Inhibition and executive functioning in Type A and ADHD boys

The present study was aimed at clarifying the standing of Type A behavior, as measured by behavioral observations, relative to Attention Deficit Hyperactivity Disorder (ADHD), using measures of inhibitory control and executive functioning. The study sample included 20 boys exhibiting Type A behavior, 21 boys exhibiting Type B behavior and 14 boys diagnosed with ADHD, ranging in age from 7 to 12 years. The results of the present study showed that the Type A children differed from Type B children on two time-related variables, response latency and reaction time, in accordance with the view of Type As as time-urgent and impatient. Furthermore, in comparisons with the ADHD group, the Type A boys were found to be superior on several performance tasks, such as Go/no-go omissions, time reproduction, story recall and memory for sequences of hand movements, although similarities between Type A and ADHD boys were evidenced in terms of response latency and reaction time. In other words, although Type A boys were similar to ADHD boys in terms of overt displays of time-urgency and impatience, Type As do not display deficits with regard to executive functioning, of the kind often found when ADHD children are compared with normal controls. It may thereby be concluded that Type A behavior and hyperactivity/ADHD appear to be well differentiated except with regard to what may be interpreted as impatience. Speculations concerning differing origins of overtly similar characteristics of Type A behavior and ADHD should be considered in future research.     

Inhibition and executive functioning in Type A and ADHD boys

The present study was aimed at clarifying the standing of Type A behavior, as measured by behavioral observations, relative to Attention Deficit Hyperactivity Disorder (ADHD), using measures of inhibitory control and executive functioning. The study sample included 20 boys exhibiting Type A behavior, 21 boys exhibiting Type B behavior and 14 boys diagnosed with ADHD, ranging in age from 7 to 12 years. The results of the present study showed that the Type A children differed from Type B children on two time-related variables, response latency and reaction time, in accordance with the view of Type As as time-urgent and impatient. Furthermore, in comparisons with the ADHD group, the Type A boys were found to be superior on several performance tasks, such as Go/no-go omissions, time reproduction, story recall and memory for sequences of hand movements, although similarities between Type A and ADHD boys were evidenced in terms of response latency and reaction time. In other words, although Type A boys were similar to ADHD boys in terms of overt displays of time-urgency and impatience, Type As do not display deficits with regard to executive functioning, of the kind often found when ADHD children are compared with normal controls. It may thereby be concluded that Type A behavior and hyperactivity/ADHD appear to be well differentiated except with regard to what may be interpreted as impatience. Speculations concerning differing origins of overtly similar characteristics of Type A behavior and ADHD should be considered in future research.     

Reduced serotonergic functioning changes heart rate in ADHD

Reduced mean heart rate (HR) was shown to be a biophysiological marker for aggression, which in turn was proven to be related to changed serotonergic neurotransmission. A total of 16 ADHD-diagnosed boys were subjected to rapid tryptophan depletion (RTD) and a placebo in a double-blind within-subject crossover-design. Mean HR was assessed under RTD/placebo. Low impulsive patients behaving aggressively under RTD showed a lowered HR under RTD versus placebo. Diminished 5-HT functioning was associated with lowered HR and aggressive behaviour. Original publication statement: This is an original publication, containing original unpublished work which has not been submitted elsewhere. Aspects of RTD on aggressive and impulsive behavioural aspects have been published elsewhere (Stadler et al. 2008; Zepf et al. 2008a).     

ADHD and executive functioning deficits in OCD youths who hoard

Hoarding is common among youth with obsessive compulsive disorder (OCD), with up to 26% of OCD youth exhibiting hoarding symptoms. Recent evidence from adult hoarding and OCD cohorts suggests that hoarding symptoms are associated with executive functioning deficits similar to those observed in subjects with attention deficit hyperactivity disorder (ADHD). However, while hoarding behavior often onsets during childhood, there is little information about executive function deficits and ADHD in affected children and adolescents.The study sample included 431 youths (ages 6–17 years) diagnosed with OCD who participated in the OCD Collaborative Genetics Study and the OCD Collaborative Genetics Association Study and completed a series of clinician-administered and parent report assessments, including diagnostic interviews and measures of executive functioning (Behavior Rating Inventory of Executive Functioning; BRIEF) and hoarding severity (Hoarding Rating Scale-Interview; HRS-I).113 youths (26%) had clinically significant levels of hoarding compulsions. Youths with and without hoarding differed significantly on most executive functioning subdomains and composite indices as measured by the parent-rated BRIEF. Groups did not differ in the frequency of full DSM-IV ADHD diagnoses; however, the hoarding group had significantly greater number of inattention and hyperactivity symptoms compared to the non-hoarding group. In multivariate models, we found that overall BRIEF scores were related to hoarding severity, adjusting for age, gender and ADHD symptoms.These findings suggest an association between hoarding and executive functioning deficits in youths with OCD, and assessing executive functioning may be important for investigating the etiology and treatment of children and adolescents with hoarding and OCD.     

Inner city disadvantage and family functioning

The co-existence of types of social, environmental and family disadvantage and domains of family dysfunction is explored through individual interviews and use of the Family Assessment Device in a cross-sectional study of 143 inner city families. The dependence upon social welfare by the family and the overall degree of disadvantage experienced both correlate significantly with all forms of family dysfunction. Marital disruption, poor physical care of the home or of the child(ren) and poor quality of mothering correlate significantly with difficulties both in role allocation and in affective involvement. Those families suffering more types of environmental disadvantage are more likely also to be dysfunctional in each domain of family life. Some possible mechanisms for these associations are highlighted and their implications for planning of effective interventions discussed.     

Quality of life in older adults with ADHD: links to ADHD symptom levels and executive functioning deficits

Abstract

Purpose and aim: The overall aim of the present study was to examine quality of life in attention deficit hyperactivity disorder (ADHD) patients age ≥60 years. First, we compared older adults with ADHD to both healthy controls of the same age and younger adults with ADHD. Second, we examined executive functioning as a possible underlying factor for quality of life among older adults with ADHD.

Methods: The study included 158 participants in three groups: (1) older adults (60–75 years of age) with ADHD (n?=?42), (2) healthy controls of the same age (n?=?58), and (3) younger adults (age 18–45 years of age) with ADHD (n?=?56). The patients with ADHD were clinically-referred. Quality of life was examined through self-ratings and executive functioning was examined using both self-ratings and tests.

Results: Older adults with ADHD differed significantly from controls the same age on all aspects of quality of life, with large effect sizes. However, they showed similar levels of quality of life compared to younger adults with ADHD. The exception was psychological health, for which older adults displayed better quality of life compared to younger adults with ADHD. Executive deficits measured through self-ratings, especially working memory, were related to quality of life, sometimes also beyond the influence of ADHD symptom levels.

Conclusions: Older adults with ADHD show serious impairments in quality of life, that are comparable to the levels found for younger adults. Impairments may increase further as these individuals grow older and clinics need to meet the needs of this increasingly larger group of patients.     

Psychiatric, psychosocial, and cognitive functioning of female adolescents with ADHD

OBJECTIVE: To characterize the psychiatric, psychosocial, and cognitive functioning of female adolescents with attention-deficit/hyperactivity disorder (ADHD) in comparison with female controls and males with ADHD. Female controls were also compared with male controls to verify gender differences in a nonclinical sample. METHOD: One hundred seven adolescents from Southern Ontario aged 13 to 16 were included: 24 females with ADHD, 35 males with ADHD, 28 control females, and 20 control males. All were assessed with semistructured interviews, questionnaires, and tests of achievement and intellectual functioning. RESULTS: After controlling for parental education and estimated Full Scale IQ, females with ADHD were more impaired than control females in depression, anxiety, distress, teacher relationships, stress, attributional styles, and locus of control and on all cognitive and achievement measures. Females with ADHD were more impaired than males with ADHD in self-reported anxiety, distress, depression, locus of control, and vocabulary scores. These group differences were confirmed by higher ratings by parents and teachers in symptoms of psychopathology. Males with ADHD were more impaired in processing speed. Some gender differences (locus of control and vocabulary scores) were eliminated when controlling for ADHD severity. The absence of any differences between male and female controls indicates gender differences were specific to the clinical groups. CONCLUSION: Females with ADHD are at high risk for more psychological impairment than both males with ADHD and control females. The identified psychosocial problems point to areas for intervention.     

Psychopathology and family functioning in mothers with epilepsy

In a prospective comparative study of children born to mothers with epilepsy and to healthy controls, maternal psychopathology, family functioning and the effects of maternal psychopathology and family functioning on child mental status were investigated. The instruments used were the Present State Examination (PSE), the Past History Schedule (PHS), a psychiatric interview for preschool children and a structured interview about family functioning. Interviewers were blind to the clinical status of the mother. The group of mothers with epilepsy differed from the control group only regarding a higher prevalence of minor psychopathology and in 1 of 4 areas of family functioning. There was no difference between mothers with epilepsy and the control group regarding major psychopathology, and almost no differences regarding family functioning. The effect of maternal psychopathology on child mental status was mediated by disturbed family functioning only in the epilepsy group.     

Focal family therapy outcome study. I: Patient and family functioning

This pilot study compared the efficacy of two models of family therapy plus medication in the treatment of ten schizophrenic patients previously considered poor responders to neuroleptics alone. Focal Family Therapy (FFT), a limited psychodynamic model, was compared with Supportive Management Counselling (SMC), an educative, problem-solving approach. Family treatment was begun during admission to hospital and continued for up to six months post-discharge. Patient and family measures were administered on assessment, termination, and at three, six and 12 month follow-up interviews. Our data suggest that patients in both groups improved significantly following treatment on measures of social functioning and community tenure. The average increase in amount of time out of hospital was a full year, compared to previous rates. Patients receiving FFT demonstrated significantly greater improvement in symptoms, compared to patients in the SMC group. On average, families scored in the normal range on the family functioning measure at assessment and upon termination of treatment.     

Marital and family functioning: different measures and viewpoints

  Background: Dysfunctional relationships have been considered to play an important part in the onset and maintenance of psychiatric disorders, particularly depression. Influential factors appear to be perception of low social support and emotional warmth and/or high levels of criticism and control by the recipient. The IBM was developed for use as a simple self-report measure to rate important components of the relationship between marital partners, described as the constructs of care and control. The aim of this study was to test the validity of the IBM. Methods: The IBM was compared with data from a structured marital interview based on the Self-Evaluation of Social Support Schedule (SESS). Data were also obtained from a nominated adult offspring witness. Family functioning was assessed using the General Functioning component of the McMaster Family Assessment Device (FAD). The General Health Questionnaire (GHQ) was used to determine levels of psychological morbidity. The witness data for sons and daughters were analysed to gauge gender effects in reporting. Results: The results show that `care' and `control' were identifiable constructs discerned by partners and witnesses with `care' rated more consistently than `control'. Care between parents was an indicator of the overall quality of the family environment. Care received by the wife from her husband seemed to set the emotional tone for the family. Daughters seemed to be more `in tune' with perceived care by both parents. Sons were less so, overall, but were more `in tune' with their fathers' perceived care than with their mothers'. Conclusion: Both the IBM, a self-report measure, and the structured marital interview provided consistent information about the quality of marital relationships, particularly perceptions of care. Perceptions of control were less consistently reported, which may suggest that `control' is a less robust construct. This may suggest that `control' is a more subjective experience, as the cues are more directed at the partner than other family members. Accepted: 20 March 2000     

Overweight in family members of probands with ADHD

The widely reported association between ADHD and overweight may be attributable to genetic and environmental factors also present in unaffected family members. Therefore, the purpose of this study was to examine the association between ADHD and overweight within families. A cohort was used of families with at least one member with ADHD, recruited as part of the Dutch node of the International Multicenter ADHD Genetics (IMAGE) study, with assessments taking place between 2003 and 2006, 2009 and 2012, and 2013 and 2015. The three assessment waves yielded N = 1828 youth assessments and N = 998 parent assessments from N = 447 unique families. Overweight was defined as a body mass index (BMI) ≥ 85th percentile for youth of the same age and sex; overweight in adults as a BMI ≥ 25. Effects of age, gender, and medication use (psychostimulants, antipsychotics, and melatonin) were taken into account. Generalized estimation equations were used to correct for within-family and within-subject correlations. There was no difference in risk between ADHD-affected youth and their unaffected siblings (OR 0.92, 95% CI 0.78–1.09). However, compared to population prevalence data, all ADHD family members alike were at increased risk for being overweight: ADHD-affected youth (OR 1.33, 95% CI 1.13–1.59), unaffected siblings (OR 1.73, 95% CI 1.45–2.08), mothers (OR 1.74, 95% CI 1.40–2.17) and fathers (OR 1.78, 95% CI 1.46–2.15). Parental overweight—but not parental ADHD—was predictive of offspring overweight (mothers OR 1.40; 95% CI 1.14–1.73, fathers OR 1.83; 95% CI 1.41–2.36). Being overweight runs in ADHD families, yet is not specifically linked to ADHD within families. Shared unhealthy lifestyle factors (including nutrition, sleep, exercise, stress) as well as genetic factors shared by family members likely explain the findings.

     

School phobia: patterns of family functioning

Seventy-six families of children with school phobia were evaluated with the Family Assessment Measure. Mothers and fathers, as separate groups, rated clinically significant dysfunction in the parent-child relationship in the areas of role performance and values and norms. There were no significant differences between intact and single-parent families on ratings of family dysfunction. There was significantly less family dysfunction as rated by mothers and by children if the child had a diagnosis of pure anxiety disorder compared to families of school phobic children in other diagnostic categories.     

Psychiatric comorbidity and functioning in clinically referred preschool children and school-age youths with ADHD

OBJECTIVE: Although the literature documents that attention-deficit/hyperactivity disorder (ADHD) commonly onsets prior to age 6, little is known about the disorder in preschool children. We evaluated the clinical characteristics, psychiatric comorbidity, and functioning of preschool children and school-age youths with ADHD referred to a pediatric psychiatric clinic for evaluation. METHOD: Structured psychiatric interviews assessing lifetime psychopathology by DSM-III-R criteria were completed with parents about their children. Family, social, and overall functioning were also assessed at intake. RESULTS: We identified 165 children with ADHD aged 4 to 6 years (preschool children) and 381 youths aged 7 to 9 years (school-age) with ADHD. Despite being younger, preschool children had similar rates of comorbid psychopathology compared with school-age youths with ADHD. There was an earlier onset of ADHD and co-occurring psychopathology in the preschool children compared to school-age youths. Both preschool children and school-age youths had substantial impairment in school, social, and overall functioning. CONCLUSIONS: The results of this study suggest that despite being significantly younger, clinically referred preschool children with ADHD are reminiscent of school-age youths with ADHD in the quality of ADHD, high rates of comorbid psychopathology, and impaired functioning. Follow-up of these clinically referred preschool children with ADHD to evaluate the stability of their diagnoses, treatment response, and their long-term outcome are necessary.     

West Indian adolescents' perceptions of family functioning

A total of 424 Barbadians aged 13-15 years completed the Family Functioning in Adolescence Questionnaire, developed in Australia by Roelofse and Middleton (1985). Findings revealed most adolescents, like their Australian peers, reported fairly favourable perceptions of their families. However, neither total nor sub-scale scores served to discriminate between sub-groups based on sex, age or household structure to any great extent. A re-grouping of items based on results of Varimax analysis also failed to yield many significant group differences, although some directions for future research were indicated. Adolescents not living with their fathers seemed to have a somewhat lower sense of personal security, but in other respects did not report their family life any less favourably than did those living with both natural parents.     

Attachment and family functioning in patients with Internet addiction

Objective

Although the Internet is used effectively in many areas of life, some users experience problems because of over-use due to a lack of control. The diagnostic criteria for Internet addiction include disruptions in family relationships, but adequate data on the attachment styles and family functioning associated with this condition are limited. This study aimed to investigate the attachment styles and family functioning of patients with Internet addiction.

Method

The sample included 30 male patients consecutively admitted to the Bak?rköy Mental Health and Research Hospital Internet Addiction Outpatient Clinic, who were diagnosed in clinical interviews as having Internet addiction according to Young’s (1998) criteria. Thirty healthy males who were matched with the experimental group in terms of sociodemographic characteristics were included as control subjects. Both groups provided sociodemographic data and completed the Beck Depression Inventory (BDI), the Experiences in Close Relationships Questionnaire-r (ECR-r) and the Family Assessment Device (FAD).

Results

Patients with Internet addiction had higher BDI scores (P< .001) and higher attachment anxiety subscores on ECR-r (P< .001) compared with those in the control group. Patients with Internet addiction evaluated their family functioning as more negative and reported problems in every aspect addressed by the FAD. Scores on the FAD behaviour control, affective responsiveness, and problem-solving subscales (P< .05) and on the FAD communication, roles, and general functioning subscales (P< .001) were significantly higher in the patient compared with the control group.

Conclusion

Patients with Internet addiction have more anxious attachment styles as well as prominent disruptions in family functioning. Thus, it may be important to evaluate the attachment styles and family functioning of patients with Internet addiction. Indeed, comprehensive treatment approaches including other family members may make important contributions to treatment success.     

A cross-cultural study of major depression and family functioning

Patterns of family functioning in families with a depressed member from two cultures (North America and Hungary) were compared. In both cultural settings, families with a depressed member reported poorer family functioning than the control families. Comparisons between the two depressed groups, however, showed that the response to family dysfunction by the two cultures differed. While depressed families in Hungary reported difficulties in setting family rules and boundaries, those in North America experienced impaired functioning in solving problems, communicating, being involved with each other, and in overall functioning. These results are discussed in terms of the interplay between culture, depression and family functioning.