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CORK Bibliography: Attention Deficit/Hyperactivity Disorder

32 citations. January 2010 to present

Prepared: March 2011

Advokat C. What are the cognitive effects of stimulant medications? Emphasis on adults with attention-deficit/hyperactivity disorder (ADHD. (review). Neuroscience and Biobehavioral Reviews 34(8): 1256-1266, 2010. (104 refs.)

The relevant literature concerning cognitive effects of amphetamine and methylphenidate, was reviewed, with an emphasis on research conducted in adults diagnosed with attention-deficit/hyperactivity disorder. As first-line treatment for ADHD, stimulant drugs are well-known to improve attention and concentration. Yet, there is increasing evidence that (as with children and adolescents), they do not promote learning and academic achievement in adult college students with ADHD. A review of neuropsychological studies indicates that, although response latencies are reduced, performance of ADHD adults on tests of 'distractibility' and 'planning' is also not consistently improved by stimulants. Studies in non-ADHD adults suggest that stimulants do not promote acquisition of new information, might improve retention of previously acquired information, and facilitate memory consolidation, but may actually impair performance of tasks that require adaptation, flexibility and planning. It is still not clear if improvement only occurs when there is a baseline deficit. Stimulants may influence cognition by their effects on physiological arousal. Regardless, the evidence does not support the conclusion that stimulants are cognitive 'enhancers.

Carpentier PJ; van Gogh MT; Knapen LJM; Buitelaar JK; De Jong CAJ. Influence of attention deficit hyperactivity disorder and conduct disorder on opioid dependence severity and psychiatric comorbidity in chronic methadone-maintained patients. European Addiction Research 17(1): 10-20, 2011. (60 refs.)

Background: Persistent attention deficit hyperactivity disorder (ADHD) and a history of conduct disorder (CD) are highly prevalent among patients with substance use disorders (SUD). We examined the influence of both diagnoses on problem severity, psychiatric comorbidity, and quality of life in methadone-maintained patients. Methods: 193 patients in long-term methadone maintenance treatment (MMT) were assessed for ADHD through a semi-structured interview. Psychiatric disorders and SUD were assessed with the MINI, the CIDI-SAM, and the SIDP-IV. Results: Childhood ADHD was diagnosed in 68 (35.2%) patients; 48 (24.9%) had persisting ADHD; a CD history was present in 116 (60.1%). Patients with adult ADHD had significantly higher problem severity scores, lower quality of life scores, more comorbid SUD and more psychiatric comorbidity. Although both ADHD and CD contributed to problem severity, addictive pathology and psychopathology, ADHD was found to substantially increase the risk of psychiatric comorbidity, independent of CD. Conclusion: ADHD in MMT patients is characterised by greater addiction severity and more comorbid psychopathology, only partly explained by the influence of a coexisting CD. The presence of ADHD in a substantial minority of patients accentuates the need for early detection and treatment of this complicating disorder.

Charach A; Yeung E; Climans T; Lillie E. Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. (review). Journal of The American Academy of Child and Adolescent Psychiatry 50(1): 9-21, 2011. (49 refs.)

Objective: in recent years cohort studies have examined childhood attention-deficit/hyper-activity disorder (ADHD) as a risk factor for substance use disorders (SUDs) in adolescence and young adulthood. The long-term risk is estimated for development of alcohol, cannabis, combined alcohol and psychoactive SUDs, combined SUDs (nonalcohol), and nicotine use disorders in children with AUHD. Method: MEDLINE, CINHAL, PsycINFO, and EMBASE were searched through October 2009; reference lists of included studies were hand-searched. Prospective cohort studies were included if they compared children with ADHD to children without, identified cases using standardized criteria by mean age of 12 years, followed participants until adolescence (nicotine use) or young adulthood (psychoactive substance use disorder, with and without alcohol, alcohol use disorder, cannabis use disorder), and reported SUD outcomes. Two independent reviewers examined articles and extracted and crosschecked data. Effects were summarized as pooled odds ratios (ORs) in a random effects model. Results: Thirteen studies were included. Only two of five meta-analyses, for alcohol use disorder (N = 3,184) and for nicotine use (N = 2,067), estimated ORs showing stability when evaluated by sensitivity analyses. Childhood ADHD was associated with alcohol use disorder by young adulthood (OR = 1.35, 95% confidence interval = 1.11-1.64) and with nicotine use by middle adolescence (OR = 2.36, 95% confidence interval = 1.71-3.27). The association with drug use disorder, nonalcohol (N = 593), was highly influenced by a single study. Conclusions: Childhood ADHD is associated with alcohol and drug use disorders in adulthood and with nicotine use in adolescence.

Covey LS; Hu MC; Winhusen T; Weissman J; Berlin I; Nunes EV. OROS-methylphenidate or placebo for adult smokers with attention deficit hyperactivity disorder: Racial/ethnic differences. Drug and Alcohol Dependence 110(1-2): 156-159, 2010. (14 refs.)

Objective: To explore racial/ethnic difference in OROS-methylphenidate (OMPH) efficacy when added to nicotine patch and counseling for treating nicotine dependence among smokers with attention deficit hyperactivity disorder (ADHD). Method: Participants were adult smokers with ADHD (202 whites and 51 non-whites) randomly assigned to OMPH or placebo in a multi-site, randomized controlled trial. Study outcomes were complete, prolonged, and point-prevalence abstinence at the end of treatment, and weekly ratings of ADHD symptoms, tobacco withdrawal symptoms, and desire to smoke. Results: The rate of four-week complete abstinence (no slips or lapses) was significantly higher with OMPH than placebo among non-white (OMPH = 42.9%, placebo = 13.3%, chi(2)(1)=5.20, p = 0.02) but not white participants (OMPH = 23.1%, placebo =23.5%, chi(2)( 1) = 0.00,p = 0.95). Patterns of prolonged and point-prevalence abstinence among non-whites were similar but fell short of statistical significance. OMPH reduced ADHD symptoms in both race/ethnic groups, and produced greater reductions in desire to smoke and withdrawal symptoms among the non-white than white participants. Change in desire to smoke, but not in withdrawal or ADHD symptoms predicted abstinence. The ability of OMPH to reduce desire to smoke among non-whites appeared to mediate the medication's positive effect on abstinence. Conclusion: Differential efficacy favoring non-whites of a medication for achieving smoking cessation is a potentially important finding that warrants further investigation. OROS-MPH could be an effective treatment for nicotine dependence among a subgroup of smokers.

de los Cobos JP; Sinol N; Puerta C; Cantillano V; Zurita CL; Trujols J. Features and prevalence of patients with probable adult attention deficit hyperactivity disorder who request treatment for cocaine use disorders. Psychiatry Research 185(1-2): 205-210, 2011. (44 refs.)

To characterize those patients with probable adult attention deficit hyperactivity disorder (ADHD) who ask for treatment of cocaine use disorders; to estimate the prevalence of probable adult ADHD among these patients. This is a cross-sectional and multi-center study performed at outpatient resources of 12 addiction treatment centers in Spain. Participants were treatment-seeking primary cocaine abusers recruited consecutively at one center and through convenience sampling at the other centers. Assessments included semi-structured clinical interview focused on Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) ADHD criteria adapted to adulthood, and the Wender-Utah Rating Scale (WURS) for screening childhood history of ADHD according to patients. Probable adult ADHD was diagnosed when patients met DSM-IV criteria of ADHD in adulthood and scored WURS > 32. All participants were diagnosed with current cocaine dependence (n = 190) or abuse (n = 15). Patients with probable adult ADHD, compared with patients having no lifetime ADHD, were more frequently male, reported higher impulsivity, and began to use nicotine, alcohol, cannabis, or cocaine earlier. Before starting the current treatment, patients with probable adult ADHD also showed higher cocaine craving for the previous day, less frequent cocaine abstinence throughout the previous week, and higher use of cocaine and tobacco during the previous month. Impulsivity and male gender were the only independent risk factors of probable adult ADHD in a logistic regression analysis. The prevalence of probable adult ADHD was 20.5% in the sub-sample of patients consecutively recruited (n = 78). A diagnosis of probable adult ADHD strongly distinguishes among treatment-seeking cocaine primary abusers regarding past and current key aspects of their addictive disorder; one-fifth of these patients present with probable adult ADHD.

Dosh T; Helmbrecht T; Anestis J; Guenthner G; Kelly TH; Martin CA. A comparison of the associations of caffeine and cigarette use with depressive and ADHD symptoms in a sample of young adult smokers. Journal of Addiction Medicine 4(1): 52-54, 2010, 2010. (24 refs.)

Objectives: This study examined the relationship between psychiatric symptoms and nicotine, caffeine, alcohol, and marijuana use in young adult smokers. Methods: Young adult smokers completed self-report measures of nicotine, caffeine, alcohol and marijuana use, Conner's Adult Attention-Deficit/Hyperactivity Disorder Rating Scale-Short Version (CAARS-SS), beck depression inventory (BDI) and Beck Anxiety Inventory (BAI), and provided a breath carbon monoxide sample. Results: Self-reported cigarette use was positively correlated with carbon monoxide, CAARS-SS, and BDI levels. Caffeine intake was correlated with CAARS-SS, BAI, and BDI levels and emerged as the more significant predictor of BDI, BAI, and CAARS-SS scores when regressed with cigarette use. Conclusions: Caffeine use is associated with psychiatric symptoms in young adult cigarette smokers and should be considered in future research.

Eliasen M; Tolstrup JS; Andersen AMN; Gronbaek M; Olsen J; Strandberg-Larsen K. Prenatal alcohol exposure and autistic spectrum disorders: A population-based prospective study of 80,552 children and their mothers. International Journal of Epidemiology 39(4): 1074-1081, 2010, 2010. (42 refs.)

Methods: Participants were 80,552 children and their mothers enrolled in the Danish National Birth Cohort from 1996 to 2002. Alcohol consumption was obtained by self-report during pregnancy. Information on ASD was obtained from the Danish Central Psychiatry Register. Follow-up ended on February 2008. Data were analysed by means of Cox regression. Results In total, 401 children were diagnosed with ASD and 157 with infantile autism. No association was found between average alcohol consumption and ASD or infantile autism, respectively. For binge drinking, the adjusted hazard ratio (HR) for ASD was 0.72 [95% confidence interval (CI): 0.53-0.97] among women who binge drank once during pregnancy compared with women who did not binge drink. The corresponding HR for infantile autism was 0.61 (95% CI: 0.36-1.02). However, the HR for ASD was 0.84 (95% CI: 0.51-1.36) when restricting the analysis to first-time pregnancies conceived within 6 months of trying. No estimate was made for infantile autism due to low number of cases. No association was seen for more than one binge episode and for the timing of binge drinking. Conclusion: Our findings do not support that a low prenatal alcohol exposure increases the risk of ASD or infantile autism. The lower risk for women who binge drank once during pregnancy is most likely non-causal.

Frodl T. Comorbidity of ADHD and substance use disorder (SUD): A neuroimaging perspective. Journal of Attention Disorders 14(2): 109-120, 2010, 2010. (100 refs.)

Introduction: ADHD has a high comorbidity with substance use disorders (SUD). Both diseases have profound social, psychological, and economic consequences and are therefore highly relevant for health systems. The high comorbidity indicates some shared underlying neurobiological substrates. Knowing these substrates may increase the understanding of the disease and help identify therapeutic processes. Method: Neuroimaging studies of ADHD were reviewed and similarities with SUD identified. For this a PubMed research was conducted with the search terms ADHD, SUD, MRI or positron emission tomography (PET) or spectroscopy or imaging. Results: Similarities were found, in both PET and fMRI studies, between patients with ADHD and those with addiction-related craving. Results from structural MRI and MR spectroscopy do not support a common pathophysiological background, probably because of the lack of studies on craving. Discussion: ADHD and SUD-related craving share some neurobiological similarities. One reason may be that patients with addiction show more craving when they also suffer from ADHD. The present review thus supports the conclusion from an earlier meta-analysis of clinical studies which found that adequate treatment of ADHD reduces craving and relapse into substance use.

Galera C; Bouvard MP; Melchior M; Chastang JF; Lagarde E; Michel G et al. Disruptive symptoms in childhood and adolescence and early initiation of tobacco and cannabis use: The Gazel Youth study. European Psychiatry 25(7): 402-408, 2010. (58 refs.)

Purpose: To examine the link between symptoms of hyperactivity-inattention and conduct disorder in childhood, and the initiation of tobacco and cannabis use, controlling for other behavioral symptoms, temperament and environmental risk factors. Method: The sample (N = 1107 participants, aged 4 to 18 years at baseline) was recruited from the population-based longitudinal Gazel Youth study with a follow-up assessment 8 years later. Psychopathology, temperament, environmental variables, and initiation of tobacco and cannabis use were self-reported. Event time analyses were performed to assess the effects of childhood disruptive symptoms on age at first use of tobacco and cannabis. Results: Proportional hazard models revealed that participants with high levels of childhood symptoms of both hyperactivity-inattention and conduct disorder were at highest risk of early tobacco initiation (in males: hazard ratio [HR]= 2.05; confidence interval [CI]: 1.24-3.38; in females: HR = 2.01; CI: 1.31-3.09), and, in males, of early cannabis initiation (HR = 1.95; CI: 1.04-3.64). Temperament, through activity in both males and females and negative emotionality in females, was also associated to early substance use initiation. Conclusions: Children who simultaneously have high levels of symptoms of hyperactivity-inattention and conduct disorder are at increased risk for early substance initiation. These associations may guide childhood health professionals to consider the liability for early substance initiation in high-risk groups.

Glass K; Flory K. Why does ADHD confer risk for cigarette smoking? A review of psychosocial mechanisms. (review). Clinical Child and Family Psychology Review 13(3): 291-313, 2010, 2010. (97 refs.)

Research has documented that adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for cigarette smoking, but less attention has examined why this risk exists. The current paper reviews the literature on different psychosocial mechanisms [self-medication hypothesis, social factors (social modeling, social impairments), cognitive factors (attitudes, coping skills), and psychological variables (ADHD symptom dimensions, comorbidity)] that might explain this increased smoking risk. Results of the review suggest that, while the self-medication hypothesis has some theoretical merit, it has not been adequately examined among adolescents and young adults with ADHD. Further, cognitive and social factors may be important mechanisms that help to explain the association between ADHD and cigarette smoking, but research in these areas is sparse. Finally, a larger body of literature suggests that different psychological aspects of ADHD (e.g., comorbidity, symptom dimensions) are related to smoking. Interpretation of findings of many of these studies was hindered due to significant methodological problems and the lack of a guiding theoretical orientation. Potential theories that might facilitate future work in this area are discussed. Future research should continue to explore these important psychosocial mechanisms as well as gene-environment interactions in examining the link between ADHD and cigarette smoking.

Gray KM; Baker NL; Carpenter MJ; Lewis AL; Upadhyaya HP. Attention-Deficit/Hyperactivity Disorder confounds nicotine withdrawal self-report in adolescent smokers. American Journal on Addictions 19(4): 325-331, 2010. (32 refs.)

Individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely than those without ADHD to initiate smoking and develop nicotine dependence. Recent research indicates that adults with ADHD experience more severe nicotine withdrawal symptoms than those without ADHD. However, little is known about nicotine withdrawal in adolescent smokers with history of ADHD. Among a sample of 134 nicotine-dependent adolescents entering a smoking cessation research study, participants completed the Minnesota Nicotine Withdrawal Scale (MNWS) and lifetime diagnostic assessment for ADHD during the baseline visit. Responses on individual items and MNWS total score were compared between participants with and without history of ADHD. In addition, correlations between MNWS responses and current ADHD symptoms were investigated among participants with history of ADHD. Forty-eight participants (36%) met lifetime ADHD criteria. Adolescent smokers with history of ADHD scored significantly higher on MNWS than those without history of ADHD. Among participants with history of ADHD, responses on the MNWS difficulty concentrating, restlessness/impatience, and anxiety/nervousness items each correlated positively with several current ADHD symptoms. Treatment-seeking adolescent smokers with history of ADHD are more likely to endorse nicotine withdrawal symptoms than those without history of ADHD. However, it does not appear that the symptoms reported in this sample represent a valid "withdrawal syndrome," particularly because these smokers had not yet formally attempted to quit. Rather, the data likely reflect common features between ADHD and nicotine withdrawal. Smoking research, particularly among adolescents in whom ADHD is so common, should carefully consider the complex issue of comorbid ADHD and nicotine dependence.

Heffner JL; Johnson CS; Blom TJ; Anthenelli RM. Relationship between cigarette smoking and childhood symptoms of inattention and hyperactivity/impulsivity in alcohol-dependent adults without attention-deficit hyperactivity disorder. Nicotine & Tobacco Research 12(3): 243-250, 2010. (46 refs.)

Symptoms of inattention and hyperactivity/impulsivity that fall below the DSM-IV diagnostic threshold for attention-deficit hyperactivity disorder (ADHD) may be associated with the high prevalence of smoking among individuals with alcohol dependence, yet no studies to date have examined the relationship between subthreshold ADHD symptoms and cigarette smoking in this group. We hypothesized that increasing levels of ADHD symptoms would be associated with increasing risk of lifetime smoking and nicotine dependence, concentration problems secondary to nicotine withdrawal, and maintenance of smoking. Participants were alcohol-dependent adults (n = 242) who did not meet criteria for ADHD or a current Axis I disorder other than alcohol and nicotine dependence. All participants were involved in treatment for alcohol dependence but not smoking cessation. The Semi-Structured Assessment for the Genetics of Alcoholism was administered to collect demographic and smoking history data and to assess symptoms of ADHD and other psychiatric disorders. A higher number of self-reported ADHD symptoms were associated with increased likelihood of ever smoking (p = .026), nicotine dependence (p = .017), and impaired concentration as a symptom of nicotine withdrawal (p = .046). There was no relationship between the number of ADHD symptoms and classification as a former versus current smoker (p = .333). Childhood symptoms of inattention and hyperactivity/impulsivity are related to cigarette smoking and nicotine dependence among alcohol-dependent individuals at levels below the ADHD diagnostic threshold. Conceptualization of ADHD symptoms as occurring on a continuum may aid identification of and early intervention for individuals who are at highest risk for initiating smoking and developing nicotine dependence.

Hennessey KA; Stein MD; Rosengard C; Rose JS; Clarke JG. Childhood attention deficit hyperactivity disorder, substance use, and adult functioning among incarcerated women. Journal Of Attention Disorders 14(3): 273-280, 2010, 2010. (44 refs.)

Objective: To estimate prevalence of childhood ADHD among incarcerated women and determine its association with substance use and adult functioning. Method: 192 female participants are recruited from the Department of Corrections in Rhode Island. Childhood ADHD is defined as scoring >46 on the Wender Utah Rating Scale. Results: The findings reveal that 46% met criteria for childhood ADHD. Multivariate analysis reveal that women meeting WURS criteria were more likely to be inconsistently employed (OR = 0.23, 95% CI = 0.10-0.54), recently homeless (OR = 2.09, 95% CI = 1.02-4.30), lifetime incarceration of more than 90 days (OR = 3.00, 95% CI = 1.37-6.57), current smokers (OR = 2.99, 95% CI = 1.24-7.20), and ever used marijuana regularly (OR = 3.47, 95% CI = 1.61-7.45). Conclusion: Among incarcerated women, childhood ADHD is associated with negative social and health behaviors.

Hesse M. Course of self-reported symptoms of attention deficit and hyperactivity in substance abusers during early treatment. Addictive Behaviors 35(5): 504-506, 2010. (10 refs.)

Attention deficit and hyperactivity disorder has been associated with poor outcome in studies of substance use disorders. This study aimed to assess the course of self-reported symptoms of both attention deficit and hyperactivity among adults presenting for treatment for substance use disorders. A sample of 75 substance abusers were assessed after they were admitted to a centralized intake unit, and followed at 3 and 6 months after intake by independent interviewers (follow-up rate 81%). Symptoms of attention deficit and hyperactivity were assessed with the Adult Self-report Scale for ADHD (ASRS). Both types of symptoms declined significantly during follow-up, but attention symptoms had a high intraclass correlation (0.79), and hyperactivity had a moderate intraclass correlation (0.64). Both baseline attention deficit and hyperactivity symptoms were associated with worse work and social adjustment after controlling for baseline functioning. Hyperactivity was associated with poorer substance use outcomes at the trend level. In conclusion, both dimensions of ADHD contribute to worse functioning during early treatment for substance abusers, and the ASRS is a reasonably stable measure of ADHD symptoms during early recovery.

Kalechstein AD; De La Garza R; Newton TF. Modafinil administration improves working memory in methamphetamine-dependent individuals who demonstrate baseline impairment. American Journal on Addictions 19(4): 340-344, 2010. (26 refs.)

Modafinil improves working memory in healthy subjects and individuals diagnosed with schizophrenia and Attention Deficit/Hyperactivity Disorder, though the effects of modafinil have not been evaluated on working memory in methamphetamine-dependent subjects. This double-blind, placebo-controlled study evaluated whether a daily dose of 400 mg of modafinil, administered over three consecutive days, would enhance performance on a measure of working memory relative to test performance at baseline and following 3 days of placebo administration in 11 methamphetamine addicted, nontreatment-seeking volunteers. The results revealed that participants demonstrating relatively poor performance on the third day of a 3-day washout period (ie, at baseline), showed significant improvement on measures of working memory, but not on measures of episodic memory or information processing speed. In contrast, for participants demonstrating relatively high performance at baseline, modafinil administration did not affect test scores. The findings provide an initial indication that modafinil can reverse methamphetamine-associated impairments in working memory.

Kollins SH; McClernon FJ; Van Voorhees EE. Monetary incentives promote smoking abstinence in adults with Attention Deficit Hyperactivity Disorder (ADHD). Experimental and Clinical Psychopharmacology 18(3): 221-228, 2010. (50 refs.)

Individuals with attention deficit hyperactivity disorder (ADHD) smoke at rates significantly higher than the general population and have more difficulty quitting than nondiagnosed individuals. Currently, there are no evidence-based approaches for reducing smoking specifically in individuals with ADHD. Adult regular smokers with or without ADHD participated in a study of extended smoking withdrawal where monetary incentives were used to promote abstinence. Participants were paid according to an escalating schedule for maintaining abstinence measured as self-report of no smoking and an expired air carbon monoxide (CO) level of 4 parts per million. Sixty-four percent (14/22) of smokers with ADHD and 50% (11/22) of smokers without ADHD maintained complete abstinence for the 2-week duration of the study. Twenty-two percent (5/22) and 9% (2/22) of smokers with ADHD and without ADHD, respectively, maintained continued abstinence for up to 10 days following the removal of the contingencies. Though abstinence rates were higher for the smokers with ADHD, the group differences were not statistically significant. Results suggest that monetary incentives may be a useful approach for promoting abstinence in adult smokers with ADHD, perhaps owing to altered reinforcement processes in these individuals.

Konstenius M; Jayaram-Lindstrom N; Beck O; Franck J. Sustained release methylphenidate for the treatment of ADHD in amphetamine abusers: A pilot study. Drug and Alcohol Dependence 108(1-2): 130-133, 2010. (23 refs.)

The efficacy of stimulant treatment in patients with substance use disorders and comorbid attention deficit hyperactivity disorder (ADHD) has been tested for cocaine and alcohol dependence but so far no studies have been conducted in amphetamine dependent individuals. The present trial was a pilot study aiming to test the feasibility of treating amphetamine dependent patients with comorbid ADHD with central stimulant medication. The study was a double-blind, placebo controlled trial with parallel groups design comparing the efficacy of a fixed dose (72 mg) of OROS methylphenidate (MPH) with placebo (PL) in reducing ADHD symptoms in currently abstinent adults with amphetamine dependence and ADHD. Twenty-four treatment seeking patients who met the DSM IV criteria for amphetamine dependence and ADHD were randomized to MPH/PL. The trial was conducted at an outpatient facility with twice weekly visits, measuring ADHD symptoms and drug use. Patients rated their ADHD symptoms on a weekly basis and provided supervised urine specimens for drug toxicology twice weekly. All patients participated in weekly sessions of a skills training programme. Both the groups significantly reduced their self-rated ADHD symptoms during the 12-week treatment but there was no difference between the two treatment arms. Drug use, both measured by urine toxicology and self-report did not differ between the groups. No difference was found between the two groups with regards to craving for amphetamine or in retention in treatment. Larger studies with higher doses combined with individual dosage and longer follow-up periods are warranted.

Levin FR; Mariani JJ; Secora A; Brooks D; Cheng WY; Bisaga A et al. Atomoxetine treatment for cocaine abuse and adult attention deficit/hyperactivity disorder (ADHD): A preliminary open trial. Journal of Dual Diagnosis 5(1): 41-56, 2009, 2009. (43 refs.)

The purpose of this 12-week open-label trial was to evaluate the potential utility of atomoxetine for the treatment of attention deficit/hyperactivity disorder (ADHD) in cocaine-dependent treatment seekers. The sample consisted of 20 participants who met DSM-IV-TR criteria for ADHD and cocaine dependence. Using several measures to assess ADHD, there was a significant reduction in ADHD symptoms. There was no significant decrease in cocaine use throughout the trial. Taken together, although cocaine-dependent individuals showed some reduction in ADHD symptoms while receiving atomoxetine, the high dropout rate and lack of impact on cocaine use may limit its utility in adults with ADHD who are currently abusing cocaine.

Lindblad F; Hjern A. ADHD after fetal exposure to maternal smoking. Nicotine & Tobacco Research 12(4): 408-415, 2010. (29 refs.)

Smoking during pregnancy has been reported to be associated with a twofold to fourfold increased risk of attention-deficit hyperactivity disorder (ADHD) in the offspring. Genetic and socioeconomic confounders may contribute to this association. The aim of this study was to investigate the association between fetal exposure to maternal smoking during pregnancy and ADHD, taking such potential confounders into consideration. A register study in a population of 982,856 children, 6-19 years of age, born at term, and residents in Sweden in 2006 was conducted. Logistic regression was used to calculate odds ratios (ORs) of maternal smoking habits during pregnancy on ADHD medication in the 927,007 study subjects where maternal smoking habits were available from the Medical Birth Register in the presence of socioeconomic and parental psychiatric morbidity confounders. To adjust the analysis also for genetic confounding, we used a within-mother between-pregnancy approach in offspring of 26,292 mothers with inconsistent smoking habits (smoking/non-smoking) between pregnancies. The OR for ADHD medication in offspring of mothers who smoked >= 10 cigarettes/day was 2.86 (2.66-3.07) in the entire study population after adjustment for sex and age, while this same exposure yielded an OR of only 1.26 (0.95-1.58) when two pregnancies of the same mother were analyzed in a within-subjects design. Smoking during pregnancy has a strong association with ADHD in the offspring in the general Swedish population, but this risk is primarily explained by genetic and socioeconomic confounding.

McRae-Clark AL; Carter RE; Killeen TK; Carpenter MJ; White KG; Brady KT. A placebo-controlled trial of atomoxetine in marijuana-dependent individuals with Attention Deficit Hyperactivity Disorder. American Journal on Addictions 19(6): 481-489, 2010, 2010. (48 refs.)

This study evaluated the effects of atomoxetine on the symptoms of attention deficit hyperactivity disorder (ADHD) and marijuana use in marijuana-dependent adults. In conjunction with motivational interviewing, participants received either atomoxetine (n = 19) or matching placebo (n = 19) for 12 weeks. Participants randomized to atomoxetine had greater improvement in ADHD on the Clinical Global Impression-Improvement scale than participants treated with placebo. No treatment group differences in self-rated ADHD symptoms, overall Wender-Reimherr Adult Attention Deficit Disorder Scale scores, or marijuana use outcomes were noted. These results suggest that atomoxetine may improve some ADHD symptoms but does not reduce marijuana use in this population.

Motlagh MG; Katsovich L; Thompson N; Lin HQ; Kim YS; Scahill L et al. Severe psychosocial stress and heavy cigarette smoking during pregnancy: An examination of the pre- and perinatal risk factors associated with ADHD and Tourette syndrome. European Child and Adolescent Psychiatry 19(10): 755-764, 2010, 2010. (62 refs.)

Attention-deficit/hyperactivity disorder (ADHD) is frequently diagnosed in children with Tourette syndrome (TS). The basis for this co-occurrence is uncertain. This study aimed to determine if specific pre- and perinatal risk factors, including heavy maternal smoking and severe psychosocial stress during pregnancy, were associated with one or both disorders, or neither. We compared maternal report data on pre- and perinatal risk factors on 222 children between the ages of 7 and 18 years including 45 individuals with TS alone, 52 individuals with ADHD alone, 60 individuals with condition of comorbid TS + ADHD, and 65 unaffected control children. Pre- and perinatal histories as well as psychiatric assessments were performed using standardized questionnaires and semi-structured interviews with the mothers and children. Logistic regression was used to determine the odds ratio for each variable of interest. Compared to the mothers of unaffected control children, the mothers of children with ADHD alone reported higher rates of heavy smoking (> 10 cigarettes per day) during pregnancy and higher levels of severe psychosocial stress during pregnancy (OR = 13.5, p < 0.01 and OR = 6.8, p < 0.002, respectively). The TS + ADHD and the TS alone patients also had higher rates heavy maternal smoking and high levels of psychosocial stress compared to the control children, but these differences failed to reach statistical significance (heavy smoking: OR = 8.5, p < 0.052, OR = 4.6, p < 0.19, respectively; severe psychosocial stress: OR = 3.1, p < 0.07, OR = 2.6, p < 0.11, respectively). Heavy maternal smoking and severe levels psychosocial stress during pregnancy were independently associated with a diagnosis of ADHD. TS patients also had higher rates of these risk factors, but the ORs failed to reach statistical significance. Efforts are needed to reduce the frequency of these risk factors in high-risk populations. Future studies, using genetically sensitive designs, are also needed to sort out the causal pathways.

Nomura Y; Marks DJ; Halperin JM. Prenatal exposure to maternal and paternal smoking on attention deficit hyperactivity disorders symptoms and diagnosis in offspring. Journal of Nervous and Mental Disease 198(9): 672-678, 2010, 2010. (52 refs.)

The study examined the effect of maternal and paternal smoking during pregnancy on the child's inattention and hyperactivity/impulsivity symptoms, and the risk for attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). Generalized estimating equations, incorporating data from multiple informants (parents and teachers), was used to evaluate levels of ADHD as a function of parental smoking. The risk for ADHD, ODD, and comorbid ADHD and ODD was evaluated using polytomous logistic regression. We found that maternal, but not paternal, smoking was significantly associated with elevated inattention, hyperactivity/impulsivity, and total ADHD symptoms in children. Children of smoking, relative to nonsmoking, mothers had a significant increased risk for comorbid ADHD and ODD and ADHD, but not ODD. Although father's smoking was not associated with an increased risk, as it strongly influenced mothers' smoking, intervention for both parents may be most effective in preventing the pathway to ADHD-related problems in the children.

Rabiner DL; Anastopoulos AD; Costello EJ; Hoyle RH; McCabe SE; Swartzwelder HS. Motives and perceived consequences of nonmedical ADHD medication use by college students are students treating themselves for attention problems? Journal of Attention Disorders 13(3): 259-270, 2009. (14 refs.)

Objective: This study examines why college students without a prescription take ADHD medication, what they perceive the consequences of this to be, and whether attention problems are associated with this behavior. Method: More than 3,400 undergraduates attending one public and one private university in the southeastern United States completed a Web-based survey. Results: Nonmedical ADHD medication use in the prior 6 months was reported by 5.4% of respondents and was positively associated with self-reported attention difficulties. Enhancing the ability to study was the most frequent motive reported; nonacademic motives were less common. Students perceived nonmedical use to be beneficial despite frequent reports of adverse reactions. Conclusion: Students without prescriptions use ADHD medication primarily to enhance academic performance and may do so to ameliorate attention problems that they experience as undermining their academic success. The academic, social, and biomedical consequences of illicit ADHD medication use among college students should be researched further.

Rabiner DL; Anastopoulos AD; Costello EJ; Hoyle RH; McCabe SE; Swartzwelder HS. The misuse and diversion of prescribed ADHD bedications by college students. Journal of Attention Disorders 13(2): 144-153, 2009. (14 refs.)

Objective: This study assesses the misuse and diversion of prescribed attention-deficit/hyperactivity disorder (ADHD) medications. Method: One hundred fifteen students, attending two universities, with prescriptions for ADHD medications completed a Web survey in spring 2007. Results: Eighty-nine of 115 students (69%) used their ADHD medications as prescribed, whereas 36 (31%) had misused during college by taking larger or more frequent doses than prescribed or by using someone else's medication. Nine students (8%) reported intranasal use during the previous 6 months, and 30 (26%) had diverted medications to peers. Misuse was associated with impulsivity and with other substance use. Enhancing the ability to study outside of class was students' primary motive for misuse, but nonacademic reasons were also reported. Students who misused ADHD medications generally felt that doing so was helpful. Conclusions: Although most students use their ADHD medication as prescribed, misuse and diversion is not uncommon. Because enhancing academic performance was the primary motive for misuse, the results raise questions about whether undergraduates with ADHD perceive their treatment as adequate and the extent to which physicians and students communicate about issues related to medication adjustments.

Sevak RJ; Stoops WW; Rush CR. Behavioral effects of d-amphetamine in humans: Influence of subclinical levels of inattention and hyperactivity. American Journal of Drug and Alcohol Abuse 36(4): 220-227, 2010. (33 refs.)

Objective: Several studies suggest a link between stimulant abuse and attention-deficit hyperactivity disorder (ADHD) symptoms (e. g., inattention and hyperactivity). To further assess the nature of this relationship, the present study examined the association between subclinical symptoms of inattention and hyperactivity and the behavioral effects of d-amphetamine. Methods: Participants were classified into a High-(n = 8) or Low-Score (n = 9) group based on their responses on a rating scale that assessed inattention and hyperactivity symptoms. Results: The participants did not differ across the High-Score and Low-Score groups in their ability to discriminate d-amphetamine. The participants in the High-Score group were significantly more sensitive to the positive participant-rated effects of d-amphetamine (e. g., Good Effects, Like Drug), but less sensitive to drug-induced increases in blood pressure and heart rate. Conclusion: The selective increase in positive subjective effects of d-amphetamine suggests that individuals with subclinical inattention and hyperactivity symptoms may have increased vulnerability to stimulant abuse.

Silva RR; Skimming JW; Muniz R. Cardiovascular safety of stimulant medications for pediatric attention-deficit hyperactivity disorder. Clinical Pediatrics 49(9): 840-851, 2010, 2010. (62 refs.)

Attention-deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder that is often treated with stimulants such as methylphenidate and mixed amphetamine salts. Despite their efficacy and long history of use, there is concern about their potential for adverse cardiovascular effects in children and adolescents. Data from placebo-controlled and open-label extension trials published after 2000 were reviewed, and cardiovascular adverse event data were compared. Both placebo-controlled and open-label extension trials have repeatedly shown stimulant-induced increases in mean blood pressure, heart rate, and QT interval in children, adolescents, and adults. Although these increases seem relatively minor, their existence raises questions regarding whether stimulants could influence the likelihood of sudden death or other serious cardiovascular consequences, especially in patients with underlying heart problems. Moreover, questions have been raised regarding the necessity of screening patients for occult or unrecognized heart problems that are felt to be adversely affected by stimulant use. Obtaining a baseline electrocardiogram for any patient starting stimulant treatment is reasonable if access to such screening is readily available and not too costly.

Sollman MJ; Ranseen JD; Berry DTR. Detection of feigned ADHD in college students. Psychological Assessment 22(2): 325-335, 2010. (56 refs.)

Significant motivations and incentives exist for young-adult students to seek a diagnosis of attention-deficit/hyperactivity disorder (ADHD). With ADHD information readily accessible on the Internet, today's students are likely to be symptom educated prior to evaluation. This may result in false-positive diagnoses. particularly when students are motivated to convey symptoms. We evaluated the utility of ADHD symptom checklists, neurocognitive tests, and measures initially developed to detect feigned neurocognitive or psychiatric dysfunction (symptom validity tests [SVTs]). The performance of 31 undergraduates financially motivated and coached about ADHD via Internet-derived information was compared to that of 29 ADHD undergraduates following medication washout and 14 students not endorsing symptomatology. Results indicated malingerers readily produced ADHD-consistent profiles. Symptom checklists, including the ADHD Rating Scale and Conners's Adult ADHD Rating Scale-Self-Rating Form: Long, were particularly susceptible to faking. Conners's Continuous Performance Test-II findings appeared more related to motivation than condition. Promising results were seen with all cognitive SVTs (Test of Memory Malingering [TOMM]. Digit Memory Test, Letter Memory Test. and Nonverbal Medical Symptom Validity Test). particularly TOMM Trial 1 when scored using Trial 2 criteria. All SVTs demonstrated very high specificity for the ADHD condition and moderate sensitivity to faking, which translated into high positive predictive values at rising base rates of feigning. Combining 2 or more failures resulted in only modest declines in sensitivity but robust specificity. Results point to the need for a thorough evaluation of history, cognitive and emotional functioning, and the consideration of exaggerated symptomatology in the diagnosis of ADHD.

Walker LR; Abraham AA; Tercyak KP. Adolescent caffeine use, ADHD, and cigarette smoking. Children's Health Care 39(1): 73-90, 2010. (59 refs.)

The purpose of this study was to describe the prevalence of adolescent caffeine use and its association with attention deficit hyperactivity disorder (ADHD) and cigarette smoking. A total of 448 adolescents between the ages of 13 and 21 years consecutively presenting for routine, well-child care were studied. Twenty-four percent had a pre-existing diagnosis of ADHD, and 47% reported a positive lifetime history of cigarette smoking. Eighty-five percent of participants reportedly consumed a caffeinated beverage within the past 30 days; 38% had consumed 1+ cups of caffeinated coffee, and 78% had consumed 1+ glasses of another caffeinated beverage other than coffee (e.g., tea or soft drinks). After controlling for sociodemographic and other potential confounding factors, an ADHD diagnosis and a positive lifetime smoking history were significantly associated with caffeine use: Adolescents with ADHD were nearly twice as likely to use more caffeine than were adolescents without ADHD (odds ratio [OR] = 2.08; 95% confidence interval [CI] = 1.23, 3.50, p = .006); lifetime smokers were 80% more likely to use more caffeine than were adolescents who had never smoked (OR = 1.80; 95% CI = 1.16, 2.79, p = .009). Caffeine use is elevated among adolescents diagnosed with ADHD and those who have ever tried cigarette smoking. Although caffeine is a non-illicit psychostimulant, these findings add to the emerging data on substance use behaviors among adolescents with ADHD. Health care professionals who work with adolescents with ADHD should regularly screen for both cigarette and caffeine use among their patients.

Weafer J; Milich R; Fillmore MT. Behavioral components of impulsivity predict alcohol consumption in adults with ADHD and healthy controls. Drug and Alcohol Dependence 113(2-3): 139-146, 2011. (72 refs.)

Background: The degree to which distinct behavioral components of impulsivity predict alcohol consumption is as yet not well-understood. Further, the possibility that this relation might be more pronounced in groups characterized by heightened impulsivity (i.e., individuals with ADHD) has not been tested. Methods: The current study examined the degree to which three specific behavioral components of impulsivity (i.e., poor response inhibition, poor attentional inhibition, and increased risk-taking) were associated with quantity and frequency of alcohol consumption in a group of young adult social drinkers with ADHD (n = 33) and in a comparison control group (n = 21). Participants performed the delayed ocular return task (attentional inhibition), the cued go/no-go task (behavioral inhibition), and the balloon analogue risk task (risk-taking). Results: Both poor behavioral inhibition and greater risk-taking were related to greater quantity of consumption in the entire sample, whereas poor attentional inhibition was related to greater quantity specifically among those with ADHD. By contrast, only risk-taking was associated with frequency of consumption, and this was found specifically in the control group. Conclusions: These findings provide important information regarding the potential role of distinct behavioral components of impulsivity in drinking behavior, and highlight unique relevance of attentional impairments to drinking behavior in those with ADHD.

Weyandt LL; Janusis G; Wilson KG; Verdi G; Paquin G; Lopes J et al. Nonmedical prescription stimulant use among a sample of college students relationship with psychological variables. Journal of Attention Disorders 13(3): 284-296, 2009. (41 refs.)

Objective: To further investigate use and potential misuse of prescription stimulants (e.g., Ritalin, Adderall, Concerta) among a sample of college students and to explore the relationship between psychological variables and nonmedical stimulant use. Method: The sample consisted of 390 college students (71.6% female, 28.4% male). Participants were asked to complete five questionnaires concerning demographic information, prescription stimulant use, internal restlessness, sensation seeking, and psychological distress. Results: The study findings revealed that, regarding nonprescribed stimulants, 7.5% reported use within the past 30 days; 60% reported knowing students who misused stimulants; and 50% agreed or strongly agreed that prescription stimulants were "easy to get on this campus." Findings: further revealed a relationship between stimulant use and degree of psychological distress and internal restlessness. Conclusions: Continued research regarding psychological variables, specific group membership (e.g., fraternity, sorority, athletics), and stimulant acquisition is suggested. Effective prevention and education efforts are needed to help address the nonmedical use of prescription stimulants on college campuses.

Winhusen TM; Somoza EC; Brigham GS; Liu DS; Green CA; Covey LS et al. Impact of attention-deficit/hyperactivity disorder (ADHD) treatment on smoking cessation intervention in ADHD smokers: A randomized, double-blind, placebo-controlled trial. Journal of Clinical Psychiatry 71(12): 1680-1688, 2010. (44 refs.)

Objective: High smoking rates in adults with attention-deficit/hyperactivity disorder (ADHD) and nicotine's amelioration of ADHD suggest that effective ADHD treatment might facilitate abstinence in smokers with ADHD. The present study evaluated if using osmotic-release oral system methylphenidate (OROS-MPH) to treat ADHD enhances response to smoking cessation treatment in smokers with ADHD. Method: A randomized, double-blind, placebo-controlled, 11-week trial with a 1-month follow-up was conducted at 6 clinical sites between December 2005 and January 2008. Adults (aged 18-55 years) meeting DSM-IV criteria for ADHD and interested in quitting smoking were randomly assigned to OROS-MPH titrated to 72 mg/d (n = 127) or placebo (n = 128). All participants received brief weekly individual smoking cessation counseling for 11 weeks and 21 mg/d nicotine patches starting on the smoking quit day (day 27) through study week 11. Outcome measures included prolonged smoking abstinence and DSM-IV ADHD Rating Scale (ADHD-RS) score. Results: Of 255 randomly assigned participants, 204 (80%) completed the trial. Prolonged abstinence rates, 43.3% and 42.2%, for the OROS-MPH and placebo groups, respectively, did not differ significantly (OR = 1.1; 95% Cl, 0.63-1.79; P = .81). Relative to placebo, OROS-MPH evidenced a greater reduction in DSM-IV ADHD-RS score (P < .0001) and in cigarettes per day during the post-quit phase (P = .016). Relative to placebo, OROS-MPH increased blood pressure and heart rate to a statistically, but not clinically, significant degree (P < .05); medication discontinuation did not differ significantly between treatments. Conclusions: Treatment for ADHD did not improve smoking cessation success; OROS-MPH, relative to placebo, effectively treated ADHD and was safe and generally well tolerated in this healthy sample of adult ADHD smokers.

Xu XH; Cook RL; Ilacqua VA; Kan HD; Talbott EO. Racial differences in the effects of postnatal environmental tobacco smoke on neurodevelopment. Pediatrics 126(4): 705-711, 2010, 2010. (38 refs.)

OBJECTIVES: We used the 2001-2004 National Health and Nutrition Examination Survey to examine the association between postnatal environmental tobacco smoke exposure, measured as serum cotinine levels, and attention-deficit/hyperactivity disorder (ADHD) among children 4 to 15 years of age. We further investigated the interactions of race and serum cotinine levels with ADHD. METHODS: Logistic regression models were used to evaluate associations. RESULTS: This study found that the prevalence of ADHD increased as blood cotinine levels increased. The effects of blood cotinine levels on ADHD differed according to race. Compared with children of the same racial group with the lowest blood cotinine levels, the odds ratios were 2.72 (95% confidence interval: 1.25-5.93) for Mexican American children and 5.32 (95% confidence interval: 1.55-18.3) for children in other racial groups with the highest blood cotinine levels, with controlling for the effect of maternal smoking during pregnancy. However, no significant associations between blood cotinine levels and ADHD were observed among non-Hispanic white or non-Hispanic black children. CONCLUSIONS: The findings of this study underscore the possibility of racial disparities in the effects of environmental tobacco smoke on behavioral problems in children. These findings warrant further investigation.