Journal of Attention Disorders Current Literature in ADHD
Abikoff, H., McGough, J., Vitiello, B., McCracken, J.,
less access to print media than their nonreferred peers.
Davies, M., Walkup, J., et al. (2005). Sequential
Nonreferred children whose homes had the same type of
pharmacotherapy for children with comorbid atten-
media environment as children with ADHD watched as
tion deficit/hyperactivity and anxiety disorders.
much television as these children. The authors discussed a
Journal of the American Academy of Child and
number of possible hypotheses to explain these differences,
Adolescent Psychiatry, 44, 418-427.
note that thus far there has yet to be a well-controlledstudy examining whether television viewing causes ADHD,
A recent pilot study examined sequential treatment
and also suggest the popular understanding “of the relation
with methylphenidate with the later addition of
between television and ADHD has been unduly influenced
Fluvoxamine, an SSRI antidepressant. Children with
by simplistic explanations of available data” (p. 10).
ADHD and anxiety were first titrated to an effective doseof methylphenidate. Those who responded favorablywere then treated with Fluvoxamine. A total of 81% ofparticipants responded to the methylphenidate, suggest-
Barkley, R. A., & Fischer, M. (2005). Suicidality in
ing that children with this combined comorbidity do in
children with ADHD, grown-up. ADHD Report,
fact respond to ADHD treatments. The benefits of adding
Fluvoxamine were less clear than in prior studies as theresponse rate to the Fluvoxamine placebo was higher
The potential association of suicidality with medica-
than expected. Fluvoxamine treatment in this study did
tions used to treat ADHD necessitates investigation of
not cause exacerbation of anxiety or physical symptoms.
this question. These authors used data from their longi-
These results suggest that stimulants are as effective and
tudinal study of 158 hyperactive and 81 control children
safe in children with ADHD and comorbid anxiety as in
followed for more than 13 years. Twelve questions deal-
ing with the topic of suicidality were asked of this sam-ple. Six of the questions dealt with these issues duringhigh school, and the same six were repeated again forfunctioning since leaving high school. The authors report
Acevedo-Polakovich, I. D., Lourch, E. P., & Milich, R.
that children growing up with hyperactivity/ADHD were
(2005). TV or not TV: Questions and answers regard-
significantly more likely to consider, attempt, and be
ing television and ADHD. ADHD Report, 13(6), 6-11.
hospitalized for suicidality during high school and weremore likely to consider suicide after high school than
Although television habits are often ascribed as cause
children in the control group. When risk factors were
for and consequence of ADHD, most studies used to
examined individually, lifetime major depressive disor-
support these positions were conducted on samples of
der, conduct disorder in adolescence, severity of ADHD
children without the disorder. These authors set out to
during the teenage years, and adult follow-up and being
address this question specifically in a population of
treated with stimulant medication in high school for
children with ADHD. The authors conclude that their
ADHD increased the likelihood of suicidal ideation and
research suggests that children with ADHD watch more
attempts in high school. However, when these variables
television than their nonreferred peers but that a child’s
were examined jointly controlling for the others, the risk
home media environment may be a strong factor driving
of suicidal ideation in the hyperactive group, both during
these differences. According to parent reports, children
high school and after high school, was significantly
with ADHD had greater access to electronic media and
predicted only by presence of lifetime major depressive
disorder. Nonetheless, the authors also noted that stimu-
The authors conclude that by their young adult years,
lant treatment remained marginally associated with sui-
youth with ADHD were at high risk for a wide range of
cidal ideation, even after controlling for the substantial
adverse psychiatric outcomes, including marketing ele-
contribution of major depressive disorder and the mar-
vated risks of antisocial, addictive, mood, and anxiety
ginally significant association with severity of teenage
disorders. The authors suggest that their findings provide
ADHD. The authors suggested these findings warrant
further evidence for the high morbidity associated with
further examination in larger studies.
Bauermeister, J. J. (2005). Comparison of the DSM-IV
Carpenter, E. M., Frankel, F., Marina, M., Duan, N.,
combined and inattentive types of ADHD in a
& Smalley, S. L. (2004). Internet treatment delivery
school-based sample of Latino/Hispanic children.
of parent-adolescent conflict training for families
Journal of Child Psychology and Psychiatry, 46,
with an ADHD teen: A feasibility study. FamilyBehavior Therapy, 2026, 1-20.
This study examined the validity and distinctiveness
These authors examined the feasibility of Internet
of ADHD subtypes within school-based sample of
delivery of a parent-adolescent conflict training program
Latino/Hispanic children, ages 6 to 11, identified by
for families with a teenager suffering from ADHD. The
classroom teachers and subsequently undergoing a com-
authors attempted to ascertain the willingness of families
prehensive diagnostic assessment. When comparing the
to participate in a Web-based study, identify relevant
subtypes with each other, the inattentive subtype was
issues related to confidentiality of Internet data collec-
associated with later onset of inattentive symptoms and
tion, and determine participant satisfaction with this
higher rates of sluggish cognitive tempo. This group was
treatment protocol. Six families participated and four
also less assertive socially and had fewer externalizing
were compliant with participation requirements. A series
symptoms than the combined type group. Both the inat-
of single subject linear aggressions revealed that all but
tentive and combined type groups exhibited lower acad-
one participant maintained a steady log-in rate over time.
emic achievement and more ADHD type behaviors
Treatment compliant results, according to these authors,
during tasks than their non-ADHD counterparts. They
were rated as “promising.” Participants provided high
also exhibited more internalizing symptoms. Parents of
ratings of the security of the Web site and satisfaction
inattentive subtype children reported less parenting
scale scores were also above neutral.
stress. These children also exhibited lower levels ofadaptive functioning.
Dickstein, D. P., Garvey, M., Pradella, A. G.,Greenstein, D. K., Sharp, W. S., Castellanos, F. X.,
Biederman, J., Monuteaux, M. C., Mick, E.,
et al. (2005). Neurologic examination of abnormal-
Spencer, T., Wilens, T. E., Silva, J. M., et al. (2006).
ities in children with Bipolar Disorder or ADHD.
Young adult outcome of ADHD: A controlled ten-
Biological Psychiatry, 58, 517-524.
year follow-up study. Psychological Medicine, 36,167-179.
ADHD and bipolar disorder in children were evalu-
ated through an examination of neurologic abnormalities
A case controlled, 10-year prospective study of 140
in this study. The authors performed the Revised
youth without ADHD and 120 with ADHD between the
Physical and Neurological Exam for Soft Signs in groups
ages of 6 and 18 was ascertained from psychiatric and
of children with ADHD, bipolar disorder, and controls.
pediatric sources. At the 10-year follow-up, 112 (80%)
Then, a blind rater evaluated motor performance. Results
and 105 (88%) of the ADHD and controls, respectively,
were analyzed using multiple analyses of covariance.
were reassessed (mean age = 22 years). The lifetime
Participants with ADHD were impaired on repetitive
prevalence for disorders including mood, anxiety, antiso-
task reaction time. In contrast, pediatric bipolar partici-
cial, developmental, and substance were significantly
pants, both with and without comorbid ADHD, were
greater in ADHD young adults compared to controls.
impaired on sequential task reaction time. The authors
conclude that this differential pattern of soft signs by
students’ on-task and spelling study behaviors. Although
diagnosis suggested pathophysiologic differences
improvement in on-task behavior was comparable across
between ADHD and bipolar disorder in children. They
the two interventions, self-monitoring of attention had pro-
hypothesize that repetitive motor performance requires
duced substantially higher gains in spelling study behavior
inhibition of nonrelevant movements. As such, ADHD
among four of the six students. This is the first study in
participants’ impairment in this domain supports the
which differential effects of these two interventions have
hypothesis that ADHD involves a core deficit of fronto-
been investigated among students with ADHD.
striatal-basal ganglia neurocircuitry. In contrast, partici-pants with bipolar disorder caused by their impairmentin sequential and motor performance appeared to reflectimpaired attentional set shifting and reversal learning
Huang-Pollock, C. L., Nigg, J. T., & Carr, T. H.
suggesting a different pathophysiology.
(2005). Deficient attention is hard to find: Applyingthe perceptual load model of selective attention toADHD subtypes. Journal of Child Psychology andPsychiatry, 46, 1211-1218.
Faraone, S. V., Biederman, J., & Mick, E. (2006). The age dependent decline of ADHD: A meta-
These authors sought to determine whether selective
analysis of follow-up studies. Psychological
attention is a primary deficit in childhood ADHD. A per-
Medicine, 36, 159-165.
ceptual load paradigm was used to examine both earlyand late selective attention problems in children with
Through a meta-analysis, these authors analyzed data
inattentive and combined subtypes of ADHD. No evi-
from published follow-up studies of ADHD. A regres-
dence emerged for selective attention deficits in either
sion model was used to separately assess the syndro-
of the subtypes. However, sluggish cognitive tempo was
matic and symptomatic persistence of ADHD. When
associated with abnormal early selection. The authors
only those meeting full criteria for ADHD were defined
concluded that at least some and possibly most children
as having “persistent ADHD,” the rate of persistence was
with DSM-IV–diagnosed ADHD have normal selective
low, approximately 15% at 25 years of age. But when
attention. They suggested their results supported a move
cases were consistent with DSM-IV’s current definition
away from theories of attention dysfunction as primary
of ADHD in partial remission, the rate of persistence was
in combined type ADHD. They also note that children
much higher, approximately 65%. The authors conclude
with ADHD who demonstrate sluggish cognitive tempo
their results demonstrate that estimates of ADHD’s per-
warrant further study for possible early selective atten-
sistence rely heavily on definition. Regardless of definition,
however, evidence for ADHD lessens with age accordingto these data.
Evans, S. W., Allen, J., Moore, S., & Strauss, E. (2005). Measuring symptoms in functioning of
Harris, K. R., Friedlander, D. B., Sadler, B.,
youth with ADHD in middle schools. Journal of
Frizzelle, R., & Graham, S. (2005). Self-monitoring
Abnormal Child Psychology, 33, 695-706.
of attention versus self-monitoring of academic per-formance: Effects among students with ADHD in
This study examined the interrater agreement of
the general education classroom. Journal of Special
teacher ratings and the relationship between ratings and
Education, 39, 145-156.
observation data for ADHD symptoms in a middleschool setting. Teacher ratings and observational data
In a counterbalanced, multiple baseline across-
were collected regularly during the course of 2 academic
subjects design, attention and performance monitoring
years for middle school students diagnosed with ADHD.
were evaluated to determine potential differential effects
Findings indicated low rates of interrater agreement as
on the on-task and spelling study behavior of six ele-
well as low rates of agreement between teachers and
mentary students with ADHD in a general education
observational data and between observational data col-
classroom. Low self-monitoring of attention and self-
lected in different classrooms. The interrater agreement
monitoring of performance had positive effects on
was lowest in late fall and gradually increased during the
second half of the year. The authors discuss implications
between the ages of 7 and 10 were examined. Two
for conducting treatment outcome evaluations of school-
assessment measures were used, including the coding of
based treatment programs and diagnostic evaluations.
causal attributions as mothers watch their children’s
As it relates to ADHD, these data reinforce the need to
behavior. Mothers of boys with ADHD plus ODD rated
collect behavioral samples across multiple classes and
the causes of oppositional and inattentive-impulsive
child behaviors as more stable and global than didmothers of nonproblem boys in identifying causes oftheir children’s failure on laboratory tasks. Mothers ofboys with ADHD plus ODD provided more child nega-
Grizenko, N., Kobacina, B., Amoral, B., Schwartz, G.,
tive attributional causes than did mothers of eitherADHD only or nonproblem boys. The authors discuss
Ter-Stepanian, M., & Joober, R. (2006). Relationship
implications for assessing and understanding attributions
between response to methylphenidate treatment in
in families of children with ADHD and ODD.
children with ADHD and psychopathology in theirfamilies. Journal of the American Academy of Childand Adolescent Psychiatry, 45, 47-53.
Familial aggregation of psychopatholgy in children
Moore, C. M., Biederman, J., Wozniak, J., Mick, E.,
with ADHD who are good responders to methylphenidate
Aleardi, M., Wardrop, M., et al. (2006). Differences
was compared to those who were poor responders. A
in brain chemistry in children and adolescents with
total of 118 clinically referred children 6 to 12 years of
ADHD with and without comorbid bipolar disorder:
age participated in a double-blind, placebo-controlled,
A proton magnetic resonance spectroscope study.
randomized, 2-week crossover trial of methylphenidate
American Journal of Psychiatry, 163, 316-318.
from 1999 to 2004. Information was collected on 342first-degree and 1,151 second-degree relatives of
The brain chemistry in the anterior cingulate cortex
children with ADHD. Forty-four participants showed
of children and adolescents with ADHD alone, children
mild or no improvement, and 74 showed moderate or
with ADHD plus bipolar disorder, and children with no
very much improvement on methylphenidate over
Axis I DSM-IV condition were evaluated using proton
placebo. First-degree relatives of good responders were
spectra analysis. Children with ADHD had a significantly
at significantly higher risk of ADHD than the relatives
higher ratio of glutamine to myo-inositol-containing
of poor responders. Second-degree relatives of good
compounds than children with ADHD plus bipolar dis-
responders were at significantly higher risk of antisocial
order and unaffected children. The authors suggest that
personality disorder compared to the relatives of poor
an understanding of these brain chemistry differences
responders. The authors conclude that the significantly
may provide information about the action of antimanic
higher presence of ADHD in the first-degree relatives
treatments such as lithium. They also suggest that these
and of antisocial personality in the second-degree rela-
chemical differences may also reflect changes in sero-
tives of good Ritalin responders suggest that this group
may at least partially be distinct from the poor respondergroup on the basis of genetic determinants.
Pelham, W. E., Manos, M., Ezzell, C., Tresco, K. E.,Gnagy, E., Hoffman, N., et al. (2005). A dose-rang-
Johnston, C., Chen, M., & Ohan, J. (2006). Mothers’
ing study of methylphenidate transdermal system in
attribution for behavior in non-problem boys, boys
children with ADHD. Journal of the American
with ADHD and boys with ADHD and oppositional
Academy of Child and Adolescent Psychiatry, 44,
defiant disorder. Journal of Clinical Child andAdolescent Psychology, 35, 60-71.
This recent study continued a series of studies being
Attributions for child behavior among mothers of 38
conducted as part of a Food and Drug Administration appli-
nonproblem boys, 26 boys with ADHD, and 25 boys
cation for methylphenidate patch. This study evaluated
with ADHD and oppositional defiant disorder (ODD)
the efficacy of a range of doses on a variety of outcome
measures for children attending a summer treatment pro-
(2005). Behavior differences in drivers with ADHD:
gram. Thirty-seven children ages 6 to 13 in this program
The driving behavior questionnaire. Accident Analysis
were administered three doses of methylphenidate via
and Prevention, 37, 996-1004.
the patch. The patch was applied either 6 through 120min before the start of the program each day, and each
ADHD has been linked to an increased number of dri-
condition was compared to placebo. The magnitude of
ving citations, particularly for speeding and a fourfold
dose was related to the number of points children earned
increase in accident risk. Using three factors—errors,
on their daily report cards and in the classroom and
lapses, and violations—these authors used regression
through observational ratings of behavior in the class-
analysis to explore the impact of ADHD status, gender,
room. More negative behavior was observed when the
and age. Results indicated that ADHD status is positively
patch was applied 120 min before the program regardless
and significantly related to driving errors, lapses, and vio-
of whether it was medication or placebo. These studies
lation scores. Older participants with ADHD did not differ
are consistent with other stimulant studies suggesting
statistically from controls relative to errors and violations.
that increased dosages yields increased effectiveness.
There were no significant effects of age on error, lapse, or
However, small doses of stimulants produced effects that
violation scores for control participants. Consistent with
were fairly comparable to larger ones.
other research, gender was significantly related to viola-tion scores but not to errors or lapses such that the maleswere more likely than females to report higher violationscores controlling for ADHD status and age.
Reich, W., Neuman, R., Volk, H. E., Joiner, C. A., &Todd, R. (2005). Comorbidity between ADHD andsymptoms of bipolar disorder in a community sam-ple of children and adolescents. Twin Research and
Saudino, K. J., Ronald, A., & Plomin, R. (2005). Human Genetics, 8, 459-466.
The etiology of behavior problems in 7-year-oldtwins. Substantial genetic influence and negligible
The prevalence and frequency of comorbidity of bipolar
shared environmental influence for parent
disorder was examined with ADHD in a nonreferred pop-
ratings and ratings by same and different teachers.
ulation of twins. Children and adolescents ages 7 to 18
Journal of Abnormal Child Psychology, 33, 113-131.
with a history of manic symptoms were identified from apopulation-based twin sample obtained from state birth
This study examined the relative contributions to teacher
records. The sample was enriched for ADHD, however
ratings made by genetic influences in twins rated by same
there was also a random control sample that allowed the
and different teachers. Parents and teachers rated nearly
authors to examine population prevalence of the
4,000 7-year-old identical and fraternal twin pairs on the
disorder. Juveniles with threshold or below threshold
Strengths and Differences Questionnaire. Individual differ-
manic episodes were further assessed for comorbidity. The
ences as measured by all three raters in hyperactivity, peer
authors found the population prevalence of broadly defined
problems, conduct problems, emotional symptoms, total
mania in the random sample was 0.2%. The possible manic
behavior problems, and prosocial behavior were found to be
episode showed significant comorbidity with population-
substantially heritable. Shared environmental influences
defined severe combined and inattentive ADHD subtypes.
were often small, with the influence of nonshared environ-
The authors concluded that there is a significant associa-
ments making more substantial contributions. Parents
tion of bipolar symptoms with two population-defined sub-
tended to contrast their children with each other when
types of ADHD. Episodes of possible bipolar disorder as
making hyperactivity ratings, leading to greater differences
defined by DSM-IV were uncommon in the nonreferred
between nonidentical siblings than predicted by genetic
sample. Finally, the authors conclude that children and
influences, while teachers displayed no such contrast
adolescents with ADHD appear to be only modestly at
effects. The authors conclude that although parents have a
increased risk for bipolar disorder.
more intimate knowledge of their child as an individual,they also have a narrower context to make judgments aboutbehavior, whereas teachers have greater expertise withchildren and observe them in a structured context. Ratings
Reimer, B., D’ambrosio, L. A., Gilbert, J.,
from both sources, however, did in fact yield consistent
Coughlin, J. F., Biederman, J., Surman, C., et al.
results regarding the causes of behavior problems.
Snyder, J., Prichard, J., Schrepferman, L., Patrick,
selecting atomoxetine therapy for children with
M. R., & Stoolmiller, N. (2004). Child impulsiveness-
ADHD. Pharmacotherapy, 25, 1541-1549.
inattention, early peer experiences and the develop-ment of early onset conduct problems. Journal of
In this survey of more than 40,000 patients, atomoxe-
Abnormal Child Psychology, 32, 579-594.
tine therapy was found to systematically be preferred forpatients with psychiatric comorbidities. In the time frame
This longitudinal study examined the relationship of
between April and December 2003, individuals were 1.5
the development of conduct problems from both trait and
times more likely to begin medication therapy with atom-
experiential perspectives. Two hundred and sixty-seven
oxetine than stimulants. It is interesting that frequent use
males and females were assessed at kindergarten entry
of behavioral health care services led to predisposal to
and again at three time points, ending at the conclusion
start treatment with atomoxetine relative to a stimulant but
of second grade. Assessment of inattentive/impulsive
not for individuals with obesity. Alcohol dependence but
traits were based on parent and teacher report as well as
not drug dependence or drug abuse was predictive of the
classroom observations and measures of working mem-
selection of atomoxetine over a short-acting stimulant.
ory. Peer measures included playground observationsand sociometric ratings. Using linear growth models,conduct problems at entry and progression during a 2-yearperiod were significantly predicted by trait/symptom
Whalen, C., Henker, B., Ishikawa, S. S., Jamner, L.
assessments made by parents and teachers. For boys,
D., Floro, J. N., Johnston, J. A., et al. (2006). An
peer rejection and negative interactions mediated initial
electronic diary study of contextual triggers and
levels and growth of conduct problems for parent ratings.
ADHD: Get ready, get set, get mad. Journal of the
For teacher ratings, the mediation relationship was
American Academy of Child and Adolescent
significant only for growth. Outcome for girls was more
Psychiatry, 45, 166-174.
complex, with social factors alone mediating symptoms/trait impact for conduct problems. Overall, peer prob-
Across 7 days, mothers and 25 children with ADHD
lems continued to have strong additive effects on the
taking stimulant medication, and mothers and 25 children
severity of conduct problems. The authors suggest that
without ADHD between the ages of 7 and 12 years were
trait-like problems could be used to identify children
provided electronic diary reports approximately every 30
who may require intervention, whereas social interac-
min between nonschool hours. The child and maternal
tions could be a target for such interventions.
perceptions of behaviors, moods, and interaction qualityduring prepatory and transitional activities were comparedwith those during other activities. Maternal reportsrevealed that child symptomatic behaviors and negative
Stevenson, J., Asherson, P., Hay, D., Levy, F.,
moods, maternal negative moods, and parent-child dis-
Swanson, J., Thapar, A., et al. (2005). Characterizing
agreement were elevated in the ADHD but not in the com-
the ADHD phenotype for genetic studies. Develop-
parison group while getting ready versus other activities. mental Science, 8, 115-121.
Children’s self-ratings also revealed situational effectsindicating that school-age children with ADHD can pro-
This article provides an excellent overview of advances
vide meaningful self-reports using carefully structured
in research on the association between ADHD symptoms
electronic diaries. Even when children with ADHD are
and genetics. The review focuses on methods to accurately
receiving stimulant pharmacotherapy, these data suggest
define ADHD symptoms predicted by genetic variation.
that preparatory tasks of daily living are especially chal-
The article reviews categorical and dimensional
lenging and disproportionately linked to child behavior
approaches, the need for multiple reporters of children’s
problems, parent negative affect, and contentious interac-
behavior, and most important, a system to sort out genetic
tions. These data provide support for the need for com-
causes of common comorbidities with ADHD.
bined medical and psychosocial treatments in ADHD.
Van Brunt, D. L., Johnston, J. A., Ye, W., Pohl, G. M.,
Wilens, T., Kratochvil, C., Newcorn, J., & Gao, H.
Sun, P. J., Sterling, K. L., et al. (2005). Predictors of
(2006). Do children and adolescents with ADHD
respond differently to atomoxetine? Journal of the
end point on a number of rating scales. There were no sta-
American Academy of Child and Adolescent
tistically significant differences in the overall effects on
Psychiatry, 45, 149-157.
ADHD symptoms, response rates, or time to responsebetween age groups. Children but not adolescents had a
These authors report data contrasting the efficacy and
higher rate of somnolence and headache relative to placebo.
tolerability of atomoxetine between children and adoles-
No other clinically meaningful treatment differences were
cents with ADHD. Efficacy measures included response
seen in adverse event rates, vital signs, weight, height, lab-
rate, times to response, and mean changes from baseline to
oratory values, or ECG between children and adolescents.
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use ----------------------------- ADVERSE REACTIONS -------------------------------------- GRALISE safely and effectively. See full prescribing information for The most common adverse reaction (greater than or equal to 5% and twice GRALISE. GRALISE® (gabapentin) tablets I
SARASOTA MEMORIAL HOSPITAL NURSING PROCEDURE DATE: 02/91 REVIEWED: 3/13 PAGES: 1 of 4 RESPONSIBILITY: PURPOSE: To provide information on the Medtronic SynchroMed Infusion DEFINITION: Medtronic SynchroMed infusion system – an implantable system designed to contain and to administer parenteral drugs intrathecally. The system consists of an implantable programmab