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Despite the pervasive nature of various forms of impairment associated with attention-deficit/hyperactivity disorder (ADHD), the precise nature of their associations with ADHD and related sluggish cognitive tempo (SCT), particularly at the heterogeneous item level, remains ambiguous. Using innovative network analysis techniques, we sought to identify and examine the concurrent validity of ADHD and SCT bridge items (i.e., those demonstrating the most robust relations with various forms of impairment) with respect to Overall, Home-School, and Community-Leisure impairment domains. Parents of a nationally representative sample of 1742 children (50.17% male) aged 6–17 years completed rating scales of ADHD, SCT, and impairment. Assessment of Bridge Expected Influence suggested eight bridge items primarily from impulsive and Task Completion (i.e., overlapping SCT and inattentive) domains that demonstrated relations with impairment in school performance, completing chores at home, interacting with family members, following rules, and playing sports. Sum scores only including bridge items exhibited relations with Overall, Home-School, and Community-Leisure impairment domains comparable to that of sum scores including all items. Bridge impairment areas were generally consistent across "Childhood" (6–11 years) and "Adolescence" (12–17 years). Problems listening and slowness emerged as bridge items in Childhood, whereas difficulties following through on instructions, problems waiting one's turn, and social withdrawal emerged in Adolescence. Given the comparable validity of ADHD- and SCT-related bridge items versus all items, bridge items, together, may be the most efficient indicators of impairment. Further clarification is needed across development to inform personalized assessment and intervention protocols that account for item-level heterogeneity in ADHD, SCT, and impairment phenotypes. [ABSTRACT FROM AUTHOR]

Symptoms of sluggish cognitive tempo (SCT) have been recognized for nearly 30 years as comprising a semi-independent set(s) of symptoms from the inattentive (IN) and hyperactive-impulsive (HI) symptoms involved in attention-deficit/hyperactivity disorder (ADHD). It has only been within the past decade that research focusing specifically on SCT symptoms and on samples of SCT cases chosen independently from ADHD samples has increased so as to address the question of whether SCT is a distinct condition from ADHD or other disorders. All but two of these studies have focused on children but the two extant large scale studies on adults have replicated those findings. This Commentary highlights not only those findings concerning SCT that appear to be relatively robust, but also those patterns that appear to be emerging yet in need of further research to corroborate their association with SCT, as well as those barely or unexplored areas that may deserve more research. Evidence to date, including the many findings in this special issue, is nearing a critical mass that likely supports the conclusion that SCT is a distinct disorder of attention from ADHD, yet one that may overlap with it in about half of all cases. SCT has unique symptom dimensions and comorbidities from ADHD, probably distinct though lesser domains of impairment and demographic correlates, and perhaps unique cognitive deficits, causes and life course risks. These latter areas, however, are in need of substantially more research as is SCT in adults and treatments specifically designed for cases of SCT. Meanwhile, the name of the condition is premature, implying a known cognitive deficit that is as yet unknown, and is proving derogatory and offensive to patients, leading this author to recommend a change to Concentration Deficit Disorder. [ABSTRACT FROM AUTHOR]

This study examined the latent structure and validity of inattention, hyperactivity-impulsivity, and sluggish cognitive tempo (SCT) symptomatology. We evaluated mother and teacher ratings of ADHD and SCT symptoms in 140 Puerto Rican children (55.7% males), ages 6 to 11 years, via factor and regression analyses. A three-factor model (inattention, hyperactivity-impulsivity, and SCT) provided the best fit for both sets of ratings. Inattention was the strongest correlate of lower scores on neuropsychological, achievement, and psychosocial measures. Externalizing problems were most strongly associated with hyperactivity-impulsivity, and internalizing problems were most strongly associated with parent-rated SCT and teacher-rated Inattention. SCT was not associated with executive function but was negatively associated with math. Inattention accounted for a disproportionate amount of ADHD-related impairment, which may explain the restricted discriminant validity of DSM-IV types. The distinct factors of hyperactivity-impulsivity and SCT had unique associations with impairing comorbidities and are roughly equivalent in predicting external correlates of ADHD-related impairment. [ABSTRACT FROM AUTHOR]

In rebuttal to Timimi et al., we show that their critique is not a form of reasonable scientific debate with informed, constructive criticism, but merely a misrepresentation of the existing scientific literature on ADHD apparently designed to convince the scientifically uninformed of its nonexistence and of the misuse of medications for its management. We show their argument to be based on faulty logic, selective citation, misreprensentation of individual studies, ignorance of the vast literature on ADHD, and innuendo that maligns the integrity of scientists studying the disorder. Our original International Consensus Statement on ADHD remains untarnished by this faux critique – indeed it was intended to refute just such unsupported and unsupportable criticism that often appears in the popular media. [ABSTRACT FROM AUTHOR]

We report on the psychiatric disorders present at young adult follow-up (Mean age 20-21 years; 13+ year follow-up) and the comorbidity among them for a large sample of hyperactive (H; N = 147) and community control (CC; N = 71) children. The H group had a significantly higher risk for any nondrug psychiatric disorders than the CC group (59% vs. 36%). More of the H group met criteria for ADHD (5%); major depressive disorder (26%); and histrionic (12%), antisocial (21%), passive-aggressive (18%), and borderline personality disorders (14%) at follow-up than the CC group. Severity of childhood conduct problems contributed to the risk for passive-aggressive, borderline, and antisocial personality disorders. But it only affected risk for antisocial personality after controlling for severity of teen conduct disorder (CD), which also contributed to the risk for these same 3 disorders. Examination for comorbidity among these disorders indicated that presence of either borderline or antisocial personality disorder significantly increased the risk for major depression and the other significant personality disorders. More of the hyperactive group had received various forms of mental health treatment during and since leaving high school than the control group. Results suggest that hyperactive children are at significant risk for at least 1 nondrug disorder in young adulthood, principally major depression and several personality disorders, and that this risk is largely mediated by severity of CD at adolescence. [ABSTRACT FROM AUTHOR]

Eighty-seven male teens (ages 12-18 years) with ADHD/ODD and their parents were compared to 32 male teens and their parents in a community control (CC) group on mother, father, and teen ratings of parent-teen conflict and communication quality, parental self-reports of psychological adjustment, and direct observations of parent-teen problem-solving interactions during a neutral and conflict discussion. Parents and teens in the ADHD/ODD group rated themselves as having significantly more issues involving parent-teen conflict, more anger during these conflict discussions, and more negative communication generally, and used more aggressive conflict tactics with each other than did parents and teens in the CC group. During a neutral discussion, only the ADHD/ODD teens demonstrated more negative behavior. During the conflict discussion, however, the mothers, fathers, and teens in the ADHD/ODD group displayed more negative behavior, and the mothers and teens showed less positive behavior than did participants in the CC group. Differences in conflicts related to sex of parent were evident on only a few measures. Both mother and father self-rated hostility contributed to the level of mother-teen conflict whereas father self-rated hostility and anxiety contributed to father-teen conflict beyond the contribution made by level of teen ODD and ADHD symptoms. Results replicated past studies of mother-child interactions in ADHD/ODD children, extended these results to teens with these disorders, showed that greater conflict also occurs in father-teen interactions, and found that degree of parental hostility, but not ADHD symptoms, further contributed to levels of parent-teen conflict beyond the contribution made by severity of teen ADHD and ODD symptoms. [ABSTRACT FROM AUTHOR]

Clinic-referred teens (ages 12-19) with ADHD and ODD (N = 101) were compared to community control (CC) teens, equated for age and sex, (N = 39) on a variety of psychological tasks assessing executive functioning (EF), temporal reward discounting, and time estimation and reproduction. A factor analysis reduced the EF measures to three dimensions, representing CPF Inattention, Working Memory, and CPT Inhibition. Results indicated that the ADHD group had significantly more CPT Inattention than the CC group. No differences were found for Working Memory or CPT Inhibition. The ADHD group displayed significantly greater temporal discounting of delayed hypothetical monetary rewards relative to immediate ones and manifested more impaired time reproduction, but not time estimation, than did the CC group. Main effects for level of IQ were found only on the Working Memory factor and largely did not interact with the group factor otherwise. The group differences in CPT Inattention, temporal discounting, and time reproduction were not a function of level of comorbid oppositional defiant disorder, delinquency, or anxiety-depression. Results are reasonably consistent with past research on EF and sense of time in children with ADHD and extend these findings to the adolescent age group. Problems with working memory and CPT inhibition found in prior studies of children with ADHD, however, were not evident here, perhaps owing to age-related improvements or insufficient task difficulty. [ABSTRACT FROM AUTHOR]

Neuropsychology has customarily taken a molecular and myopic view of executive functioning, concentrating largely on those proximal processes of which it may be comprised. Although commendable as a starting point, such an approach can never answer the question, “Why executive functioning?” The present paper encourages neuropsychologists to contemplate the longer-term, functional nature of the executive functions (EFs), using an evolutionary perspective. For purely illustrative purposes, a previously developed model of the EFs is briefly presented and is then examined from an evolutionary perspective. That model views the EFs as forms of behavior-to-the-self that evolved from overt (public) to covert (private) responses as a means of self-regulation. That was necessary given the interpersonal competition that arises within this group-living species. The EFs serve to shift the control of behavior from the immediate context, social others, and the temporal now to self-regulation by internal representations regarding the hypothetical social future. The EFs seem to meet the requirements of a biological adaptation, being an improbable complex design for a purpose that exists universally in humans. Discovering the adaptive problems that the EFs evolved to solve offers an invaluable research agenda for neuropsychology lest that agenda be resolved first by other scientific disciplines. Some adaptive problems that the EFs may have evolved to solve are then considered, among them being social exchange (reciprocal altruism or selfish cooperation), imitation and vicarious learning as types of experiential theft, mimetic skill (private behavioral rehearsal) and gestural communication, and social self-defense against such theft and interpersonal manipulation. Although clearly speculative at the moment, these proposals demonstrate the merit of considering the larger adaptive problems that the EFs evolved to solve. Taking the evolutionary stance toward the EFs would achieve not only greater insight into their nature, but also into their assessment and into those larger adaptive capacities that may be diminished through injury or developmental impairment toward that system. [ABSTRACT FROM AUTHOR]

The multimodal treatment study of attention deficit hyperactivity disorder (MTA Study) constitutes a landmark in the history of treatment research in child psychopathology, being the largest single study of its kind ever undertaken. Important findings have emerged from this project, as the papers in the present volume will attest. This commentary focuses on several concerns about the assumptions that appear to have guided the design of the MTA study, particularly its psychosocial treatment component, as well as the manner in which treatment results have been presented to date. In particular, no explicit theory of ADHD appears to have guided the construction of the treatment components, relying instead on implicit theories associated with those treatments, such as the notion that the symptoms of ADHD arise through faulty learning and defective contingencies of reinforcement. Future articles from this study will need to address these and other concerns if the results of the study are to be properly interpreted and the scientific and clinical yield is to be maximized. [ABSTRACT FROM AUTHOR]

This paper describes the 2-year post-treatment follow-up of preschool children identified as having high levels of disruptive behavior at kindergarten entry. They were assigned to four treatment conditions: A no-treatment group, parent-training only, treatment classroom only, and the combination of parent training with the treatment classroom. Interventions lasted the entire kindergarten academic year. Initial post-treatment results reported previously indicated no effects for the parent-training program but some efficacy for the classroom intervention program. For this report, the disruptive behavior (DB) children were subdivided into those who did (n = 74) and did not (n = 77) receive the treatment classroom. Two-year post-treatment follow-up results indicated no differences between the classroom treated and untreated DB groups. These groups also failed to differ in the percentage of children using available treatments across the follow-up period. The DB children in both groups had significantly more symptoms of ADHD and ODD than a community control group (N = 47) at follow-up. They also received higher ratings of externalizing problems on the parent Child Behavior Checklist, more severe ratings of behavior problems at home, and ratings of more pervasive behavior problems at school, and had poorer academic skills. Results suggested that early intervention classrooms for DB children may not produce enduring effects once treatment is withdrawn, and that better approaches are needed for identifying those DB children at greatest risk for later maladjustment. [ABSTRACT FROM AUTHOR]

Children with high levels of aggressive-hyperactive-impulsive-inattentive behavior (AHII; n = 154) were subdivided into those with (n = 38) and without (n = 116) adaptive disability (+AD/-AD) defined as a discrepancy between expected versus actual adaptive functioning. They were compared to each other and a control group of 47 normal children. Both AHII groups were more likely to have attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder than control children; more symptoms of general psychopathology; greater social skills deficits; more parental problems; and lower levels of academic achievement skills. Compared to AHII - AD children, AHII + AD children had (1) more conduct disorder; (2) greater inattention and aggression symptoms; (3) more social problems, less academic competence, and poorer self-control at school; (4) more severe and pervasive behavior problems across multiple home and school settings; and (5) parents with poorer child management practices. Thus, adaptive disability has utility as a marker for more severe and pervasive impairments in AHII children. [ABSTRACT FROM AUTHOR]

Relates the concerns of international scientists over the inaccuracy of media reports concerning attention deficit hyperactivity disorder (ADHD). Views of non-expert doctors on ADHD; Recognition given by health agencies to ADHD; Way in which the media could help ADHD patients.

Introduction and objective(s): This presentation will discuss two related issues that are essential to further research into the neuroscience of ADHD: (1) What endophenotype is most suitable to study ADHD and (2) What is the nature of executive functioning (EF) in ADHD? Discussion: Research findings related to these two issues as well as an analysis of the concepts endophenotype and EF will be discussed emphasizing the limitations that are placed on research by viewing both as unitary and uni-level. Investigators will also benefit from an awareness of natural selection in biological evolution for generating hypotheses as to the adaptive problems that are solved by the evolution of specific endophenotypes or EFs. Conclusion: Both the concept of endophenotype and of EF need to be considered as multi-component, multi-level constructs in the context of human evolution and selecting mechanisms (physical environment, social environment, sexual selection) rather than being unitary, uni-level, and devoid of an evolutionary context. Selection of the component and level of each to be studied will be based upon the hypotheses of the investigator and whether getting closer to neurological processes or conversely to the levels of behavioural and social functioning at which natural selection operates best serve the investigator’s goals. [ABSTRACT FROM AUTHOR]

Presents a correction to the article 'Young Adult Follow-Up of Hyperactive Children: Self-Reported Psychiatric Disorders, Comorbidity and the Role of Childhood Conduct Problems and Teen CD' the was previously published in the 'Journal of Abnormal Child Psychology.'