Objective To compare the clinical presentation of ADHD between youth with autism spectrum disorder (ASD) and ADHD and a sample of youth with ADHD only. Method A psychiatrically referred sample of autism spectrum disorder (ASD) youth with ADHD attending a specialized ambulatory program for ASD (n = 107) and a sample of youth with ADHD attending a general child psychiatry ambulatory clinic (n = 74) were compared. Results Seventy-six percent of youth with ASD met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for ADHD. The clinical presentation of ADHD in youth with ASD was predominantly similar to its typical presentation including age at onset (3.5 ± 1.7 vs. 4.0 ± 1.9; p = .12), distribution of diagnostic subtypes, the qualitative and quantitative symptom profile, and symptom severity. Combined subtype was the most frequent presentation of ADHD in ASD youth. Conclusion Despite the robust presentation of ADHD, a significant majority of ASD youth with ADHD failed to receive appropriate ADHD treatment (41% vs. 24%; p = .02). A high rate of comorbidity with ADHD was observed in psychiatrically referred youth with ASD, with a clinical presentation typical of the disorder.

Whereas the adverse impact of attention-deficit/hyperactivity disorder (ADHD) on emotional and psychosocial well-being has been well investigated, its impact on physical health has not. The main aim of this study was to assess the impact of ADHD on lifestyle behaviors and measures of adverse health risk indicators. Subjects were 100 untreated adults with ADHD and 100 adults without ADHD of similar age and sex. Unhealthy lifestyle indicators included assessments of bad health habits, frequency of visits to healthcare providers, and follow through with recommended prophylactic tests. Assessments of adverse health risk indicators included measurements of cardiovascular and metabolic parameters, weight, body mass index, and waist circumference. No differences were identified in health habits between subjects with and without ADHD, but robust differences were found in a wide range of adverse health risk indicators. ADHD is associated with an adverse impact in health risk indicators well known to be associated with high morbidity and mortality.

Objective The goal of this study is to describe the natural history of Dry Eye Disease (DED), which chronically affects millions of people in the US alone. Design This study includes cohorts from the Women's Health Study (WHS) and Physicians' Health Studies (PHS), and utilizes a combination of cross-sectional surveys and review of existing medical records. Participants 398 men from the PHS and 386 women from the WHS who reported they had DED and responded to a questionnaire about change in various aspects of the disease since initial diagnosis. Methods Three subscales were developed based on factor analysis of questionnaire responses: ocular surface symptoms, vision-related symptoms, and social impact. We examined correlates of patient-reported worsening on each subscale. We also obtained medical records from a subset of 261 study participants, and examined changes in clinical signs of DED over time. Main Outcome Measures Ocular surface symptoms, vision-related symptoms, and social impact plus presence/absence of various clinical signs in patients' medical charts. Results Participants reported an average duration of DED of 10.5 years (SD 9.5 years). Worsening was reported by 24% for ocular surface symptoms, 29% for vision-related symptoms, and 10% for social impact. Factors associated with worsening on at least 2 of 3 subscales included a previous report of severe DED symptoms (OR=2.17 for ocular surface symptoms; OR=2.35 for vision-related symptoms), spending >$20 a month on DED treatments (OR=1.80 for ocular surface symptoms; OR=1.99 for vision-related symptoms), history of blepharitis or meibomian gland dysfunction (MGD) (OR=1.57 for vision-related symptoms; OR=2.12 for social impact) and use of systemic beta-blockers (OR=1.62 for ocular surface symptoms; OR=1.84 for vision-related symptoms, and OR=1.86 for the social impact of DED). Presence of corneal staining based on review of medical records was associated with use of level 2 or higher DED treatments (OR=1.54, CI=1.01-2.36), a previous report of severe DED symptoms (OR=1.79, CI=1.07-3.00), having a tear break-up test performed (OR=2.73, CI=1.72-4.36), and with having either blepharitis or MGD (OR=0.59, CI=0.35-0.98). Conclusions The present study suggests that a proportion of DED patients experience worsening of their DED over time, tending to present with more severe symptoms earlier in the disease. Forthcoming data on the natural history of DED from prospective studies should help clarify some of the limitations of this retrospective study.

Key Points Question Are current risk prediction models accurate at estimating risk of initial atherosclerotic cardiovascular (ASCVD) events in veterans? Findings In this cohort study of 1 672 336 veterans with an outpatient visit between 2002 and 2007, the 2013 American College of Cardiology/American Heart Association model overestimated absolute risk of ASCVD during 5 years of follow-up. Statin use was associated with 7% lower relative risk of ASCVD and 25% lower relative risk of ASCVD mortality. Meaning The findings of this study suggest that reestimation and the inclusion of statin use in ASCVD prediction models might be needed for their appropriate use in a health care system.

Background Recent studies have identified subthreshold forms of bipolar (BP)-I disorder and deficits in emotional regulation as risk factors for bipolar disorder in youth. The primary aim of this study was to investigate whether emotional dysregulation and subthreshold forms of BP-I disorder increase the risk for BP switches in ADHD youth with non-bipolar MDD. Methods We used data from two large controlled longitudinal family studies of boys and girls with and without ADHD. Subjects (N=522) were followed prospectively and blindly over an average follow up period of 11.4 years. Comparisons were made between ADHD youth with unipolar major depression (MDD) who did (N=24) and did not (N=79) switch to BP-I disorder at follow-up. Results The rate of conversion to BP-I disorder at follow up was higher in MDD subjects with subthreshold BP-I disorder at baseline compared to those without (57% vs. 21%; OR=9.57, 95%CI=1.62–56.56, p=0.013) and in MDD subjects with deficient emotional self regulation (OR=3.54, 95%CI=1.08–11.60, p=0.037). Limitations The sample was largely Caucasian, so these results may not generalize to minority groups. The sample of youth with SED was small, which limited the statistical power for some analyses. Conclusions Switches from unipolar MDD to BP-I disorder in children with ADHD and MDD were predicted by baseline subthreshold BP-I disorder symptoms and baseline deficits in emotional regulation. More work is needed to assess whether these risk factors are operant outside the context of ADHD.