Initial moderator analyses in the Multimodal Treatment Study of Children with ADHD (MTA) suggested that child anxiety ascertained by parent report on the Diagnostic Interview Schedule for Children 2.3 (DISC Anxiety) differentially moderated the outcome of treatment. Left unanswered were questions regarding the nature of DISC Anxiety, the impact of comorbid conduct problems on the moderating effect of DISC Anxiety, and the clinical significance of DISC Anxiety as a moderator of treatment outcome. Thirty-three percent of MTA subjects met DSM-III-R criteria for an anxiety disorder excluding simple phobias. Of these, two-thirds also met DSM-III-R criteria for comorbid oppositional-defiant or conduct disorder whereas one-third did not, yielding an odds ratio of approximately two for DISC Anxiety, given conduct problems. In this context, exploratory analyses of baseline data suggest that DISC Anxiety may reflect parental attributions regarding child negative affectivity and associated behavior problems (unlike fearfulness), particularly in the area of social interactions, another core component of anxiety that is more typically associated with phobic symptoms. Analyses using hierarchical linear modeling (HLM) indicate that the moderating effect of DISC Anxiety continues to favor the inclusion of psychosocial treatment for anxious ADHD children irrespective of the presence or absence of comorbid conduct problems. This effect, which is clinically meaningful, is confined primarily to parent-reported outcomes involving disruptive behavior, internalizing symptoms, and inattention; and is generally stronger for combined than unimodal treatment. Contravening earlier studies, no adverse effect of anxiety on medication response for core ADHD or other outcomes in anxious or nonanxious ADHD children was demonstrated. When treating ADHD, it is important to search for comorbid anxiety and negative affectivity and to adjust treatment strategies accordingly.
Over the past decade, the MTA has provided a bewildering wealth of data (70 peer-reviewed articles) addressing treatment-related questions for children with attention-deficit/hyperactivity disorder (ADHD); however, the take-home messages for clinicians may not always be clear. Therefore, this article reviews key findings, including relative benefits of medication and behavioral treatments, long-term effects at two and three years, treatment mediators and moderators, preliminary delinquency and substance use outcomes, and growth suppression related to stimulant use. Appropriate interpretations of the findings and their limitations are discussed and recommendations for clinical practice are derived.
The genetic study of ADHD has made considerable progress. Further developments in the field will be reliant in part on identifying the most appropriate phenotypes for genetic analysis. The use of both categorical and dimensional measures of symptoms related to ADHD has been productive. The use of multiple reporters is a valuable feature of the characterization of psychopathology in children. It is argued that the use of aggregated measures to characterize the ADHD phenotype, particularly to establish its pervasiveness, is desirable. The recognition of the multiple comorbidities of ADHD can help to isolate more specific genetic influences. In relation to both reading disability and conduct disorder there is evidence that genes may be involved in the comorbid condition that are different from pure ADHD. To date, progress with the investigation of endophenotypes for ADHD has been disappointing. It is suggested that extending such studies beyond cognitive underpinnings to include physiological and metabolic markers might facilitate progress.
Schematic of the SNAP25 gene. The exons are shown in green and red arrows indicate the location of the polymorphisms used in a study of the association of this gene with attention deficit hyperactivity disorder. There is a finding that the dimensions of hyperactivity/impulsivity and inattention were associated with SNAP25. For more information, see the paper by Feng et al on pages 998-1005.
Researchers report mental health disparities that indicate that children and families with the highest need for services often are less likely to use them. Only a few investigators have focused on service delivery models to address underuse of services. This study examines the Children's Hospital of Orange County (CHOC)/University of California, Irvine (UC Irvine) Initiative for the Development of Attention and Readiness (CUIDAR) model of service delivery in reducing disparities in access to and use of services and in decreasing child behavior problems in a community-based study with 169 self-referred, low-income, and predominantly minority families. The findings indicate that among minority families, CUIDAR is both more accessible and more equitably used than local, publicly funded mental health services. Among Latinos, attendance rates are higher when services are provided in Spanish. Parents report significant improvements in overall child difficulty and conduct problems. In addition, parents report high levels of satisfaction with the program.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.