Objective To develop and validate a hierarchical decision tree model, combining neurobehavioral and physical measures, for identification of children affected by prenatal alcohol exposure even when facial dysmorphology is not present. Study design Data were collected as part of a multisite study across the United States. The model was developed after evaluating over 1000 neurobehavioral and dysmorphology variables collected from 434 children (8–16y) with prenatal alcohol exposure, with and without fetal alcohol syndrome (FAS), and non-exposed controls, with and without other clinically-relevant behavioral or cognitive concerns. The model was subsequently validated in an independent sample of 454 children in two age ranges (5–7y or 10–16y). In all analyses, the discriminatory ability of each model step was tested with logistic regression. Classification accuracies and positive and negative predictive values were calculated. Results The model consisted of variables from 4 measures (2 parent questionnaires, an IQ score, and a physical examination). Overall accuracy rates for both the development and validation samples met or exceeded our goal of 80% overall accuracy. Conclusions The decision tree model distinguished children affected by prenatal alcohol exposure from non-exposed controls, including those with other behavioral concerns or conditions. Improving identification of this population will streamline access to clinical services, including multidisciplinary evaluation and treatment.

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To date, there remains no consensus about the best evidence-based method for integrating multiple informant data in the diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD). Several approaches exist, including the psychometrically sound approach of averaging scores, as well as the use of "OR" and "AND" algorithms, which are still commonly used in research. The current study tested these major integration methods in their concurrent and longitudinal prediction of clinician-rated impairment, teacherrated academic, and parent-and self-rated social skill ratings in children overrecruited for ADHD across a 6-year span from childhood to adolescence. The sample included a total of 800 children, 480 with ADHD, ages 6 to 13, who completed a "gold standard" assessment of ADHD and associated impairment. Overall, the "OR," "AND," and average integration approaches showed significantly high interrelations with one another (r range from .78 to .96) and were all significantly and strongly related to impairment measures concurrently and longitudinally. Multivariate regressions demonstrated that the average integration approach concurrently and longitudinally out predicted the other two approaches. Results demonstrated that the average approach slightly outperformed the other two in its prediction of concurrent and longitudinal clinician-rated impairment, teacher-rated academic skills, and parent-and self-rated child social skills across childhood and adolescence. Evidence-based assessment integration of parent and teacher ratings of ADHD in childhood might best utilize an averaging approach, as it is most related to later impairment ratings, particularly if such findings are replicated by other groups. Public Significance StatementAn average approach to integrating parent and teacher ratings of ADHD slightly outperforms other, more complicated integration approaches in prediction of later clinician-rated impairment, teacher-rated academic skills, and parent-and self-rated social skills. Therefore, average integration of ADHD symptom ratings may be the best and easiest integration approach for use in clinical practice.

The current study visualized attention-deficit/hyperactivity disorder (ADHD) symptom networks in a longitudinal sample of participants across childhood and adolescence with exploratory examination of age and gender effects. Eight hundred thirty-six children ages 7-13 years were followed annually for 8 years in total. Across parent and teacher report, results suggested "is easily distracted" and "difficulties sustaining attention" as central symptoms across three testing points (i.e., Year 1, Year 3, and Years 5-8 collapsed). "Difficulties following instructions" and "intrudes/interrupts" also emerged as parentreported central symptoms. Assessment of network structure across the three testing points suggested global robustness of relations among ADHD symptoms from midchildhood into early adolescence. However, relations among symptoms that cause problems in school settings (i.e., being easily distracted) were stronger in teacher-reported than parent-reported networks. When aggregated into a sum score, central symptoms during Year 1 predicted total difficulties related to mental health problems 5 years later just as well as all 18 symptoms. Central symptoms of ADHD may be useful as screeners of future emotional and behavioral difficulties.

Attention-deficit hyperactivity disorder (ADHD) is a common, chronic, and impairing disorder, yet presentations of ADHD and clinical course are highly heterogeneous. Despite substantial research efforts, both (a) the secondary co-occurrence of ADHD and complicating additional clinical problems and (b) the developmental pathways leading toward or away from recovery through adolescence remain poorly understood. Resolving these requires accounting for transactional influences of a large number of features across development. Here, we applied a longitudinal cross-lagged panel network model to a multimodal, multilevel dataset in a well-characterized sample of 488 children (nADHD = 296) to test Research Domain Criteria initiative-inspired hypotheses about transdiagnostic risk. Network features included Diagnostic and Statistical Manual of Mental Disorders symptoms, trait-based ratings of emotional functioning (temperament), and performance-based measures of cognition. Results confirmed that ADHD symptom domains, temperamental irritability, and working memory are independent transdiagnostic risk factors for psychopathology based on their direct associations with other features across time. ADHD symptoms and working memory each had direct, independent associations with depression. Results also demonstrated tightly linked co-development of ADHD symptoms and temperamental irritability, consistent with the possibility that this type of anger dysregulation is a core feature that is co-expressed as part of the ADHD phenotype for some children.

Using network analysis and random forest regression, this study identified attention-deficit/hyperactivity disorder (ADHD) symptoms most important for indicating impairment in various functional domains. Participants comprised a nationally representative sample of 1249 adults in the United States. Bridge symptoms were identified as those demonstrating unique relations with impairment domains that, in total, were stronger than those involving other symptoms. Results suggested three inattentive (i.e., difficulty organizing; does not follow through; makes careless mistakes) and one hyperactive ( difficulty engaging in leisure activities) bridge symptoms. Random forest regression results supported bridge symptoms as most important (compared to other symptoms) for predicting global and specific impairment domains. Hyperactive/impulsive symptoms appeared more strongly related to impairment in women, whereas difficulty organizing and easily distracted appeared more related to impairment in men. Clarification of bridge symptoms may help identify core characteristics of ADHD in adulthood and specify screening and intervention targets to reduce risk for related impairment.