Cognitive factors differentiating attention deficit–hyperactivity disorder with and without a comorbid mood disorder.

Mood disorders and attention deficit–hyperactivity disorder (ADHD) co-occur in 20–30% of children and adolescents diagnosed in both epidemiological and clinical studies, but little information is available regarding cognitive factors that may be relevant to the expression of co-occurring mood disorders and ADHD. This study examined whether ADHD with and without a comorbid mood disorder could be differentiated on the basis of cognitive factors associated with prominent theories of depression. Children meeting diagnostic criteria for ADHD (n?=?14) or ADHD and a comorbid mood disorder (n?=?27) were assessed on a variety of cognitive indices. Children in the comorbid group reported more negative views of themselves and a more depressogenic attributional style. Cognitive disturbances associated with A. T. Beck's (1967) cognitive model and attributional style theories of depression differentiate ADHD children with significant mood pathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Classification of behavior disorders in adolescence: Scaling methods, predictive validity, and gender differences.

The present study examined issues relating to the measurement and discriminant validity of Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for behavior disorders in adolescence (conduct disorder [CD], oppositional defiant disorder [ODD], attention-deficit/hyperactivity disorder [ADHD]). Data were obtained from a birth cohort of 995 New Zealand–born individuals studied to the age of 25 years and modeled associations between behavior disorder from ages 14 to 16 years and later outcomes including crime, substance use, mental health, parenthood and partnership outcomes, and education and employment outcomes to age 25 years. The associations between behavior disorders and outcomes were adjusted for both comorbid behavior disorders and a range of confounding factors. The results suggested that (a) dimensional measures of behavior disorder were more strongly correlated with outcomes than categorical (DSM) measures; (b) CD, ODD, and ADHD each had a distinctive pattern of associations with longer term consequences; and (c) there was no evidence to suggest that the developmental consequences of CD, ODD, and ADHD differed by gender. In general, the results supported the validity of DSM diagnostic domains but also highlighted the importance of including in DSM–V methods for both recognizing the severity of disorder and addressing subclinical symptom levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of comorbid oppositional or conduct problems on attention-deficit hyperactivity disorder

OBJECTIVE: To investigate whether the presence of comorbid oppositional defiant disorder (ODD) or conduct disorder (CD) alters the correlates of attention-deficit hyperactivity disorder (ADHD). METHOD: Three groups of children (33 "pure" ADHD, 46 ADHD + ODD, and 12 ADHD + CD) were compared on measures of ADHD, aggression, anxiety, parental psychopathology, self-esteem, school, and social-emotional functioning. RESULTS: Findings indicated that the presence of comorbid oppositional or conduct problems in children with ADHD altered the correlates of ADHD across a number of areas, including greater ADHD symptom severity and social dysfunction. Nevertheless, some correlates were more closely linked with the comorbid condition of ADHD + CD (e.g., higher aggression, anxiety, and maternal pathology, as well as decreased self-esteem), while others appeared more closely linked with ADHD + ODD (e.g., social withdrawal, elevated academic achievement paired with higher perceived scholastic competence). CONCLUSIONS: Findings support the distinctive profiles of the disruptive behavior disorder groups and emphasize the deleterious effects on the quality of life experienced by the comorbid conditions. The need for syndrome-specific interventions is stressed.     

Temporary vascular occlusion during cerebral aneurysm surgery

Mood disorders and attention deficit-hyperactivity disorder (ADHD) co-occur in 20-30% of children and adolescents diagnosed in both epidemiological and clinical studies, but little information is available regarding cognitive factors that may be relevant to the expression of co-occurring mood disorders and ADHD. This study examined whether ADHD with and without a comorbid mood disorder could be differentiated on the basis of cognitive factors associated with prominent theories of depression. Children meeting diagnostic criteria for ADHD (n = 14) or ADHD and a comorbid mood disorder (n = 27) were assessed on a variety of cognitive indices. Children in the comorbid group reported more negative views of themselves and a more depressogenic attributional style. Cognitive disturbances associated with A. T. Beck's (1967) cognitive model and attributional style theories of depression differentiate ADHD children with significant mood pathology.     

GABA and mood disorders: a brief review and hypothesis

Considerable evidence implicates the neurotransmitter gamma-aminobutyric acid (GABA) in the biochemical pathophysiology of mood disorders. Animal models of depression show regional brain GABA deficits and GABA agonists have antidepressant activity in these models. Somatic treatments for depression and mania upregulate the GABAB receptor, similar to the effect of GABA agonists. Clinical data indicate that decreased GABA function accompanies depressed or manic mood states. GABA agonists are effective antidepressant and antimanic agents. Low GABA levels are found in brain, cerebrospinal fluid and plasma of patients with depression and in plasma of patients with mania. Plasma GABA levels, which reflect brain GABA, are not normalized with treatment and clinical remission in depression, suggesting low GABA is not a marker for mood state. Some somatic treatments, including valproic acid and electroconvulsive shock, reduced plasma GABA and response to these correlates with higher levels of baseline plasma GABA. From these data, a GABA hypothesis for mood disorders is formulated. Low GABA function is proposed to be an inherited biological marker of vulnerability for development of mood disorders. Environmental factors, including stress and excessive alcohol use, may increase GABA, causing symptoms of depression or mania. Treatment, or the passage of time, then returns GABA to its presymptomatic baseline as the symptoms remit. This hypothesis, applicable to a subset of mood disordered persons, is testable.     

Neuropsychological correlates of childhood attention-deficit/hyperactivity disorder: explainable by comorbid disruptive behavior or reading problems?

Questions remain as to whether neuropsychological processing deficits associated with child attention-deficit/hyperactivity disorder (ADHD) are accounted for by co-occurring disorders, especially in clinical samples. The authors examined ADHD and comorbid oppositional defiant, conduct, and reading disorders. Boys with ADHD displayed hypothesized deficits on effortful neuropsychological tasks regardless of categorical or dimensional control of comorbid antisocial behavior problems. The same result held when reading problems were controlled, although boys with ADHD plus reading disorder (n = 16) exhibited specific impairment on linguistic output tasks. Simultaneous control of reading and behavior problems yielded the same result. Overall, results suggest that in a clinical sample, difficulties on effortful neuropsychological tasks that require planning or controlled motor output pertain at least in part to ADHD and are not fully accounted for by comorbid conditions.     

Disentangling the overlap between Tourette's disorder and ADHD

OBJECTIVE: To identify similarities and differences in neuropsychiatric correlates in children with Tourette's syndrome (TS) and those with ADHD. METHOD: The sample consisted of children with Tourette's syndrome with ADHD (N = 79), children with Tourette's syndrome without ADHD (N = 18), children with ADHD (N = 563), psychiatrically referred children (N = 212), and healthy controls (N = 140). RESULTS: Disorders specifically associated with Tourette's syndrome were obsessive compulsive disorder (OCD) and simple phobias. Rates of other disorders, including other disruptive behavioral, mood, and anxiety disorders, neuropsychologic correlates, and social and school functioning were indistinguishable in children with Tourette's and ADHD. However, children with Tourette's syndrome plus ADHD had more additional comorbid disorders overall and lower psychosocial function than children with ADHD. CONCLUSIONS: These findings confirm previously noted associations between Tourette's syndrome and OCD but suggest that disruptive behavioral, mood, and anxiety disorders as well as cognitive dysfunctions may be accounted for by comorbidity with ADHD. However, Tourette's syndrome plus ADHD appears to be a more severe condition than ADHD alone.     

Adolescent outcome of boys with attention-deficit/hyperactivity disorder and social disability: Results from a 4-year longitudinal follow-up study.

IQ-achievement discrepancy methodology similar to that used in defining learning disabilities has recently been used to identify a subset of boys with attention-deficit/hyperactivity disorder (ADHD) evidencing marked impairment in social functioning. In this study, 2 issues were examined: (a) What is the longitudinal outcome of boys with ADHD identified at baseline as "socially disabled?" (b) Is social disability at baseline a significant predictor of severe long-term outcomes (such as substance use disorders) in boys with ADHD? If so, are its predictive relationships accounted for by conditions that are comorbid with ADHD? Results showed that, at follow-up, ADHD boys with ADHD who also had social disability evidenced significantly higher rates of mood, anxiety, disruptive, and substance use disorders, compared with nonsocially disabled boys with ADHD and comparison boys without ADHD. Findings also showed that social disability at baseline in boys with ADHD was a significant predictor of later conduct disorder and most substance use disorders after baseline mood and conduct disorders and behavior checklist ratings of aggressive behavior and attention problems were controlled. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does comorbid substance use disorder exacerbate borderline personality features? A comparison of borderline personality disorder individuals with vs. without current substance dependence.

There is compelling evidence that comorbid borderline personality disorder (BPD) negatively impact the clinical courses and outcomes of substance use disorders (SUD). Conversely, there is little evidence that concurrent SUD exacerbates the clinical characteristics of BPD. Thus, this study sought to examine whether the presence of current substance dependence among BPD patients would be associated with stronger BPD-relevant personality traits and behavioral characteristics. Female BPD patients without (BOR; n = 37) or with current substance dependence (BSUD; n = 19), and female non-BPD/SUD controls (CON; n = 48) were compared with respect to impulsivity, affective lability, affective intensity, externalizing behaviors, and self-harming/suicidal tendencies, taking into consideration their comorbid mood disorders, anxiety disorders, and antisocial personality disorder. Results indicated that both BOR and BSUD groups scored higher than CON in most of the measures, but BOR and BSUD failed to reveal significant group differences especially when the influence of comorbid psychopathology was removed. The overall pattern of findings remained identical even when comparing BPD patients with versus without the diagnosis of lifetime substance dependence. Our results do not support the notion that BPD individuals with SUD display more severe BPD features than individuals with BPD alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distinguishing anxiety and depression: Reexamination of the reconstructed Hamilton scales.

The discriminant validities of the original and the reconstructed Hamilton anxiety and depression scales (J. H. Riskind et al, 1987) were compared in patients who had principal Diagnostic and Statistical Manual of Mental Disorders-III—Revised (DSM-III—R) anxiety disorders with or without 1 or more comorbid mood disorders. The reconstructed anxiety and depression scales had better discriminant validity (scale intercorrelation?=?.61) than the original scales did (r?=?.78). However, the reconstructed scales shared considerable variance (about 37%), which was significantly higher than the shared variance (about 2%) reported by Riskind et al. Discriminant analyses showed that the reconstructed scales did not distinguish anxiety patients with comorbid mood disorders from those without comorbid mood disorders better than the original scales did. However, the reconstructed scales eliminate item overlap, an obvious source of artifactual correlations between scores on the Hamilton anxiety and depression scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance-dependent, conduct-disordered adolescent males: severity of diagnosis predicts 2-year outcome

Most delinquent youths have conduct disorder (CD), often with comorbid substance use disorder (SUD), attention-deficit/hyperactivity disorder (ADHD) and depression. Some youths' conduct problems later abate, while those of others persist into adult antisocial personality disorder. Earlier CD onset and ADHD reportedly predict persisting antisocial problems, but predictors of persisting SUD are poorly understood. Males aged 13-19 years (n = 89), most referred by criminal justice and social service agencies, received residential treatment for comorbid CD and SUD. They had diagnostic assessments for SUD at intake and for CD, ADHD, and depression (as well as drug-use assessments) at intake and 6, 12 and 24 months later. At intake nearly all had DSM-III-R substance dependence (usually on alcohol and marijuana) and CD with considerable violence and criminality. The 2-year follow-ups revealed improvements in criminality, CD, depression and ADHD, but substance use remained largely unchanged. Various aspects of conduct, crime and substance outcomes at 2 years were predicted by intake measures of intensity of substance involvement, and by CD severity and onset age, but not by severity of either ADHD or depression, nor by treatment duration. Earlier CD onset, more severe CD and more drug dependence predicted worse outcomes, supporting the validity of these diagnoses in adolescents.     

Medications prescribed for children with mood disorders: Effects of a family-based psychoeducation program.

Few controlled trials have examined psychotropic medications in children with mood disorders. Multiple medications are often prescribed for these children, who frequently suffer from several comorbid conditions. However, this polypharmacy has been infrequently studied and may lead to adverse drug-drug interactions. Multi-Family Psychoeducation Groups (MFPGs) are an 8-session, manual-driven treatment for children with mood disorders, designed as an adjunct to current medications and psychotherapy. In part, MFPG teaches parents and children to be better consumers of mental health care, including medications. This study examined the effect of MFPG on medications taken by 165 children, ages 8-11, with mood disorders. The authors hypothesized that MFPG would not affect the mean number of medications taken but that the variance in number of medications would decrease from pre- to posttreatment (i.e., the number of medications prescribed for any given child should become more closely distributed around the sample mean). Approximately 70% of participants were diagnosed with bipolar spectrum disorders, and 30% were diagnosed with depressive spectrum disorders. Most had both comorbid behavioral (97%) and anxiety (69%) disorders. Information regarding medications was gathered 4 times: at baseline, 6, 12, and 18 months. Approximately half (n=78) of the participants were randomized into immediate treatment, and half (n=87) were randomized into a 1-year wait-list condition. All were encouraged to continue treatment as usual throughout the study. As hypothesized, no significant pre- to posttreatment differences were found between groups for the mean number of current medications, but variance declined significantly from pre- to posttreatment. Implications and future research goals are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intellectual performance and school failure in children with attention deficit hyperactivity disorder and in their siblings.

Made psychiatric and intellectual assessments of 140 children with attention deficit hyperactivity disorder (ADHD), 120 normal controls, and their 303 siblings. The index children were White, non-Hispanic boys. ADHD children were more likely to have had learning disabilities, repeated grades, been placed in special classes, and received academic tutoring. They also did worse on the Wechsler Intelligence Scale for Children—Revised (WISC—R). Among ADHD probands, comorbid conduct, major depressive, and anxiety disorders predicted school placement more than school failure or WISC—R scores. However, the neuropsychological disability of all ADHD children could not be attributed to comorbid disorders because those without comorbidity had more school failure and lower WISC—R scores than normal controls. Intellectual impairment was also increased among siblings of ADHD children. This provides converging evidence that the ADHD syndrome is familial. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Executive functions and adhd in adults: Evidence for selective effects on ADHD symptom domains.

Dual-process models of attention-deficit/hyperactivity disorder (ADHD) suggest that both executive functioning and regulatory functions (e.g., processing speed) are involved and that executive function weaknesses may be associated specifically with symptoms of inattention-disorganization but not hyperactivity-impulsivity. Adults aged 18-37 (105 with ADHD, 90 controls) completed a neuropsychological battery. The ADHD group had weaker performance than did the control group (p = .01) on both executive and speed measures. Symptoms of inattention-disorganization were uniquely related to executive functioning with hyperactivity-impulsivity controlled. Inattention was associated with slower response speed, and hyperactivity-impulsivity with faster output speed. Results were not accounted for by IQ, age, gender, education level, or comorbid disorders. Findings are discussed in terms of developmental and dual-process models of ADHD leading into adulthood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Axis I and II comorbidity in adults with ADHD.

Ongoing debate over the validity of the attention-deficit/hyperactivity disorder (ADHD) construct in adulthood is fueled in part by uncertainty regarding implications of potentially extensive yet incompletely described comorbid Axis I and II psychopathology. Three hundred sixty-three adults ages 18 to 37 completed semistructured clinical interviews; informants were also interviewed, and best estimate diagnoses were obtained. Results were as follows: First, ADHD combined type (ADHD-C) had an excess of externalizing and internalizing Axis I disorders, suggesting a gradient-of-severity relationship between it and ADHD inattentive type (ADHD-I). Second, ADHD-C and ADHD-I did not differ in frequency of Axis II disorders. Third, however, ADHD overall was associated with increased rates of Axis II disorders, compared with rates in non-ADHD control participants, including both Cluster B (primarily borderline personality disorder) and Cluster C disorders. Fourth, ADHD incrementally accounted for clinician-rated global assessment of functioning scores above and beyond comorbid conditions or symptoms on either Axis I or Axis II. Results further inform nosology of ADHD in adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse and bipolar affective disorder

This interview study was conducted to explore the onset, course, and features of bipolar affective disorder complicated by substance abuse. Forty-four patients with a diagnosis of bipolar affective disorder were interviewed using the Structured Clinical Interview for DSM-III-R, Hamilton Rating Scale for Depression, Young Mania Rating Scale, and a questionnaire concerning psychiatric history. Current substance users averaged twice as many hospitalizations for mood problems. The age of onset of mood problems for substance users was significantly earlier than that of the nonusers (p < or = .05). Substance users were four times as likely to have other comorbid axis I disorders (p < or = .05) and twice as likely to have dysphoric mania at time of interview. This preliminary study suggests that individuals with bipolar affective disorder complicated by substance abuse may have more hospitalizations, a higher incidence of dysphoric mania, earlier onset of mood problems, and more comorbid axis I disorders.     

An auxiliary peptide required for the function of two activation domains in upstream stimulatory factor 2 (USF2) transcription factor

OBJECTIVE: In adolescents, conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), and depression are frequently comorbid with substance dependence (SD). We hypothesized that the prevalence and severity of CD, major depressive disorder (MDD), and ADHD would differ by gender, and that these conditions would associate differentially with severity of SD in males and females. METHODS: We examined these issues, using standardized diagnostic interviews, in 285 male and 82 female adolescents referred for comorbid CD and SD. RESULTS: Males and females did not differ significantly in severity of substance involvement, MDD, or ADHD, but males had more severe CD. MDD severity was the only variable significantly associated with SD severity for females, while for males, severity of CD combined with MDD and ADHD was significantly associated with SD severity. CONCLUSIONS: Among referred adolescents, CD, MDD, and ADHD may all be important concomitants of SD in males, while in females, depression may be the primary variable related to SD.     

Rage attacks in children and adolescents with Tourette''s disorder: a pilot study

BACKGROUND: Sudden, explosive episodes of rage occur in a significant number of clinically referred children with Tourette's disorder and cause considerable psychosocial morbidity. The etiology of these symptoms is unknown. We conducted a pilot study of 12 consecutive children with Tourette's disorder and rage attacks to determine whether comorbidity of Tourette's-associated disorders is related to these symptoms. METHOD: Twelve consecutive children with Tourette's disorder who presented with rage attacks were evaluated, including 2 females and 10 males. Tourette's disorder diagnosis, presence of comorbid disorders, and tic severity were assessed using DSM-IV diagnostic criteria and standardized rating scales. RESULTS: All 12 children met diagnostic criteria for Tourette's disorder, obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD). Two children were also diagnosed with comorbid oppositional defiant disorder, and 4 children were diagnosed with comorbid conduct disorder. None of the subjects met diagnostic criteria for a mood disorder. All subjects had only mild tic severity. CONCLUSION: The clinical phenomenon of rage attacks in children with Tourette's disorder resembles intermittent explosive disorder and may reflect specific underlying neurologic disturbances. This pilot study suggests that rage attacks in Tourette's disorder may be related to the presence of comorbid disorders.     

Association of parental psychopathology to the comorbid disorders of boys with attention deficit-hyperactivity disorder.

This study examined whether particular forms of parental psychopathology are related to similar forms of comorbid psychopathology in offspring with attention deficit-hyperactivity disorder (ADHD). Parental disorders were assessed using maternal interviews, and child disorders were assessed using multiple-informant interviews for 111 clinic-referred boys (aged 7–12) with Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.: American Psychiatric Association, 1987) ADHD. Associations between parental and child internalizing disorders and between parental and child externalizing disorders were found, but associations across categories of disorder (i.e., internalizing and externalizing) were not. Similar relationships were observed in 66 clinic-referred boys without ADHD. These findings support specific modes of familial transmission, in contrast to theories that comorbidity simply reflects more severe psychopathology in children with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contribution of ADHD symptoms to substance problems and delinquency in conduct-disordered adolescents

We examined adolescents with conduct disorder (CD) and substance problems to determine if those with attention deficit hyperactivity disorder (ADHD) symptomatology had more severe delinquency and substance involvement. ADHD symptomatology was assessed in two ways: (1) by self-reports using the Diagnostic Interview Schedule for Children (DISC) and (2) by use of DISC plus reports of others (parents, program staff, and program teacher). We divided boys into three ADHD groups based on DISC: those who met criteria, those who reported at least eight current symptoms, and those who reported fewer than eight symptoms. We also divided the same boys into two groups: those with reports of ADHD by two or more sources and those without this multisource ADHD. Examining these definitions of ADHD revealed that boys with either self- or multisource ADHD had more CD symptoms, earlier age of CD onset, more substance dependence diagnoses, and more comorbid depression and anxiety.