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Objective: The Before School Functioning Questionnaire and Parent Rating of Evening and Morning Behavior–Revised assess early morning (BSFQ, PREMB-R AM subscale) and late afternoon/evening (PREMB-R PM subscale) functional impairment in children with ADHD. Clinically meaningful improvements were identified and applied to a trial of delayed-release and extended-release methylphenidate (DR/ER-MPH) in children with ADHD (NCT02520388) to determine if the statistically-determined improvements in functional impairment were also clinically meaningful. Method: Clinically meaningful improvements in BSFQ/PREMB-R were established post hoc by receiver operating characteristics curves, using anchors of Clinical Global Impression–Improvement (CGI-I) = 1 and CGI-I ≤ 2. Percentages of participants achieving these thresholds were calculated. Results: Thresholds for CGI-I = 1/CGI-I ≤ 2, respectively, were 27/20 (BSFQ), 5/3 (PREMB-R AM), and 9/5 (PREMB-R PM)-point decreases. More children achieved clinically meaningful improvements with DR/ER-MPH versus placebo (all p Conclusion: DR/ER-MPH increased proportions of children achieving clinically meaningful improvements in BSFQ and PREMB-R.

Objective: To describe consequences of the nonmedical use (NMU) of prescription amphetamines (AMPs). Method: Data from the U.S. National Poison Data System yielded four groups: intravenous NMU ( IV NMU) intentionally injected AMP, Nasal NMU intentionally inhaled AMP but did not inject, Oral NMU intentionally ingested AMP, and controls reported unintentional oral exposure to AMP. Results: The Nasal NMU group was at greater risk of admission to a health care facility. All NMU groups were at greater risk for adverse clinical effects. IV NMU had the greatest number of adverse effects, followed by Nasal and Oral NMU. Nasal NMU had a greater risk for major medical outcomes versus Oral NMU. The IV NMU group was 21.9 times more likely to die from AMP NMU than controls. Oral NMU conferred a significantly greater risk of suicide attempts. Conclusion: Oral and nonoral NMU of AMP are associated with significant risks of morbidity and mortality.

Objective: To examine efficacy and safety of adjunctive guanfacine extended release (GXR) on morning and evening ADHD symptoms using the Conners’ Global Index–Parent (CGI-P) and Before-School Functioning Questionnaire (BSFQ). Method: Participants 6 to 17 years with ADHD ( N = 461) and suboptimal psychostimulant response were maintained on current psychostimulants and randomized to dose-optimized GXR (≤4 mg/d) in the morning (GXR AM) or evening (GXR PM), or placebo. Results: CGI-P scores improved with GXR (morning assessment, GXR AM, placebo-adjusted least squares [LS] mean = -1.7, GXR PM = -2.6; evening assessment, GXR AM = -2.4, GXR PM = -3.0; all ps < .01). Parent-rated BSFQ scores reflected improved morning functioning with GXR (GXR AM, placebo-adjusted LS mean = -5.1; GXR PM = -4.7; both ps < .01). Most adverse events were mild or moderate. Conclusion: Adjunctive GXR AM or GXR PM was associated with improvements in morning and evening ADHD symptoms in children and adolescents.

Objective: Youth diagnosed with ADHD are at heightened risk of depression. However, many do not develop depression. Individuals with specific cognitive biases are more likely to develop depression yet it remains untested whether these vulnerability-stress models apply to depression risk in youth with ADHD. Method: We examined whether interpretation and attention biases moderated the relation between stressful life events and depressive symptoms in a sample of adolescents ( Mage = 14.42) with ADHD ( n = 59) and without ADHD ( n = 36). Results: Youth with ADHD experienced more stressful life events compared with those without ADHD. Interpretation biases moderated the association between stress and depressive symptoms in youth with and without ADHD. Attention biases moderated the association between stress and depressive symptoms in the non-ADHD youth only. Conclusion: These results enhance our understanding of vulnerability for depression in adolescence with ADHD and inform targeted prevention and treatment models during this critical developmental juncture.

Objective: Children with ADHD frequently manifest behavioral difficulties in the morning prior to school. We sought to assess the reliability and validity of the Before-School Functioning Questionnaire (BSFQ) as a measure of morning behaviors impaired by ADHD. Method: We used pre-treatment data from a randomized crossover study of 6- to 12-year-old participants comparing the methylphenidate transdermal delivery system (MTS) with a placebo transdermal system (PTS) for a total of 4 weeks. Results: The BSFQ investigator–rated scale shows very good internal homogeneity (Cronbach’s α = .91), good test–retest reliability ( r = .60), good concurrent validity ( r range = .42-.86), and a strong treatment effect (effect size = −.93). The self-rated BSFQ showed lower levels of reliability and validity. Conclusion: The investigator-rated BSFQ should be used in future trials of ADHD medications aimed at assessing efficacy in the morning before school.

Objective: Despite the increasing recognition of attention deficit hyperactivity disorder (ADHD) in adults, the use of pharmacotherapeutics remains less established.Methods: A systematic review of the literature identified 15 studies (N = 435 subjects) of stimulants, and 22 studies of non- stimulant medications (N = 421 subjects) including antidepressants, antihypertensives, amino acids, and wake-promoting agents for the treatment of ADHD in adults.Results: Studies with stimulants and antidepressants demonstrated significant short-term improvement in ADHD symptoms compared to placebo in adults. Methylphenidate (MPH) and amphetamine had an immediate onset of action whereas the ADHD response to pemoline and antidepressants appeared delayed. The response to amphetamine and MPH appears to be dose-dependent. Controlled data on nicotonic and noradrenergic compounds appear promising. There was considerable variability In diagnostic criteria, dosing parameters, and response rates between the various studies.Conclusions: Under controlled conditions, the aggregate literature shows that the stimulants and noradrenergic antidepressants had a clinically and statistically significant beneficial effect on treating ADHD in adults.

Objective: Despite the increasing recognition of persistent ADHD into adulthood, there is a paucity of information available on its clinical presentation in adults. To this end, we evaluated ADHD symptoms in a large group of outpatient adults with ADHD attending to issues of psychiatric comorbidity, gender, and age. Methods: We assessed 149 clinically referred outpatient ADHD adults (mean age [±SD] of 37 ±11 years) using structured diagnostic interviews for psychopathology including current and childhood ADHD symptoms. Using DSM III-R symptoms, we determined DSM-IV subtypes by proxy. Results: Inattentive symptoms were most frequently endorsed in over 90% of ADHD adults. An assessment of current ADHD symptoms showed that 56% of adults had the combined ADHD subtype, 37% the inattentive only subtype, and 2% the hyperactive/impulsive subtype. Psychiatric comorbidity with ADHD was more prominent in adults with hyperactivity-impulsivity as part of their clinical picture. Whereas females had fewer childhood hyperactive-impulsive symptoms than males, there were no gender differences in their current ADHD presentation. Conclusion: Findings from the current study suggest that the vast majority of adults with ADHD present with prominent symptoms of inattention. Given that ADHD adults are presenting from multiple domains, clinicians should carefully query for the inattentive aspects of ADHD when evaluating these individuals.

To examine efficacy and safety of adjunctive guanfacine extended release (GXR) on morning and evening ADHD symptoms using the Conners' Global Index-Parent (CGI-P) and Before-School Functioning Questionnaire (BSFQ).Participants 6 to 17 years with ADHD ( N = 461) and suboptimal psychostimulant response were maintained on current psychostimulants and randomized to dose-optimized GXR (≤4 mg/d) in the morning (GXR AM) or evening (GXR PM), or placebo.CGI-P scores improved with GXR (morning assessment, GXR AM, placebo-adjusted least squares [LS] mean = -1.7, GXR PM = -2.6; evening assessment, GXR AM = -2.4, GXR PM = -3.0; all ps.01). Parent-rated BSFQ scores reflected improved morning functioning with GXR (GXR AM, placebo-adjusted LS mean = -5.1; GXR PM = -4.7; both ps.01). Most adverse events were mild or moderate.Adjunctive GXR AM or GXR PM was associated with improvements in morning and evening ADHD symptoms in children and adolescents.

Objective: Atomoxetine is a nonstimulant medication for treating child, adolescent, and adult ADHD. This meta-analysis compared the effects in younger and older adults. Method: A post hoc analysis was conducted using data from two double-blind, placebo-controlled clinical trials. Data from patients aged 18-25 years were compared with data from patients older than 25 years. Results: In younger adults (mean age = 21.7), atomoxetine produces greater improvement than placebo on the Conners’ Adult ADHD Rating Scale’s total ADHD symptom score ( p = .041, effect size = .797) and the clinical global impressions severity ( p = .006, effect size = 1.121). In older adults (mean age = 43.4 years), atomoxetine also produces significant benefit on the CAARS—Inv:SV ( p < .001, effect size = .326) and CGI-ADHD-S ( p < .001, effect size = .346). The study findings reveal response rates to be 56.4% and 47.8% for the younger and older adults, respectively ( p = .188). Tolerability is similar although older adults reported more sexual side effects. Conclusion: Younger and older adults show similar improvements at endpoint. The effect size is higher in younger adults, but this is due primarily to greater variability of response in older patients. (J. of Att. Dis. 2010; 13(4) 401-406)

Background: Recent studies reported ADHD-like symptoms and cognitive deficits in pervasive developmental disorder (PDD). Because work in dementia documents improvement in executive function deficits with the acetylcholinesterase inhibitor donepezil, the authors reason that similar benefits could be obtained in PDD. Method: The authors describe eight cases of PDD youth ages 10 to 17 treated with donepezil targeting ADHD-like symptoms associated with PDD. Results: Most participants improve ADHD-like symptomatology. In addition, improvement in communication and socialization is noted. Conclusion: Donepezil may have a role in treating ADHD-like symptoms in children with PDD.