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Objective: This study examined trajectories of inattention and hyperactivity/impulsivity symptom levels across one preschool year and explored variation in trajectories by age, sex, and end-of-year impairment. Method: Participants were 261 preschoolers (87% Head Start; 59% Caucasian; 53% boys; Mage = 3.97 years). Teachers rated ADHD symptom levels four times throughout one academic year. Results: Results showed a course of increasing inattention that decelerated over time and steadily increasing hyperactivity/impulsivity. Group-based finite mixture modeling revealed three trajectories of inattention: stable low (57%), change (32%), and stable high (11%), as well as three trajectories of hyperactivity/impulsivity: stable low (63%), increasing (26%), and stable high (11%). Compared to children with increasing or changing symptoms levels, children with stable high levels were more impaired and children with stable low symptom levels were less impaired. Conclusion: Findings suggest a “wait and see” approach to treatment may miss an important opportunity for early intervention.

This study evaluates if the Kiddie Children and Teachers on the Move physical activity (PA) program improves the proportion of days meeting the Institute of Medicine (IOM) PA guideline, and whether meeting the guideline is correlated with improvement in school readiness. Thirteen Head Start-affiliated pre-kindergarten classrooms participated in this study. Minutes per hour of moderate-to-vigorous physical activity (MVPA) and proportion of days meeting the IOM PA guideline were examined across three types of intervention days: days during a non-intervention period, non-program days during the intervention period, and program days during the intervention period. Children displayed increasingly more MVPA and a greater proportion of days meeting the IOM guideline from non-intervention days to non-program days, and from non-program days to program days. Proportion of days meeting the guideline significantly predicted improvement in school readiness in five of six domains. Examination of program fidelity indicated the program was run with high fidelity.

Introduction: Stimulant medication is effective in treating Attention Deficit Hyper-activity Disorder, and by removing barriers to success, may enhance perceptions of authenticity (i.e., feeling like one's true, core, autonomous self) among those receiving medication. In contrast, it is also possible that stimulant medications undermine perceptions of authenticity.Methods: To examine these two possibilities, 64 undergraduate students with a history of ADHD and medication usage wrote a narrative about a time when they felt either: least authentic while taking medication, most authentic while taking medication, least authentic while unmedicated, or most authentic while unmedicated. Participants then completed retrospective assessments concerning that experience.Results: Supporting the medication enhancement possibility, participants reported greater need satisfaction and more positive mood states when recalling states in which they were most like their true selves on medication than when off—especially when reporting on their academic selves. No differences were found on a state measure of prescriptive authenticity.Discussion: Results are discussed with respect to linkages to the literature on attributions and stimulant medications. Limitations and future research design possibilities are discussed as more research is needed regarding managing stimulant medication and authentic identities.

As more schools begin to include preschool classrooms, teachers and administrators may need physical activity (PA) curricula that are inclusive, specially designed for young children, and linked to...

We examined developmental trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary education (PSE; N = 749; 79% boys; 63% White, 17% non-Hispanic Black, 10% Hispanic, and 10% other ethnicities). In a multisite study (recruitment based in New York, North Carolina, Pennsylvania, California, and Quebec), participants were originally enrolled between 1994 and 1998 at ages 7 to 9.9 and followed up through 2012 (M

This study examined the unique and interactive effects of receptive language ability and ADHD behaviors on six school readiness outcomes, over and above the effects of socioeconomic status, in 49 preschoolers (Mage = 3.98, SDage = .58; 53.06% female) recruited from Head Start-affiliated classrooms. Hierarchical regression analyses revealed unique positive associations between receptive language ability and cognitive and mathematics readiness, and unique negative associations between ADHD behaviors and social-emotional, physical, cognitive, and literacy readiness. Moderation analyses indicated that at higher, but not lower, levels of ADHD behaviors, lower receptive language ability was associated with lower social-emotional readiness. Results highlight that, when considered together, children’s receptive language ability and ADHD behaviors vary in how they predict school readiness. Further, results provide preliminary evidence for ADHD behaviors as a risk factor in the association between receptive language deficits and social-emotional school readiness. Educational and clinical practice implications are discussed.

Past research raises concerns about whether the presence of self-perceptual biases among children with attention-deficit/hyperactivity disorder (ADHD) interferes with accurate assessment and/or diminishes treatment response. Yet, it remains unclear whether self-perceptual bias is a construct that can be modified. The current study examines individual differences in how children with ADHD (n = 178) display and modify their self-perceptions of competence in the presence of an external motivator for self-perceptual accuracy. Participants were grouped based on the presence and modifiability of their self-perceptual biases across three experimental conditions. Results demonstrate that the presence and modifiability of participants’ self-perceptual biases across conditions was associated with adjustment (i.e., externalizing and internalizing problems) and cognitive functioning. Findings suggest multiple factors may be associated with self-perceptual bias (e.g., self-protection and cognitive impairment), and that these factors may differ across children. Implications for intervention, including whether assessment and treatment can be improved, are discussed.

Background: According to the US Institute of Medicine guideline, preschool-aged children should participate in ≥15 minutes of physical activity (PA) per hour or 3 hours per day over 12 hours. Examinations of PA guideline compliance to date averaged time spent in PA over several days; however, children could exceed the guideline on some days and not on others. Therefore, this cross-sectional study examined PA guideline compliance in preschool children based on number of minutes per hour (average method) and percentage of days the guideline was met (everyday method). Methods: PA was measured by accelerometry during the preschool day for up to 10 days in 177 children (59.3% males, Mage = 4.23). Minutes per hour and percentage of time in light, moderate to vigorous, and total PAs were calculated. Percentage of days in compliance was determined by number of days in compliance (defined as the child active on average ≥15 min/h) divided by total accelerometer days. Results: Children engaged in PA, on average, 17.01 minutes per hour, suggesting that on average, children are meeting the guideline. However, children were only in compliance with the PA guideline 62.41% of assessment days. Conclusions: Findings demonstrate the importance of examining compliance with both the average and everyday methods to more accurately portray level of Institute of Medicine PA guideline compliance.

BACKGROUND Children with attention-deficit/hyperactivity disorder (ADHD) often present with additional psychiatric conditions. Comorbidity is associated with poorer long-term outcomes, highlighting the need for effective assessment and intervention. However, self-perceptual biases may mask the presence of symptoms for a subgroup of children with ADHD. This study examined the role of social self-perceptual biases in children with ADHD versus control children on self-reports of loneliness, and depressive and anxious symptoms. METHODS The research question was examined in two samples. Sample 1 consisted of 7.7-12.8-year-old boys with ADHD (n = 199) and control boys (n = 74); Sample 2 consisted of 7.7-11.4-year-old boys and girls with ADHD (n = 178) and control children (n = 86). Across samples, children reported social competence and symptoms of anxiety and depression. Child-reported loneliness was examined in Sample 1. A social competence discrepancy score (difference between self-report and teacher-report) was used as an indicator of social self-perceptual bias. RESULTS Hierarchical multiple regression analyses tested social self-perceptual bias as a suppressor variable. The magnitude of the associations between ADHD and self-reported feelings of depression, anxiety and loneliness was greater when social self-perceptual bias was included in models as compared to models that did not include social self-perceptual bias (ΔR2 s range = 0.04-0.19). CONCLUSIONS Findings across both samples suggest that social self-perceptual biases may mask internalizing symptom severity on self-reports for individuals who overestimate their social competence. More research is needed to determine the best approach to assessing internalizing problems among children with ADHD.

This study evaluates if the Kiddie Children and Teachers on the Move physical activity (PA) program improves the proportion of days meeting the Institute of Medicine (IOM) PA guideline, and whether meeting the guideline is correlated with improvement in school readiness. Thirteen Head Start-affiliated pre-kindergarten classrooms participated in this study. Minutes per hour of moderate-to-vigorous physical activity (MVPA) and proportion of days meeting the IOM PA guideline were examined across three types of intervention days: days during a non-intervention period, non-program days during the intervention period, and program days during the intervention period. Children displayed increasingly more MVPA and a greater proportion of days meeting the IOM guideline from non-intervention days to non-program days, and from non-program days to program days. Proportion of days meeting the guideline significantly predicted improvement in school readiness in five of six domains. Examination of program fidelity indicated the program was run with high fidelity.

Background Preschool ADHD symptoms have predictive utility for later presence of ADHD diagnoses (Harvey, Youngwirth, Thakar, & Errazuriz, 2009, Journal of Consulting and Clinical Psychology, 77, 349; Lahey et al., 2004, American Journal of Psychiatry, 161(11), 2014), yet some level of inattention, hyperactivity, and impulsivity are present even in typically developing preschoolers. Physical activity (PA) is known to have a broad spectrum of positive effects on the brain in school-age typically developing children (Centers for Disease Control and Prevention, 2010, The association between school based physical activity, including physical education, and academic performance. Atlanta, GA: U.S. Department of Health and Human Services), including functions impaired by ADHD (Halperin, Berwid, & O'Neill, 2014, Child and Adolescent Psychiatric Clinics of North America, 23, 899), yet links between PA and ADHD levels and impairments have rarely been studied in either typically developing or at-risk preschool children. Importantly, impaired processing speed (PS), though not a symptom of ADHD, is a robust neuropsychological correlate (Willcutt & Bidwell, 2011, Treating attention deficit hyperactivity disorder: Assessment and intervention in developmental context. Kingston, NJ: Civic Research Institute) that may indicate additional risk for ADHD. Hence, we examined whether baseline PS moderates the association between preschoolers' PA, specifically moderate-to-vigorous PA (MVPA), and changes in ADHD levels and related behaviors. Method Eighty-five preschoolers (49.4% female; Mage = 4.14, SDage = .64) were drawn from a larger study of the effects of the Kiddie Children and Teachers (CATs) on the Move PA program on school readiness. The sample was largely Head Start eligible (68.2%) and ethnically diverse. Hierarchical regressions were utilized to examine links between MVPA, averaged over a school year, and changes in inattention (IA), hyperactivity/impulsivity (HI), oppositional behaviors, moodiness, and peer functioning, and whether these associations varied based on baseline PS. Results Results indicated that for IA, HI, and peer functioning, higher amounts of MVPA were associated with greater adaptive change for those with lower (but not higher) levels of PS. Conclusions Preschool MVPA may be a viable method of reducing ADHD levels and impairments for those with lower PS.

Introduction Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for smoking cigarettes, but there is little longitudinal research on the array of smoking characteristics known to be prognostic of long-term smoking outcomes into adulthood. These variables were studied into early adulthood in a multisite sample diagnosed with ADHD combined type at ages 7-9.9 and followed prospectively alongside an age- and sex-matched local normative comparison group (LNCG). Methods Cigarette smoking quantity, quit attempts, dependence, and other characteristics were assessed in the longitudinal Multimodal Treatment Study of Children with ADHD (MTA) eight times to a mean age of 24.9 years: ADHD n = 469; LNCG n = 240. Results In adulthood, the ADHD group had higher rates of daily cigarette smoking, one or more quit attempts, shorter time to first cigarette of the day, and more severe withdrawal than the LNCG. The ADHD group did not appear to have better smoking cessation rates despite a higher proportion quitting at least once. Smoking quantity and nicotine dependence did not differ between groups. The ADHD group reported younger daily smoking onset and faster progression from smoking initiation to daily smoking across assessments. Finally, ADHD symptom severity in later adolescence and adulthood was associated with higher risk for daily smoking across assessments in the ADHD sample. Conclusions This study shows that ADHD-related smoking risk begins at a young age, progresses rapidly, and becomes resistant to cessation attempts by adulthood. Prevention efforts should acknowledge the speed of uptake; treatments should target the higher relapse risk in this vulnerable population. Implications Although childhood ADHD predicts later smoking, longitudinal studies of this population have yet to fully characterize smoking behaviors into adulthood that are known to be prognostic of long-term smoking outcome. The current study demonstrates earlier and faster progression to daily smoking among those with a childhood ADHD diagnosis, as well as greater risk for failed quit attempts. Prevention efforts should address speed of smoking uptake, while treatments are needed that address smoking relapse risk. The current study also demonstrates ADHD symptom severity over development increases daily smoking risk, implicating the need for continuous ADHD symptom management.

ObjectiveTo determine motor vehicle crash (MVC) risk in adults with a history of childhood attention-deficit/hyperactivity disorder (ADHD) and persistent ADHD symptoms.MethodParticipants with (n= 441) and without (n= 239; local normative comparison group) childhood ADHD from the Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) Study were included. Participants provided self-reports on total number of MVCs they had been involved in and the time of licensure. Driving experience was estimated as the number of months since licensure. Total number of MVCs by adulthood was regressed on baseline ADHD status adjusting for sex, age at follow-up, driving experience, baseline oppositional defiant disorder/conduct disorder comorbidity, baseline household income level, adult oppositional defiant disorder/conduct disorder symptoms, adolescent and adult substance use, and adult antisocial personality disorder symptoms. We repeated the analysis using adult ADHD status (persistent versus desistant versus local normative comparison group) and symptom level as the predictor variables. Results are presented as incidence rate ratio (IRR) and CI.ResultsChildhood ADHD was associated with a higher number of MVCs (IRR= 1.45, CI= 1.15-1.82), and adult ADHD symptom persistence was associated with more MVCs than desistance (IRR= 1.46, CI= 1.14-1.86). ADHD desistance was not associated with a significantly increased risk for MVCs compared with the local normative comparison group (IRR= 1.24, CI= 0.96-1.61). Concurrent symptoms of inattention and hyperactivity/impulsivity predicted MVC risk.ConclusionPersistence of ADHD into adulthood is a stronger predictor of MVC risk than childhood-limited ADHD.Clinical trial registration informationMultimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study; https://clinicaltrials.gov; NCT00000388.

Childhood attention-deficit/hyperactivity disorder (ADHD) is prospectively linked to substance use and disorder. Depression emerging in adolescence is an understudied risk factor that may explain some of this risk. In the present study, we considered mediating and moderating roles of adolescent depression in explaining this association by using longitudinal data from the prospective 16-year follow-up of the Multimodal Treatment Study of ADHD (MTA). Participants were 547 children diagnosed with DSM-IV ADHD Combined Type, and 258 age- and sex-matched comparison children. In adolescence, depressive symptoms did not exacerbate effects of childhood ADHD on any substance use. For both groups, time-varying and average depressive symptoms were associated with more frequent use of all substances. Prospectively, we found no evidence of depression mediation to adult substance use. However, adolescent depression moderated the association between childhood ADHD and adult marijuana use. Although adults without ADHD histories used marijuana more frequently if they had elevated depressive symptoms in adolescence, marijuana use by adults with ADHD histories was independent of their adolescent depression. In adulthood, depression diagnoses and ADHD persistence continued to operate as independent, additive correlates of substance use risk. Our findings suggest a circumscribed role for depression in substance use risk that adds to, but does not alter or explain, ADHD-related risk.

Factor analytic studies of attention-deficit/hyperactivity disorder (ADHD) in children and adults have shown that second-order and bifactor models better represent ADHD symptoms than two- or three-factor models, yet there is far less evidence for a bestfitting model of ADHD in adolescence. Thus, the current study examined the factor structure of ADHD in adolescence and further evaluated the external validity of the best fitting model. Participants were 588 adolescents (22 % female; 366 with a childhood ADHD diagnosis; mean age 15.9 years) from the 8-year assessment of the Multimodal Treatment Study of Children with ADHD (MTA). ADHD symptoms were assessed via adolescent self-report, parent report, and teacher report on the SNAP-IV scale. Potential factor structures for the 18 symptoms of ADHD were tested for each informant, which included traditional one-factor, two-factor, and three-factor models of ADHD, as well as second-order factor (specific factors loading onto general factor) and bifactor (items loading onto both specific and general factors) models. Unique associations between external criteria and the identified factors of each informant's best fitting model were examined. Although several of the proposed models exhibited good fit, the second-order two-factor model best accounted for ADHD in adolescence according to self-report and parent report, and the second-order three-factor model was optimal according to teacher report. Several key measurement issues emerged for the hierarchical bifactor models, such as numerous Heywood cases and out-of-bound parameter estimates, which rendered them unfit as optimal representations of ADHD in adolescence. These findings and the implications of the best fitting model of ADHD in adolescence suggest that a possible reorganization of this disorder may eventually aid clinicians in the accurate diagnosis of ADHD in adolescents.

We examined the relation between physical fitness and psychological well-being in children ages 10–14 years (N = 222), and the potential moderation of this relation by sex. Participants completed a physical fitness assessment comprised of seven tasks and a diverse set of self-report well-being measures assessing depressive symptoms, loneliness, and competence. Peers reported on social status and teachers rated adaptive functioning, internalizing symptoms, and externalizing symptoms. Multiple regression analyses indicated a significant association between physical fitness and psychological well-being for both boys and girls. Higher levels of physical fitness were associated with lower levels of peer dyadic loneliness and fewer depressive symptoms; greater cognitive, social, and athletic competence; greater feelings of self-worth; and better teacher reports of adaptive functioning. An interaction between internalizing and sex indicated a significant and negative association between physical fitness and internalizing symptoms for males only. No other moderation effects by sex were observed. Results suggest that physical fitness is associated with a range of well-being indicators for both boys and girls in this age group.

Children with attention-deficit/hyperactivity disorder (ADHD) often present with additional psychiatric conditions. Comorbidity is associated with poorer long-term outcomes, highlighting the need for effective assessment and intervention. However, self-perceptual biases may mask the presence of symptoms for a subgroup of children with ADHD. This study examined the role of social self-perceptual biases in children with ADHD versus control children on self-reports of loneliness, and depressive and anxious symptoms.The research question was examined in two samples. Sample 1 consisted of 7.7-12.8-year-old boys with ADHD (n = 199) and control boys (n = 74); Sample 2 consisted of 7.7-11.4-year-old boys and girls with ADHD (n = 178) and control children (n = 86). Across samples, children reported social competence and symptoms of anxiety and depression. Child-reported loneliness was examined in Sample 1. A social competence discrepancy score (difference between self-report and teacher-report) was used as an indicator of social self-perceptual bias.Hierarchical multiple regression analyses tested social self-perceptual bias as a suppressor variable. The magnitude of the associations between ADHD and self-reported feelings of depression, anxiety and loneliness was greater when social self-perceptual bias was included in models as compared to models that did not include social self-perceptual bias (ΔRFindings across both samples suggest that social self-perceptual biases may mask internalizing symptom severity on self-reports for individuals who overestimate their social competence. More research is needed to determine the best approach to assessing internalizing problems among children with ADHD.

This chapter describes the long-term outcomes in the Multimodal Treatment study of ADHD (MTA), which began in 1994 and ended in 2014. First, we provide a short history of the origin of the MTA. Second, we review the design as a 14-month randomized clinical trial and the transition to a long-term follow-up. Third, we present findings from 12 key publications describing outcomes in four stages of the MTA from childhood to adulthood. Fourth, we discuss how the final adult assessments of the MTA address critical issues about symptomatic persistence of ADHD, functional outcomes outside the parental home, and cost-benefit analyses of residual effects of treatment with medication.

Background Inconsistent findings exist regarding long-term substance use (SU) risk for children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The observational follow-up of the Multimodal Treatment Study of Children with ADHD (MTA) provides an opportunity to assess long-term outcomes in a large, diverse sample. Methods Five hundred forty-seven children, mean age 8.5, diagnosed with DSM-IV combined-type ADHD and 258 classmates without ADHD (local normative comparison group; LNCG) completed the Substance Use Questionnaire up to eight times from mean age 10 to mean age 25. Results In adulthood, weekly marijuana use (32.8% ADHD vs. 21.3% LNCG) and daily cigarette smoking (35.9% vs. 17.5%) were more prevalent in the ADHD group than the LNCG. The cumulative record also revealed more early substance users in adolescence for ADHD (57.9%) than LNCG (41.9%), including younger first use of alcohol, cigarettes, marijuana, and illicit drugs. Alcohol and nonmarijuana illicit drug use escalated slightly faster in the ADHD group in early adolescence. Early SU predicted quicker SU escalation and more SU in adulthood for both groups. Conclusions Frequent SU for young adults with childhood ADHD is accompanied by greater initial exposure at a young age and slightly faster progression. Early SU prevention and screening is critical before escalation to intractable levels.

Using laboratory-type Theory of Mind (ToM) tasks (our measure of ‘explicit’ ToM competence) and a more ecologically-valid measure of ToM (our measure of ‘applied’ ToM competence), we found that for composite scores, typically developing (TD) males performed near ceiling levels on both indices and age-matched males with autism spectrum disorder (ASD) performed near floor levels on both indices. The scores for age-matched males with attention-deficit hyperactivity disorder (ADHD) showed a different pattern such that the ADHD group had high scores on the explicit measure and low scores on the applied measure. Subscale scores (early, basic, advanced ToM) for the two indices also revealed that (1) despite variable complexity, explicit ToM almost always distinguished the ASD group from the other two groups but never distinguished the ADHD and TD groups and (2) level of complexity was critical for distinguishing groups with regard to applied ToM. We suggest that although children with ADHD can calculate the content of traditional laboratory ToM tasks, this explicit ToM competence fails to be applied and expressed in real world demonstrations of ToM (especially when advanced ToM skills are assessed). By contrast, the ToM difficulties of children with ASD seem to be attributable to a deeper metarepresentational deficit. Our results have implications for practice and extend current models of social cognition in developmental disabilities by isolating variable aspects of competence that predict specific and testable models for future research.

We examined the relation between aerobic fitness and inhibition in young children with and without attention deficit hyperactivity disorder (ADHD)-risk status. Participants (91 ADHD risk, 107 typically developing, Mage = 6.83, 53.5% male, 68.2% Caucasian) completed an assessment of aerobic fitness and a flanker task requiring variable amounts of inhibitory control. Aerobic fitness was positively associated with inhibition. When inhibitory control demands were largest, the relation varied as a function of ADHD-risk status such that the link between aerobic fitness and inhibition was significant only for children with ADHD risk. The relation between aerobic fitness, status, and inhibition was further moderated by age for interference control. Specifically, the positive relation between aerobic fitness and interference control was only significant for younger children with ADHD risk. A fitness-cognition link appears in young childhood that seems particularly salient for those in the earliest school years with ADHD risk. The findings extend work on typically developing children and suggest that exploring aerobic fitness interventions to address executive function impairments in children at risk for ADHD is warranted.

For the past couple decades, the recommended evidence-based treatments for attention-deficit/hyperactivity disorder (ADHD) have remained largely consistent: medication, behavior therapy, and their combination (American Academy of Pediatrics’ Subcommittee on ADHD, Steering Committee on Quality Improvement and Management, 2011; MTA Cooperative Group, 1999). Although important new pharmaceutical preparations have emerged, as well as variations on behavioral intervention strategies, the basic approach to treating the disorder has remained largely the same. Yet, medication is considered unpalatable or unworkable (e.g., due to side effects) for some families (Halperin & Healey, 2011) and behavior therapy is considered cumbersome to others (Benner-Davis & Heaton, 2007). Further, with both treatments, as well as their combination, symptoms generally return upon treatment cessation (Jensen et al., 2007). In the past decade, our understanding of the life course of the disorder has advanced, making clear that in a majority of cases, impairment associated with ADHD persists into adulthood (Barkley, Fischer, Smallish, & Fletcher, 2002; Biederman, Petty, Clarke, Lomedico, & Faraone, 2011; Hinshaw et al., 2012). Given the chronic nature of ADHD, sustainable lifestyle changes should be explored that enable a proactive, chronic approach to its treatment, much like the approach taken to manage chronic medical disorders (Hoza et al., 2014) such as heart disease. One relatively unexplored approach to managing ADHD symptoms over the long term is the use of chronic aerobic physical activity (PA). To our knowledge, only one large-scale randomized clinical trial has applied aerobic PA to management of ADHD symptoms and impairments in young children (Hoza, et al., 2014), and we are unaware of any well-controlled randomized trials applying aerobic PA to older children or adolescents with ADHD. A handful of smaller sample studies, however, are present in the literature. Although forms of PA and methods of measuring outcomes vary widely across these extant studies, the emerging message from this small body of work is that PA may be a promising strategy for managing ADHD symptoms and impairments both in the short and long term (see Berwid & Halperin, 2012, and Halperin, Berwid, & O’Neill, 2014, for reviews).

The goal of this study was to compare the effects of before school physical activity (PA) and sedentary classroom-based (SC) interventions on the symptoms, behavior, moodiness, and peer functioning of young children (M age = 6.83) at risk for attention-deficit/hyperactivity disorder (ADHD-risk; n = 94) and typically developing children (TD; n = 108). Children were randomly assigned to either PA or SC and participated in the assigned intervention 31 min per day, each school day, over the course of 12 weeks. Parent and teacher ratings of ADHD symptoms (inattention, hyperactivity/impulsivity), oppositional behavior, moodiness, behavior toward peers, and reputation with peers, were used as dependent variables. Primary analyses indicate that the PA intervention was more effective than the SC intervention at reducing inattention and moodiness in the home context. Less conservative follow-up analyses within ADHD status and intervention groups suggest that a PA intervention may reduce impairment associated with ADHD-risk in both home and school domains; interpretive caution is warranted, however, given the liberal approach to these analyses. Unexpectedly, these findings also indicate the potential utility of a before school SC intervention as a tool for managing ADHD symptoms. Inclusion of a no treatment control group in future studies will enable further understanding of PA as an alternative management strategy for ADHD symptoms.

Peer problems are common among children with emotional and behavioral disorders (EBD). However, the extent to which children’s peer functioning varies across settings is unknown, as is the incremental power of peer functioning in different settings in predicting subsequent psychopathology. Participants were 57 children with Attention-Deficit/Hyperactivity Disorder (ADHD) who had peer sociometric nominations collected in general education classrooms and a Summer Treatment Program (STP) with all-EBD peers. Significant, small-to-medium correlations existed between nomination rates across settings. Lower rates of STP positive nominations and higher rates of STP negative nominations (but not classroom nominations) predicted exacerbated self-reported depression and antisocial behavior 1 year later. Lower rates of STP positive nominations, but higher rates of classroom positive nominations, predicted increased self-reported depression 2 years later. For children with high rates of classroom positive nominations, higher rates of STP positive nominations predicted reduced parent-reported internalizing behavior 1 year later. For children with low rates of classroom negative nominations, higher rates of STP negative nominations predicted increased teacher-reported externalizing behavior 1 year later and self-reported depression 2 years later. Results suggest that sociometric nominations collected within an EBD peer group may have stronger predictive power for later adjustment than nominations collected in a mainstream classroom.

Peer substance use strongly predicts adolescent and young adult substance use, but its role in ADHD-related risk for substance use, especially in adulthood, is unclear. In a sample with (n = 516) and without (n = 249) childhood ADHD from the Multimodal Treatment Study of ADHD, we compared associations between change over time in peer substance use and personal substance use (alcohol, cigarettes, marijuana, illicit drugs) from age 14–26 by ADHD status. Developmentally typical peer substance use trajectories across adolescence and young adulthood coincided with similar changes in personal use – but less so for those with ADHD histories. Concurrent associations between peer and personal use in adolescence and young adulthood were weaker for those with ADHD histories than without for commonly used substances (alcohol, marijuana). Prospectively, escalating peer use during adolescence forecasted adulthood declines for commonly used substances, yet persistently high substance use at age 25, regardless of ADHD history. In the reverse direction, growth in adolescent substance use predicted developmentally normative young adult declines in peer use – but for the ADHD group, adolescent heavy drinking predicted increases in young adult peer use. Findings suggest that individuals with ADHD may have difficulty emulating their peers' developmentally normative declines in substance use, highlighting the importance of social factors when treating young adults affected by ADHD and substance abuse.

This study investigated the role of externalizing behavior as a mediator of the relation between social self-control and peer liking among children with Attention-Deficit/Hyperactivity Disorder-Combined Type (ADHD-CT). A model was proposed whereby externalizing behavior would fully statistically account for the direct relation of social self-control to peer liking. One hundred seventy two children ages 7.0-9.9 years with ADHD-CT were rated by their teachers regarding their social self-control and by their parents and teachers regarding their rates of externalizing behavior. Same-sex classmates provided ratings of overall liking. Structural Equation Modeling (SEM) was used to assess the proposed model. Results supported the proposed model of externalizing behavior as fully statistically accounting for the relation of social self-control to peer liking. This study demonstrated the crucial role that externalizing behaviors play in the social impairment commonly seen among children with ADHD-CT.

This study extends previous research and examines whether working memory (WM) is associated with multiple measures of concurrent social functioning (peer rejection, overall social competence, relational aggression, physical aggression, and conflict resolutions skills) in typically developing fourth- and fifth-grade children (N = 116). Poor central executive WM was associated with both broad social impairments (peer rejection and poor overall social competence) and specific social impairments (physical aggression, relational aggression, and impaired conflict resolution skills); poor verbal storage was associated only with greater peer rejection, and spatial storage was not associated with any measures of social impairment. Analyses also examined whether specific impairments in aggressive behavior and conflict resolution skills mediated the association between central executive and broad measures of social functioning. Greater physical aggression and impaired conflict resolution skills were both significant mediators; relational aggression was not. Implications for theory and future research are discussed.

This article summarizes the evidence for management of attention-deficit/hyperactivity disorder (ADHD) using chronic aerobic physical activity (PA). Known studies comparing chronic aerobic PA to at least one control group are listed; uncontrolled studies and studies of non-aerobic PA are not considered. Key challenges to conducting chronic PA studies with children and youth with ADHD are summarized. After condensing information from widely varying studies, measures, and research designs, conclusions are stated in broad brush stroke terms. Preliminary evidence supports PA as beneficial for ADHD symptoms, executive function, and motor abilities. Social, emotional, and behavioral outcomes also may benefit. The preliminary state of the evidence supports PA as an adjunctive treatment for ADHD at this time, but the body and sophistication of the research to date is insufficient at present to support PA as a stand-alone treatment. Critical directions for future research are discussed.

Objective To compare educational, occupational, legal, emotional, substance use disorder, and sexual behavior outcomes in young adults with persistent and desistent attention-deficit/hyperactivity disorder (ADHD) symptoms and a local normative comparison group (LNCG) in the Multimodal Treatment Study of Children with ADHD (MTA). Method Data were collected 12, 14, and 16 years postbaseline (mean age 24.7 years at 16 years postbaseline) from 476 participants with ADHD diagnosed at age 7 to 9 years, and 241 age- and sex-matched classmates. Probands were subgrouped on persistence versus desistence of DSM-5 symptom count. Orthogonal comparisons contrasted ADHD versus LNCG and symptom-persistent (50%) versus symptom-desistent (50%) subgroups. Functional outcomes were measured with standardized and demographic instruments. Results Three patterns of functional outcomes emerged. Post−secondary education, times fired/quit a job, current income, receiving public assistance, and risky sexual behavior showed the most common pattern: the LNCG group fared best, symptom-persistent ADHD group worst, and symptom-desistent ADHD group between, with the largest effect sizes between LNCG and symptom-persistent ADHD. In the second pattern, seen with emotional outcomes (emotional lability, neuroticism, anxiety disorder, mood disorder) and substance use outcomes, the LNCG and symptom-desistent ADHD group did not differ, but both fared better than the symptom-persistent ADHD group. In the third pattern, noted with jail time (rare), alcohol use disorder (common), and number of jobs held, group differences were not significant. The ADHD group had 10 deaths compared to one death in the LNCG. Conclusion Adult functioning after childhood ADHD varies by domain and is generally worse when ADHD symptoms persist. It is important to identify factors and interventions that promote better functional outcomes.

This study examines whether positively biased self-perceptions relate to social behaviors in children with attention-deficit/hyperactivity disorder (ADHD) as compared to control children. The social behaviors of children with ADHD ( n = 87) were examined relative to control children (CTL; n = 38) during a laboratory-based dyadic social interaction task. Children with ADHD were subgrouped into those with a positive illusory bias (PIB) in their self-perceptions (ADHD + PIB) versus those without such a bias (ADHD – PIB). Using a behavioral coding system adapted for this study, ADHD + PIB, ADHD – PIB, and CTL participants were compared on objectively coded social behaviors occurring within the context of the social interaction task. Whereas both ADHD groups displayed more disruptive behavior than controls, only the ADHD + PIB group displayed less prosocial behavior and less effortful behavior. This study breaks new ground by examining positively biased self-perceptions as they relate to social behavior in children with ADHD and provides promising new insight into the social problems experienced by these children.

The current study examined the incremental utility of rating scales, a structured diagnostic interview, and multiple informants in a comprehensive assessment of attention-deficit/hyperactivity disorder (ADHD). The sample included 185 children with ADHD ( Mage = 9.22, SD = 0.95) and 82 children without ADHD ( Mage = 9.24, SD = 0.88). Logistic regressions were used to examine the incremental contribution of each method within an assessment of ADHD. Results indicated that information collected from a structured diagnostic interview was unable to significantly improve a prediction model including parent and teacher ratings (Block χ2 = 0.91, ρ = .64). Teacher ratings on symptom-based scales resulted in significant model improvement beyond parent ratings alone (Block χ2 = 48.47, ρ < .001). Exploratory analyses indicated that using behavioral rating scales correctly classified all participants by diagnosis. Clinical implications are highlighted, and future research directions are discussed.

Even after evidence-based treatment, Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with poor long-term outcomes. These outcomes may be partly explained by difficulties in peer functioning, which are common among children with ADHD and which do not respond optimally to standard ADHD treatments. We examined whether peer rejection and lack of dyadic friendships experienced by children with ADHD after treatment contribute to long-term emotional and behavioral problems and global impairment, and whether having a reciprocal friend buffers the negative effects of peer rejection. Children with Combined type ADHD (N = 300) enrolled in the Multimodal Treatment Study of Children with ADHD (MTA) were followed for 8 years. Peer rejection and dyadic friendships were measured with sociometric assessments after the active treatment period (14 or 24 months after baseline; M ages 9.7 and 10.5 years, respectively). Outcomes included delinquency, depression, anxiety, substance use, and general impairment at 6 and 8 years after baseline (Mean ages 14.9 and 16.8 years, respectively). With inclusion of key covariates, including demographics, symptoms of ADHD, ODD, and CD, and level of the outcome variable at 24 months, peer rejection predicted cigarette smoking, delinquency, anxiety, and global impairment at 6 years and global impairment at 8 years after baseline. Having a reciprocal friend was not, however, uniquely predictive of any outcomes and did not reduce the negative effects of peer rejection. Evaluating and addressing peer rejection in treatment planning may be necessary to improve long-term outcomes in children with ADHD.

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) are thought to have fundamental deficits in the allocation of attention for information processing. Furthermore, it is believed that these children possess a fundamental difficulty in motoric timing, an assertion that has been explored recently in adults and children. In the present study we extend this recent work by fully exploring the classic Wing and Kristofferson (1973) analysis of timing with typically developing children (n = 24) and children with ADHD (n = 27). We provide clear evidence that not only do children with ADHD have an overall timing deficit, they also time less consistently when using a similar strategy to typically developing children. The use of the Wing and Kristofferson approach to timing, we argue, will result in the discovery of robust ADHD-related timing differences across a variety of situations.

Objective: Physical activity associates with mental health and neurocognitive function, showing potential for addressing ADHD symptoms. As a preliminary assessment of this potential, the authors piloted a before-school physical activity intervention for young children. Method: Seventeen children (Grades K-3) exhibiting four or more hyperactivity/impulsivity symptoms on the Disruptive Behavior Disorders Rating Scale (Pelham, 2002) completed about 26 min of continuous moderate-to-vigorous physical activity daily over eight school weeks. The authors administered cognitive, motor, social, and behavioral functioning measures at pre- and postprogram, assessed response inhibition weekly, and coded negative behaviors daily. Results: Several measures showed significant or marginally significant change over time (effect size = 0.35-0.96) with additional measures showing meaningful effect size values (≥ 0.20). Response inhibition effects were most consistent. Most participants (64% to 71%) exhibited overall improvement according to postprogram parent, teacher, and program staff ratings. Conclusion: Physical activity shows promise for addressing ADHD symptoms in young children.

Mothers and fathers often disagree in their ratings of child behavior, as evidenced clinically and as supported by a substantial literature examining parental agreement on broadband rating scales. The present study examined mother—father agreement on Diagnostic and Statistical Manual—based symptom-specific ratings of Attention-Deficit/Hyperactivity Disorder (ADHD), as compared to agreement on broadband ratings of externalizing behavior. Based on mother and father ratings of 324 children who participated in the Multimodal Treatment Study of Children with ADHD (MTA), parental agreement was computed and patterns of disagreement examined. Mother—father ratings were significantly correlated; however, a clear pattern of higher ratings by mothers was present. Agreement on attention-deficit/hyperactivity disorder symptom-specific ratings was significantly lower than that for broadband externalizing behaviors and oppositional defiant disorder symptoms. Of several moderator variables tested, parental stress was the only one that predicted the discrepancy in ratings. Disagreement between parents is clinically significant and may pose complications to the diagnostic process.

ObjectivePast research suggests that many children with behavior problems display overly positive self-views (“positive illusions”); some researchers have hypothesized that these positive illusions may prevent these children from improving their behavior. This research investigates positive illusions in the behavioral domain as a moderator and mediator of the relation between ADHD status and behavior in a summer program setting.MethodBoys with ADHD and comparison boys rated their own behavioral competence; discrepancies between these self-ratings and the reports of boys’ teachers served as an index of behavioral positive illusions. Dependent variables were derived from a behavioral point system that provided specific data about boys’ positive and negative behaviors and from counselor ratings of behavior.Results/ConclusionHierarchical multiple regression analyses revealed no evidence supporting a moderational association, although ADHD status and behavioral positive illusions were additive predictors of the dependent variables. Post hoc analyses revealed a pattern of mediational effects that were strongest for dependent variables assessing conduct problem behaviors. (J. of Att. Dis. 2008; 12(3) 227-238)

Objective: To review and provide details about the primary and secondary findings from the Multimodal Treatment study of ADHD (MTA) published during the past decade as three sets of articles. Method: In the second of a two part article, we provide additional background and detail required by the complexity of the MTA to address confusion and controversy about the findings outlined in part I (the Executive Summary). Results: We present details about the gold standard used to produce scientific evidence, the randomized clinical trial (RCT), which we applied to evaluate the long-term effects of two well-established unimodal treatments, Medication Management (MedMGT) and behavior therapy (Beh), the multimodal combination (Comb), and treatment “as usual” in the community (CC). For each of the first three assessment points defined by RCT methods and included in intent-to-treat analyses, we discuss our definition of evidence from the MTA, interpretation of the serial presentations of findings at each assessment point with a different definition of long-term varying from weeks to years, and qualification of the interim conclusions about long-term effects of treatments for ADHD based on many exploratory analyses described in additional published articles. Conclusions: Using a question and answer format, we discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families, clinicians, and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD. (J. of Att. Dis. 2008; 12(1) 15-43)

Possible mediators of the relation between maternal depressive symptomatology and parenting behavior were examined for 96 children with ADHD and their mothers drawn from the Multimodal Treatment Study of Children with ADHD (MTA) as part of an add-on investigation conducted by two of the six MTA sites. General cognitions (i.e., maternal locus of control and self-esteem) and parenting-specific factors (i.e., maternal parenting efficacy and parenting stress) were examined as possible mediators. Findings provide initial support that maternal parenting stress, as well as maternal locus of control and self-esteem mediate the relation between maternal depressive symptomatology and parenting behavior. This provides support for the argument that some families of children with ADHD may benefit from an expanded version of parent management training that includes sessions directly targeting affective and cognitive factors in parents, similar to treatment programs used to treat childhood conduct problems.