Parental perspectives on attention-deficit/hyperactivity disorder treatments for children.

This study investigated parental perspectives and experiences on the evaluation and treatment process associated with attention-deficit/hyperactivity disorder (ADHD). Five hundred sixty-eight parents of youth 2-28 years-old (M = 9.37; SD = 4.11) diagnosed with ADHD responded to a 14-item online survey about their child's diagnosis and treatment. Parents reported that they had tried an average of 4.49 interventions (SD = 2.63). Parents further shared factors in treatment selection, most helpful parenting strategies, and preferences for types of treatments and treatment targets. A majority of parents reported incorporating many non-traditional strategies (e.g., exercise, healthy eating, outdoor activities) with goals of improving their child's coping skills, study habits, and anger management. The findings show that treatment choices were often selected based on trust in the provider, research support, and the child's preference. Given parental preferences for non-traditional strategies, treatment development efforts should consider these strategies as a component of a broader multimodal treatment approach to ADHD.

Evaluation of underlying mechanisms in the link between childhood ADHD symptoms and risk for early initiation of substance use.

Although there has been support for attention-deficit/hyperactivity disorder (ADHD) as a risk for early substance use, this link is not fully established or understood. Furthermore, the potential mechanisms explaining these associations are unclear. The current study examined peer rejection, school bonding, and internalizing problems as potential mediators of the association between childhood ADHD symptoms and risk for early initiation of substance use. The sample included a control group of 126 students with problematic aggression (79% African American, 66% male) from an intervention study following children from fourth to ninth grade. Results suggested that ADHD symptoms follow a path to early initiation of tobacco use through the combined effects of peer rejection and internalizing problems as well as through internalizing problems alone. ADHD symptoms were also associated with the cubic slope of marijuana use initiation, such that increased ADHD symptoms were associated with a strong cubic trend (e.g., a more rapid acceleration of risk for initiation). ADHD symptoms were not associated with risk for early initiation of alcohol use. Identification of important vulnerability factors in children with ADHD symptoms highlight the need for primary prevention and psychological interventions that target these factors and decrease the likelihood of early tobacco and marijuana use initiation.

THE RELATIONSHIP BETWEEN MALE-PERPETRATED INTERPARENTAL AGGRESSION, PATERNAL CHARACTERISTICS, AND CHILD PSYCHOSOCIAL FUNCTIONING.

It is well established that children in homes where interparental violence is present are at increased risk for psychosocial (i.e., internalizing, externalizing, and attention) difficulties. However, previous studies have provided a limited view on the variety of factors that commonly co-occur in these environments (e.g., other characteristics of the parents and family) and how they may collectively impact children. Knowing this information could have implications for parental interventions aimed at preventing the continuation or initiation of psychosocial problems in children. Thus, the present study simultaneously examined the association between father-perpetrated interparental aggression, father characteristics, and child psychosocial functioning in a sample of 145 men arrested for domestic violence. Results showed that of all the variables examined, paternal antisocial personality traits and interpersonal hostility were uniquely associated with overall child psychosocial impairment, externalizing problems, and attention problems. Implications for intervention programs are discussed.

Associations between effortful control, psychological control and proactive and reactive aggression.

The current study examined relations between effortful control (ones ability to focus and shift attention in an adaptive manner), psychological control (caregiver attempts to manipulate the child's internal world) and proactive and reactive aggression. Participants were 69 children (54% male) ranging from 9 to 12 years of age (M = 10.35, SD = 1.14) and their primary caregivers from a community-recruited sample. Results indicate that psychological control and effortful control interacted and contributed to proactive aggression. At high levels of effortful control psychological control was positively associated with proactive aggression, whereas at low levels of effortful control psychological control was unrelated to proactive aggression. In contrast, although both effortful control and psychological control were correlated with reactive aggression, only effortful control was uniquely negatively associated with reactive aggression. Implications for prevention and intervention are discussed.

Sex differences in the functional neuroanatomy of working memory in adults with ADHD.

OBJECTIVE: Although attention deficit hyperactivity disorder (ADHD) in adults is associated with significant morbidity and dysfunction and afflicts both sexes, relatively few imaging studies have examined female subjects and none have had sufficient power to adequately examine sex differences. The authors examined sex differences in the neural functioning of adults with ADHD during performance of a verbal working memory task. METHOD: The participants were 44 adults with ADHD matched on age, sex, and estimated IQ to 49 comparison subjects. Accuracy and reaction time on an N-back task were measured to assess working memory. The blood-oxygen-level-dependent functional MRI response was used as a measure of neural activity. RESULTS: A group-by-sex analysis of variance showed no between-group differences in either reaction time or percent correct for the working memory task. For both sexes combined, the adults with ADHD showed less activity than comparison subjects in prefrontal regions. However, sex-by-group analyses revealed an interaction, such that male ADHD subjects showed significantly less activity in right frontal, temporal, and subcortical regions and left occipital and cerebellar regions relative to male comparison subjects, whereas female ADHD subjects showed no differences from female comparison subjects. Exploratory correlation analyses revealed negative associations between working-memory-related activation and number of hyperactive symptoms for men and number of inattentive symptoms for women. CONCLUSIONS: Male but not female adults with ADHD showed significantly altered patterns of neural activity during a verbal working memory task. Men and women showed different associations between neural activity and ADHD symptoms.

Concordance between cigarette smoking and the modified Fagerström Tolerance Questionnaire in controlled studies of ADHD.

Our objective was to compare scores on a smoking questionnaire to a diagnosis of cigarette smoking. As part of follow-ups in studies of ADHD, we assessed for cigarette smoking using structured interviews and the modified Fagerstrom Tolerance Questionnaire (mFTQ). Data were obtained from 162 subjects (mean = 19.2 yrs). ROC analysis and kappa coefficients revealed that a cutoff score of 3 on the mFTQ showed the strongest agreement with a full diagnosis of cigarette smoking (kappa = 0.68). Clinicians and researchers using the mFTQ in adolescents and young adults should consider a cutoff score of 3 to be indicative of cigarette smoking.

Cigarette smoking associated with attention deficit hyperactivity disorder.

OBJECTIVE: To evaluate the association between attention deficit hyperactivity disorder (ADHD) and severity of physical dependence on nicotine in a controlled study of adolescents and young adults with ADHD. STUDY DESIGN: In controlled longitudinal family studies of ADHD, we examined self-reports on the modified Fagerström Tolerance Questionnaire (mFTQ) for degrees of physical dependence on nicotine. RESULTS: We obtained mFTQ data from 80 ADHD probands and 86 control probands (mean age, 19.2 years). The smokers with ADHD had significantly higher scores on the mFTQ, indicative of more severe physical dependence on nicotine. Similarly, in current smokers, a positive linear relationship was found between mFTQ score and both inattentive and hyperactive ADHD symptoms. Environmental factors, such as current parental smoking, peer smoking, and living with a smoker, all increased the risk for smoking in those with ADHD compared with controls. CONCLUSION: Male and female smokers with ADHD manifest more severe physical dependence on smoking compared with controls. Important environmental factors appear to add to the risk of smoking associated with ADHD.