Journal of Attention Disorders最新文献

Objective: The effectiveness of behavioural interventions to improve sleep in children with ADHD has been demonstrated, although most treatments are conducted in-person, with limited evidence for paediatric telehealth approaches. Study 1 is a randomised controlled trial evaluating the ADHD Sleeping Sound^© intervention to compare outcomes between in-person and telehealth modalities. Study 2 examined whether baseline sleep problems and treatment response were predicted by baseline symptom presentation, attachment security, and family functioning.

Method: Children aged 5 to 12 years (65.4% male) with ADHD received either in-person (n = 40) or telehealth (n = 38) treatment. Subjective (Children's Sleep Habits Questionnaire) and objective (actigraphy) sleep variables were assessed at baseline, post-intervention (1 week), and follow-up (3 months).

Results: As expected, subjectively measured sleep disturbance significantly improved post-treatment, with no significant difference in rate of change between in-person and telehealth modalities. For Study 2, baseline measures comprised the Conners CBRS, Attachment Insecurity Screening Inventory, Security Scale, and Family Assessment Device. Latent growth curve modelling analysed data via intention-to-treat (primary) and per protocol (secondary) methods. Higher attachment insecurity and lower family functioning were significantly associated with greater (subjective) baseline sleep problems. Additionally, attachment security predicted changes in sleep duration over time, highlighting the importance of considering relational family factors when designing sleep interventions.

Conclusion: Telehealth ADHD sleep interventions represent a promising approach to enhancing health equity and access for families experiencing geographical and/or structural barriers to in-person treatment.Trial RegistrationANZCTR, ACTRN12621001681842. Registered 9 December 2021 - https://anzctr.org.au/ACTRN12621001681842.aspx.

Objective: The goal of this review was to more clearly understand what encourages or discourages treatment adherence in individuals with ADHD across different points in life. Instead of simply listing barriers, we set out to identify true, evidence-based strategies that could help patients and clinicians maximize long-term dedication to care.

Method: Following PRISMA guidelines, we systematically reviewed 52 peer-reviewed articles between 2014 and 2024. The primary sources used were five electronic databases (Scopus, Science Direct, PubMed, and Taylor & Francis). The studies included heterogeneous age groups-children, adolescents, and adults-and had diverse methodologies ranging from randomized controlled trials to qualitative interviews.

Results: Adherence to treatment for ADHD remains a problem, especially among teenagers. We organized the influencing factors into five main areas: sociodemographic, psychological/clinical features, medication-related issues, beliefs and attitudes, and broader systemic or environmental challenges. Conversely, interventions like pharmacological strategies, digital interventions and mobile-based reminders, psychoeducational and behavioral approaches, multimodal and long-term interventions, and consent-based strategies were all linked to improved adherence.

Conclusion: Improving adherence in ADHD requires a multifaceted, personalized approach that considers clinical, psychological, and contextual factors. Interventions that integrate pharmacologic and psychosocial strategies, while addressing barriers such as stigma, system fragmentation, and cultural mismatch, are essential to achieving better treatment outcomes and quality of life for individuals with ADHD.

Objective: ADHD and obesity frequently co-occur in children, yet differences in visceral adipose tissue (VAT) distribution between co-occurring ADHD + Obesity and obesity alone are incompletely characterized. This study compared depot-specific adiposity between these groups.

Methods: This cross-sectional analysis (December 2022-2024, Beijing Children's Hospital) included 306 children (6-12 years) stratified into: ADHD + Obesity (n = 65), obesity-only (n = 77), and Control (n = 164). Body composition was assessed using bioelectrical impedance. Group comparisons for depot-specific adiposity and metabolic markers were performed using multivariable linear regression, adjusting for age, sex, and BMI z-score.

Results: The ADHD + Obesity group exhibited significantly greater visceral adiposity than the Obesity-only group, as reflected by a 16.84 cm² larger visceral fat area (VFA) and a 1.03 kg/m² higher fat mass index (FMI). The ADHD + Obesity group also showed a more adverse metabolic profile, including elevated liver enzymes and fasting glucose.

Conclusion: Excess visceral adiposity represents a distinct phenotypic feature of ADHD + Obesity. These findings support the need for integrated clinical management addressing both neurobehavioral and metabolic domains and inform future mechanistic investigations.

Objective: Discourse-level language abilities are critical for successful participation in social, academic, and vocational pursuits. These abilities encompass both narrative and non-narrative genres, each serving distinct communicative functions. Narrative discourse involves spoken accounts of events or experiences, typically with a setting, characters, and a sequence of actions. Non-narrative discourse includes genres like explanations, arguments, and descriptions that convey information or ideas without a temporal structure. The aim of this review was to synthesise extant literature on discourse abilities of children and adults with ADHD across these genres.

Methods: Systematic searches were conducted via CINAHL, PsycINFO, Medline, and ProQuest. The review adhered to PRISMA guidelines and was registered with PROSPERO [CRD 42022377007].

Results: Thirty-nine studies were included in our review. Most studies investigated the narrative abilities of children with ADHD. ADHD was associated with atypical verbal output, characterised by atypical brevity and verbosity, dysfluency, reduced syntactic complexity, and grammatical errors. Individuals with ADHD produced fewer pronouns and conjunctions. Additionally, their discourse was less coherent and included more frequent topic changes. Similarly, speakers with ADHD omitted critical components of discourse genres. The effect of ADHD on discourse varied between adults and children with ADHD and was evident in both narrative and non-narrative discourse.

Conclusion: Published evidence to date indicates that ADHD affects micro-linguistic to super-structural discourse features in children and adults, likely impacting communication success in social and academic environments. Assessing the structure and content of narrative and non-narrative genres should form routine functional evaluation in ADHD for adults and children. More research is indicated given current major gaps in areas reviewed.

Objective: Cognitive behavioral therapy (CBT) is an efficacious treatment for adult ADHD, yet access and availability concerns limit scalability. Mobile health apps are promising tools for delivering scalable CBT. The current study reports findings from a randomized controlled trial (RCT) of a CBT-informed health app for adults with ADHD.

Methods: A sample of assessed adults with ADHD (N = 154; ages 18-55 years) were recruited to participate and randomized to either 8 weeks of use of the CBT-informed app or a waitlist control condition. Participants in both groups completed measures of ADHD symptoms and functioning at baseline, at 4 weeks, and at 8 weeks.

Results: Linear mixed-effects models for repeated measurements revealed significant group x time interactions for inattentive symptoms (η² = .15), hyperactive-impulsive symptoms (η² = .05), and ADHD associated quality of life (η² = .04) in favor of the CBT-informed app relative to participants who knew they were not receiving help; however, these results did not extend to a measure of functional impairment. Changes in organizational, time management, and planning behaviors and ADHD-related cognitions partially mediated the association between group and inattentive symptom changes. ADHD inattentive symptom reductions were positively associated with the total number of app exercises completed.

Conclusions: The confidence in our results is limited by our use of a waitlist control design. However, participants who used the CBT-informed app perceived improvements in inattentive and hyperactive-impulsive symptoms and quality of life relative to participants who knew they were not receiving help.

Background: Research has consistently demonstrated a negative correlation between socioeconomic status (SES) and the prevalence of ADHD, with SES exerting a significant influence on brain development. ADHD, closely intertwined with neurological development, often manifests as impairments within brain regions associated with memory, executive function, and emotion regulation. Nevertheless, the specific brain structural mediators linking SES to ADHD remain unclear.

Method: We explored whether the brain surface area (SA) and thickness (TH) mediated the relationship between SES indicators (Townsend deprivation index at recruitment, average total household income before tax, and job involves heavy manual or physical work) and ADHD utilizing two-step Mendelian Randomization (MR) and multivariate MR method.

Results: The MR analysis indicated that higher SES corresponds to a lower prevalence of ADHD. Genetically predicted household income was positively correlated with the SA of insula (β = .31, p = 1.02 × 10^-4), and physical work was positively correlated with the TH of entorhinal cortex (β = .74, p = 3.73 × 10^-5). Mediation analysis showed that the SA of insula was identified as a partial mediator in the protective effect of household income against ADHD prevalence, with a mediation ratio of 5.6%. Concerning potential causal relationships between IDPs and ADHD, reduced total brain SA increased ADHD risk (OR = 0.77, p = 5.60 × 10^-9), while reduced the TH of lateral occipital was protective (OR = 1.54, p = 2.02 × 10^-4).

Conclusions: SES influences ADHD through brain structural changes, offering insights for prevention and intervention strategies.

Objective: The Conners Continuous Performance Test-3 (CCPT-3) is a computerized test of attention frequently used in clinical neuropsychology. In the present factor analysis, we seek to assess the factor structure of the CCPT-3 and evaluate the suggested dimensions in the CCPT-3 Manual.

Method: Data from a mixed clinical sample of 931 adults referred for neuropsychological assessment across four centers were analyzed. Nine standard and eight experimental measures were subjected to an exploratory factor analysis to evaluate factor models ranging from one to six factors.

Results: The analysis supported a four-factor model with one overall attention factor and three factors of distinct mechanisms underlying inattention: impulsivity, vigilance, and sustained attention. This closely aligns with the four dimensions outlined in the CCPT-3 Technical Manual and the factor analyses from the CCPT-II. There were some differences between the four-factor model and the interpretations recommended in the Technical Manual. Perseverations were associated with the inattention factor rather than the impulsivity factor, and reaction time was exclusively linked to impulsivity. Incorporating error measures into the vigilance factor suggests that decreases in responsivity, rather than decreases in correct responses, underpin vigilance decrements. Including response bias by inter-stimulus interval (ISI) and by blocks in the analysis indicates that a decrease in arousal may also explain impairments in sustained attention.

Conclusion: This study supports the notion in the Technical Manual that CCPT-3 measures both overall attention and three different mechanisms that mediate inattention: impulsivity, vigilance and sustained attention.

Objective: Depression is a major public health concern with a 19% lifetime prevalence in youth, often precipitating other concerns, including suicidal behavior, poor school performance, and worsened peer relationships. ADHD is also common among youth and frequently presents alongside major depressive disorder (MDD), with this comorbidity associated with increased impairment. More research is needed to elucidate the clinical characteristics of this comorbidity (MDD + ADHD), especially as it relates to youth with MDD and no ADHD (MDD - ADHD). The present study examined the clinical correlates of MDD + ADHD in youth and the presence of an ADHD diagnosis as a moderator of the relationship between depressive symptoms and suicidality, peer relationships, and school functioning, respectively.

Methods: Our sample included 797 youth with MDD ages 8 to 20 years (M_age = 15.5 years) with and without ADHD.

Results: Youth with MDD + ADHD experienced more severe depressive symptoms, higher levels of suicidality, impulsivity, and irritability, and worse academic performance compared to those with MDD - ADHD. ADHD diagnosis did not moderate the relationships between depression severity and suicidality, peer relationships, or school functioning, respectively, suggesting that having an ADHD diagnosis may not affect these outcomes in depressed youth in this way.

Conclusion: Findings shed light on the impact of ADHD in depressed youth, which may allow for earlier and more tailored intervention efforts aimed at identifying and targeting depression, suicidality, peer relationships, and school functioning.

Objective: To examine the Strengths and Weaknesses of ADHD-Symptoms and Normal Behavior scale (SWAN) clinical utility as a diagnostic measure of ADHD in an ADHD clinic sample.

Method: In a sample of 357 children (6-11 years old) referred for evaluation at an academic medical center, we explored the SWAN's diagnostic and convergent validity with the Hyperactivity-Inattention subscale of the Strengths and Difficulties Questionnaire (SDQ/HI) and concurrent validity with the Impairment Rating Scale (IRS).

Results: The averaged (SWAN total) and the SWAN Hyperactivity/Impulsivity subscale (SWAN HI) showed significant and large correlations with the SDQ/HI (r = .69 and .65), respectively. The SWAN Attention Deficit subscale (SWAN AD) had a significant but smaller correlation (r = .49). The SWAN total had moderate correlation with the IRS average score ( = .33). In receiver operating characteristic (ROC) curve analyses (area under the curve (AUC) = 0.71) for the SWAN total, the SWAN distinguished ADHD cases from non-ADHD cases with sensitivity of 83% but specificity of 47%.

Conclusion: In a clinical sample, the SWAN total scores displayed a near-normal distribution. ADHD cases were distinguished from non-ADHD cases by the SWAN. The SWAN showed adequate convergent and concurrent validity with other symptoms and impairment measures.

Objectives: Although ADHD has its roots in childhood, significant symptoms persist into adulthood for more than half of individuals. Adults with ADHD are heterogeneous in terms of symptom presentations, impairment domains, and relative strengths. Consequently, it is essential to better understand the diverse self-perceptions and experiences of adults with ADHD; qualitative methods are a valuable complement to quantitative work in this area. Our aim is to provide a scoping review of qualitative studies on adults with ADHD to articulate the current status of the field and establish future research directions.

Method: We review 41 studies, separating findings into four subpopulations: (1) adults with childhood ADHD, (2) college students with ADHD, (3) adults diagnosed with ADHD in adulthood, and (4) other studies (unspecified age of diagnosis).

Results: Qualitative research on all four subgroups identifies recurring themes: substance use, decisions about medication for ADHD, perceived domains of impairment, factors that promote or hinder success, and concerns about identity and stigma. Notably, the relative emphasis of each theme varies as a function of sample type. Specifically, qualitative research among adults with a childhood ADHD diagnosis focuses principally on substance use and treatment desistance, whereas studies of individuals diagnosed with ADHD as adults often examine emotional responses to receiving the diagnosis. For college students with ADHD, themes frequently relate to struggles with the increased independence demanded by post-secondary educational environments and the adoption of accommodations or coping strategies. For future studies of adult ADHD, we highlight key domains for which mixed-methods strategies will be critical: (a) similarities and differences between multiple reporters of functioning, (b) willingness to receive treatment, (c) women, (d) participants from diverse racial and ethnic groups, and (e) middle age and older adults.

Conclusion: In all, we highlight the value of qualitative and mixed-methods approaches to ensure that research captures the beliefs, intentions, experiences, emotions, and self-perspectives of people with ADHD.