John T. Mitchell

A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation.

Objective: Mindfulness meditation training is garnering increasing empirical interest as an intervention for ADHD in adulthood, although no studies of mindfulness as a standalone treatment have included a sample composed entirely of adults with ADHD or a comparison group. The aim of this study was to assess the feasibility, acceptability, and preliminary efficacy of mindfulness meditation for ADHD, executive functioning (EF), and emotion dysregulation symptoms in an adult ADHD sample. Method: Adults with ADHD were stratified by ADHD medication status and otherwise randomized into an 8-week group-based mindfulness treatment (n = 11) or waitlist group (n = 9). Results: Treatment feasibility and acceptability were positive. In addition, self-reported ADHD and EF symptoms (assessed in the laboratory and ecological momentary assessment), clinician ratings of ADHD and EF symptoms, and self-reported emotion dysregulation improved for the treatment group relative to the waitlist group over time with large effect sizes. Improvement was not observed for EF tasks. Conclusion: Findings support preliminary treatment efficacy, though require larger trials.

Functional adult outcomes 16 years after childhood diagnosis of Attention-Deficit/Hyperactivity Disorder:MTA results

OBJECTIVE To compare educational, occupational, legal, emotional, substance use disorder, and sexual behavior outcomes in young adults with persistent and desistent attention-deficit/hyperactivity disorder (ADHD) symptoms and a local normative comparison group (LNCG) in the Multimodal Treatment Study of Children with ADHD (MTA). METHOD Data were collected 12, 14, and 16 years postbaseline (mean age 24.7 years at 16 years postbaseline) from 476 participants with ADHD diagnosed at age 7 to 9 years, and 241 age- and sex-matched classmates. Probands were subgrouped on persistence versus desistence of DSM-5 symptom count. Orthogonal comparisons contrasted ADHD versus LNCG and symptom-persistent (50%) versus symptom-desistent (50%) subgroups. Functional outcomes were measured with standardized and demographic instruments. RESULTS Three patterns of functional outcomes emerged. Post-secondary education, times fired/quit a job, current income, receiving public assistance, and risky sexual behavior showed the most common pattern: the LNCG group fared best, symptom-persistent ADHD group worst, and symptom-desistent ADHD group between, with the largest effect sizes between LNCG and symptom-persistent ADHD. In the second pattern, seen with emotional outcomes (emotional lability, neuroticism, anxiety disorder, mood disorder) and substance use outcomes, the LNCG and symptom-desistent ADHD group did not differ, but both fared better than the symptom-persistent ADHD group. In the third pattern, noted with jail time (rare), alcohol use disorder (common), and number of jobs held, group differences were not significant. The ADHD group had 10 deaths compared to one death in the LNCG. CONCLUSION Adult functioning after childhood ADHD varies by domain and is generally worse when ADHD symptoms persist. It is important to identify factors and interventions that promote better functional outcomes.

An analysis of reinforcement sensitivity theory and the five-factor model

Reinforcement Sensitivity Theory (RST) and the Five‐Factor Model (FFM) are two prominent personality accounts that have emerged from different backgrounds. Although the two accounts are applied to similar research topics, there is limited empirical work examining the correspondence between them. The current study explored the relationship between RST‐based personality traits and the FFM domains and facets in an undergraduate sample (n = 668). Regression analyses indicated that Sensitivity to Punishment (SP) was positively associated with Neuroticism and Agreeableness, and negatively associated with Extraversion, Openness, and Conscientiousness. In contrast, Sensitivity to Reward (SR) was positively associated with Extraversion and Neuroticism, and negatively associated with Agreeableness and Conscientiousness. Exploratory analyses at the facet level specified the relationship between SP, SR, and each domain. A factor analysis was also conducted to explore the higher‐order factor structure of RST and the FFM domains. Three factors emerged, which we labelled SP, Stability‐Impulsivity, and Sensation Seeking. Taken together, these findings suggest that there is substantial overlap between these two accounts of personality. Copyright

The Expression of Adult ADHD Symptoms in Daily Life: An Application of Experience Sampling Methodology

Objective: To use experience sampling method (ESM) to examine the impact of inattentive and hyperactive-impulsive ADHD symptoms on emotional well-being, activities and distress, cognitive impairment, and social functioning assessed in the daily lives of young adults. The impact of subjective appraisals on their experiences is also examined. Method: Participants (n = 206) complete up to 56 in-the-moment assessments of mood and current activities using Personal Digital Assistants for 1 week. Results: Multilevel modeling techniques reveal that ADHD inattentive and hyperactive-impulsive symptoms differentially relate to daily experiences. Higher inattentive symptoms are associated with indices of general distress, including less positive and more negative mood as well as more concentration problems. Higher hyperactive-impulsive symptoms are associated with reduced sensitivity to contextual factors in perceptions of situations. Conclusion: These findings demonstrate predictive validity for adult self-report of ADHD symptoms in a general population sample and suggest future research directions using ESM. (J. of Att. Dis. 2008; 11(6) 652-663)

An examination of the relationship between behavioral approach system (BAS) sensitivity and social interaction anxiety.

BACKGROUND Both behavioral inhibition system (BIS) and behavioral approach system (BAS) sensitivity have been proposed to play a role in social anxiety; however, findings concerning the relationship between BAS and social anxiety have been mixed. Moreover, recent evidence suggests that low levels of BAS may only be associated with the social interaction subdimension of social anxiety. METHOD Measures of BIS, BAS, social interaction anxiety, and social observation anxiety were administered to three large analogue samples. RESULTS As hypothesized, BAS was inversely related to social interaction anxiety, but was unrelated to social observation anxiety across all three samples. In addition, individuals with generalized social fears were found to report both higher levels of BIS and lower levels of BAS compared to individuals with few or specific social fears. CONCLUSION These findings suggest that a complete motivational account of generalized social anxiety should include both BIS and BAS.

Sex, ADHD symptoms, and smoking outcomes: An integrative model

Both females and individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) have been found to be at increased risk for a range of smoking outcomes, and recent empirical findings have suggested that women with ADHD may be particularly vulnerable to nicotine dependence. On a neurobiological level, the dopamine reward processing system may be implicated in the potentially unique interaction of nicotine with sex and with ADHD status. Specifically, nicotine appears to mitigate core ADHD symptoms through interaction with the dopamine reward processing system, and ovarian hormones have been found to interact with nicotine within the dopamine reward processing system to affect neurotransmitter release and functioning. This article synthesizes data from research examining smoking in women and in individuals with ADHD to build an integrative model through which unique risk for cigarette smoking in women with ADHD can be systematically explored. Based upon this model, the following hypotheses are proposed at the intersection of each of the three variables of sex, ADHD, and smoking: (1) individuals with ADHD have altered functioning of the dopamine reward system, which diminishes their ability to efficiently form conditioned associations based on environmental contingencies; these deficits are partially ameliorated by nicotine; (2) nicotine interacts with estrogen and the dopamine reward system to increase the positive and negative reinforcement value of smoking in female smokers; (3) in adult females with ADHD, ovarian hormones interact with the dopamine reward system to exacerbate ADHD-related deficits in the capacity to form conditioned associations; and (4) during different phases of the menstrual cycle, nicotine and ovarian hormones may interact differentially with the dopamine reward processing system to affect the type and value of reinforcement smoking provides for women with ADHD. Understanding the bio-behavioral mechanisms underlying cigarette addiction in specific populations will be critical to developing effectively tailored smoking prevention and cessation programs for these groups. Overall, the goal of this paper is to examine the interaction of sex, smoking, and ADHD status within the context of the dopamine reward processing system not only to elucidate potential mechanisms specific to female smokers with ADHD, but also to stimulate consideration of how the examination of such individual differences can inform our understanding of smoking more broadly.

Behavioral approach in ADHD: testing a motivational dysfunction hypothesis.

Objective: Etiological models of attention-deficit hyperactivity disorder (ADHD) increasingly support the role of a motivational dysfunction pathway, particularly for hyperactive-impulsive symptoms. Overactive behavioral approach tendencies are implicated among these motivational accounts. However, other externalizing disorder symptoms, such as the psychopathy dimension, are also associated with behavioral approach and frequently co-occur with ADHD. The current study tested the hypothesis that behavioral approach is differentially associated with hyperactive-impulsive ADHD and psychopathy symptoms. Method: A sample of young adults ( n = 220) completed self-report measures assessing behavioral approach and inhibition, ADHD symptoms, and psychopathy symptoms. Results: Structural equation analyses supported the hypothesis that behavioral approach predicts hyperactive-impulsive ADHD symptoms while considering symptom overlap with psychopathy symptoms. Conclusion: These findings support motivational accounts that behavioral approach tendencies are predictive of ADHD symptoms and address concerns about externalizing comorbidity. Implications for ADHD etiology are discussed.

Sensitivity to punishment and low maternal care account for the link between bulimic and social anxiety symptomology.

OBJECTIVE The current study examined the joint effect of personality and parenting factors on the prediction of bulimia nervosa (BN) and social anxiety disorder (SAD) symptomology in a sample of female college students. The study also tested whether personality and parenting factors might account for the association between BN and SAD symptoms. METHOD One-hundred twenty-eight participants completed self-report measures assessing maternal care (MC), maternal overprotection, sensitivity to punishment (SP), sensitivity to reward (SR), and BN and SAD symptomology. RESULTS SP, SR, and MC each uniquely predicted BN symptoms, whereas only SP and MC predicted SAD symptoms. High SP interacted with low MC to predict BN and SAD symptoms over the main effects. In addition, SP, MC, and the interaction term SP x MC mediated the association between SAD and BN symptoms. CONCLUSION High SP and low MC appear to account for the link between BN and SAD symptomology, whereas high SR appears to distinguish the disorders.

Method of adult diagnosis influences estimated persistence of childhood ADHD: a systematic review of longitudinal studies

Several studies have questioned the stability of attention-deficit hyperactivity disorder (ADHD) from childhood to adulthood. This systematic review illustrates how variability in diagnostic methods influences adult ADHD persistence estimates. Systematic database searches identified studies reporting adult ADHD persistence rates that were published in English between Jan 1, 1992, and May 31, 2016. Study inclusion criteria were systematic childhood diagnosis of attention-deficit disorder, ADHD, or a research diagnostic protocol that matched DSM-III, DSM-III-R, or DSM-IV standards; mean childhood age of younger than 12·0 years with no participants older than 18·0 years; and mean adult age of 18·0 years or older with no participants younger than 17·0 years. Across 12 included samples, we identified 41 estimates of ADHD persistence, which ranged from 4·0% to 77·0%. Methods of diagnosing ADHD in adulthood varied widely with respect to source of information, diagnostic instruments (eg, rating scales, interviews), diagnostic symptom threshold, and whether impairment was required for diagnosis. Sole reliance on self reports and a strict threshold of six DSM symptoms led to very low persistence estimates. To minimise false-negative and false-positive classifications, recommended methods for determining adult persistence of ADHD include collecting self and informant ratings, requiring the presence of impairment, and using an age-appropriate symptom threshold. Very few persistence estimates utilised these methods, but those that did indicated persistence rates of 40-50%.

Late-Onset ADHD Reconsidered With Comprehensive Repeated Assessments Between Ages 10 and 25

OBJECTIVE Adolescents and young adults without childhood attention deficit hyperactivity disorder (ADHD) often present to clinics seeking stimulant medication for late-onset ADHD symptoms. Recent birth-cohort studies support the notion of late-onset ADHD, but these investigations are limited by relying on screening instruments to assess ADHD, not considering alternative causes of symptoms, or failing to obtain complete psychiatric histories. The authors address these limitations by examining psychiatric assessments administered longitudinally to the local normative comparison group of the Multimodal Treatment Study of ADHD. METHOD Individuals without childhood ADHD (N=239) were administered eight assessments from comparison baseline (mean age=9.89 years) to young adulthood (mean age=24.40 years). Diagnostic procedures utilized parent, teacher, and self-reports of ADHD symptoms, impairment, substance use, and other mental disorders, with consideration of symptom context and timing. RESULTS Approximately 95% of individuals who initially screened positive on symptom checklists were excluded from late-onset ADHD diagnosis. Among individuals with impairing late-onset ADHD symptoms, the most common reason for diagnostic exclusion was symptoms or impairment occurring exclusively in the context of heavy substance use. Most late-onset cases displayed onset in adolescence and an adolescence-limited presentation. There was no evidence for adult-onset ADHD independent of a complex psychiatric history. CONCLUSIONS Individuals seeking treatment for late-onset ADHD may be valid cases; however, more commonly, symptoms represent nonimpairing cognitive fluctuations, a comorbid disorder, or the cognitive effects of substance use. False positive late-onset ADHD cases are common without careful assessment. Clinicians should carefully assess impairment, psychiatric history, and substance use before treating potential late-onset cases.