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1.  Simulated Driving Performance of Adults with ADHD: Comparisons with Alcohol Intoxication 
Previous research has demonstrated that adults with ADHD are more likely to experience driving-related problems, which suggests that they may exhibit poorer driving performance. However, direct experimental evidence of this hypothesis is limited. The current study involved two experiments that evaluated driving performance in adults with ADHD in terms of the types of driving decrements typically associated with alcohol intoxication. Experiment 1 compared the simulated driving performance of 15 adults with ADHD to 23 adult control participants, who performed the task both while sober and intoxicated. Results showed that sober adults with ADHD exhibited decrements in driving performance compared to sober controls, and that the profile of impairment for the sober ADHD group did in fact resemble that of intoxicated drivers at the BAC level for legally impaired driving in the United States. Driving impairment of the intoxicated individuals was characterized by greater deviation of lane position, faster and more abrupt steering maneuvers, and increased speed variability. Experiment 2 was a dose-challenge study in which 8 adults with ADHD and 8 controls performed the driving simulation task under three doses of alcohol: 0.65 g/kg, 0.45 g/kg, and 0.0 g/kg (placebo). Results showed that driving performance in both groups was impaired in response to alcohol, and that individuals with ADHD exhibited generally poorer driving performance than did controls across all dose conditions. Together the findings provide compelling evidence to suggest that the cognitive and behavioral deficits associated with ADHD might impair driving performance in such a manner as to resemble that of an alcohol intoxicated driver. Moreover, alcohol might impair the performance of drivers with ADHD in an additive fashion that could considerably compromise their driving skill even at blood alcohol concentrations below the legal limit.
doi:10.1037/1064-1297.16.3.251
PMCID: PMC4305387  PMID: 18540785
2.  The Effects of Preresponse Cues on Inhibitory Control and Response Time in Adults with ADHD 
Journal of attention disorders  2013;10.1177/1087054713495737.
Objective
To examine the effects of preresponse cues on behavioral control in adults with attention-deficit/hyperactivity disorder (ADHD).
Method
Eighty-eight adults with ADHD and 67 adults with no history of ADHD completed a cued go/no-go task. This task requires participants to respond or inhibit a response to go and no-go targets, respectively, and preresponse cues provide participants with predictive information about the upcoming target.
Results
Overall, participants with ADHD made more inhibitory failures and responded more slowly than controls. These group differences were only present in the valid-cue condition, and there were no significant group differences in the invalid-cue conditions.
Conclusion
These findings suggest that adults with ADHD are less able to utilize predictive environmental information to facilitate behavioral control.
doi:10.1177/1087054713495737
PMCID: PMC4026333  PMID: 23881558
3.  Inhibitory Functioning across ADHD Subtypes: Recent Findings, Clinical Implications and Future Directions 
Although growing consensus supports the role of deficient behavioral inhibition as a central feature of the combined subtype of ADHD (ADHD/C; Barkley, 2007; Nigg, 2001), little research has focused on how this finding generalizes to the primarily inattentive subtype (ADHD/I). This question holds particular relevance in light of recent work suggesting that ADHD/I might be better characterized as a disorder separate from ADHD/C (Diamond, 2005; Milich et al., 2001). The current paper describes major findings in the area of inhibitory performance in ADHD and highlights recent research suggesting important areas of divergence between the subtypes. In particular, preliminary findings point to potential differences between the subtypes with respect to how children process important contextual information from the environment, such as preparatory cues that precede responses and rewarding or punishing feedback following behavior. These suggestive findings are discussed in the context of treatment implications, which could involve differential intervention approaches for each subtype targeted to the specific deficit profiles that characterize each group of children. Future research avenues aimed toward building a sound theoretical model of ADHD/I and a better understanding of its relation to ADHD/C are also presented. Specifically, investigators are encouraged to continue studying the complex interplay between inhibitory and attentional processes, as this area seems particularly promising in its ability to improve our understanding of the potentially distinct pathologies underlying the ADHD subtypes.
doi:10.1002/ddrr.37
PMCID: PMC4131681  PMID: 19072751
ADHD; subtypes; inhibition; contextual factors
4.  Examining Manual and Visual Response Inhibition among ADHD Subtypes 
This study compared inhibitory functioning among ADHD subtype groups on manual and visual versions of the stop task. Seventy-six children, identified as ADHD/I (n = 17), ADHD/C (n =43), and comparison (n = 20) completed both tasks. Results indicated that both ADHD groups were slower to inhibit responses than the comparison group on both tasks. Comparison children were faster to inhibit than activate responses on both tasks. Children in the ADHD groups also demonstrated this robust pattern on the manual task. However, on the visual task, the ADHD groups evidenced slowed inhibition comparable to the time required to activate responding. This implies that the visual task is more sensitive than the manual task to inhibitory deficits associated with ADHD. The ADHD/I and the ADHD/C groups did not differ on most measures, suggesting that neither stop task is effective in differentiating the subtypes. These findings extend work highlighting the role of disinhibition in ADHD, and contrast recent work suggesting divergence between ADHD subtypes.
doi:10.1007/s10802-010-9420-3
PMCID: PMC4100534  PMID: 20449644
ADHD; subtypes; inhibition; oculomotor
5.  Reduced Acute Recovery from Alcohol Impairment in Adults with ADHD 
Psychopharmacology  2013;228(1):65-74.
Rationale
Prior research has found that adults with attention-deficit/hyperactivity disorder (ADHD) show increased sensitivity to the impairing effects of alcohol (Weafer et al. 2009). However, these studies have focused exclusively on the ascending limb of the blood alcohol concentration (BAC) curve, and it is unclear whether these adults continue to show increased sensitivity during the later phase of the dose as BAC is declining.
Objective
This study tested the hypothesis that those with ADHD would display increased response to alcohol during the ascending limb of the BAC curve and less recovery from the impairing effects during the descending limb.
Methods
Adult social drinkers with ADHD and control adults completed measures of motor coordination, reaction time, and subjective intoxication twice following 0.64 g/kg alcohol and placebo. The measures were administered during the ascending limb of the BAC curve and again during the descending limb.
Results
During the ascending limb, alcohol reduced motor coordination, slowed reaction time (RT), and increased self-reports of subjective intoxication. Those with ADHD displayed greater impairment of motor coordination compared with controls. During the descending limb, controls reported diminished subjective intoxication and showed recovery from the impairing effects of alcohol on both their motor coordination and their RT. Those with ADHD showed reduced subjective intoxication and faster RT during this time, but they did not recover motor control.
Conclusions
The protracted time course of motor impairment in adults with ADHD despite reductions in subjective intoxication may contribute to poor decision making and diminished behavioral control in this group.
doi:10.1007/s00213-013-3016-x
PMCID: PMC3679354  PMID: 23430161
acute recovery; alcohol impairment; motor control; response time; ADHD; at-risk drinkers
6.  Interactive effects of drinking history and impulsivity on college drinking 
Addictive behaviors  2013;38(12):2860-2867.
The transition from adolescence into emerging adulthood is a critical developmental period for changes in alcohol use and drinking related problems. Prior research has identified a number of distinct developmental alcohol use trajectories, which appear to be differentially related to young adult drinking outcomes. Another correlate of alcohol use in early adulthood is impulsivity. The primary aim of this study was to examine the moderating role of impulsivity in the relation between patterns of past alcohol use and hazardous drinking during the first year of college. Participants (N=452; 49% male; mean age 18.5 years; 82% Caucasian) completed self-report measures during the first year of college, including retrospective alcohol use calendars, current alcohol use and drinking problems, and personality. Group-based trajectory modeling was used to identify groups with similar adolescent drinking history from retrospective, self-report. Four groups were identified: abstainers/very light users, late/moderate users, early/moderate users, and steep increase/heavy users. The abstainer/very light user group reported the lowest levels of alcohol use and problematic drinking in college; the steep increase/heavy use group reported the highest levels of alcohol use and problematic drinking. As predicted, the role of personality—specifically urgency, or emotion-based rash action—was strongest among moderate use groups. These findings may be helpful in guiding targeted prevention and intervention programs for alcohol use and abuse.
doi:10.1016/j.addbeh.2013.08.009
PMCID: PMC4075284  PMID: 24018231
alcohol; impulsivity; urgency; college students; drinking trajectories
7.  A Developmental Examination of Story Recall and Coherence Among Children with ADHD 
This study investigated developmental differences in story recall in children with attention-deficit/hyperactivity disorder (ADHD), N=57 (77.2% male) and their comparison peers, N=98 (61.2% male). Children at the ages of 4–6 or 7–9 completed a free recall immediately after viewing each of two televised stories, once in the presence of toys during viewing and once in their absence. This procedure was repeated with new stories 21 months later. Comparison children recalled more story events and showed a greater sensitivity to the thematic importance of the story events than did children with ADHD, a pattern that remained stable over time. Older comparison children showed a dramatic increase over time in the global coherence of their narrations, whereas the older children with ADHD showed limited improvement over time. The implications of these findings for academic performance and the possible need for remediation are discussed.
doi:10.1007/s10802-009-9377-2
PMCID: PMC4036495  PMID: 20024672
ADHD; Longitudinal; Story recall; Story coherence
8.  Negative Urgency, Distress Tolerance, and Substance Abuse Among College Students 
Addictive Behaviors  2012;37(10):1075-1083.
Objective
Negative affect has been consistently linked with substance use/problems in prior research. The present study sought to build upon these findings by exploring how an individual’s characteristic responding to negative affect impacts substance abuse risk. Trait negative affect was examined in relation to substance abuse outcomes along with two variables tapping into response to negative affect: Distress Tolerance, an individual’s perceived ability to tolerate negative affect, and Negative Urgency, the tendency to act rashly while experiencing distress.
Method
Participants were 525 first-year college students (48.1% male, 81.1% Caucasian), who completed self-report measures assessing personality traits and alcohol-related problems, and a structured interview assessing past and current substance use. Relations were tested using Zero-Inflated Negative Binomial regression models, and each of the personality variables was tested in a model on its own, and in a model where all three traits were accounted for.
Results
Negative Urgency emerged as the best predictor, relating to every one of the substance use outcome variables even when trait negative affect and Distress Tolerance were accounted for.
Conclusions
These findings suggest that Negative Urgency is an important factor to consider in developing prevention and intervention efforts aimed at reducing substance use and problems.
doi:10.1016/j.addbeh.2012.04.017
PMCID: PMC3389263  PMID: 22698894
negative urgency; substance abuse; distress tolerance; negative affect; alcohol
9.  Drinking Motives as Mediators of the Impulsivity-Substance Use Relation: Pathways for Negative Urgency, Lack of Premeditation, and Sensation Seeking 
Addictive Behaviors  2012;37(7):848-855.
Trait impulsivity is a reliable, robust predictor of risky, problematic alcohol use. Mounting evidence supports a multidimensional model of impulsivity, whereby several distinct traits serve as personality pathways to rash action. Different impulsivity-related traits may predispose individuals to drink for different reasons (e.g., to enhance pleasure, to cope with distress) and these different motives may, in turn, influence drinking behavior. Previous findings support such a mediational model for two well-studied traits: sensation seeking and lack of premeditation. This study addresses other impulsivity-related traits, including negative urgency. College students (N = 432) completed questionnaires assessing personality, drinking motives, and multiple indicators of problematic drinking. Negative urgency, sensation seeking, and lack of premeditation were all significantly related to problematic drinking. When drinking motives were included in the model, direct effects for sensation seeking and lack of premeditation remained significant, and indirect effects of sensation seeking and lack of premeditation on problematic drinking were observed through enhancement motives. A distinct pathway was observed for negative urgency. Negative urgency bore a significant total effect on problematic drinking through both coping and enhancement motives. This study highlights unique motivational pathways through which different impulsive traits may operate, suggesting that interventions aimed at preventing or reducing problematic drinking should be tailored to individuals' personalities. For instance, individuals high in negative urgency may benefit from learning healthier strategies for coping with distress.
doi:10.1016/j.addbeh.2012.03.016
PMCID: PMC3356454  PMID: 22472524
impulsivity; urgency; drinking motives; alcohol
10.  Drinking to Distraction: Does Alcohol Increase Attentional Bias in Adults with ADHD? 
Previous research has shown that social drinkers continue to show attentional bias towards alcohol-related stimuli even after consuming a moderate dose of alcohol. In contrast, little is known about how alcohol acutely affects attentional bias in groups at risk to develop alcohol-related problems, such as adults with attention-deficit/hyperactivity disorder (ADHD). Such individuals may show increased attentional bias following alcohol relative to nonclinical controls. The present study tested this hypothesis by examining acute alcohol effects on attentional bias in 20 social drinkers with ADHD and 20 social drinkers with no history of ADHD. Participants performed a visual-probe task after receiving the following doses of alcohol: 0.64 g/kg, 0.32 g/kg, and 0.0 g/kg (placebo). Those in the ADHD group showed increased attentional bias under active alcohol doses, whereas attentional bias was similar across doses in the control group. Attentional bias predicted ad libitum alcohol consumption during a taste-rating session. This relation was observed only in the ADHD group. These findings indicate that an acute alcohol dose increases attentional bias in adults with ADHD. Further, attentional bias appears to be a predictor of ad libitum consumption in this group.
doi:10.1037/a0026379
PMCID: PMC3338153  PMID: 22121850
Attentional bias; ADHD; Alcohol; Ad libitum consumption; At-risk drinkers
11.  Linking Impulsivity and Inhibitory Control Using Manual and Oculomotor Response Inhibition Tasks 
Acta psychologica  2011;138(3):419-428.
Separate cognitive processes govern the inhibitory control of manual and oculomotor movements. Despite this fundamental distinction, little is known about how these inhibitory control processes relate to more complex domains of behavioral functioning. This study sought to determine how these inhibitory control mechanisms relate to broadly defined domains of impulsive behavior. Thirty adults with attention-deficit/hyperactivity disorder (ADHD) and 28 comparison adults performed behavioral measures of inhibitory control and completed impulsivity inventories. Results suggest that oculomotor inhibitory control, but not manual inhibitory control, is related to specific domains of self-reported impulsivity. This finding was limited to the ADHD group; no significant relations between inhibitory control and impulsivity were found in comparison adults. These results highlight the heterogeneity of inhibitory control processes and their differential relations to different facets of impulsivity.
doi:10.1016/j.actpsy.2011.09.002
PMCID: PMC3205291  PMID: 21982865
impulsivity; inhibitory control; manual; oculomotor; ADHD
12.  Does Response Variability Predict Distractibility among Adults with Attention-Deficit/Hyperactivity Disorder? 
Psychological assessment  2011;23(2):427-436.
Increased intra-individual variability in response time (RTSD) has been observed reliably in ADHD and is often used as a measure of inattention. RTSD is assumed to reflect attentional lapses and distractibility, though evidence for the validity of this connection is lacking. We assessed whether RTSD is an indicator of inattention by comparing RTSD on the stop-signal task (SST) to performance on the Delayed Oculomotor Response (DOR) Task, a measure of distractibility. Participants included 30 adults with ADHD and 28 controls. Participants completed the SST and the DOR task, which measured subjects’ ability to maintain attention and avoid distraction by inhibiting reflexive saccades toward distractors. On the SST, the ADHD group was slower to inhibit than controls, indicating poorer inhibitory control in ADHD. The ADHD group also displayed slower RTs, greater RTSD, and more omission errors. On the DOR task, the ADHD group displayed more premature saccades (i.e., greater distractibility) than controls. Greater variability in RT was associated with increased distraction on the DOR task but only in ADHD participants. Results suggest that RTSD is linked to distractibility among adults with ADHD and support the use of RTSD as a valid measure of inattention in ADHD.
doi:10.1037/a0022112
PMCID: PMC3115498  PMID: 21443365
ADHD; adults; variable attention; eye movements
13.  Separating Automatic and Intentional Inhibitory Mechanisms of Attention in Adults with Attention-Deficit/Hyperactivity Disorder 
Journal of abnormal psychology  2011;120(1):223-233.
Researchers in the cognitive sciences recognize a fundamental distinction between automatic and intentional mechanisms of inhibitory control. The use of eye-tracking tasks to assess selective attention has led to a better understanding of this distinction in specific populations such as children with attention-deficit/hyperactivity disorder (ADHD). This study examined automatic and intentional inhibitory control mechanisms in adults with ADHD using a saccadic interference (SI) task and a delayed ocular response (DOR) task. Thirty adults with ADHD were compared to 27 comparison adults on measures of inhibitory control. The DOR task showed that adults with ADHD were less able than comparison adults to inhibit a reflexive saccade towards the sudden appearance of a stimulus in the periphery. However, SI task performance showed that the ADHD group did not differ significantly from the comparison group on a measure of automatic inhibitory control. These findings suggest a dissociation between automatic and intentional inhibitory deficits in adults with ADHD.
doi:10.1037/a0021408
PMCID: PMC3065892  PMID: 21058752
ADHD; inhibition; automatic; intentional
14.  Behavioral Components of Impulsivity Predict Alcohol Consumption in Adults with ADHD and Healthy Controls 
Drug and alcohol dependence  2010;113(2-3):139-146.
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.
doi:10.1016/j.drugalcdep.2010.07.027
PMCID: PMC3010339  PMID: 20863628
behavioral impulsivity; alcohol consumption; ADHD
15.  Impulsivity and Attention Deficit-Hyperactivity Disorder: Subtype Classification Using the UPPS Impulsive Behavior Scale 
This study examined the classification accuracy of the UPPS Impulsive Behavior Scale (UPPS) in discriminating several attention deficit/hyperactivity disorder (ADHD) subtypes, including predominantly inattentive type (ADHD/I), combined type (ADHD/C), and combined type with behavioral problems (ADHD/ODD), between each other and a non-ADHD control group using logistic regression analyses. The sample consisted of 88 children ranging in age from 9.0 years to 12.8 years, with a mean of 10.9 years. Children were predominantly male (74%) and Caucasian (86%) and in grades 3–7. Results indicated that the UPPS performed well in classifying ADHD subtypes relative to traditional diagnostic measures. In addition, analyses indicated that differences in symptoms between subtypes can be explained by specific pathways to impulsivity. Implications for the assessment of ADHD and conceptual issues are discussed.
doi:10.1007/s10862-009-9155-z
PMCID: PMC3137261  PMID: 21765593
ADHD; Impulsivity; UPPS; ADHD subtypes

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