Ronna Fried

Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder: 11-year follow-up in a longitudinal case-control study.

OBJECTIVE Few follow-up studies have been conducted of girls with ADHD, and none have followed girls into adulthood. The authors sought to estimate the prevalence of psychopathology in girls with and without ADHD followed into young adulthood. METHOD The authors conducted a longitudinal case-control study of 6- to 18-year-old girls with (N=140) and without (N=122) ADHD ascertained from psychiatric and pediatric sources. At the 11-year follow-up, 96 (69%) of the girls with ADHD and 91 (75%) of the comparison girls were reassessed (mean age=22 years). Participants were blindly assessed by structured diagnostic interviews. RESULTS Lifetime and 1-year risks for all composite categories of psychopathology were significantly greater in girls with ADHD grown up relative to comparison girls; lifetime hazard ratios were 7.2 (95% CI=4.0-12.7) for antisocial disorders, 6.8 (95% CI=3.7-12.6) for mood disorders, 2.1 (95% CI=1.6-2.9) for anxiety disorders, 3.2 (95% CI=2.0-5.3) for developmental disorders, 2.7 (95% CI=1.6-4.3) for addictive disorders, and 3.5 (95% CI=1.6-7.3) for eating disorders. For lifetime psychopathology, all six composite categories remained statistically significant after controlling for other baseline psychopathology. Except for addictive disorders, significant 1-year findings remained significant after controlling for baseline psychopathology. The 1-year prevalences of composite disorders were not associated with lifetime or 1-year use of ADHD medication. CONCLUSION By young adulthood, girls with ADHD were at high risk for antisocial, addictive, mood, anxiety, and eating disorders. These prospective findings, previously documented in boys with ADHD, provide further evidence for the high morbidity associated with ADHD across the life cycle.

Impact of Psychometrically Defined Deficits of Executive Functioning in Adults With Attention Deficit Hyperactivity Disorder

OBJECTIVE The association between deficits in executive functioning and functional outcomes was examined among adults with attention deficit hyperactivity disorder (ADHD). METHOD Subjects were adults who did (N=213) and did not (N=145) meet DSM-IV criteria for ADHD. The authors defined having deficits in executive functioning as having at least two measures of executive functioning with scores 1.5 standard deviations below those of matched comparison subjects. RESULTS Significantly more adults with ADHD had deficits of executive functioning than comparison subjects. Deficits of executive functioning were associated with lower academic achievement, irrespective of ADHD status. Subjects with ADHD with deficits of executive functioning had a significantly lower socioeconomic status and a significant functional morbidity beyond the diagnosis of ADHD alone. CONCLUSIONS Psychometrically defined deficits of executive functioning may help identify a subgroup of adults with ADHD at high risk for occupational and academic underachievement. More efforts are needed to identify cost-effective approaches to screen individuals with ADHD for deficits of executive functioning.

Does ADHD Predict Substance-Use Disorders? A 10-Year Follow-up Study of Young Adults With ADHD

OBJECTIVE High rates of substance-use disorders (SUD) have been found in samples of adolescents and adults with attention-deficit/hyperactivity disorder (ADHD). Predictors of SUD in children with ADHD who are at risk for the development of SUDs remain understudied. The main aims of this study were to identify clinically meaningful characteristics of children that predicted the future development of SUDs and to see whether the role of these characteristics varied by sex. METHOD Subjects were children and adolescents with (n = 268; mean age ± standard deviation = 10.9 ± 3.2 years) and without (n = 229; mean age 11.9 ± 3.3 years) DSM-III-R ADHD followed prospectively and blindly over a 10-year follow-up period onto young adult years. Subjects were assessed with structured diagnostic interviews for psychopathology and SUDs. RESULTS Over the 10-year follow-up period, ADHD was found to be a significant predictor of any SUD (hazards ratio 1.47; 95% confidence interval 1.07-2.02; p = .01) and cigarette smoking (2.38; 1.61-3.53; p < .01). Within ADHD, comorbid conduct disorder (2.74; 1.66-4.52; p < .01) and oppositional defiant disorder (2.21; 1.40-3.51; p < .01) at baseline were also found to be significant predictors of SUDs. Similar results were found for cigarette-, alcohol-, and drug-use disorders. There were few meaningful sex interaction effects. No clinically significant associations were found for any social or family environment factors or for cognitive functioning factors (p > .05 for all comparisons). CONCLUSIONS These results indicate that ADHD is a significant risk factor for the development of SUDs and cigarette smoking in both sexes.

Stability of executive function deficits into young adult years: a prospective longitudinal follow-up study of grown up males with ADHD

Objective:  Although individuals with attention deficit‐hyperactivity disorder (ADHD) commonly exhibit deficits in executive functions that greatly increase the morbidity of the disorder, all available information on the subject is cross sectional.

Neuropsychological Functioning in Youth with Bipolar Disorder

BACKGROUND Little is known about the neuropsychological status of youth with bipolar disorder (BPD) or whether cognitive deficits in this population are accounted for by comorbidity with attention deficit/hyperactivity disorder (ADHD). We compared neuropsychological and academic functioning of youth with and without DSM-IV BPD, controlling for effects of comorbid ADHD. METHODS Fifty-seven youth with BPD and 46 healthy control subjects were assessed on a battery of clinical neuropsychological measures including subtests from the Wechsler Intelligence Scales for Children and Adults (Third Editions), the Stroop, the Wisconsin Card Sorting Test, the Rey-Osterreith Complex Figure, an auditory working memory Continuous Performance Test, a measure of verbal learning, and the Wide Range Achievement Test-Third Edition. RESULTS Bipolar disorder was associated with impairments on subtests reflecting sustained attention, working memory, and processing speed after controlling for ADHD. Additionally, decrements of moderate effect sizes were found for measures of interference control, abstract problem solving, and verbal learning but did not meet criteria for statistical significance. CONCLUSIONS After controlling for ADHD, youth with BPD show neuropsychological deficits similar to impairments found in adults with the disorder. Further studies are needed to understand the clinical implications of these impairments as well as their role in the underlying risk for pediatric BPD.

Are cognitive deficits in attention deficit/hyperactivity disorder related to the course of the disorder? A prospective controlled follow-up study of grown up boys with persistent and remitting course

To investigate the longitudinal course of cognitive functions in boys with persistent and remittent attention deficit/hyperactivity disorder (ADHD) from childhood into young adult years. Males (n=217) 15-31 years with and without ADHD were assessed at 3 time points over 10 years into young adulthood. Subjects were stratified into Remittent ADHD, and Persistent ADHD based on the course of ADHD. Cognitive domains included: 1) overall IQ (overall IQ, block design IQ, vocabulary IQ); 2) achievement scores in reading and math and measures of executive function (Wechsler arithmetic, digit span, digit symbol, Rey-Osterrieth, Wisconsin Card Sorting Test, and the Stroop Test). Cognitive outcomes were modeled as a function of group (Controls, Remittent ADHD, and Persistent ADHD), age, group by age interaction, and any demographic confounders using linear growth-curve models. There were no significant interaction effects of group by time. Main group effects indicated that persistent and remittent ADHD groups both had significantly lower scores on all cognitive outcomes compared with controls, and these did not differ between the ADHD subgroups Psychometrically defined cognitive deficits are relatively stable into young adult years and appear to be independent of the course of ADHD. More work is needed to help define the implications of these deficits in individuals with a remitting course of ADHD.

The impact of distractions on young adult drivers with attention deficit hyperactivity disorder (ADHD).

Young adults with attention deficit hyperactivity disorder (ADHD) are at higher risk for being involved in automobile crashes. Although driving simulators have been used to identify and understand underlying behaviors, prior research has focused largely on single-task, non-distracted driving. However, in-vehicle infotainment and communications systems often vie for a drivers attention, potentially increasing the risk of collision. This paper explores the impact of secondary tasks on individuals with and without ADHD, a medical condition known to affect the regulation of attention. Data are drawn from a validated driving simulation representing periods before, during, and after participation in a secondary cognitive task. A hands-free phone task was employed in a high stimulus, urban setting and a working memory task during low stimulus, highway driving. Drivers with ADHD had more difficulty on the telephone task, yet did not show an increased decrement in driving performance greater than control participants. In contrast, participants with ADHD showed a larger decline in driving performance than controls during a secondary task in a low demand setting. The results suggest that the interaction of the nature of the driving context and the secondary task has a significant influence on how drivers with ADHD allocate attention and, in-turn, on the relative impact on driving performance. Drivers with ADHD appear particularly susceptible to distraction during periods of low stimulus driving.

Discordance Between Psychometric Testing and Questionnaire-Based Definitions of Executive Function Deficits in Individuals With ADHD

Objective: One suspected source of negative outcomes associated with ADHD has been deficits in executive functions. Although both psychometrically defined and self-reported executive function deficits (EFDs) have been shown to be associated with poor academic and occupational outcomes, whether these two approaches define the same individuals remains unknown. Method: Participants were 194 adults with ADHD from a case-control study of ADHD. Empirically based cutoffs were ascertained for an EFD diagnosis on both psychometric tests and scores on the Current Behavior Scale. Results: Results showed a modest overlap between the psychometric and self-reported definitions of EFDs. Whereas neuropsychological testing largely identified individuals with lower IQ and achievement testing, the behavioral questionnaire largely identified individuals with higher levels of ADHD symptoms, psychiatric comorbidity, and interpersonal deficits. Conclusion: Results indicate that behavioral questionnaires cannot be used interchangeably with neuropsychological testing for the assessment of EFDs in adults with ADHD. (J. of Att. Dis. 2008; 12(1) 92-102)

Stability of executive function deficits in girls with ADHD: a prospective longitudinal followup study into adolescence.

Neuropsychological deficits in the executive system are major sources of morbidity in individuals with attention-deficit/hyperactivity disorder (ADHD). We conducted a 5-year longitudinal study of girls with (N = 140) and without (N = 122) ADHD, aged 6–18 years at baseline. Neuropsychological functioning was assessed using standard neuropsychological testing assessing executive functions (EFs). Girls with ADHD were significantly more impaired than controls in all neuropsychological domains except set shifting. Despite variability in the stability of individual domains of EFs, the majority (79%) of girls with ADHD that met the categorical definition of executive function deficits (EFDs, defined as two or more EF tasks impaired) at baseline continued to have EFDs at the five-year followup. These findings document the stability of EFDs in girls with ADHD from childhood into adolescence.

Can bipolar disorder-specific neuropsychological impairments in children be identified?

This study examined neuropsychological deficits among children with bipolar disorder while attending to its comorbidity with attention-deficit/hyperactivity disorder (ADHD). Seventy-three unmedicated children (ages 6-17 years) with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) bipolar disorder plus ADHD (BPD + ADHD) were compared with 102 unmedicated children with ADHD without bipolar disorder, and 120 children without bipolar disorder or ADHD. Ninety-four percent of participants were Caucasian, 58% were male, and 42% were female. On average participants were of middle to upper socioeconomic status. Participants were assessed with a comprehensive neuropsychological battery and measures of academic achievement, school failure, and special education placement. Participants with BPD + ADHD and with ADHD were impaired in interference control, verbal learning, and arithmetic achievement and had higher rates of special school services. Across all of the measures of neuropsychological functioning, the only difference observed between youths with BPD + ADHD and youths with ADHD was that youths with BPD + ADHD performed more poorly on one measure of processing speed. Thus, comorbidity with ADHD may account for many of the neuropsychological deficits observed in children with bipolar disorder.