Journal of Attention Disorders最新文献

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.

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.

Background: First-time diagnoses of attention-deficit/hyperactivity disorder (ADHD) in adults can be challenging due to diverse methodologies available for assessment, and the choices clinicians need to make about how to interpret diagnostic criteria. Network analysis is a statistical approach that has received growing attention in clinical research of recent years. It has the potential to aid visualization and illustrate the intricate relationships between the wide range of clinical measures.

Aim: The goal of the present study is to examine the value of network analysis on a sample of N = 896 adults newly diagnosed with ADHD in an outpatient referral context.

Method and results: The network depicts the interrelationship of a comprehensive set of measures and test variables, including symptom self- and other-reports, cognitive tests, motor activity, as well as measures of symptom and performance validity.

Conclusion: Our network analysis supports ADHD symptom clusters with distinct networks of motor activity and attention/impulsivity and reflects the mode of assessment, i.e., neuropsychological versus self- and observer-ratings. The network further depicts the dissociable role of symptom and performance validity measures, and the different nature of embedded and freestanding validity tests. We discuss the future application of network analysis in clinical research on ADHD.

Background: Individuals with cognitive disengagement syndrome (CDS) report both lower physical activity levels and more insomnia than the general population. However, reliable data on adults with CDS are missing so far. The aims of the present study were three-fold: (1) to investigate the associations between CDS and physical activity patterns among young adults, and more specifically dimensions of physical activity (walking time/week, bicycling time/week, and aerobic physical activity/week), (2) to explore, if CDS scores, physical activity patterns, and insomnia were interrelated, and (3) to explore, if physical activity was directly or indirectly associated with CDS via decreased insomnia.

Method: A total of 246 young adult students (M_age = 22.62; 56.3% females) participated in the present cross-sectional study. They completed a booklet of questionnaires covering socio-demographic information, cognitive disengagement syndrome (Adult Concentration Inventory; ACI), physical activity patterns (International Physical Activity Questionnaire; IPAQ), and insomnia (Insomnia Severity Index; ISI).

Results: Higher scores for the ACI as a proxy of CDS were associated with lower physical activity patterns (durations of walking, bicycling, and aerobic exercising per week), and with higher scores for insomnia. Conditional effects modelings showed that while there was no direct and indirect association of physical activity on CDS scores, both a direct and indirect association of insomnia via lower physical activity on higher CDS scores was observed.

Conclusions: Among a smaller sample of young adults, higher CDS scores were associated with lower physical activity patterns and with more insomnia. Given that standardized behavioral intervention programs are available to improve both daily and weekly physical activity patterns and insomnia, such interventions might also favorably improve CDS.

Objectives: Work performance is a critical aspect of daily living, significantly impacted by the characteristics of ADHD. However, current research lacks sophisticated, theoretically, and empirically supported instruments for assessing work performance in this context. Therefore, this study aimed to develop a comprehensive and psychometrically sound self-report instrument for assessing the work performance of adults with ADHD and related disorders.

Methods: An initial set of 40 work performance items was developed based on a multifactorial model, various preexisting questionnaires, and input from an interdisciplinary working group. Extensive psychometric analyses were conducted on a community sample of 714 participants engaged in paid work for at least 9 hr a week, randomly split into two subsamples.

Results: Confirmatory factor analyses (CFA) validated the 7-factor structure of the work performance scale. The initial set of items was reduced by 10 based on internal consistency and item redundancy, resulting in a final set of 30 items which we called Work and Occupational Performance in ADHD (WOPA). The WOPA was further evaluated for floor and ceiling effects, internal consistency, and item-rest correlation. Additionally, associations of work performance were examined concerning work characteristics, ADHD symptom severity, indicators of functional impairments, executive function deficits, and internal emotional states.

Discussion: The 30-item WOPA was developed based on empirically informed models, clinical considerations, and robust psychometric foundations. Subsequent clinical application is necessary to demonstrate its utility in clinical practice.

Objective: This study examines the impact of long-acting stimulant (LAS) pharmacotherapy for ADHD on academic outcomes among students in grades K-12 using retrospective analysis of administrative data.

Methods: ADHD diagnosis was identified based on ADHD management plans in school records, physician notes in billing records, and/or prescription records. Prescription records identified LAS-treated students (n = 15,544), excluding those treated with immediate/intermediate-acting stimulants or atomoxetine. A control group without ADHD (n = 204,681), and another with untreated ADHD (n = 27,880) were also identified. The following outcomes were examined using multivariate regression: report card scores, standardized assessment exam performance, graduation from high school, school attendance, and transition to post-secondary education.

Results: ADHD was associated with lower average report card scores and provincial assessment exam scores and increased frequency of school absence among grades K-12, and decreased likelihood of high school graduation and transition to post-secondary education. LAS treatment was associated with improved report card (score estimate -4.93 Treated, -6.19 Untreated) and provincial assessment exam scores (percentile rank estimate -9.20 Treated, -11.50 Untreated) among grades 9 to 12, reduced absences among grades K-12 (absence rate estimate -3.33 Treated, 7.96 Untreated), and increased likelihood of graduation (OR of failure to graduate 1.39 Treated, 2.22 Untreated) and transition to post-secondary education (OR of no transition 0.77 Treated, 1.42 Untreated; reference = No ADHD group).

Conclusion: LAS pharmacotherapy is associated with improved academic performance, attendance, and likelihood of graduation and transition to post-secondary education.