking characteristics known to be prognostic of long-term smoking outcomes into adulthood. These variables were studied into early adulthood in a multisite sample diagnosed with ADHD combined type at ages 7-9.9 and followed prospectively alongside an age- and sex-matched local normative comparison group (LNCG). METHODS: Cigarette smoking quantity, quit attempts, dependence, and other characteristics were assessed in the longitudinal Multimodal Treatment Study of Children with ADHD (MTA) eight times to a mean age of 24.9 years: ADHD n = 469; LNCG n = 240. RESULTS: In adulthood, the ADHD group had higher rates of daily cigarette smoking, one or more quit attempts, shorter time to first cigarette of the day, and more severe withdrawal than the LNCG. The ADHD group did not appear to have better smoking cessation rates despite a higher proportion quitting at least once. Smoking quantity and nicotine dependence did not differ between groups. The ADHD group reported younger daily smoking onset and faster progression from smoking initiation to daily smoking across assessments. Finally, ADHD symptom severity in later adolescence and adulthood was associated with higher risk for daily smoking across assessments in the ADHD sample. CONCLUSIONS: This study shows that ADHD-related smoking risk begins at a young age, progresses rapidly, and becomes resistant to cessation attempts by adulthood. Prevention efforts should acknowledge the speed of uptake; treatments should target the higher relapse risk in this vulnerable population. IMPLICATIONS: Although childhood ADHD predicts later smoking, longitudinal studies of this population have yet to fully characterize smoking behaviors into adulthood that are known to be prognostic of long-term smoking outcome. The current study demonstrates earlier and faster progression to daily smoking among those with a childhood ADHD diagnosis, as well as greater risk for failed quit attempts. Prevention efforts should address speed of smoking uptake, while treatments are needed that address smoking relapse risk. The current study also demonstrates ADHD symptom severity over development increases daily smoking risk, implicating the need for continuous ADHD symptom management.

Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study.

BACKGROUND: Inconsistent findings exist regarding long-term substance use (SU) risk for children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The observational follow-up of the Multimodal Treatment Study of Children with ADHD (MTA) provides an opportunity to assess long-term outcomes in a large, diverse sample. METHODS: Five hundred forty-seven children, mean age 8.5, diagnosed with DSM-IV combined-type ADHD and 258 classmates without ADHD (local normative comparison group; LNCG) completed the Substance Use Questionnaire up to eight times from mean age 10 to mean age 25. RESULTS: In adulthood, weekly marijuana use (32.8% ADHD vs. 21.3% LNCG) and daily cigarette smoking (35.9% vs. 17.5%) were more prevalent in the ADHD group than the LNCG. The cumulative record also revealed more early substance users in adolescence for ADHD (57.9%) than LNCG (41.9%), including younger first use of alcohol, cigarettes, marijuana, and illicit drugs. Alcohol and nonmarijuana illicit drug use escalated slightly faster in the ADHD group in early adolescence. Early SU predicted quicker SU escalation and more SU in adulthood for both groups. CONCLUSIONS: Frequent SU for young adults with childhood ADHD is accompanied by greater initial exposure at a young age and slightly faster progression. Early SU prevention and screening is critical before escalation to intractable levels.

Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression.

BACKGROUND: The Multimodal Treatment Study (MTA) began as a 14-month randomized clinical trial of behavioral and pharmacological treatments of 579 children (7-10 years of age) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type. It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates (258 without ADHD) added as a local normative comparison group (LNCG), with assessments 2-16 years after baseline. METHODS: Primary (symptom severity) and secondary (adult height) outcomes in adulthood were specified. Treatment was monitored to age 18, and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication (Consistent, Inconsistent, and Negligible). For the follow-up, hypothesis-generating analyses were performed on outcomes in early adulthood (at 25 years of age). Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit (symptom reduction) and cost (height suppression) associated with extended use of medication. RESULTS: For ratings of symptom severity, the ADHD-LNCG comparison was statistically significant for the parent/self-report average (0.51 ± 0.04, p < .0001, d = 1.11), documenting symptom persistence, and for the parent/self-report difference (0.21 ± 0.04, p < .0001, d = .60), documenting source discrepancy, but the comparisons of naturalistic subgroups reflecting medication effects were not significant. For adult height, the ADHD group was 1.29 ± 0.55 cm shorter than the LNCG (p < .01, d = .21), and the comparisons of the naturalistic subgroups were significant: the treated group with the Consistent or Inconsistent pattern was 2.55 ± 0.73 cm shorter than the subgroup with the Negligible pattern (p < .0005, d = .42), and within the treated group, the subgroup with the Consistent pattern was 2.36 ± 1.13 cm shorter than the subgroup with the Inconsistent pattern (p < .04, d = .38). CONCLUSIONS: In the MTA follow-up into adulthood, the ADHD group showed symptom persistence compared to local norms from the LNCG. Within naturalistic subgroups of ADHD cases, extended use of medication was associated with suppression of adult height but not with reduction of symptom severity.

Aerobic Fitness and Inhibition in Young Children: Moderating Roles of ADHD Status and Age.

We examined the relation between aerobic fitness and inhibition in young children with and without attention deficit hyperactivity disorder (ADHD)-risk status. Participants (91 ADHD risk, 107 typically developing, Mage = 6.83, 53.5% male, 68.2% Caucasian) completed an assessment of aerobic fitness and a flanker task requiring variable amounts of inhibitory control. Aerobic fitness was positively associated with inhibition. When inhibitory control demands were largest, the relation varied as a function of ADHD-risk status such that the link between aerobic fitness and inhibition was significant only for children with ADHD risk. The relation between aerobic fitness, status, and inhibition was further moderated by age for interference control. Specifically, the positive relation between aerobic fitness and interference control was only significant for younger children with ADHD risk. A fitness-cognition link appears in young childhood that seems particularly salient for those in the earliest school years with ADHD risk. The findings extend work on typically developing children and suggest that exploring aerobic fitness interventions to address executive function impairments in children at risk for ADHD is warranted.

Exploration of the Factor Structure of ADHD in Adolescence through Self, Parent, and Teacher Reports of Symptomatology.

Factor analytic studies of attention-deficit/hyperactivity disorder (ADHD) in children and adults have shown that second-order and bifactor models better represent ADHD symptoms than two- or three-factor models, yet there is far less evidence for a bestfitting model of ADHD in adolescence. Thus, the current study examined the factor structure of ADHD in adolescence and further evaluated the external validity of the best fitting model. Participants were 588 adolescents (22 % female; 366 with a childhood ADHD diagnosis; mean age 15.9 years) from the 8-year assessment of the Multimodal Treatment Study of Children with ADHD (MTA). ADHD symptoms were assessed via adolescent self-report, parent report, and teacher report on the SNAP-IV scale. Potential factor structures for the 18 symptoms of ADHD were tested for each informant, which included traditional one-factor, two-factor, and three-factor models of ADHD, as well as second-order factor (specific factors loading onto general factor) and bifactor (items loading onto both specific and general factors) models. Unique associations between external criteria and the identified factors of each informant's best fitting model were examined. Although several of the proposed models exhibited good fit, the second-order two-factor model best accounted for ADHD in adolescence according to self-report and parent report, and the second-order three-factor model was optimal according to teacher report. Several key measurement issues emerged for the hierarchical bifactor models, such as numerous Heywood cases and out-of-bound parameter estimates, which rendered them unfit as optimal representations of ADHD in adolescence. These findings and the implications of the best fitting model of ADHD in adolescence suggest that a possible reorganization of this disorder may eventually aid clinicians in the accurate diagnosis of ADHD in adolescents.

Functional Adult Outcomes 16 Years After Childhood Diagnosis of Attention-Deficit/Hyperactivity Disorder: MTA Results.

OBJECTIVE: To compare educational, occupational, legal, emotional, substance use disorder, and sexual behavior outcomes in young adults with persistent and desistent attention-deficit/hyperactivity disorder (ADHD) symptoms and a local normative comparison group (LNCG) in the Multimodal Treatment Study of Children with ADHD (MTA). METHOD: Data were collected 12, 14, and 16 years postbaseline (mean age 24.7 years at 16 years postbaseline) from 476 participants with ADHD diagnosed at age 7 to 9 years, and 241 age- and sex-matched classmates. Probands were subgrouped on persistence versus desistence of DSM-5 symptom count. Orthogonal comparisons contrasted ADHD versus LNCG and symptom-persistent (50%) versus symptom-desistent (50%) subgroups. Functional outcomes were measured with standardized and demographic instruments. RESULTS: Three patterns of functional outcomes emerged. Post-secondary education, times fired/quit a job, current income, receiving public assistance, and risky sexual behavior showed the most common pattern: the LNCG group fared best, symptom-persistent ADHD group worst, and symptom-desistent ADHD group between, with the largest effect sizes between LNCG and symptom-persistent ADHD. In the second pattern, seen with emotional outcomes (emotional lability, neuroticism, anxiety disorder, mood disorder) and substance use outcomes, the LNCG and symptom-desistent ADHD group did not differ, but both fared better than the symptom-persistent ADHD group. In the third pattern, noted with jail time (rare), alcohol use disorder (common), and number of jobs held, group differences were not significant. The ADHD group had 10 deaths compared to one death in the LNCG. CONCLUSION: Adult functioning after childhood ADHD varies by domain and is generally worse when ADHD symptoms persist. It is important to identify factors and interventions that promote better functional outcomes.

Using Physical Activity to Manage ADHD Symptoms:The State of the Evidence.

This article summarizes the evidence for management of attention-deficit/hyperactivity disorder (ADHD) using chronic aerobic physical activity (PA). Known studies comparing chronic aerobic PA to at least one control group are listed; uncontrolled studies and studies of non-aerobic PA are not considered. Key challenges to conducting chronic PA studies with children and youth with ADHD are summarized. After condensing information from widely varying studies, measures, and research designs, conclusions are stated in broad brush stroke terms. Preliminary evidence supports PA as beneficial for ADHD symptoms, executive function, and motor abilities. Social, emotional, and behavioral outcomes also may benefit. The preliminary state of the evidence supports PA as an adjunctive treatment for ADHD at this time, but the body and sophistication of the research to date is insufficient at present to support PA as a stand-alone treatment. Critical directions for future research are discussed.