Functional consequences of attention‐deficit hyperactivity disorder on children and their families

Attention‐deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with core symptoms that include hyperactivity, impulsiveness, and inattention, and it is the most common psychiatric disorder among children and adolescents. These core symptoms are continuously recognized throughout the day from childhood to adulthood. Furthermore, children with ADHD from childhood to adulthood might also have various comorbid psychiatric disorders. Recently, bipolar disorder and disruptive mood dysregulation disorder, a new clinical issue, have been discussed as comorbid disorders or differential disorders associated with ADHD. Furthermore, comorbid disorders of ADHD are related to quality of life and family burden. Children with ADHD have poorer long‐term outcomes than controls with respect to: academic achievement and attainment, occupational rank and job performance, risky sexual practices and early unwanted pregnancies, substance use, relationship difficulties, marital problems, traffic violations, and car accidents. Irritability of children with ADHD has been a key symptom that clinicians and researchers have used to evaluate the developmental condition of children with ADHD. ADHD is sometimes a chronic disorder that occurs over a long period, increasing the family burden of these children (including health‐care costs), which will increase with aging for unremitted children with ADHD. Therefore, clinicians should evaluate not only the mental condition of the child but also the family burden. Children with ADHD should be treated during childhood to reduce their clinical symptoms and family burden.     

Lost in transition: A review of the unmet need of patients with attention deficit/hyperactivity disorder transitioning to adulthood

This review discusses the unmet needs of patients with attention deficit/hyperactivity disorder (ADHD) who are transitioning into adulthood. Although awareness and recognition of ADHD in children, adolescents, and adults have improved in recent years, there is often an interruption in management of the disorder when adolescent patients transition to adult health care services. This review has the following objectives: (1) to identify key issues patients with ADHD (with or without an early diagnosis) face during transition into adulthood; (2) to review the current clinical practice and country‐specific approaches to the management of the transition into adulthood for patients with ADHD; (3) to discuss challenges facing clinicians and their patients when drug treatment for ADHD is initiated; (4) to review current ADHD guidelines on transition management in Hong Kong, Singapore, South Korea, Turkey, and Africa; and (5) to examine economic consequences associated with ADHD. The review suggests that the transition period to adult ADHD may be an underresearched and underserved area. The transition period plays an important role regarding how ADHD symptoms may be perceived and acted upon by adult psychiatrists. Further studies are needed to explore the characteristics of the transition period. If only a fraction of adolescents go on to have mental disorders during adulthood, especially ADHD, it is crucial to identify their characteristics to target appropriate interventions at the beginning of the course of illness. There continues to be low recognition of adult ADHD and a severe lack of medical services equipped to diagnose and care for patients with ADHD transitioning from child to adult services.     

Recent developments in the genetics of attention‐deficit hyperactivity disorder

Attention‐deficit hyperactivity disorder (ADHD) is a developmental psychiatric disorder that affects children and adults. ADHD is one of the psychiatric disorders with the strongest genetic basis according to familial, twin, and single nucleotide polymorphisms (SNP)‐based epidemiological studies. In this review, we provide an update of recent insights into the genetic basis of ADHD. We discuss recent progress from genome‐wide association studies (GWAS) looking at common variants as well as rare copy number variations. New analysis of gene groups, so‐called functional ontologies, provide some insight into the gene networks afflicted, pointing to the role of neurodevelopmentally expressed gene networks. Bioinformatic methods, such as functional enrichment analysis and protein–protein network analysis, are used to highlight biological processes of likely relevance to the etiology of ADHD. Additionally, copy number variations seem to map on important pathways implicated in synaptic signaling and neurodevelopment. While some candidate gene associations of, for example, neurotransmitter receptors and signaling, have been replicated, they do not seem to explain significant variance in recent GWAS. We discuss insights from recent case–control SNP–GWAS that have presented the first whole‐genome significant SNP in ADHD.     

The presentation of depression symptoms in attention‐deficit/hyperactivity disorder: comparing child and parent reports

Background

Attention‐deficit/hyperactivity disorder (ADHD) frequently co‐occurs with depression, and outcomes are poor when both are present. Little is known about whether depression symptoms present differently in ADHD compared to the general population, or how reliable young people with ADHD are at reporting these symptoms. This study aimed to describe depression symptoms in a clinical ADHD sample compared to a population sample, and compare self‐reports of depression symptoms with parent‐reports.

Methods

Two hundred and forty‐nine children with ADHD and their parents completed follow‐up questionnaires around 5 years after taking part in a Cardiff University ADHD study. Child depression symptoms were measured using parent‐ and child‐reported Mood and Feelings Questionnaires (MFQ) and compared to a population sample with MFQ data (n = 1460). Within both samples, child‐ and parent‐reported depression symptoms were compared.

Results

Although the profile of depression symptoms was similar between young people with ADHD and those in the general population, depression symptoms were much more common in the ADHD sample (parent‐rated MFQ score = 24.52 vs. 9.39; child‐rated = 21.02 vs. 11.86). The most common symptoms in both samples included irritability, restlessness and concentration difficulties, with core depression symptoms such as feeling miserable/unhappy also prominent. Within the ADHD sample, but not the population sample, children reported depression symptoms less frequently than their parents.

Conclusions

Young people with ADHD are at high risk of experiencing symptoms of depression but may under‐report the severity of their symptoms. Obtaining parent reports of depression symptoms in this group may be important to avoid missing key indicators of risk.     

The relation between procrastination and symptoms of attention‐deficit hyperactivity disorder (ADHD) in undergraduate students

Procrastination is defined as the tendency to delay activities that have to be completed before a deadline. It is often part of psychotherapies for adults with attention‐deficit hyperactivity disorder (ADHD). However, procrastination is officially not acknowledged as an ADHD‐related symptom. Therefore, little is known about the role of procrastination in ADHD. We investigated the relation between procrastination and ADHD‐related symptoms of inattention, hyperactivity, and impulsivity in 54 students with varying levels of self‐reported ADHD‐related behaviours. Various measures of procrastination were used, including questionnaires of academic, general procrastination and susceptibility to temptation as well as direct observation of academic procrastination while solving math problems. We expected a positive relation between severity of ADHD‐related behaviours and procrastination, specifically for impulsivity. However, partial correlations (corrected for the other symptom domain of ADHD) indicated that only inattention was correlated with general procrastination. This specific and preliminary finding can stimulate future research in individuals diagnosed with ADHD. Copyright © 2014 John Wiley & Sons, Ltd.     

Deficient neural activity subserving decision‐making during reward waiting time in intertemporal choice in adult attention‐deficit hyperactivity disorder

Aim

Impulsivity, which significantly affects social adaptation, is an important target behavioral characteristic in interventions for attention‐deficit hyperactivity disorder (ADHD). Typically, people are willing to wait longer to acquire greater rewards. Impulsivity in ADHD may be associated with brain dysfunction in decision‐making involving waiting behavior under such situations. We tested the hypothesis that brain circuitry during a period of waiting (i.e., prior to the acquisition of reward) is altered in adults with ADHD.

Methods

The participants included 14 medication‐free adults with ADHD and 16 healthy controls matched for age, sex, IQ, and handedness. The behavioral task had participants choose between a delayed, larger monetary reward and an immediate, smaller monetary reward, where the reward waiting time actually occurred during functional magnetic resonance imaging measurement. We tested for group differences in the contrast values of blood‐oxygen‐level dependent signals associated with the length of waiting time, calculated using the parametric modulation method.

Results

While the two groups did not differ in the time discounting rate, the delay‐sensitive contrast values were significantly lower in the caudate and visual cortex in individuals with ADHD. The higher impulsivity scores were significantly associated with lower delay‐sensitive contrast values in the caudate and visual cortex.

Conclusion

These results suggest that deficient neural activity affects decision‐making involving reward waiting time during intertemporal choice tasks, and provide an explanation for the basis of impulsivity in adult ADHD.     

Sensation‐to‐cognition cortical streams in attention‐deficit/hyperactivity disorder

We sought to determine whether functional connectivity streams that link sensory, attentional, and higher‐order cognitive circuits are atypical in attention‐deficit/hyperactivity disorder (ADHD). We applied a graph‐theory method to the resting‐state functional magnetic resonance imaging data of 120 children with ADHD and 120 age‐matched typically developing children (TDC). Starting in unimodal primary cortex—visual, auditory, and somatosensory—we used stepwise functional connectivity to calculate functional connectivity paths at discrete numbers of relay stations (or link‐step distances). First, we characterized the functional connectivity streams that link sensory, attentional, and higher‐order cognitive circuits in TDC and found that systems do not reach the level of integration achieved by adults. Second, we searched for stepwise functional connectivity differences between children with ADHD and TDC. We found that, at the initial steps of sensory functional connectivity streams, patients display significant enhancements of connectivity degree within neighboring areas of primary cortex, while connectivity to attention‐regulatory areas is reduced. Third, at subsequent link‐step distances from primary sensory cortex, children with ADHD show decreased connectivity to executive processing areas and increased degree of connections to default mode regions. Fourth, in examining medication histories in children with ADHD, we found that children medicated with psychostimulants present functional connectivity streams with higher degree of connectivity to regions subserving attentional and executive processes compared to medication‐naïve children. We conclude that predominance of local sensory processing and lesser influx of information to attentional and executive regions may reduce the ability to organize and control the balance between external and internal sources of information in ADHD. Hum Brain Mapp 36:2544–2557, 2015. © 2015 Wiley Periodicals, Inc .