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Objective: A robust and bidirectional Co. morbidity between attention deficit hyperactivity disorder (ADHD) and psychoactive substance use disorder (alcohol or drug abuse or dependence) has been consistently reported in the extant literature. Method: First-degree relatives from a large group of pediatrically and psychiatrically referred boys with (112 probands, 385 relatives) and without (105 probands, 358 relatives) ADHD were comprehensively assessed by blind raters with structured diagnostic interviews. Familial risk analysis examined the risks in first-degree relatives for ADHD, psychoactive substance use disorder, alcohol dependence, and drug dependence after stratifying probands by the presence and absence of these disorders. Results: ADHD in the proband was consistently associated with a significant risk for ADHD in relatives. Drug dependence in probands increased the risk for drug dependence in relatives irrespective of ADHD status, whereas alcohol dependence in relatives was predicted only by ADHD probands with comorbid alcohol dependence. In addition, ADHD in the proband predicted drug dependence in relatives, and drug dependence in comparison probands increased the risk for ADHD in relatives. Both alcohol dependence and drug dependence bred true in families without evidence for a common risk between these disorders. Conclusions: Patterns of familial risk analysis suggest that the association between ADHD and drug dependence is most consistent with the hypothesis of variable expressivity of a common risk between these disorders, whereas the association between ADHD and alcohol dependence is most consistent with the hypothesis of independent transmission of these disorders. Findings also suggest specificity for the transmission of alcohol and drug dependence. [ABSTRACT FROM AUTHOR]

Objective: Diagnosing attention deficit hyperactivity disorder (ADHD) in adults is difficult when diagnosticians cannot establish an onset before the DSM-IV criterion of age 7 or if the number of symptoms recalled does not achieve DSM's diagnosis threshold. Method: The authors addressed the validity of DSM-IV's age-at-onset and symptom threshold criteria by comparing four groups of adults: 127 subjects with full ADHD who met all DSM-IV criteria for childhood-onset ADHD, 79 subjects with late-onset ADHD who met all criteria except the age-at-onset criterion, 41 subjects with subthreshold ADHD who did not meet full symptom criteria for ADHD, and 123 subjects without ADHD who did not meet any criteria. The authors hypothesized that subjects with late-onset and subthreshold ADHD would show patterns of psychiatric comorbidity, functional impairment, and familial transmission similar to those seen in subjects with full ADHD. Results: Subjects with late-onset and full ADHD had similar patterns of psychiatric comorbidity, functional impairment, and familial transmission. Most children with late onset of ADHD (83%) were younger than 12. Subthreshold ADHD was milder and showed a different pattern of familial transmission than the other forms of ADHD. Conclusions: The data about the clinical features of probands and the pattern of transmission of ADHD among relatives found little evidence for the validity of subthreshold ADHD among such subjects, who reported a lifetime history of some symptoms that never met DSM-IV's threshold for diagnosis. In contrast, the results suggested that late-onset adult ADHD is valid and that DSM-IV's age-at-onset criterion is too stringent. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates workplace deficits among adults with attention-deficit hyperactivity disorder (ADHD) by assessing performance during a simulated workplace experience. Adults with and without ADHD were recruited and those who did not meet the Diagnostic and Statistical Manual of Mental Disorders-IV criteria for ADHD were selected for a control group. Compared to control participants, those with ADHD demonstrated impaired performance in reading comprehension and math fluency.

Objective: In a previous study, the authors found that, compared with referred boys with attention deficit hyperactivity disorder (ADHD), girls are less likely to manifest comorbid disruptive behavior disorders and learning disabilities-characteristics that could adversely affect identification of ADHD in girls. However, because referral bias can affect outcome, these findings require replication in nonreferred groups of ADHD subjects. Method: The authors evaluated gender effects in a large group of nonreferred siblings (N=577) of probands with ADHD and non-ADHD comparison subjects. Ninety- eight of the nonreferred siblings (N=73 males, N=25 females) met the criteria for diagnosis of ADHD, and 479 (N=244 males, N=235 females) did not meet those criteria. All siblings were systematically and comprehensively assessed with measures of emotional, school, intellectual, interpersonal, and family functioning. The assessment battery used for the siblings was the same as that used for the probands. Results: The nonreferred males and fe- males with ADHD did not differ in DSM-IV subtypes of ADHD, psychiatric comorbidity, or treatment history. They also showed similar levels of cognitive, psychosocial, school, and family functioning. Conclusions: These findings suggest that the clinical correlates of ADHD are not influenced by gender and that gender differences reported in groups of subjects seen in clinical settings may be caused by referral biases. [ABSTRACT FROM AUTHOR]

Objective: Conventional wisdom among pediatricians has been that children with attention-deficit hyperactivity disorder (ADHD) who receive their diagnosis and are managed in the primary care setting have fewer comorbid psychiatric disorders and milder impairments than those seen in psychiatric clinics. The authors sought to determine whether comorbidity and clinical correlates of ADHD differ among children in these two settings. Methods: A case-control study design was used. Participants were 522 children and adolescents of both sexes, six to 18 years of age, with (N=280) and without (N=242) ADHD. Participants were drawn from pediatric and psychiatric clinics in a tertiary care hospital and a health maintenance organization in a large metropolitan area. Assessments were conducted with standardized measures of psychiatric, cognitive, social, academic, and family function. Results: The number, type, clusters, and age at onset of ADHD symptoms were nearly identical for youths at pediatric and psychiatric ascertainment sources. Regardless of source, participants with ADHD were significantly more likely than controls to have a higher prevalence of mood disorders, other disruptive behavior, anxiety disorders, and substance use disorders. Significant impairments of intellectual, academic, interpersonal, and family functioning did not differ between ascertainment sources. Conclusions: Children with ADHD from both psychiatric and pediatric practices have prototypical symptoms of the disorder; high levels of comorbidity with mood, anxiety, and disruptive behavior disorders; and impairments in cognitive, interpersonal, and academic function that do not differ by ascertainment source. These findings suggest that children cared for in pediatric practice have similar levels of comorbidity and dysfunction as psychiatrically referred youth. [ABSTRACT FROM AUTHOR]

Presents the influence of gender on attention deficit hyperactivity disorder (ADHD) among children referred to psychiatric clinic. Assessment by structured diagnostic interviews and neuropsychological batteries; Predominance of girls on ADHD; Implications of ADHD.

Analyzes the association between the seven-repeat allele of dopamine D[sub 4] receptor gene and attention deficit hyperactivity disorder (ADHD). Definition of ADHD; Role of meta-analysis in the linkage studies of complex traits; Etiology of ADHD.

Evaluates the impact of co-morbid attention-deficit hyperactivity disorder (ADHD) and tic disorders from a life span perspective. Clinical characteristics of ADHD; Significance of findings of a higher proportion of adults with ADHD have tic disorders; Limited impact of tic disorders on ADHD.

Objective: The authors' goal was to investigate phosphatidyl-inositol and glutamatergic metabolism in the anterior cingulate cortex of children and adolescents with attention deficit hyperactivity disorder (ADHD) alone, children with ADHD plus bipolar disorder, and children with no axis I diagnosis. Method: Proton spectra were acquired from a 4.8-ml voxel placed in the anterior cingulate cortex of 30 subjects who were 6 to 13 years old. Fifteen subjects had ADHD and no comorbid disorder, eight had ADHD plus bipolar disorder, and seven were healthy comparison subjects. Results: Children with ADHD had a significantly higher ratio of glutamate plus glutamine to myo-inositol-containing compounds than children with ADHD plus bipolar disorder and healthy children. Conclusions: myo-inositol-containing compounds may provide information on the action of antimanic treatments such as lithium, valproate, and carbamazepine. Glutamate and glutamine are measures of glutamatergic neurotransmission and thus may also reflect changes in serotonin and dopamine pathways. [ABSTRACT FROM AUTHOR]

Explores the nature of deficit hyperactivity disorder (ADHD) in African American children. Characteristics of ADHD; Information on study design and methodology; Statistics on comorbid psychiatric diagnoses of African American children.

Examines the symptom decline in attention deficit hyperactivity disorder (ADHD) with different definitions of remission. Association between age and decline in total ADHD symptoms and symptoms of hyperactivity, impulsiveness and inattention; Variability in the proportion of subjects experiencing remission.

Objective: Attention deficit hyperactivity disorder (ADHD) is a common, highly heritable psychiatric disorder. Because of its multifactorial etiology, however, identifying the genes involved has been difficult. The authors followed up on recent findings suggesting that rare copy number variants (CNVs) may be important for ADHD etiology. Method: The authors performed a genome-wide analysis of large, rare CNVs (<1% population frequency) in children with ADHD (N=896) and comparison subjects (N=2,455) from the IMAGE II Consortium. Results: The authors observed 1,562 individually rare CNVs >100 kb in size, which segregated into 912 independent loci. Overall, the rate of rare CNVs >100 kb was 1.15 times higher in ADHD case subjects relative to comparison subjects, with duplications spanning known genes showing a 1.2-fold enrichment. In accordance with a previous study, rare CNVs >500 kb showed the greatest enrichment (1.28-fold). CNVs identified in ADHD case subjects were significantly enriched for loci implicated in autism and in schizophrenia. Duplications spanning the CHRNA7 gene at chromosome 15q13.3 were associated with ADHD in single-locus analysis. This finding was consistently replicated in an additional 2,242 ADHD case subjects and 8,552 comparison subjects from four independent cohorts from the United Kingdom, the United States, and Canada. Presence of the duplication at 15q13.3 appeared to be associated with comorbid conduct disorder. Conclusions: These findings support the enrichment of large, rare CNVs in ADHD and implicate duplications at 15q13.3 as a novel risk factor for ADHD. With a frequency of 0.6% in the populations investigated and a relatively large effect size (odds ratio=2.22, 95% confidence interval=1.5-3.6), this locus could be an important contributor to ADHD etiology. [ABSTRACT FROM AUTHOR]