Timo Hennig

Measuring fluctuations across the Continuum of Auditory Hallucinations. Development and validation of a state inventory

In order to identify causes and triggers of hallucinations that can inform therapy, reliable, valid, and change-sensitive instruments to assess hallucinatory experiences in the subclinical and clinical range are needed. We developed and validated a novel scale, the Continuum of Auditory Hallucinations - State Assessment (CAHSA), to be used for repeated assessment of the subclinical factors vivid imagination, intrusive thoughts, and perceptual sensitivity as well as auditory hallucinations. After selecting items for the four factors in a first test sample (n=84), we tested factorial validity using CFA and criterion validity with self-reported psychosis-like experiences (n=534). Finally, within-subject variation of CAHSA scores over 14 days and time-lagged associations between its factors were explored (n=85). A 9-item CAHSA was selected that showed good factorial validity, criterion validity, and substantial, valid within-subject variation. Time-lagged regression showed that vivid imagination, perceptual sensitivity, and intrusive thought precede auditory hallucinations. In sum, the CAHSA validly measures fluctuation along the continuum of auditory hallucinations, is sensitive to change, and well suited for experimental studies, repeated measurement, and longitudinal research.

Bullying Mediates Between Attention-Deficit/Hyperactivity Disorder in Childhood and Psychotic Experiences in Early Adolescence

Although a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) is known to be linked to psychotic experiences and psychotic disorders in later life, the developmental trajectories that could explain this association are unknown. Using a sample from the prospective population-based Avon Longitudinal Study of Parents and Children (ALSPAC) (N = 8247), we hypothesized that the previously reported association of ADHD combined subtype in childhood and psychotic experiences in early adolescence is mediated by traumatic events and by involvement in bullying. Moreover, we expected this mediation to be specific to ADHD and tested this by comparison with specific phobia. Children with ADHD combined subtype at age 7 were more often involved in bullying at age 10 (OR 3.635, 95% CI 1.973-6.697) and had more psychotic experiences at age 12 (OR 3.362, 95% CI 1.781-6.348). Moreover, children who were involved in bullying had more psychotic experiences (2.005, 95% CI 1.684-2.388). Bullying was a significant mediator between ADHD and psychotic experiences accounting for 41%-50% of the effect. Traumatic events from birth to age 11 were also significantly associated with ADHD combined subtype and psychotic experiences; however, there was no evidence of mediation. Specific phobia was significantly associated with psychotic experiences, but not with bullying. To conclude, bullying is a relevant translating mechanism from ADHD in childhood to psychotic experiences in early adolescence. Interventions that eliminate bullying in children with ADHD could potentially reduce the risk of having psychotic experiences in later life by up to 50%. Clinicians should thus screen for bullying in routine assessments of children with ADHD.

Attention-Deficit/Hyperactivity Disorder Symptoms and Life Satisfaction in a Representative Adolescent and Adult Sample

Abstract Although it is well documented that attention-deficit/hyperactivity disorder (ADHD) is associated with reduced life satisfaction, the mechanisms that might explain this co-occurrence are unclear. We examined the correlation of ADHD symptoms with life satisfaction and whether this association is mediated by (lacking) social support and depressive symptoms. Self-reported ADHD symptoms, life satisfaction, social support, and depressive symptoms were assessed in a representative, predominantly adult sample from the general population (14–91 years, N = 2517). Attention-deficit/hyperactivity disorder symptoms correlated negatively with life satisfaction (r = −0.41, p < 0.01), even after demographic factors (gender, age, income) and common risk factors (not being in a relationship, being unemployed) were controlled for (r = −0.39, p < 0.01). Social support mediated up to 23% and depressive symptoms up to 44% in the association between ADHD symptoms and life satisfaction. Counteracting problems with social relationships and treating depressive symptoms may help to increase life satisfaction in adults with ADHD symptoms.

Cross-Informant Disagreement on Behavioral Symptoms in Adolescent Attention-Deficit/Hyperactivity Disorder and Its Impact on Treatment Effects

In assessing adolescent behavior difficulties, parents, teachers, and the adolescents themselves are key informants. However, substantial disagreement has been found between informants. Specifically, children with attention-deficit/hyperactivity disorder (ADHD) tend to overestimate their competencies, also known as “positive (illusionary) bias.” This study compared parent, teacher, and adolescent ratings of ADHD and other behavioral symptoms in a sample of 114 adolescents with ADHD. Further, the effect of cross-informant disagreement (CID) on treatment outcomes was investigated in a subsample of 54 adolescents who had undergone a training and coaching intervention. Overall, there was moderate agreement among informants. Parent and adolescent ratings were more strongly correlated with each other than with teacher ratings. The strongest discrepancy was found between teacher and adolescent ratings on prosocial behavior. This discrepancy explained 12% of the variance in parent-rated ADHD symptom severity after the intervention. The treatment was less effective in participants with high teacher-adolescent disagreement on prosocial behavior (d = 0.41) than with low disagreement (d = 0.98). These findings suggest that professionals working with adolescents with ADHD should consider multiple sources of information before initiating treatment and pay attention to cross-informant disagreements because these may indicate a risk of diminished treatment effects.

Mediation and Moderation of Outcome in a Training Intervention for Adolescents With Attention-Deficit/Hyperactivity Disorder

Objective: A training intervention that aims to improve the problem-solving and organization skills of adolescents with attention-deficit/hyperactivity disorder (ADHD) has been investigated. Aim of this study was to examine the mechanisms of change that occurred during the intervention in an empirical trial. Method: Forty-nine adolescents with ADHD aged 12–17 years took part in the intervention. The primary outcome of the intervention was the reduction of ADHD symptoms. To understand how the intervention facilitated the improvement of the outcome, we conducted mediation and moderation analyses. As potential mediators, improvement in academic enablers and meta- and neurocognitive functioning were investigated. Age, gender, and medication status were analyzed as potential moderators of the outcome. Results: An improvement in academic enablers partially mediated symptom reductions. There were no effects of moderation. Conclusions: Enhancing academic skills can reduce ADHD symptom severity. The training intervention examined in this study is a promising treatment for adolescents with ADHD.

Training Problem Solving and Organizational Skills in Adolescents With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial

Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent psychiatric disorder in adolescence and results severe impairment. Few psychosocial interventions aim at ADHD in adolescence and are rarely evaluated in randomized controlled trials (RCTs). Therefore, an intervention combining adolescent-directed problem-solving and organizational skills training with behavioral parent and teacher training has been developed. Its efficacy in comparison to waiting list and active controls is reported. One hundred thirteen adolescents (mean age = 13.99 years) with ADHD were randomly assigned to the training, a waiting list or an active control condition (progressive muscle relaxation [PMR]). Parents and teachers rated ADHD symptoms, academic enablers, and comorbid problems before and after. Results: The training significantly reduced ADHS symptoms and parent- and teacher-rated internalizing problems and increased teacher rated academic enablers compared to waiting list controls. Compared to active controls, results were in the range of small nonsignificant effects. A skills training is an efficacious treatment for adolescent ADHD, however, not significantly superior to PMR. Contrasts between both interventions need to be further investigated.