Developing and implementing a public health co-research program for Special Olympics athletes.

Individuals with intellectual and developmental disabilities are often the subject of research while rarely being included in formulating research questions, planning studies, and making decisions related to protocols and analyses. In turn, most research regarding people with intellectual and developmental disabilities is not carried out by researchers with disabilities themselves. We developed a co-research training program where individuals with intellectual and developmental disabilities were taught about research. The program was designed using best practices and existing materials resources. We recruited four participants from Special Olympics Massachusetts and conducted the training in the Fall of 2021. We evaluated the program with surveys, qualitative interviews, and tracking continued involvement of co-researchers in research projects. Participants were partners in the evaluation process. The training program was six sessions and included lessons about why research is important, how to conduct research, and an experiential learning project where co-researchers conducted a study of their coaches. The program was well received by participants, and one year later they were still involved with research projects. A co-researcher training focused on public health for Special Olympics athletes is feasible and beneficial for athletes, researchers, and Special Olympics programs. However, there are still barriers like a lack of funding and time, that need to be addressed to ensure wide program success.

Co-research offers people with intellectual and developmental disabilities an opportunity to conduct research, rather than be the subjects. We developed a six-session co-researcher training in 2021 focused on public health for Special Olympics athletes. We found that co-research is feasible and rewarding for people with intellectual and developmental disabilities. Additional co-research activities and evaluation are needed. Special Olympics already conducts public health research activities and co-research training could be incorporated.

Are subsyndromal manifestations of attention deficit hyperactivity disorder morbid in children? A systematic qualitative review of the literature with meta-analysis.

We conducted a qualitative review (n = 15 manuscripts) and meta-analysis (n = 9 manuscripts) of the extant literature to evaluate the prevalence and morbidity of subthreshold Attention Deficit Hyperactivity Disorder (ADHD). Our qualitative review showed that a sizable minority (mean: 17.7%) of clinically referred and non-referred children met a priori definitions of subthreshold ADHD. Those affected exhibited significantly higher rates of family dysfunction, cognitive impairment, executive dysfunction, interpersonal and school deficits, temperament problems, psychiatric comorbidity, and juvenile delinquency compared to children with no ADHD symptoms. These deficits were highly consistent with those observed in children with full threshold ADHD. These findings indicate that children with subthreshold ADHD symptoms are at significantly greater risk for negative outcomes in a wide range of non-overlapping functional domains worthy of further clinical and scientific consideration.

Further Evidence of Morbidity and Dysfunction Associated With Subsyndromal ADHD in Clinically Referred Children.

BACKGROUND: While the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) have evolved over the years, some children with impairing ADHD symptoms fail to meet the full diagnostic threshold for the disorder. The main aim of this study was to evaluate the morbidity and dysfunction of subsyndromal ADHD in the clinical setting. METHODS: Subthreshold and full ADHD subjects were derived from consecutive referrals (n = 2,947) to a pediatric psychopharmacology program at a major academic center. Subjects were diagnosed with subthreshold ADHD if they met at least 1 of the following criteria: (1) their age at onset for ADHD was ≥ 7 years; (2) they had ≥ 5 but < 8 ADHD symptoms using the DSM-III-R or ≥ 4 but < 6 ADHD inattentive or hyperactive/impulsive symptoms using the DSM-IV. Healthy controls were derived from 2 identically designed longitudinal case-control studies of youth with and without ADHD. Psychiatric assessments relied on clinical structured interviews and measures of psychopathology, social functioning, cognitive ability, and academic achievement. RESULTS: Of the 1,931 children diagnosed with ADHD, 140 (7%) were diagnosed with subthreshold ADHD. 48% of subthreshold ADHD subjects had an age at onset ≥ 7 years, and 73% had insufficient symptoms. Reanalysis of findings using DSM-5 criteria showed that only 21% of our subthreshold ADHD subjects would have met DSM-5 criteria based on age at onset of < 12 years, while 79% would have maintained their subthreshold diagnoses. Subjects with subthreshold ADHD differed from controls in the mean number of comorbid disorders; rates of mood, anxiety, and elimination disorders (all P < .001) and substance use disorders (P < .05); scores on all Child Behavior Checklist clinical and social functioning scales; scores on 7 of the 10 Social Adjustment Inventory for Children and Adolescents scales; rates of requiring extra help in school and being placed in a special class; and scores on 4 of the 5 Wechsler Intelligence Scale for Children-Revised Version subscales (excluding Digit Span) as well as in Freedom from Distractibility Index score (P < .001). Subthreshold and full ADHD subjects had similarly elevated Global Assessment of Functioning scores versus controls (P < .001), but subjects with subthreshold ADHD had fewer perinatal complications and better family functioning scores and were more likely to be female and older and to come from families of higher socioeconomic status than subjects with full ADHD. CONCLUSIONS: Clinically referred children failing to meet full-threshold diagnosis for ADHD due to either insufficient symptoms or later age at onset have patterns of clinical features highly similar to those with the full syndrome. These results extend to previously reported findings in nonreferred samples documenting the high morbidity and disability associated with subthreshold ADHD.

Working memory and executive function decline across normal aging, mild cognitive impairment, and Alzheimer's disease.

Alzheimer's disease (AD) is a progressive neurodegenerative disease marked by deficits in episodic memory, working memory (WM), and executive function. Examples of executive dysfunction in AD include poor selective and divided attention, failed inhibition of interfering stimuli, and poor manipulation skills. Although episodic deficits during disease progression have been widely studied and are the benchmark of a probable AD diagnosis, more recent research has investigated WM and executive function decline during mild cognitive impairment (MCI), also referred to as the preclinical stage of AD. MCI is a critical period during which cognitive restructuring and neuroplasticity such as compensation still occur; therefore, cognitive therapies could have a beneficial effect on decreasing the likelihood of AD progression during MCI. Monitoring performance on working memory and executive function tasks to track cognitive function may signal progression from normal cognition to MCI to AD. The present review tracks WM decline through normal aging, MCI, and AD to highlight the behavioral and neurological differences that distinguish these three stages in an effort to guide future research on MCI diagnosis, cognitive therapy, and AD prevention.