Journal of Attention Disorders最新文献

Objective: The association between perceived stress (PS) and ADHD symptoms in adulthood is well established, yet the underlying mechanisms remain unclear. This study employed a genetically informative design to investigate the roles of gene-environment (GE) correlation and gene-environment interaction (G × E) in explaining this association. Three G × E interaction models were considered: the diathesis-stress model, the bioecological model, and the differential sensitivity model.

Method: In total, 1,270 twins (mean age: 23.3 ± 2.4 years) participated in an online survey, which included ADHD symptoms and PS scales. The PS scale measured stress across five categories: Friendship Stress (FS), Family Conflicts (FC), Financial Difficulties (FD), Academic Stress (AS), and Future Career Concerns (FCC).

Results: Bivariate Cholesky model-fitting analyses revealed significant genetic correlations between ADHD symptoms and all five PS categories, indicating a pervasive influence of GE correlations on these associations. Further bivariate G × E model-fitting analyses showed that G × E interaction effects were not significant for FS or FC but were significant for FD, AS, and FCC. Specifically, the relationship between FD and ADHD symptoms aligned with the differential sensitivity model, where genetic variance was heightened at extreme levels of FD. The association between AS and ADHD symptoms followed the bioecological model, characterized by increased shared environmental variance at higher stress levels. Finally, the association between FCC and ADHD symptoms was consistent with the diathesis-stress model, where genetic influences amplified with increasing stress levels.

Conclusion: These findings underscore the complex interplay of genetic and environmental factors in the ADHD symptoms-PS relationship and suggest the importance of incorporating these mechanisms into intervention strategies for ADHD symptoms.

Objective: Few trials in ADHD incorporate participant-centered outcomes that evaluate the impact of interventions on meaningful life activities. Additionally, in psychiatry, the translation of changes in symptom rating scales into meaningful impacts on participants' lives has been questioned. The Transcranial Direct Current Stimulation (tDCS) for the Treatment of Inattention Symptoms in Adult Patients with ADHD (TUNED) trial demonstrated improved inattention symptoms, assessed using a clinician-administrated scale, after a 4-week treatment with daily home-based tDCS in adults with ADHD. Here, our primary objective was to evaluate the impact of tDCS in ADHD using a participant-centered and clinically relevant outcome.

Method: We analyzed data from the TUNED trial (ClinicalTrials.gov Identifier: NCT04003740), a randomized, double-blind, parallel, sham-controlled study testing tDCS in adults with ADHD. At the baseline assessment, all participants were instructed to select up to three goals they desired to achieve during the trial period. The goals had to be specific, measurable, achievable, relevant, and time-bound. Our main outcome was the number of goals achieved at the end of the intervention.

Results: Of the 64 participants randomized, 55 completed the trial and were included in the analyses (26 [47%] inattentive presentation and 29 [53%] combined presentation; mean (SD) age, 38.1 [9.8] years; 40% women). In the active tDCS group (n = 25), eight participants (32%) achieved one goal, 5 (20%) achieved two goals, 3 (12%) achieved all three goals, and 9 (36%) achieved no goals. In the sham tDCS group (n = 30), 3 (10%) participants achieved one goal, 3 (10%) achieved two goals, 3 (10%) achieved all three goals, and 21 (70%) achieved no goals. Ordinal logistic regression analyses showed that participants in the active tDCS group were more likely to achieve a higher number of goals compared to those in the tDCS sham group (OR = 3.05, 95% CI [1.06, 8.75], p = .03]).

Conclusion: This study demonstrated that tDCS can significantly enhance the ability to achieve personal goals in adults with ADHD. By using a participant-centered approach, our findings not only support tDCS as a promising treatment for ADHD but also align with the growing emphasis on personalized medicine and clinically relevant, participant-reported outcomes in clinical research.

Background: ADHD often overlaps with pediatric asthma, leading to difficulties in treatment and management in clinical work. Previous research has explored their correlations but gained different conclusions. Thus, this work aims to fill this evidence gap.

Methods: Initially, we conducted a cross-sectional study based on data from the National Health and Nutrition Survey (NHANES) 2001 to 2004. The association between ADHD and pediatric asthma was explored by the weighted multivariate-adjusted logistic regression. Then, the bidirectional univariate Mendelian randomization (UVMR) analyses were performed to estimate the causal effects and then investigate if risk factors of pediatric asthma mediated in the causal pathways. Last, we conducted multivariable MR (MVMR) analyses adjusting for these mediating/confounding factors to determine the direct causality between ADHD and pediatric asthma.

Results: In the cross-sectional analysis, ADHD was positively associated with pediatric asthma both before (OR = 1.79, 95% CI [1.26, 2.53], p = .008) and after adjusting for all covariates (OR = 1.62, 95% CI [1.10, 2.39], p = .048). In the UVMR analysis using the inverse-variance weighting (IVW) method, ADHD was found to increase the risk of pediatric asthma (OR = 1.070, 95% CI [1.029, 1.112], p = 6.566 × 10⁻⁴). This association remained significant after adjusting for confirmed mediating factors (obesity traits and smoking exposures) using MVMR (OR = 1.088, 95% CI [1.021, 1.160], p = .009). Another adjustment for remaining potential confounders (atopic dermatitis, allergic rhinitis, and inflammatory bowel diseases) via MVMR maintained the significant causal link (OR = 1.272, 95% CI [1.159, 1.396], p < .001).

Conclusions: ADHD increased the onset of pediatric asthma with mediating factors including obesity and smoke exposure.

Objective: This study used a large U.S. population-based dataset to examine associations between childhood attention problems and adolescent substance use, sexual risk behavior, and delinquency.

Methods: This prospective cohort study used data from the Future of Families and Child Wellbeing Study (n = 2,716). Bivariate statistics, multivariable logistic regression, and negative binomial models assessed associations between attention problems at age 9 years and subsequent use of cigarettes, alcohol, and marijuana, engagement in sex without a condom, and delinquency at age 15 years.

Results: Nearly one-fifth (18.3%) of adolescents had elevated scores (more than 1 standard deviation above the sample mean) for attention problems at age 9 years. Adolescents with elevated attention problem scores in childhood were more likely than adolescents who did not have elevated scores to have ever smoked an entire cigarette (9% vs. 4%) and ever tried marijuana (24% vs. 20%). Elevated attention problem scores were associated with higher odds of ever having smoked an entire cigarette (adjusted odds ratio [AOR] = 2.06, 95% CI [1.39, 3.05], p < .01) and higher delinquent behavior scores (incidence rate ratio [IRR] = 1.30, 95% CI [1.11, 1.53], p < .01). In adjusted models, there were no significant associations between elevated attention problem scores and ever having tried marijuana, consumed alcohol, or engaged in unprotected sex.

Conclusions: This study found that elevated attention problem scores in childhood were associated with higher risk of cigarette smoking and delinquent behaviors in adolescence. Results provide support for screening for attention problems among elementary school-age children and early intervention strategies to prevent health risk behaviors in adolescence.

Objective: ADHD is a commonly diagnosed neurodevelopmental disorder in the U.S., with symptoms including hyperactivity, inattention, and impulsivity. These symptoms can lead to increased engagement in unhealthy behaviors. The current study examined the associations between health risk factors and ADHD among a community-based sample of 345 students (4th-12th grade) by ADHD alone or with co-occurring disorders, ADHD medication use, and ADHD symptom count. Distinct from prior studies, our analysis also examined associations among pairs of health risk factors by ADHD diagnostic criteria.

Method: Data came from the Replication Project to Learn About Youth-Mental Health, using a two-stage design, incorporating teacher, parent, and student reported data.

Result: Students with ADHD experienced a higher prevalence of not using a bike helmet (prevalence ratio [PR] = 1.17, 95% confidence interval [CI] [1.01, 1.35]), being bullied, threatened, or feeling unsafe at school (PR = 1.83, 95% CI [1.02, 3.30]) carrying a weapon (PR = 7.02, 95% CI [2.58, 19.08]), and feeling sad or hopeless within the past 2 weeks (PR = 2.74, 95% CI [1.01, 7.47]) compared to those with no disorder. Students with ADHD exhibited different risk associations compared to those with no disorder, specifically for interpersonal violence risk. Medication treatment for ADHD was not associated with fewer health risks, except that students taking ADHD medication were less likely to skip breakfast (PR = 0.40, 95% CI [0.20, 0.78]) compared to those without ADHD. Higher ADHD symptom counts were associated with elevated television screen time, stimulant medication misuse, physical fight involvement, and carrying a weapon (p < .05).

Conclusion: Evaluating participation in health risk factors and developing tailored interventions may benefit youth with ADHD, regardless of treatment status.

Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) is a common behavioral health condition that impacts 5% to 8% of children and 2.5% of adults worldwide. The symptoms of ADHD are effectively managed with medication, yet patients with ADHD may inconsistently take their medication. We assessed medication adherence among patients with ADHD and identified factors associated with medication adherence that may be utilized to optimize adherence.

Method: This is a retrospective, observational study among patients aged 4 years and older with a diagnosis of ADHD at primary care and multispecialty outpatient clinics during May 2021 to May 2023. We assessed sociodemographic characteristics, stratified by medication adherence status (Percentage of Days Covered ≥ 80%) using simple proportion, Student's t-test, and Chi-square test. We conducted univariable and multivariable logistic regression analyses to assess potential medication adherence factors, including sociodemographic characteristics, depressive symptoms, suicide risk, health service utilization, and social determinants of health (SDOH).

Results: We found 7,661 patients diagnosed with ADHD, with a mean (SD) age of 21.8 (14.8) years. The ADHD prevalence was 5.5% for patients aged 4 to 12, 4.4% for 13 to 17, and 0.8% for 18+ years old. Most patients were male (56.9%), non-Hispanic White (37.6%), and privately insured (55.1%). Among these patients, only 4,242 (55.4%) were treated with medication. Among 4,011 patients with medication adherence information, the average adherence rate was 56%, and only 1,113 patients (27.5%) met our threshold for adherence to ADHD treatment (80%). Adherence was positively associated with being adults, having more BH and PCP visits, and negatively associated with racial and ethnic minorities and more severe depressive symptoms.

Conclusion: Only half of patients with ADHD were treated with medication. Of those treated, less than a third adhered to medication. Age, race and ethnicity, depressive symptoms, and BH and PCP visits were statistically associated with medication adherence. Healthcare providers may need to address factors such as coexisting depressive symptoms, and unmet SDOH needs to improve medication adherence among patients with ADHD. Also, patients reaching adolescence may need enhanced medication management.

Objectives: Although extensive research has documented associations between Attention-Deficit/Hyperactivity Disorder (ADHD) and differences in resting-state electroencephalography (EEG) oscillatory activity, the causal nature of these relationships remains uncertain. This study aimed to determine whether there is a causal relationship between resting-state EEG activity and ADHD using genetic methods.

Methods: We performed a bidirectional two-sample Mendelian Randomization analysis using summary-level genome-wide association study data. EEG data were obtained from the ENIGMA-EEG consortium, including resting-state EEG spectral power measurements from 7,983 subjects. ADHD genome-wide association study summary statistics were derived from 225,534 individuals, alongside data for six additional psychiatric disorders from the Psychiatric Genomics Consortium. Mendelian Randomization analysis was used to test for causal relationships in both directions between EEG activity and ADHD.

Results: We identified a significant unidirectional causal relationship, with genetic variants influencing resting alpha-band EEG activity conferring risk for ADHD (odds ratio = 0.89, 95% confidence interval [0.82, 0.96], p = 1.52 × 10⁻³). No evidence was found for reverse causation from ADHD liability to alpha EEG power band activity (odds ratio = 1.07, 95% confidence interval [0.88, 1.30], p = .52).

Conclusions: Our findings provide genetic evidence that reduced resting-state alpha power is not merely correlated with ADHD but may causally predispose individuals to developing the disorder. This supports previous observational studies linking lower alpha activity to ADHD and establishes a causal pathway from altered EEG activity to ADHD risk, with important implications for understanding ADHD pathophysiology and potential biomarker development.

Background: In response to the increasing prevalence of ADHD, efforts have focused on understanding methods to optimize psychosocial, emotional, and behavioral well-being, defined as flourishing. Mood disturbances, environmental vulnerabilities, and Adverse Childhood Experiences (ACEs) are risk factors for not flourishing. There is limited research on protective relational factors, as measured by Positive Childhood Experiences (PCEs), as facilitators of flourishing in children with ADHD and comorbid mood disturbances.

Method: Using a nationally representative sample of 4,847 children, aged 6 to 17 years-old, currently diagnosed with ADHD, hierarchical binary logistic regression examined whether the number of PCEs present for children with and without mood disturbances could significantly predict who was flourishing or not. The initial model included demographics, ADHD treatment-related variables, and the number of ACEs encountered.

Results: After controlling for covariates, the odds of flourishing measured by the Child Flourishing Index (CFI) for children with ADHD were 7.31 [4.51, 11.86] times greater for those with 6 to 7 PCEs compared to peers with 0 to 2 PCEs, and 3.37 [2.24, 5.06] times greater for those with 3 to 5 PCEs relative to peers with 0 to 2 PCEs. Furthermore, parents who reported their children had neither current anxiety nor depression were 2.92 [1.87, 4.55] times more likely to flourish than children currently reported to have both anxiety and depression. These associations were consistent regardless of the level of ACEs.

Conclusions: Our findings suggest that more PCEs and the absence of mood disturbance may attenuate the influence of ACEs on healthy adjustment for children with ADHD. Encouraging resilience in families, connecting with caregivers, and community volunteering were the most predictive positive childhood experiences of flourishing in this national sample of youth with ADHD and comorbid mood disturbance. Current results also provide guidance for future research on PCEs measurement, screening for comorbidities, and clinical intervention in neurodiverse samples.

Objective: ADHD can impair children's functioning. Socioeconomic and sociodemographic factors present barriers to treatment access and lead to disparate outcomes in children with ADHD. The purpose of this study was to describe trajectories of functional outcomes and ADHD symptom counts across 3 years and explore the moderating effects of income and race/ethnicity on these trajectories among U.S. children with ADHD.

Method: This longitudinal study of children currently and/or previously meeting diagnostic criteria for ADHD (N = 1,587, age = 9-10 years at baseline) used data from the Adolescent Brain Cognitive Development (ABCD) Study^®. Outcomes were child-reported functional outcome measures (family conflict, prosocial behavior, and school experiences) and parent-reported inattentive and hyperactive symptom counts across 3 years. Multi-level, mixed-effects models for longitudinal data were used to characterize each outcome trajectory and examine the moderating effects of baseline household income and race/ethnicity.

Results: The sample was 68% male and 54% White, with 53% meeting diagnostic criteria for past-only ADHD, 12% current-only ADHD, and 35% both past and current ADHD. Significant changes in family conflict, school experiences, inattentive symptom counts, and hyperactive symptom counts were demonstrated across 3 years (trajectories, p < .05). Income significantly moderated prosocial behavior trajectories, while race/ethnicity significantly moderated family conflict and prosocial behavior trajectories (time interaction, p < .05).

Conclusions: The findings suggest that factors related to income and race/ethnicity influence trajectories of change in family conflict and prosocial behavior outcomes in children with a history of ADHD. Future studies should explore these disparities and identify targets for intervention, such as increased access to diagnosis and treatment for individuals at risk of poorer functional outcomes.

ObjectiveChildren and adolescents frequently struggle with social skills performance in academic settings, which can negatively impact quality of life. As such, social skills training is frequently recommended; however, the effectiveness of school-based social skills training has not been synthesized. As such, the purpose of the current study was to evaluate the empirical evidence pertaining to both stand-alone and multimodal school-based social skills programs for students with ADHD, and to assess the effects of potential moderating variables.

Method: A systematic review and meta-analysis was conducted of studies between the years of 1975 and 2023 following the recommendations of the Cochrane Foundation and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results: Seventeen studies, single-case, within group, and between-group designs met the established inclusion criteria, with 10 included in the meta-analysis. The findings revealed small to large effects; however, the overall meta-analytic effect size was negligible (ES = 0.09). The differences in social skills approaches, intensity, parent involvement, and setting did not moderate the effects.

Conclusion: These findings underscore the necessity for ongoing exploration and refinement of social skills interventions tailored for youth with ADHD.