Cynthia M. Hartung

Sex Differences in Young Children Who Meet Criteria for Attention Deficit Hyperactivity Disorder

Examined sex differences in a mostly clinic-referred sample of 127 children (22 girls, 105 boys) who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; [DSM-IV], American Psychiatric Association, 1994) criteria for attention deficit hyperactivity disorder (ADHD) and 125 comparison children (24 girls, 101 boys) matched on age, sex, and race-ethnicity. Children in both groups ranged in age from 3 years, 10 months to 7 years, 0 months. Both girls and boys who met criteria for ADHD were more impaired than same-sex controls on a variety of measures when intelligence and other types of psychopathology were controlled. Teachers reported that boys with ADHD were more inattentive and more hyperactive/impulsive than girls with ADHD. These findings suggest that the diagnosis of ADHD is valid for both girls and boys in this young age range. Young girls and boys who meet DSM-IV criteria for ADHD are more similar than different, but boys tend to display more symptoms of ADHD, particularly in school.

Are there sex differences in the predictive validity of DSM-IV ADHD among younger children?

We assessed the predictive validity of attention-deficit/hyperactivity disorder (ADHD) in 20 girls and 98 boys who met the Diagnostic and Statistical Manual for Mental Disorders (4th ed., American Psychiatric Association, 1994) criteria for ADHD at 4 to 6 years of age compared to 24 female and 102 male comparison children. Over the next 8 years, both girls and boys who met criteria for ADHD in Year 1 exhibited more ADHD symptoms and impairment than same-sex comparison children. Effect sizes were consistently large, indicating that the diagnosis of ADHD at 4 to 6 years of age has predictive validity for both sexes. Both girls and boys with ADHD in Year 1 also exhibited higher levels of symptoms of conduct disorder, major depression, and anxiety disorders in early adolescence than same-sex comparison children, controlling levels of the same symptoms in Year 1. This indicates both substantial homotypic and heterotypic continuity for ADHD in both sexes, but significant interactions with time indicated that childhood ADHD predicts more steeply rising symptoms of anxiety and depression during early adolescence in girls than in boys.

Sex Differences in the Manifestation of ADHD in Emerging Adults.

Objective: Given the mixed literature in the area, the aim of the current study was to determine whether sex differences exist in inattention, hyperactivity, and impairment in college adults with ADHD. Method: Individuals from three universities were recruited for the study. Participants with (n = 164) and without ADHD (n = 710) completed on-line measures of symptoms and impairment. Results: College women with ADHD were shown to have higher rates of inattention, hyperactivity, and impairment than college women without ADHD and college men with ADHD. Analyses revealed that women in college who have ADHD experience higher levels of impairment in the following domains: home life, social life, education, money management, and daily life activities. Conclusion: Overall, clear differences emerged between men and women with ADHD. Implications and future directions are discussed.

Stimulant medication use in college students: comparison of appropriate users, misusers, and nonusers.

While stimulant medication is commonly prescribed to treat Attention-Deficit/Hyperactivity Disorder in children and adolescents (Merikangas, He, Rapoport, Vitiello, & Olfson, 2013; Zuvekas & Vitiello, 2012) and is considered an empirically supported intervention for those groups (Barkley, Murphy, & Fischer, 2008; Pelham & Fabiano, 2008; Safren et al., 2005) surprisingly little is known about the efficacy of stimulants in the slightly older emerging adult population. A focus has emerged, however, on illicit stimulant use among undergraduates, with studies suggesting such behavior is not uncommon (e.g., Arria et al., 2013). Unfortunately, details are lacking regarding outcomes and personal characteristics associated with different patterns of stimulant misuse. The current study compares the characteristics of four groups of college students, including those with stimulant prescriptions who use them appropriately (i.e., appropriate users), those who misuse their prescription stimulants (i.e., medical misusers), those who obtain and use stimulants without a prescription (i.e., nonmedical misusers), and those who do not use stimulant medications at all (i.e., nonusers). Undergraduates (N = 1,153) from the Southeastern, Midwest, and Rocky Mountain regions completed online measures evaluating patterns of use, associated motives, side effects, ADHD symptomatology, and other substance use. Both types of misusers (i.e., students who abused their prescriptions and those who obtained stimulants illegally) reported concerning patterns of other and combined substance use, as well as higher prevalence of debilitating side effects such as insomnia and restlessness. Research and practical implications are discussed.

Biases in ratings of disruptive behavior in children: effects of sex and negative halos.

Objective: Behavior disorders are more prevalent among boys than girls, but the etiology of this difference is unclear. Studies have not tested for sex bias in ratings as a contributing factor to the differential sex prevalence rates. However, there are several studies showing “negative halo effects” in ratings of boys (i.e., the presence of one type of behavior artificially inflating ratings of another behavior). These findings have only been extended to girls in one recent study. The current study is designed to test for sex difference in (a) ratings of boys and girls who exhibit the same degree of disruptive behavior and (b) negative halo effects. Method: Two hundred and thirty-nine college students participated. Sex differences in ratings are not found. Nonetheless, bidirectional negative halo effects are found for boys and girls (i.e., the presence of oppositionality artificially increased ratings of inattention and hyperactivity; the presence of inattention and hyperactivity artificially increased oppositionality).

Efficacy of an Organizational Skills Intervention for College Students With ADHD Symptomatology and Academic Difficulties

Objective: We sought to elucidate the effects of an organization, time management, and planning (OTMP) skills training intervention for college students reporting elevated levels of ADHD symptomatology and academic impairment. Method: Undergraduate participants enrolled in either the intervention (n = 22) or comparison (n = 15) condition in exchange for psychology course credit. Those in the intervention condition attended three weekly group meetings designed to improve organizational skills. Treatment effectiveness was evaluated by comparing pre- and postmeasurements of academic impairment, inattention, hyperactivity/impulsivity, and OTMP skills utilization. Results: Intervention group participants improved significantly on ratings of inattention, hyperactivity/impulsivity, and academic impairment, relative to the comparison group. Intervention group participants also improved in their use of OTMP skills, relative to their baseline ratings. Conclusion: This study suggests an organizational skills intervention has the potential to ameliorating ADHD symptomatology and academic impairment among college students.

Psychometric Properties of the Weiss Functional Impairment Rating Scale: Evidence for Utility in Research, Assessment, and Treatment of ADHD in Emerging Adults

Objective: The current study examines psychometric properties of the Weiss Functional Impairment Rating Scale (WFIRS), a measure of adult ADHD-related impairment. It is a self-report questionnaire that provides a metric of overall life impairment and domain-specific dysfunction. Method: Using data from a large (N = 2,093), multi-institution sample of college students and including a subsample of collateral informants (n = 262), a series of analyses were conducted. Results: The WFIRS demonstrated robust internal reliability, cross-informant agreement on par or superior to other measures of ADHD symptomatology and impairment, and concurrent validity. The WFIRS was not shown to be uniquely associated with ADHD, as internalizing symptoms also associated with the total and domain scores. Conclusion: The use of the WFIRS in identifying ADHD-related impairment in emerging adults appears to be psychometrically supported, and will prove useful to clinicians and researchers.

Preliminary Examination of a New Mental Health Screener in a Pediatric Sample

INTRODUCTION Approximately 80% of children with mental health problems do not receive services. It has been recommended that mental health screening be conducted during pediatric visits (Huffman & Nichols, 2004). METHODS The Primary Care Mental Health Screener (PCMHS) was designed to screen for DSM-IV disorders (APA, 1994) in children. The PCMHS was completed by 328 parents of 3- to 12-year-olds. RESULTS The long-form showed adequate to excellent internal consistency across three age groups and eight subscales with one exception (depression in preschoolers). Next, data were used to shorten the screener without compromising internal consistency, resulting in a 32-item short-form. DISCUSSION The long-form of the PCMHS is a promising mental health screener. The internal consistency of the proposed short-form should be examined with a separate sample. Additional research is needed to improve the reliability of the PCMHS for 3- to 5-year-olds and, in general, to examine the validity of this screener.

DSM-5 and Other Symptom Thresholds for ADHD Which Is the Best Predictor of Impairment in College Students?

Objective: Approximately 5% of adults have ADHD. Despite recommendations regarding the diagnosis of emerging adults, there is not a strong consensus regarding the ideal method for diagnosing ADHD in both emerging and mature adults. We were interested in determining whether a threshold of four, five, or six ADHD symptoms would be associated with significantly different levels of functional impairment and be more or less indicative of a potential ADHD diagnosis. Method: We examined the relation between functional impairment and these ADHD symptom thresholds in 2,577 college students. Results: Our findings suggest that none of these symptom thresholds are differentially better at predicting functional impairment. Conclusion: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) threshold of five symptoms for ages 17 years and older is not necessarily predictive of ADHD-related impairment in college students and may not be preferable to other thresholds. Options for resolving this diagnostic dilemma are discussed.

Contrast sensitivity in children with and without attention deficit hyperactivity disorder symptoms.

Dopamine regulation may play a role in attention-deficit hyperactivity disorder (ADHD). Visual contrast sensitivity has been proposed as a measure of retinal dopamine that may predict frontal lobe dopamine levels. Individuals with disorders involving dopamine dysregulation (e.g., Parkinsons disease, Phenylketonuria) have shown poor contrast sensitivity. In this study, 110 6- to 13-year-old children with and without ADHD completed a task measuring visual contrast sensitivity. As predicted, contrast sensitivity was significantly worse in children with ADHD-Combined Type than controls. Contrast sensitivity was significantly correlated with inattention and hyperactivity. However, unlike many neuropsychological studies of ADHD, only hyperactivity accounted for unique variance.