Journal of Attention Disorders最新文献

Objective: At least a third of U.S. adults with ADHD do not access recommended treatments (medication or cognitive behavioral therapy [CBT]), and those receiving treatment face barriers (e.g., inconsistent availability of medication). We investigated systemic inequities in CBT access for adults with ADHD versus psychiatric diagnoses with similar prevalence.

Method: We accessed and extracted publicly available listings from the Psychology Interjurisdictional Compact (PSYPACT) provider directory (N = 12,898) in April 2025.

Results: Only 26.4% of PSYPACT providers explicitly offer any services for adult ADHD. They were nearly three times more likely to treat adult depression (69.2%) and anxiety (74.0%). CBT for adult ADHD was offered by just 21.3% of providers.

Conclusion: U.S. psychologists are chief CBT providers for adult mental disorders; however, they systemically underserve adults with ADHD. Contributors to this inequity must be identified to advance adult ADHD care, as untreated ADHD is a costly public health burden.

Objective: To estimate the adherence of children and adults to oral stimulant ADHD treatments in Sweden during the period 2015 to 2020.

Methods: This retrospective, nationwide, register-based study evaluated all patients who were dispensed oral formulation stimulants (Anatomical Therapeutic Chemical [ATC] codes: N06BA01, N06BA02, N06BA04, N06BA12) identified in the Swedish Prescribed Drug Register. Treatment episodes were constructed based on drug dispensation data, and treatment adherence was calculated for each treatment episode using a Proportion of Days Covered approach with a modified one-pill-a-day method.

Results: Between 2015 and 2020, 158,413 treatment episodes were recorded in 128,366 patients, corresponding to a median 1.23 treatment episodes per patient. The majority of treatment episodes involved methylphenidate (64.0%), followed by lisdexamfetamine (32.2%), dexamfetamine (3.0%), and amphetamine (0.8%). Overall treatment adherence was high (78.2%), and was similar for patients receiving methylphenidate, lisdexamfetamine, and dexamfetamine. The proportion of patients with ≥80% medication adherence was high (69.3%-71.8%) for adults aged ≥25 years, but was low for adolescents aged 12 to 17 years (49.7%-52.4%).

Conclusions: The overall rates of treatment adherence are high for children and adults receiving ADHD medication in Sweden. We observed lower adherence among adolescents, which warrants further study.

Objective: This study aims to investigate the complex relation between adult ADHD symptoms, procrastination, and mediating factors, in light of leading procrastination theories: the Temporal Motivation Theory (TMT), emotion regulation, and a General Architecture for Modeling the Dynamics of Goal-Directed Motivation and Decision-Making - the GOAL architecture.

Method: The study was preregistered. A survey was conducted with 640 adults recruited online to examine the associations between ADHD symptoms, procrastination, and seven mediating factors. Participants completed measures assessing ADHD symptoms, procrastination tendencies, emotion regulation, motivation, and goal-related behaviors. Structural equation modeling (SEM) was used to test the direct and indirect pathways among the variables.

Results: A positive association was revealed between ADHD inattention symptoms and procrastination tendencies. The mediating factors that significantly contributed to this relations were sensitivity to delay, perceived low value of the task, and flexible goal adjustment. While ADHD inattention symptoms was associated with all seven variables, three variables directly contributed to increased procrastination behavior, thus explaining the link between inattention symptoms and procrastination.

Conclusions: The study highlights the relations between procrastination and adult ADHD symptoms and underscores the need to address mediating factors in intervention strategies. Understanding these mechanisms is essential for developing targeted interventions to improve functional outcomes for individuals with ADHD.

Objective: Cognitive Disengagement Syndrome (CDS) is increasingly viewed as a distinct childhood condition. Although it overlaps with ADHD in some features, emerging evidence suggests a unique behavioral and cognitive profile. However, research examining social functioning and emotion recognition in children with pure CDS remains limited.

Methods: This study compared social competence and facial emotion recognition abilities among children aged 8 to 12 years across three groups: those with elevated CDS symptoms (n = 43), those with ADHD (n = 40), and healthy controls (n = 43). Social functioning and peer relationships were evaluated using parent- and child-report social skills scales and peer interaction questionnaires. Emotion recognition was measured with the Reading the Mind in the Eyes Test (RMET).

Results: Children with CDS showed significantly lower social skills and RMET scores than both ADHD and control groups (p < .001). Teachers reported fewer school friendships for the CDS group compared to ADHD and controls (p < .001), and CDS children also reported fewer out-of-school friendships than peers in the other groups (p = .035). Both child and teacher reports noted greater peer relationship difficulties in the CDS group compared to the other groups (p < .001). Teachers also observed more solitary behavior and lower group participation among CDS children (p < .001). Within the CDS group, social skills were negatively associated with oppositionality (r = -.347) and positively associated with inattention severity (r = .346). Regression analysis identified social skills scores as independent predictors of peer relationships across the full sample (p < .001).

Conclusion: These findings suggest that children with elevated CDS symptoms experience greater social difficulties and more pronounced emotion recognition impairments than both ADHD and typically developing peers, reflecting a distinct social-cognitive profile that extends beyond overlapping ADHD symptoms. The results underscore the importance of early recognition and targeted interventions.

Objective: ADHD is a common neurodevelopmental disorder of childhood characterized by altered projections of dopaminergic neurons and connectivity issues in various brain regions. In our study, we aim to investigate the potential effects of axon guidance molecules, Netrin-1 and Semaphorins 3A, 4D, and 7A, on these connectivity problems by examining the levels of these molecules in the peripheral blood of children with ADHD compared to healthy controls.

Methods: A total of 43 children with ADHD and 40 healthy controls 6 to 12 years of age were included in the study. The K-SADS-PL was administered to exclude any additional psychopathologies (excluding ODD in the ADHD group). The Revised Child Anxiety and Depression Scale was provided to the children, while parents completed the revised Conners' Parent Rating Scale (CPRS-R), the Social Responsiveness Scale (SRS), and the Behavior Rating Inventory for Executive Functioning (BRIEF). Additionally, teachers of the ADHD group were given the Conners' Teacher Rating Scale. Furthermore, the WISC-4 was administered to assess the IQ profile of 35 children in the ADHD group.

Results: Netrin-1 was found to be statistically higher in the ADHD group. When the R-CADS scores were recalculated taking the covariate into account, the significant increase in the ADHD group remained. There was no statistically significant difference between the two groups for semaphorin 3A, 4D, and 7A. The positive correlation of Netrin-1 with the hyperactivity subscores on the CPRS-R and the Global Executive Score on the BRIEF scale is noteworthy.

Conclusion: Netrin-1 may play a role in the etiopathogenesis of ADHD. Further studies are needed to clarify the relationship between Netrin-1 and ADHD.

Objective: Learning unfolds in distinct stages-acquisition, consolidation, and maintenance-shaped by cognitive mechanisms such as saliency processing, interference control, and sustained attention. ADHD in adults is associated with deficits in these cognitive processes, which in turn might lead to learning difficulties.

Method: Using a novel protocol that incorporates a visual attention task with gestalt-image targets and primer distractors, we investigated these cognitive mechanisms across different stages of learning in 53 adults diagnosed with ADHD and 18 neurotypical Controls.

Results: Our findings reveal that adults with ADHD exhibit reduced neural activations in the occipital and parietal areas, indicating diminished bottom-up visual processing and challenges in handling distractions. Nevertheless, individuals with ADHD demonstrate increased frontal activity in the late stages of visual processing, suggesting compensatory mechanisms employed by the group. Behaviorally, both groups achieve comparable performance, though ADHD participants do so at the expense of greater variability and attentional lapses. Furthermore, while Controls reach the plateau already after the acquisition phase, the ADHD group is gradually improving its performance throughout the experiment.

Conclusion: These findings demonstrate that adults with ADHD can acquire and retain new skills but do so through different-and usually more effortful-pathways. By mapping neural and behavioral dynamics onto learning stages, this study offers a more nuanced framework for learning in ADHD and supports the development of phase-specific intervention strategies.

Objectives: ADHD is now recognized as a common condition in adulthood, but the evidence supporting a separate characterization of a cognitive profile for ADHD in older adults is scarce. Consequently, the goal of the current study was to conduct a systematic review that helps clarify the cognitive characteristics of ADHD in older individuals.

Method: We conducted a systematic review with narrative synthesis, considering studies on older adults with ADHD and research on cognitive domains involved in adults 50 years old and older with a confirmed diagnosis of ADHD, in three electronic databases (PubMed, Web of Science, and Embase). Ten studies (3 longitudinal and 7 cross-sectional) with clearly separated cognitive data for older adults with ADHD were included in this review.

Results: Results showed an overall worse performance in attention and episodic memory for older adults with ADHD compared to their younger counterparts and older healthy controls. Evidence concerning executive functions was mixed, with some studies showing a worse performance in working memory compared to older healthy controls, but with other studies showing a similar or even better performance than younger adults with ADHD.

Conclusions: A cognitive characterization of ADHD in older adults requires further research to clarify whether it can be considered a separate entity and how to establish a differential diagnosis with other age-related conditions. Moreover, there is a need for internationally agreed common neuropsychological assessment protocols that set boundaries between younger and older adults with ADHD.

Objective: The study aims to examine the contributions of Emilio Mira y López (1896-1964) to the early conceptualization and treatment of what is now known as Attention Deficit Hyperactivity Disorder (ADHD). It seeks to contextualize his ideas within broader historical, pedagogical, and psychiatric developments in Spain and internationally.

Method: A historical-analytical approach was employed, reviewing Mira y López's publications El niño que no aprende (The Child Who Does Not Learn, 1947), as well as related psychiatric and educational literature from the early 20th century. His work was analyzed alongside contributions from contemporaries and predecessors, with a focus on terminology, neurophysiological concepts, and early treatment strategies.

Results: Mira y López described the "unstable child" or "butterfly child" with symptoms that align closely with modern ADHD: impulsivity, distractibility, and lack of sustained attention. He proposed that these children suffer from an imbalance between excitatory and inhibitory brain functions, suggesting early therapeutic interventions including behavioral techniques and opotherapeutic (hormonal) medications. His research emphasized a medical and pedagogical approach to learning difficulties and prefigured ideas found in the emerging field of child psychopharmacology.

Conclusion: Emilio Mira y López's understanding of childhood instability reflected the influence of French and Anglo-American psychiatry and anticipated key elements of today's ADHD frameworks. His physiological model of inhibition mirrors Charles Bradley's "inhibition hypothesis," which led to the use of stimulants for hyperactivity. Mira's early proposals contributed to shaping a more comprehensive, interdisciplinary view of childhood mental health and learning difficulties in Spain and Latin America.

Background: Attention Deficit Hyperactivity Disorder (ADHD) and Specific Learning Difficulties (SLD) are both associated with attentional and cognitive difficulties. This study examined the extent to which the cognitive impairments could be consequences of elevated levels of inattention and hyperactivity/impulsivity.

Method: Secondary analysis was conducted on data from four groups selected from the Centre for Attention, Learning, and Memory, a neurodivergent cohort of children aged 5 to 18 years with a mean age of 9 years : children with ADHD only (n = 70), learning difficulties only (n = 406), ADHD with learning difficulties (n = 128), and a comparison group (n = 166). Covariance analyses examined whether any differences in basic cognitive skills and higher executive functions between the neurodivergent and comparison groups could result from variations in inattention and hyperactivity/impulsivity.

Results: Irrespective of ADHD status, children with learning difficulties had low scores in short-term memory, working memory, sustained attention, processing speed, set sequencing, and set shifting. These cognitive deficits largely persisted when inattention and hyperactivity/impulsivity were covaried. In contrast, the ADHD only group performed at age-appropriate levels on measures of verbal short-term memory, verbal and visuospatial working memory, processing speed, and sustained attention. Their difficulties with set sequencing and visuospatial short-term memory were accounted for by inattention and hyperactivity/impulsivity, whereas their challenges with set shifting were independent of these attentional behaviors.

Conclusions: The results point to distinct neurodevelopmental pathways to cognitive functioning for children with learning difficulties and those with ADHD. The independence of learning-related cognitive skills from levels of inattention and hyperactivity/impulsivity in children with learning difficulties either with or without ADHD suggests they represent the core deficits that underlie their learning difficulties. The limited cognitive challenges of children with ADHD without learning difficulties may be consequences of their elevated levels of attentional behaviors. Understanding the cognitive and learning profiles of children with ADHD and learning difficulties vital for identifying optimal intervention and support strategies that address their individual needs.

Objective: Susceptibility to visual illusions is a consequence of the adaptation of the visual system, however, their perception or lack of it reflects differences in more general, global cognitive processes. Few studies have focussed on the susceptibility of individuals with attention-deficit/hyperactivity disorder (ADHD), even though visual impairment and percept differences have been thoroughly documented.

Method: The present study evaluated 75 children (ages 6.09-12.99 years, 72% male) and 37 teenagers (ages 13-16.95 years, 62% male) with ADHD, and a sex-and-age matched sample of typically developing peers. They were tested with 103 pairs of illusory and control images spanning five illusion types.

Results: We found increased susceptibility to the Müller-Lyer and Kanizsa Subjective Contour and decreased susceptibility to the Ebbinghaus illusion among children with ADHD when compared to typically developing controls. No differences were found for susceptibility to the Simultaneous Contrast and Moving Snake illusions. As for reaction times, we did not find differences between participants with ADHD and their control peers when judging illusions; however, in general participants give answers faster in the illusory trials than in control trials with the same magnitude of difficulties which also confirm the susceptibility of the illusions.

Conclusion: Our findings point to small but important perceptual alterations, such as slightly reduced or delayed top-down or global processing ability in children with ADHD. Further research can focus on how these alterations may be useful to detect developmental alterations and understand perceptual difficulties in children with neuropathology.