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1.  Does Executive Functioning (EF) Predict Depression in Clinic-Referred Adults?: EF Tests vs. Rating Scales 
Journal of affective disorders  2012;145(2):270-275.
Deficits in executive functioning (EF) are implicated in neurobiological and cognitive-processing theories of depression. EF deficits are also associated with Attention-deficit/hyperactivity disorder (ADHD) in adults, who are also at increased risk for depressive disorders. Given debate about the ecological validity of laboratory measures of EF, we investigated the relationship between depression diagnoses and symptoms and EF as measured by both rating scales and tests in a sample of adults referred for evaluation of adult ADHD.
Data from two groups of adults recruited from an ADHD specialty clinic were analyzed together: Adults diagnosed with ADHD (N=146) and a clinical control group of adults referred for adult ADHD assessment but not diagnosed with the disorder ADHD (N=97). EF was assessed using a rating scale of EF deficits in daily life and a battery of tests tapping various EF constructs. Depression was assessed using current and lifetime SCID diagnoses (major depression, dysthymia) and self-report symptom ratings.
EF as assessed via rating scale predicted depression across measures even when controlling for current anxiety and impairment. Self-Management to Time and Self-Organization and Problem-Solving showed the most robust relationships. EF tests were weakly and inconsistently related to depression measures.
Prospective studies are needed to rigorously evaluate EF problems as true risk factors for depressive onset.
EF problems in everyday life were important predictors of depression. Researchers and clinicians should consistently assess for the ADHD-depression comorbidity. Clinicians should consider incorporating strategies to address EF deficits when treating people with depression.
PMCID: PMC3519951  PMID: 22858220
executive functioning; depressive disorders; attention-deficit/hyperactivity disorder; ADHD; neuropsychological tests; rating scales
2.  The Structure and Diagnosis of Adult ADHD: An Analysis of Expanded Symptom Criteria from the Adult ADHD Clinical Diagnostic Scale (ACDS) 
Archives of general psychiatry  2010;67(11):1168-1178.
Controversy exists about the appropriate criteria for a diagnosis of adult attention-deficit/hyperactivity disorder (ADHD)
To examine the structure and symptoms most predictive of DSM-IV adult ADHD.
Data come from clinical interviews in enriched sub-samples of the National Comorbidity Survey Replication (NCS-R) (n = 131) and a survey of a large managed healthcare plan (n = 214). The clinician-administered Adult ADHD Clinical Diagnostic Scale (ACDS) was used to assess childhood ADHD and expanded symptoms of current adult ADHD. Analyses examined stability of symptoms from childhood to adulthood, the structure of adult ADHD, and the adult symptoms most predictive of current clinical diagnoses.
The ACDS was administered telephonically by clinical research interviewers with extensive experience in diagnosis and treatment of adult ADHD.
An enriched sample of community respondents
DSM-IV/ACDS diagnoses of adult ADHD
Almost half (45.7%) of respondents who had childhood ADHD continued to meet full DSM-IV criteria for current adult ADHD, with 94.9% of these cases having current attention-deficit disorder and 34.6% current hyperactivity disorder. Adult persistence was much greater for inattention than hyperactivity-impulsivity. Additional respondents met full criteria for current adult ADHD despite not having met full childhood criteria. A three-factor structure of adult symptoms included executive functioning, inattention-hyperactivity, and impulsivity. Stepwise logistic regression found executive functioning problems to be the most consistent and discriminating predictors of adult DSM-IV/ACDS ADHD.
These findings document the greater persistence of inattentive than hyperactive/impulsive childhood symptoms of ADHD in adulthood, but also show that inattention in not specific to ADHD, as it is strongly associated with other adult mental disorders. Executive functioning problems, in comparison, are more specific and consistently important predictors of DSM-IV adult ADHD despite not being in DSM-IV, suggesting that the number of executive functioning symptoms should be increased in DSM-V/ICD-11.
PMCID: PMC3131739  PMID: 21041618
3.  Impairment in Occupational Functioning and Adult ADHD: The Predictive Utility of Executive Function (EF) Ratings Versus EF Tests 
Attention deficit hyperactivity disorder (ADHD) is associated with deficits in executive functioning (EF). ADHD in adults is also associated with impairments in major life activities, particularly occupational functioning. We investigated the extent to which EF deficits assessed by both tests and self-ratings contributed to the degree of impairment in 11 measures involving self-reported occupational problems, employer reported workplace adjustment, and clinician rated occupational adjustment. Three groups of adults were recruited as a function of their severity of ADHD: ADHD diagnosis (n = 146), clinical controls self-referring for ADHD but not diagnosed with it (n = 97), and community controls (n = 109). Groups were combined and regression analyses revealed that self-ratings of EF were significantly predictive of impairments in all 11 measures of occupational adjustment. Although several tests of EF also did so, they contributed substantially less than did the EF ratings, particularly when analyzed jointly with the ratings. We conclude that EF deficits contribute to the impairments in occupational functioning that occur in conjunction with adult ADHD. Ratings of EF in daily life contribute more to such impairments than do EF tests, perhaps because, as we hypothesize, each assesses a different level in the hierarchical organization of EF as a meta-construct.
PMCID: PMC2858600  PMID: 20197297
Adult ADHD; Executive functioning (EF); EF ratings; EF tests; Occupational impairment
4.  The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication 
The American journal of psychiatry  2006;163(4):716-723.
Despite growing interest in adult attention-deficit/hyperactivity disorder (ADHD), little is known about prevalence or correlates.
A screen for adult ADHD was included in a probability sub-sample (n = 3199) of 18–44 year old respondents in the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey that used a lay-administered diagnostic interview to assess a wide range of DSM-IV disorders. Blinded clinical follow-up interviews of adult ADHD were carried out with 154 NCS-R respondents, over-sampling those with a positive screen. Multiple imputation (MI) was used to estimate prevalence and correlates of clinician-assessed adult ADHD.
Estimated prevalence of current adult ADHD is 4.4%. Significant correlates include being male, previously married, unemployed, and Non-Hispanic White. Adult ADHD is highly comorbid with many other NCS-R/DSM-IV disorders and is associated with substantial role impairment. The majority of cases are untreated, although many obtain treatment for other comorbid mental and substance disorders.
Efforts are needed to increase the detection and treatment of adult ADHD. Research is needed to determine whether effective treatment would reduce the onset, persistence, and severity of disorders that co-occur with adult ADHD.
PMCID: PMC2859678  PMID: 16585449
Attention Deficit Hyperactivity Disorder - AJP0005; Diagnosis And Classification - AJP0086; Epidemiology - AJP0087
5.  Patterns and predictors of ADHD persistence into adulthood: Results from the National Comorbidity Survey Replication 
Biological psychiatry  2005;57(11):1442-1451.
Despite growing interest in adult ADHD, little is known about predictors of persistence of childhood cases into adulthood.
A retrospective assessment of childhood ADHD, childhood risk factors, and a screen for adult ADHD were included in a sample of 3197 18–44 year old respondents in the National Comorbidity Survey Replication (NCS-R). Blinded adult ADHD clinical reappraisal interviews were administered to a sub-sample of respondents. Multiple imputation (MI) was used to estimate adult persistence of childhood ADHD. Logistic regression was used to study retrospectively reported childhood predictors of persistence. Potential predictors included socio-demographics, childhood ADHD severity, childhood adversity, traumatic life experiences, and comorbid DSM-IV child-adolescent disorders (anxiety, mood, impulse-control, and substance disorders).
36.3% of respondents with retrospectively assessed childhood ADHD were classified by blinded clinical interviews as meeting DSM-IV criteria for current ADHD. Childhood ADHD severity and childhood treatment significantly predicted persistence. Controlling for severity and excluding treatment, none of the other variables significantly predicted persistence even though they were significantly associated with childhood ADHD.
No modifiable risk factors were found for adult persistence of ADHD. Further research, ideally based on prospective general population samples, is needed to search for modifiable determinants of adult persistence of ADHD.
PMCID: PMC2847347  PMID: 15950019
Attention Deficit Hyperactivity Disorder; Diagnosis And Classification, Epidemiology
6.  An Examination of the Behavioral and Neuropsychological Correlates of Three ADHD Candidate Gene Polymorphisms (DRD4 7+, DBH TaqI A2, and DAT1 40bp VNTR) in Hyperactive and Normal Children Followed to Adulthood 
Several candidate gene polymorphisms have been implicated in attention deficit hyperactivity disorder (ADHD), including DAT1 40bp VNTR, DRD4 7+, and DBH TaqI A2 alleles. We used the Milwaukee longitudinal study of hyperactive (N=122) and normal (N=67) children to compare participants with and without these respective polymorphisms on ADHD-related behavioral ratings at childhood, 8 years later in adolescence, and 13+ years later into young adulthood. Neuropsychological tests were given at the adolescent and young adulthood follow-up. No differences were found between the DRD4-7+ and 7- repeat polymorphism. The DBH TaqI A2 allele, when homozygous, was associated with being more hyperactive in childhood, having more pervasive behavior problems at adolescence, and earning less money on a Card Playing Task in adulthood. At adolescence, poorer test scores were also found only in the hyperactive group with homozygous for this allele. The DAT1 40bp VNTR heterozygous 9/10 repeat, however, differed from the 10/10 repeat pair in many respects, having greater ADHD and externalizing symptoms at all three follow-ups, more cross-situational behavioral problems at both childhood and adolescence, poorer mother-teen relations at adolescence, and lower class rankings in high school. Participants with the 9/10 pair in the control group also had lower work performance, a lower grade point average in high school, greater teacher rated externalizing symptoms at adolescence, and greater omission errors on a continuous performance test in adulthood. The DAT1 40bp VNTR 9/10 polymorphism pairing appears to be reliably associated with greater symptoms of ADHD and externalizing behavior from childhood to adulthood, and with family, educational, and occupational impairments. We also present a contrary view on the appropriate endophenotypes for use in behavioral genetic research on ADHD.
PMCID: PMC2562041  PMID: 16741944

Results 1-6 (6)