The impact of ADHD symptom severity on reinforcement and punishment learning among adults.

Introduction: Aberrations in feedback learning are hypothesised to contribute to the behavioural disruptions and impairment of attention-deficit/hyperactivity disorder (ADHD). However, few studies have evaluated the relation of reward/punishment feedback and ADHD symptom severity on learning. The current study evaluates the differential effects of reward and punishment feedback on learning among adults with elevated ADHD. Methods: One hundred five participants self-reported their level of current ADHD symptoms and completed an innovative instrumental learning task. Results: Consistent with predictions, participants with low self-reported ADHD symptom severity benefitted equally from reward and punishment feedback during the learning task, whereas participants with high self-reported symptom severity performed better (indexed by accuracy on learning task) from reward than punishment feedback trials. Conclusions: Overall, adults with high self-reported symptom severity of ADHD learned more from reward-based feedback, which provides critical implications for motivational theories about ADHD, as well as for treatment protocols. Future work should examine the translatability of results within a treatment setting.

Parental Deprivation- and Threat-Based Factors Associated with Youth Emotion-Based Neurocircuitry and Externalizing Behavior: A Systematic Review.

Parental factors, including negative parenting practices (e.g., family conflict, low monitoring), parental depression, and parental substance use, are associated with externalizing behaviors among youth. However, the ways in which these parental factors are associated with youth brain function and consequent externalizing behavior has been less studied. Both the dimensional and stress acceleration models provide frameworks for understanding how parental factors may be associated with frontolimbic and frontoparietal networks implicated in emotional attention and regulation processes. The current review builds upon this work by examining how deprivation- and threat-based parental factors are associated with youth neurocircuitry involved in emotional functioning and externalizing behaviors. A systematic review using PRISMA guidelines was completed and included five studies assessing parenting behaviors, six studies assessing parental depressive symptoms and/or diagnosis, and 12 studies assessing parental history of substance use. Synthesis of reviewed studies discusses support for the dimensional and stress acceleration models within the context of deprivation and threat. Further, a limited number of studies tested (i.e., six studies) and supported (i.e., three studies) youth neural structure and function as a mediator of the association between parental factors and youth externalizing behavior. Specific recommendations for future work include more deliberate planning related to sample composition, improved clarity related to parental constructs, consistency in methodology, and longitudinal study design in order to better understand associations between contextual parental influences and youth neural and behavioral functioning.

Diversity and representation in ADHD psychosocial treatment research: A comprehensive synthesis with data from over 10,000 participants.

Demographic data from nearly 50 years of treatment research for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are synthesized. Comprehensive search identified ADHD treatment studies that were between-group designs, included a psychosocial, evidence-based treatment, and were conducted in the United States. One hundred and twenty-six studies that included 10,604 youth were examined. Reporting of demographics varied with 48% of studies (k = 61) reporting ethnicity, 73% (k = 92) reporting race, 80% (k = 101) reporting age (M age = 8.81, SD = 2.82), and 88% (k = 111) reporting gender. Most participants identified as non-Hispanic/Latine (15.99% Hispanic/Latine), White (62.54%), and boys (74.39%; 24.47% girls). Since the 1970s, zero youth in ADHD treatment studies identified as Middle Eastern/North African, 0.1% were American Indian/Alaskan Native or Native Hawaiian Pacific Islander, 1.77% were Asian, 15.10% were Black, and 3.14% were Multiracial. Based on publication year, the proportions of girls, racially minoritized youth, and Hispanic/Latine youth included in ADHD treatment research have increased over time. Girls, non-binary and non-cisgender youth, young children, adolescents, Hispanic/Latine youth, and youth from all racial groups other than White are underrepresented in ADHD treatment research. Research gaps are discussed, and recommendations for comprehensive demographic reporting in child and adolescent psychological research are provided.

An Individualized, Data-Driven Biological Approach to Attention-Deficit/Hyperactivity Disorder (ADHD) Heterogeneity.

Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed mental health disorder in childhood, however, there is well-established heterogeneity in both the presentation of ADHD symptoms and secondary characteristics across the literature. Existing Diagnostic and Statistical Manual of Mental Disorders (DSM-5) nosology has been ineffective in explaining such heterogeneity in terms of both pathophysiology and clinical trajectories. The current study investigated ADHD heterogeneity via a biologically-based, data-driven approach (k-Means algorithm). Specifically, unique biological profiles (derived from patterns of parasympathetic and sympathetic functioning) were identified and utilized as predictors of clinical presentations. Two hundred eighty-nine participants (167 youth with ADHD), ages 5 to 13 years, completed an emotion-based task while indexes of parasympathetic (i.e., respiratory sinus arrhythmia [RSA]) and sympathetic (i.e., electrodermal activity [EDA]) activity were obtained. Overall, results suggest that three distinct biological profiles among youth with ADHD are evident, with biological profiles differing in regulation and arousal levels during emotionally evocative contexts: (Profile 1) underregulated, hyperaroused (negative contexts only), (Profile 2) typically regulated, underaroused, and (Profile 3) overregulated (positive contexts only), hyperaroused. Results are supported by several dopaminergic- and reward-based theories, integrating differing concepts across the literature, and adds biological support for existing models. Behaviorally, results may translate into differing clinical presentations, however, further work is needed. In general, youth with ADHD are heterogenous in autonomic functioning, which could have implications for synthesizing across differing theories within the literature, predicting clinical presentations, and developing targeted treatments.

Methylphenidate Improves Autonomic Functioning among Youth with Attention-Deficit/Hyperactivity Disorder.

Psychostimulants are commonly prescribed medications for youth with attention-deficit/hyperactivity disorder (ADHD). Limited studies have evaluated how psychostimulants (e.g., methylphenidate [MPH]) impact autonomic nervous system (ANS) indexes among youth with ADHD. Understanding the effects of MPH on autonomic functioning is essential, given that youth with ADHD have been shown to experience atypical autonomic functioning (i.e., reduced activity across both sympathetic and parasympathetic branches) compared to typically developing youth. The current study investigated how a specific psychostimulant, Osmotic Release Oral System [OROS] MPH, impacts parasympathetic (indexed by respiratory sinus arrhythmia [RSA]) and sympathetic (indexed by electrodermal activity [EDA]) functioning among youth with ADHD via a within-subjects, double-masked, cross-over design. Two hundred fifty-six participants (157 youth with ADHD), ages 5 to 13 years, completed a two-minute resting baseline task while electrocardiograph and electrodermal data were obtained. Youth with ADHD completed the resting baseline task twice, 3 weeks apart, once during active medication and once during placebo conditions (counterbalanced). Typically developing youth were assessed without medication or placebo. Youth with ADHD during the placebo condition exhibited reduced RSA and EDA compared to typically developing youth. In contrast, youth with ADHD during the medication condition did not differ significantly from typically developing youth with respect to either RSA nor EDA. As such, OROS MPH appears to normalize RSA and EDA levels among youth with ADHD to levels comparable to typically developing youth. Future studies including indexes of the ANS among youth with ADHD are urged to consider the impact of MPH.

The Roles of Salience and Value in Inattention Among Children With Attention-Deficit/Hyperactivity Disorder: A Pilot Investigation.

Although inattention is a key symptom subdomain of attention-deficit/hyperactivity disorder (ADHD), the mechanisms underlying this subdomain and related symptoms remain unclear. There is a need for more granular approaches that allow for greater specificity in linking disruptions in specific domains of cognitive performance (e.g., executive function and reward processing) with behavioral manifestations of ADHD. Such approaches may inform the development of more targeted therapeutic interventions. Here, we describe the results of a pilot study of elementary-aged children (ages 6-12years) with ADHD (n=50) and typically developing children (n=48) utilizing a cognitive science task designed to target two dissociable mechanisms of attentional selection: a goal-driven mechanism (i.e., reward/value-driven) and a salience-driven mechanism. Participants were asked to optimally extract and combine information about stimulus salience and value to maximize rewards. While results of this pilot study are ambiguous due to the small sample size and limited number of task trials, data suggest that neither participants with ADHD nor typically developing participants performed optimally to maximize rewards, though typically developing participants were somewhat more successful at the task (i.e., more likely to report high-value targets) regardless of task condition. Further, the manuscript examines several follow-up questions regarding group differences in task response times and group differences in task performance as related to sustained attention across the duration of the task. Finally, the manuscript examines follow-up questions related to heterogeneity in the ADHD group (i.e., age, DSM 5 presentation, and comorbid diagnosis) in predicting task performance.

The role of temperament in alcohol use among college students.

Alcohol use and alcohol use disorder (AUD) among young adults are important public health concerns. The high prevalence and negative effects of alcohol use suggests that there is a need for improved understanding of the mechanisms underlying alcohol use. The current study utilizes the model of adult temperament proposed by Evans and Rothbart (2007) as the framework with which to examine the interplay among temperament domains and alcohol use. Specifically, we examined individual and interactive associations among self-report ratings of positive affect, negative affect, effortful control, orienting sensitivity and alcohol use patterns, among a large sample of college students. ANOVA and linear regression analyses indicated that positive affect was associated with engagement in hazardous alcohol use and binge drinking. Furthermore, effortful control was associated with reduced engagement in overall alcohol use. These results corroborate and extend previous work which suggests that positive affect and effortful control temperament domains are linked to alcohol use patterns in college-age young adults. These findings may serve as an important step for informed decision-making about prevention and intervention efforts related to problematic alcohol use in young adults.

Emotion Regulation via the Autonomic Nervous System in Children with Attention-Deficit/Hyperactivity Disorder (ADHD): Replication and Extension.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent disorder characterized by symptoms of inattention, hyperactivity, and/or impulsivity, as well as executive dysfunction. Recent work underlines the importance in understanding the role of emotion reactivity and regulatory deficits in the context of the disorder. One study (i.e., Musser et al. 2011) utilized a positive and negative emotion induction and suppression task, as well as indexes of autonomic nervous system reactivity, to examine emotional functioning in youth with ADHD. This study revealed inflexible parasympathetic-based regulation across emotion conditions among youth with ADHD compared to typically developing youth. The present study sought to replicate and extend these findings to a clinically recruited, diverse sample, while also examining sympathetic functioning. Two hundred fifty-nine participants (160 youth with ADHD), aged 5 to 13, completed the task utilized in Musser et al. 2011, while indexes of parasympathetic (i.e., respiratory sinus arrhythmia [RSA]) and sympathetic (i.e., pre-ejection period [PEP] and electrodermal activity [EDA]) reactivity were obtained. ADHD was associated with significantly elevated parasympathetic (i.e., augmented RSA) and sympathetic (as indexed by EDA) reactivity. Overall, results replicate and extend Musser et al. 2011, revealing sympathetic-linked disruptions in emotion reactivity and parasympathetic-linked disruptions in emotion regulation among youth with ADHD. Future studies of behavioral therapies for ADHD should consider the efficacy of adding an emotion regulation skills training component.