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ObjectiveIt is estimated that childhood attention deficit hyperactivity disorder (ADHD) remits by adulthood in approximately 50% of cases; however, this conclusion is typically based on single endpoints, failing to consider longitudinal patterns of ADHD expression. The authors investigated the extent to which children with ADHD experience recovery and variable patterns of remission by adulthood.MethodsChildren with ADHD (N=558) in the Multimodal Treatment Study of ADHD (MTA) underwent eight assessments over follow-ups ranging from 2 years (mean age, 10.44 years) to 16 years (mean age, 25.12 years) after baseline. The authors identified participants with fully remitted, partially remitted, and persistent ADHD at each time point on the basis of parent, teacher, and self-reports of ADHD symptoms and impairment, treatment utilization, and substance use and mental disorders. Longitudinal patterns of remission and persistence were identified that considered context and timing.ResultsApproximately 30% of children with ADHD experienced full remission at some point during the follow-up period; however, a majority of them (60%) experienced recurrence of ADHD after the initial period of remission. Only 9.1% of the sample demonstrated recovery (sustained remission) by study endpoint, and only 10.8% demonstrated stable ADHD persistence across study time points. Most participants with ADHD (63.8%) had fluctuating periods of remission and recurrence over time.ConclusionsThe MTA findings challenge the notion that approximately 50% of children with ADHD outgrow the disorder by adulthood. Most cases demonstrated fluctuating symptoms between childhood and young adulthood. Although intermittent periods of remission can be expected in most cases, 90% of children with ADHD in MTA continued to experience residual symptoms into young adulthood.

Objective: Recent studies suggest attention-deficit/hyperactivity disorder (ADHD) may emerge post-childhood. We integrate qualitative methods to systematically characterize contextual factors that may (a) delay identification of ADHD in childhood and (b) inform why ADHD symptoms emerge post-childhood. Method: Suspected late-onset ADHD cases from the local normative comparison group of the Multimodal Treatment Study of ADHD completed a qualitative interview (14 young adults and 7 caregivers). Interviews were qualitatively analyzed. Results: We identified five themes. Three themes may attenuate or delay identification of childhood ADHD: external factors (e.g., supportive adults), internal factors (e.g., strong intellectual functioning), and other factors (e.g., dismissive attitudes toward ADHD). Two themes may accompany an increase in ADHD symptoms post-childhood: external factors (e.g., increased external demands) and internal factors (e.g., perceived stress). Conclusion: Clinicians should probe these factors in suspected late-onset cases to address (a) whether, how, and to what extent ADHD was attenuated in childhood and (b) why symptoms emerge post-childhood.

Objective: ADHD is associated with risky sexual behavior and early pregnancy, but few studies have examined mechanisms of risk linking childhood ADHD to early pregnancy. The present study utilized data from the Multimodal Treatment Study of ADHD to examine potential mechanisms that may account for the association between childhood ADHD and becoming pregnant or causing a pregnancy by age 18. Method: Participants were 579 children with ADHD and 289 comparison peers followed over 16 years. Results: Relative to the comparison group, those with childhood ADHD were at more than two times increased risk of early pregnancy. Univariately, persistence of ADHD symptoms, delinquency/substance use, and academic performance/achievement during adolescence each mediated the association between childhood ADHD and early pregnancy. When considered together, only delinquency/substance use remained a significant mediator of this relationship. Conclusion: Findings point toward specific targets of intervention for youth with ADHD to prevent early pregnancy.

Background: Relations among attention-deficit/hyperactivity disorder (ADHD), sleep, and substance-related negative consequences are largely unknown. In this cross-sectional study, we examined associations among ADHD diagnosis, sleep, and alcohol-related consequences. We also evaluated the independent and interactive effects of sleep and ADHD on alcohol-related negative consequences, above and beyond levels of alcohol use. Methods: College students who drink alcohol with (n = 51) and without (n = 50) ADHD completed an assessment that included a diagnostic interview assessing ADHD, and questionnaire measures of sleep quality, substance use, and associated consequences. Analyses utilized a series of hierarchical linear regression models and explored these aims for cannabis use in a subset of participants (n = 52 participants that used cannabis). Results: College students who drink alcohol with ADHD reported significantly worse sleep quality and more alcohol-related consequences, relative to those without ADHD. When ADHD and sleep quality were included in the model, ADHD—but not sleep quality—was independently associated with alcohol consequences, but not cannabis consequences. There were no moderating effects of ADHD on the associations between sleep and substance-related consequences. Conclusions: Students who drank alcohol with ADHD may be particularly vulnerable to experiencing poor sleep and consequences from their substance use, compared to their heavy drinking peers without ADHD. Future, larger scale studies should consider longitudinal effects as well as underlying mechanisms of risk. [ABSTRACT FROM AUTHOR]

One method for addressing barriers disabled college students face is by increasing access to academic accommodations. However, for college students with ADHD, little is known about the associations between receipt of accommodations and academic performance, behavioral functioning, and mood status. Considering college students with ADHD are at a higher risk of experiencing academic difficulties and internalizing symptoms compared to their peers without ADHD, further research into these relations is warranted. To address the existing knowledge gap, we compared academic, behavioral, and mood functioning among college student drinkers with ADHD who self-reported having been granted academic accommodations (n = 23) to those who denied ever receiving academic accommodations (n = 88). The present study also explored reasons college students with ADHD receiving academic accommodations may not utilize their provided accommodations consistently. Results indicated that self-reported use of accommodations was not associated with college grade point average (GPA), self-reported symptoms of ADHD, executive dysfunction, depression, emotion dysregulation, or overall functional impairment. Common reasons for not using academic accommodations (e.g., not feeling they were needed, being too difficult to obtain) highlight the salience of cognitive and systemic barriers to utilization. The results broadly imply that academic accommodations may be perceived as beneficial by college students with ADHD, but not sufficient to improve academic performance or indirectly impact mood- and behavior-related concerns. [ABSTRACT FROM AUTHOR]

Background: Attention‐deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset as early as preschool and impairment across the lifespan. Temperament factors, specifically those that theoretically map onto ADHD symptoms, may be early markers of risk for developing later childhood ADHD that could be identifiable in infancy or toddlerhood. This meta‐analysis examined the associations between these early temperamental factors and later symptoms and diagnosis of ADHD and mapped early temperament constructs onto the three ADHD symptom dimensions. Methods: A systemic review of the literature was conducted to identify prospective longitudinal studies that included theoretically relevant temperament constructs (sustained attention, activity level, inhibition, and negative emotionality) examined from birth to 36 months old and ADHD (symptoms or diagnosis) in preschool or childhood. The association between each temperament construct and ADHD outcomes was examined using pooled standardized estimates in meta‐analyses. Results: Forty‐eight articles (n = 112,716 infants/toddlers) prospectively examined temperament and the relation to childhood ADHD symptoms or diagnosis. Activity level (k = 18) in infancy and toddlerhood was moderately associated with childhood ADHD (r =.39, CI = 0.27, 0.51, p <.001). Moderate effect sizes were also observed for sustained attention (k = 9; r = −.28, CI = −0.42, −0.12, p <.001) and negative emotionality (k = 33; r =.25, CI = 0.16, 0.34, p <.001) with ADHD. The specificity of each temperament construct for later ADHD symptom dimensions was such that activity level and negative emotionality were predictive of all three symptom dimensions (i.e., inattention, hyperactivity/impulsivity, and combined), whereas sustained attention was only associated with combined symptoms. Conclusions: Infant and toddler temperament is an early risk factor for the development of childhood ADHD that could be utilized for early intervention identification. Yet, this systematic review found that relatively few prospective longitudinal studies have examined sustained attention (k = 9) and inhibition (k = 15) in infancy and toddlerhood in relation to later ADHD highlighting the need for further research. [ABSTRACT FROM AUTHOR]

• ADHD is a risk factor for depression and requires tailored depression efforts. • Schools represent an optimal environment to reduce the disparity between research evidence and access to care for black adolescents with ADHD in urban areas. • The Behaviorally Enhancing Adolescents' Mood in Schools (BEAMS) program was iteratively developed using stakeholder feedback. • BEAMS was implemented easily by the school mental health provider and resulted in reductions in irritability and emotion regulation as depicted in case study vignettes. Attention-deficit/hyperactivity disorder (ADHD) is a prevalent disorder, particularly among Black youth and youth in urban settings. In addition to well-documented academic and social dysfunction, ADHD is associated with increased risk for depression and suicide. However, there is a stark mismatch between services available and need among adolescents with ADHD, especially those from low-income backgrounds. Implementation of services in schools is one promising way to overcome barriers to care, decrease stigma associated with mental health care, and offer the ability to practice mental health skills in a more natural environment. As such, the current study aims to (a) describe the iterative development of a school-based depression prevention program (i.e., Behaviorally Enhancing Adolescents' Mood in Schools [BEAMS]) for adolescents with ADHD in an underresourced, urban school district using stakeholder feedback; and (b) evaluate the preliminary effectiveness of an open trial of BEAMS. Raw data for all participants (n = 6; 83% Black, 17% biracial; 83% male) with indications for significant Reliable Change Indices are presented in addition to two case vignettes to illustrate treatment components and exemplify participant response. Pre- and posttreatment focus group data are presented to depict the development of the BEAMS program, lessons learned, and modifications made to BEAMS, in preparation for a larger randomized trial. Future directions are discussed. [ABSTRACT FROM AUTHOR]

Objective: ADHD and depression co-occur at higher than chance levels in adolescence, but moderators of this association are not well understood. Consistent with a developmental-transactional framework, one such moderator may be maternal emotion regulation (ER) difficulties. Using latent growth curve modeling, the current study examined the independent and interactive effects of adolescent ADHD symptoms and maternal ER difficulties on the trajectory of depressive symptoms across adolescence. Method: This study included a community sample of 247 adolescents (Mage = 13.06 years) assessed annually over a 6-year period. Results: Findings suggested that youth with greater ADHD symptoms whose mothers evidenced more ER difficulties demonstrated steeper increases in depressive symptoms over time relative to their peers with lower ADHD symptoms or whose mothers reported fewer ER difficulties. Conclusion: This work highlights the importance of maternal ER difficulties in predicting the trajectory of depressive symptoms among adolescents with ADHD symptomatology. [ABSTRACT FROM AUTHOR]

Objective: To examine recurrence and timing of maternal depression as predictors of depressive and conduct symptoms in children with and without ADHD. Method: Children aged 4 to 6 years (125 ADHD, 122 comparison) were followed over 8 years. Maternal depression was assessed annually. Youth depressive and conduct symptoms were assessed at ages 12 to 14. Results: Recurrence of maternal depression predicted youth depressive and conduct symptoms at ages 12 to 14; child ADHD moderated relations between recurrence of maternal depression and youth depressive (but not conduct) symptoms. Early adolescent exposure to maternal depression predicted age 12 to 14 depressive symptoms for all children. Exposure to maternal depression during early childhood, childhood, and early adolescence each independently predicted youth conduct symptoms. Conclusion: Recurrence and timing of maternal depression predict comorbid symptoms in early adolescents, particularly for youth with ADHD. Findings inform the prevention of comorbidities in children with ADHD where maternal depression is present. (J. of Att. Dis. XXXX; XX(X) XX-XX). [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is an unprecedented social-emotional stressor significantly impacting intervention services for at-risk college students with attention-deficit/hyperactivity disorder (ADHD). In order to succeed in the new remote learning context, students are tasked with employing strong organizational, time management, and planning skills. They must self-regulate thoughts, actions, and emotions, inhibit task-irrelevant activity, and cope with unprecedented stressors. These ingredients for success nearly completely overlap with the core dysfunctions of ADHD. Recognizing the importance of providing psychosocial services during this high-risk time and in response to social distancing and university guidelines, we initiated a telehealth version of our program for college students with ADHD (i.e., SUCCEEDS). In the current paper, we describe novel and creative clinical strategies designed to assist students with ADHD in problem solving, adaptive coping, organizational skills, and time management strategies during the COVID-19 pandemic. Specifically, we: (1) detail the initial set-up of remote delivery services and supervision, (2) describe key components of the SUCCEEDS program developed to support students' unique needs during the COVID-19 pandemic, (3) present focus group and qualitative feedback from SUCCEEDS coaches and students, (4) provide an illustrative case vignette of application, and (5) discuss future directions and "lessons learned" in moving SUCCEEDS to a remote platform. In so doing, our hope is to contribute to an ongoing dialog surrounding optimal delivery of remote services to college students with ADHD, particularly during high-risk periods. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to describe the extent to which students with ADHD received school-based intervention services and identify demographic, diagnostic, and impairment-related variables that are associated with service receipt in a large, nationally drawn sample. Method: Parent-reported data were obtained for 2,495 children with ADHD aged 4 to 17 years from the National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NS-DATA). Results: The majority (69.3%) of students with ADHD currently receive one or more school services. Educational support (62.3%) was nearly twice as prevalent as classroom behavior management (32.0%). More than 3 times as many students with ADHD had an individualized education program (IEP; 42.9%) as a Section 504 plan (13.6%). Conclusion: At least one in five students with ADHD do not receive school services despite experiencing significant academic and social impairment, a gap that is particularly evident for adolescents and youth from non-English-speaking and/or lower income families. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare children with ADHD with children without ADHD on frustration tolerance and to examine the role of oppositional defiant disorder (ODD) in frustration tolerance within the sample. Method: Participants included 67 children ages 10 to 14 years-old with (n = 37) and without (n = 30) Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) ADHD who completed the Mirror Tracing Persistence Task (MTPT), a validated computerized behavioral measure of frustration tolerance. Results: Children with ADHD were more likely to quit this task than children without ADHD, demonstrating lower levels of frustration tolerance. There were no differences in frustration tolerance between children with ADHD + ODD and those with ADHD - ODD. Moreover, ODD did not moderate the relationship between ADHD and frustration tolerance. Conclusion: Our results suggest that low frustration tolerance is directly linked to ADHD and not better accounted for by ODD. This research highlights specific behavioral correlates of frustration in children with ADHD. [ABSTRACT FROM AUTHOR]

Despite gaining admission to college, many students with attention-deficit/hyperactivity disorder (ADHD) struggle to achieve academic, social, and occupational success. Additionally, college students with ADHD experience higher rates of problem drinking and comorbid psychology (e.g., depression). This paper describes the development of the Students Understanding College Choices: Encouraging and Executing Decisions for Success (SUCCEEDS) program for college students diagnosed with ADHD who are engaging in problem drinking. SUCCEEDS combines ADHD psychoeducation, behavioral activation, and brief motivational intervention treatment elements to help college students with ADHD achieve healthier and more fulfilling lifestyles. SUCCEEDS aims to decrease problem drinking by increasing substance-free, goal-directed behavior allowing for success in college. The iterative treatment development process, two SUCCEEDS illustrative case examples, and reliable change indices are presented. Preliminary results suggest that SUCCEEDS may be effective in reducing problem drinking and functional impairment in areas relevant to college students (e.g., academics). • SUCCEEDS combines ADHD psychoeducation, BA, and MI treatment elements. • SUCCEEDS was developed with UCC and SHC input to enhance dissemination potential. • Two case examples illustrate the implementation of SUCCEEDS. • Case examples decreased total weekly drinks and impairment in various domains. • Preliminary evidence shows SUCCEEDS beneficial for college students with ADHD. [ABSTRACT FROM AUTHOR]

Background: ADHD is a neurodevelopmental disorder with a complex pathogenesis. Individual differences in temperamental reactivity – in particular, anger reactivity – are predictive of ADHD. The goal of this study was to examine the moderating (maternal caregiving behaviors; MCB) and mediating (inhibitory control) variables of reactivity using a 9‐year multimethod prospective longitudinal design. Methods: Participants included 291 children (135 male; 156 female) who participated in a larger study of temperament and social‐emotional development. Anger reactivity was assessed by observation of facial anger during an arm restraint task, and MCB were observed during a series of semi‐structured mother–infant tasks, both at 9 months of age. Inhibitory control was assessed by performance on a go/no‐go task at 5 years of age. ADHD symptoms were assessed by parent and teacher report questionnaires at 7 and 9 years, respectively. Results: Anger reactivity and poor inhibitory control were predictive of later ADHD symptoms. Results supported a moderated mediation model, in which the indirect effects of anger reactivity on ADHD symptoms through inhibitory control were conditional on quality of early MCB. Inhibitory control mediated the effect of anger reactivity on ADHD symptoms, but only among children exposed to lower‐quality MCB. Conclusions: Infant anger reactivity exerts a direct effect on later ADHD from infancy, suggesting anger reactivity as a very early indicator of ADHD risk. Higher‐quality caregiving did not buffer against the direct risk of anger reactivity on ADHD but did buffer against the indirect risk by reducing the negative effect of anger reactivity on inhibitory control. Thus, in the developmental pathway from anger reactivity to ADHD, more sensitive, less intrusive parenting supports the development of protective mechanisms (i.e. inhibitory control) to remediate ADHD risk. [ABSTRACT FROM AUTHOR]

Objective: Parental attention-deficit/hyperactivity disorder (ADHD) is associated with suboptimal parenting and reduces the effectiveness of child ADHD treatments. We conducted a Pilot Sequential, Multiple Assignment, Randomized Trial (SMART Pilot) to evaluate the feasibility and acceptability of sequencing medication and behavioral treatments for mothers with ADHD to target outcomes, including maternal ADHD, parenting, and child ADHD symptoms/impairment in multiplex ADHD families. Methods: Thirty-five mothers with ADHD and their 5- to 8-year-old child with ADHD symptoms were enrolled. Mothers were randomized to 8 weeks of individually titrated stimulant medication (MSM) or behavioral parent training (BPT), followed by rerandomization to 8 weeks of continued first-line treatment (with as-needed modifications) or combined treatment, leading to four treatment sequences (MSM-MSM, MSM-BPT, BPT-MSM, and BPT-BPT). Results: Recruitment of multiplex ADHD families came primarily from child providers. Mothers were adherent to medication and had high therapy session attendance. Mothers and clinicians found both treatments to be acceptable and preferred combination treatment, especially receiving medication before BPT. Monotherapy treatment visits were viewed as more burdensome (MSM-MSM, BPT-BPT). Conclusions: Maternal stimulant medication and BPT are acceptable and feasible interventions for families in which both the mother and child have ADHD symptoms. Mothers with concerns about their children's ADHD symptoms are receptive to receiving treatment themselves as an initial strategy for improving their children's health and functioning. Fully powered SMART designs show promise in evaluating the sequencing of interventions and helping clinicians develop algorithms for treating multiplex families in real-world practice settings. [ABSTRACT FROM AUTHOR]

Objective: More than 50% of mothers of children with attention-deficit/hyperactivity disorder (ADHD) have a lifetime history of major depressive disorder (MDD). Maternal depressive symptoms are associated with impaired parenting and predict adverse developmental and treatment outcomes for children with ADHD. For these reasons, we developed and examined the preliminary efficacy of an integrated treatment targeting parenting and depressive symptoms for mothers of children with ADHD. This integrated intervention incorporated elements of 2 evidence-based treatments: behavioral parent training (BPT) and cognitive behavioral depression treatment. Method: Ninety-eight mothers with at least mild depressive symptoms were randomized to receive either standard BPT (n = 51) or the integrated parenting intervention for ADHD (IPI-A; n = 47). Participants were assessed at baseline, posttreatment, and 3- to 6-month follow-up on measures of (a) self-reported maternal depressive symptoms, (b) observed positive and negative parenting, and (c) observed and mother-reported child disruptive behavior and mother-reported child and family impairment. Results: The IPI-A produced effects of small to moderate magnitude relative to BPT on maternal depressive symptoms, observed negative parenting, observed child deviance, and child impairment at posttreatment and on maternal depressive symptoms, child disruptive behavior, child impairment and family functioning at follow-up. Contrary to expectations, the BPT group demonstrated moderate to large effects relative to IPI-A on observed positive parenting at follow-up. Conclusions: This treatment development study provides encouraging preliminary support for the integrated intervention targeting parenting and depressive symptoms in mothers of children with ADHD. Future studies should examine whether this integrated intervention improves long-term developmental outcomes for children with ADHD. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to examine the prospective relationship between a history of attention-deficit/hyperactivity disorder (ADHD) assessed in mid-adolescence and the onset of major depressive disorder (MDD) through early adulthood in a large school-based sample. A secondary aim was to examine whether this relationship was robust after accounting for comorbid psychopathology and psychosocial impairment. Method One thousand five hundred seven participants from the Oregon Adolescent Depression Project completed rating scales in adolescence and structured diagnostic interviews up to four times from adolescence to age 30. Results Adolescents with a lifetime history of ADHD were at significantly higher risk of MDD through early adulthood relative to those with no history of ADHD. ADHD remained a significant predictor of MDD after controlling for gender, lifetime history of other psychiatric disorders in adolescence, social and academic impairment in adolescence, stress and coping in adolescence, and new onset of other psychiatric disorders through early adulthood (hazard ratio, 1.81; 95% confidence interval, 1.04, 3.06). Additional significant, robust predictors of MDD included female gender, a lifetime history of an anxiety disorder, and poor coping skills in mid-adolescence, as well as the onset of anxiety, oppositional defiant disorder, and substance-use disorder after mid-adolescence. Conclusions A history of ADHD in adolescence was associated with elevated risk of MDD through early adulthood and this relationship remained significant after controlling for psychosocial impairment in adolescence and co-occurring psychiatric disorders. Additional work is needed to identify the mechanisms of risk and to inform depression prevention programs for adolescents with ADHD. [ABSTRACT FROM AUTHOR]

Objective: Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited.Method: We conducted an individual participant data meta-analysis (IPDMA), including data of randomized controlled behavioral intervention trials for individuals with ADHD <18 years of age. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood.Results: For raters most proximal to treatment, small- to medium-sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were available only for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, and ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children.Conclusion: Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those who have severe CD or ADHD symptoms, a CD diagnosis, or are single parents should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention. [ABSTRACT FROM AUTHOR]

College students with attention-deficit/hyperactivity disorder (ADHD) are at risk for alcohol-related problems and disorders relative to their typically developing peers. Despite risk, the optimal therapeutic approach for reducing problem alcohol use in students with ADHD, and mechanisms of change underlying treatment effects in this population, are largely unknown. The current study evaluated putative mechanisms of change in a randomized controlled trial of two harm reduction interventions for college student drinkers with ADHD (N = 113; 49% male): brief motivational intervention plus supportive counseling (BMI + SC) versus brief motivational intervention plus behavioral activation (BMI + BA). Results showed that participants in the BMI + BA condition engaged in more goal-directed activation and less avoidant behavior over the course of treatment compared to those in the BMI + SC condition, in turn predicting reductions in alcohol-related negative consequences. Effects were more robust 1 month following intervention, and diminished by 3 months. Sensitivity analyses revealed a significant indirect effect of treatment condition on alcohol-related negative consequence via reductions in avoidance over treatment. Post hoc moderated mediations showed that BMI + BA engaged target mechanisms more robustly for students with more severe ADHD and depressive symptoms compared to BMI + SC. These findings support the application of BMI + BA intervention, particularly in targeting goal-directed activation and avoidance/rumination in at-risk student drinkers with ADHD. [ABSTRACT FROM AUTHOR]