Intraindividual variability in brain activation-A novel correlate of obesity risk among female college students.

There are published data describing impairments in the brain function of adolescents or young adults who have a genetic or familial predisposition for obesity. From these descriptions, it is often assumed that the impairments are appropriately captured by a central tendency estimate and therefore consistently detectable. The present study questions this assumption and shows that the variability in brain function over the time course of a cognitive task is a better predictor of familial risk than its central tendency. Sixty-nine female young adults lacking an obese parent and 24 female young adults with an obese parent were compared on the average amplitude and inter-trial variability (ITV) in amplitude of their P300 electroencephalographic responses to rarely-occurring stimuli during a selective attention task. Simple group comparisons revealed statistically significant findings with effect sizes that were markedly greater for analyses of P300 ITV versus P300 average amplitude. It is suggested that the elevation in P300 ITV among young adults with familial risk indicates temporal instability in systems responsible for the maintenance of attention. These fluctuations may episodically disrupt their attention to satiety cues as well as other cues that influence behavior regulation.

Altered brain activation in uncomplicated pediatric obesity: The second moment is more sensitive than the first.

Traditionally, studies of the neurocognitive correlates of obesity have computed a central tendency across trials of a task to estimate the functional abilities of individual members of obese and non-obese groups. This computation assumes that the correlate is stable over time-a questionable assumption when individuals are impulsive, periodically inattentive, and capable of overcompensation following awareness of failure. The present investigation departs from the tradition by focusing on the second moment, or variability, in brain activation during a simple selective attention task. It compared 124 non-obese and 80 obese teenaged girls on the across-trial average amplitude and inter-trial variability (ITV) of a sensitive biomarker of attention, the P300 event-related electroencephalographic potential. It found that P300 ITV outperformed P300 average amplitude in differentiating the groups. Further, it found that the elevated P300 ITV among obese teenagers was associated with other indicators of impulsivity and inattention as well as slower reaction times and a trend toward more variable reaction times. Future studies should investigate the value of P300 ITV as an objective and sensitive endpoint for cognitive training focused on improving the attention skills of obese children.

Inter-trial variability in postural control and brain activation: Effects of previous opiate abuse.

There is an abundant literature demonstrating the superiority of inter-trial variability (ITV) of reaction time over mean reaction time in the early identification of subtle cognitive processing decrements. The present study extends these ideas by examining brain activation and postural control ITV among participants with versus without a history of chronic opiate abuse. Participants enrolled in opiate abuse (n = 82) and control (n = 112) groups completed tasks that challenged selective attention and balance. During the respective tasks, the inter-trial variabilities in frontal P300a electroencephalographic responses and sway strategy scores outperformed their mean levels in differentiating the groups. The relevance of several potential alternative explanations for the differences, including premorbid conduct disorder and comorbid alcohol abuse, depression, and methadone use, was discounted via simultaneous or post hoc analyses. It appears that chronic opiate abuse has adverse CNS effects that persist into the protracted abstinence period. These effects alter the temporal stability of its response to external and internal stimuli.

Signal in the noise: Altered brain activation among adolescent alcohol users detected via the analysis of intra-individual variability1.

RATIONALE: Unlike its average level, the variability in brain activation over time or trials can capture subtle and brief disruptions likely to occur among participants with low-to-moderate levels of substance use or misuse. OBJECTIVE: The present study used this intra-individual variability measurement approach to detect neural processing differences associated with light-to-moderate use of alcohol among 14-19-year-old adolescents. METHOD: A total of 128 participants reporting any level of alcohol use during the previous 6 months and 87 participants reporting no use during this period completed intake questionnaires and interviews as well as an assessment of P300 electroencephalographic responses to novel stimuli recorded during two separate tasks. RESULTS: In addition to differing in recent alcohol use, the groups differed in nicotine and cannabis use, risk-taking behavior and conduct disorder symptoms, and P300 amplitude inter-trial variability (ITV) across both tasks. Across all participants, P300 ITV was positively correlated with a family history of depression but not with a family history of alcohol dependence. There were no group differences in P300 amplitude averaged across trials. CONCLUSIONS: Recent reports attributing brain volume or brain function differences to an effect of light-to-moderate alcohol use should be viewed with great caution. In the present analysis of brain function differences among substance-using adolescents, the group differences were small, complicated by many factors coinciding with or preceding alcohol use, and not reflected in a stable central tendency.

Temporal instability in brain activation: a novel paradigm for evaluating the maintenance of attention among substance dependent patients.

RATIONALE: Prior studies have demonstrated statistically significant but subtle differences in brain function between patients with a history of substance dependence (SD) and control groups. OBJECTIVES: The goal of the present study was to show that variability in brain activation over the trials of a cognitive task is more useful for revealing the putative impact of SD than analyses focusing on the amplitude of activation averaged over trials. The study also tested the additional contribution of antisocial personality disorder (ASPD)-a prevalent comorbidity that promotes both an early onset and more severe course of SD. METHODS: Two hundred eleven adults performed two selective attention tasks while P300 event-related electroencephalographic potentials were recorded. They were assigned to one of 3 mutually exclusive groups: no lifetime history of SD or ASPD (n = 67), a SD history but no ASPD (n = 68), or both SD and ASPD (n = 76). RESULTS: The major finding was a statistically significant elevation of P300 amplitude inter-trial variability (ITV) in the SD plus ASPD group in comparison to the group with neither attribute. The elevation was detected during both selective attention tasks and most prominent at electrodes sites located over the frontal brain. There were no group differences in P300 amplitude averaged over trials. CONCLUSIONS: We conclude from these findings that the ITV of P300 amplitude is an efficient and sensitive biomarker of the maintenance of attention. It is valuable for revealing group differences associated with substance dependence and ASPD. It may ultimately be valuable for detecting improvements resulting from psychostimulant treatment or other interventions, including cognitive remediation.

Neural Responses to Signals for Behavior Change: Greater Within-Person Variability is Associated With Risk Factors for Substance Dependence.

BACKGROUND: An impaired ability to change behavior in the face of cues indicating a need for change is one means of defining risk for substance dependence. The present study used a cognitive task administered in a laboratory as a model of this process. It focused on 2 known and related correlates of risk (conduct disorder, borderline personality disorder) and examined their associations with reactivity to cues requesting a change in motor behavior. METHODS: A total of 224 teenagers, 14 to 19 years of age, performed a task during which white noise bursts were used to cue a requirement to reverse the mapping of right and left key press responses onto high- and low-frequency pure tones during a subsequent trial block. The amplitude of the P300 electroencephalographic (EEG) response to each cue was summarized by calculating its across-trial average as well as its intertrial variability (ITV). In addition, the number of motor response reversal failures (perseveration errors) was calculated. RESULTS: The ITV of the P300 response to cues for behavior change was superior to its average amplitude in revealing associations with risk: It was significantly greater among teenagers with more conduct problems and more borderline personality disorder symptoms in comparison with their less-affected peers. ITV was also positively correlated with perseveration errors. No group differences were found in P300 amplitude averaged over trials. CONCLUSIONS: The findings suggest that the measurement of intertrial variability in brain activity may be more valuable than the average level for revealing neurophysiological differences associated with impulsivity and personality risk factors for dependence. EEG measures may be particularly valuable in this context because they offer superior temporal resolution and signal-to-noise characteristics.

GRM8 genotype is associated with externalizing disorders and greater inter-trial variability in brain activation during a response inhibition task.

OBJECTIVE: The present investigation tested the association of a novel measure of brain activation recorded during a simple motor inhibition task with a GRM8 genetic locus implicated in risk for substance dependence. METHODS: 122 European-American adults were genotyped at rs1361995 and evaluated against DSM-IV criteria for Alcohol Dependence, Cocaine Dependence, Conduct Disorder, and Antisocial Personality Disorder. Also, their brain activity was recorded in response to rare, so-called "No-Go" stimuli presented during a continuous performance test. Brain activity was quantified with two indices: (1) the amplitude of the No-Go P300 electroencephalographic response averaged across trials; and (2) the inter-trial variability of the response. RESULTS: The absence of the minor allele at the candidate locus was associated with all of the evaluated diagnoses. In comparison to minor allele carriers, major allele homozygotes also demonstrated increased inter-trial variability in No-Go P300 response amplitude but no difference in average amplitude. CONCLUSIONS: GRM8 genotype is associated with Alcohol and Cocaine Dependence as well as personality risk factors for dependence. The association may be mediated through an inherited instability in brain function that affects cognitive control. SIGNIFICANCE: The present study focuses on a metric and brain mechanism not typically considered or theorized in studies of patients with substance use disorders.

Inter-trial variability in brain activity as an indicator of synergistic effects of HIV-1 and drug abuse.

BACKGROUND: The objective of this investigation was to detect evidence of the synergism in the effects of HIV-1 and drug abuse on brain function that has been hypothesized but rarely shown. The investigation incorporated several noteworthy improvements in the approach. It used urine toxicology tests to exclude participants complicated by recent methadone use and illicit drug use. Also, it defined drug abuse on a scale that considered symptom severity. Most importantly, it examined inter-trial variability in brain activity as a potentially more sensitive indicator of group differences and functional impairment than the across-trial average. METHODS: 173 participants were assigned to groups defined by their HIV-1 serostatus and Drug Abuse Screening Test score (DAST < vs. > = 6). They completed a simple letter discrimination task including rare target and rare nontarget stimuli. Event-related electroencephalographic responses and key press responses were measured on each trial. During a separate assessment, posturographic measures were recorded. RESULTS: The inter-trial standard deviation of P300-like activity was superior to the mean amplitude of this activity in differentiating the groups. Unlike the mean, it revealed synergistic statistical effects of HIV and drug abuse. It also correlated significantly with static ataxia. CONCLUSIONS: Inter-trial variability in P300-like activity is a useful marker for detecting subtle and episodic disruptions in brain function. It demonstrates greater sensitivity than the mean amplitude for detecting differences across groups. Also, as a putative indicator of a disruption in the attentional monitoring of behavior, it predicts subtle impairments in gross motor function.

HIV/AIDS and an overweight body mass are associated with excessive intra-individual variability in response preparation.

Factors other than HIV/AIDS may influence the cognitive function of patients living with this disease. The present study tested the influence of a common comorbid problem-an overweight body mass. It also examined intra-task variabilities in performance and brain activation as potentially more sensitive indicators of dysfunction than their mean levels. One-hundred seventy-eight participants were recruited and categorized by HIV-1 serostatus (-/+) and body mass (BMI < 26/≥ 26 kg/m2). They performed a simple time estimation task during which response time accuracy and electroencephalographic readiness potentials were recorded. A few hours later, they completed a battery of tests measuring balance and gait. The analyses revealed an advantage of variability over the mean in differentiating groups: the presence of HIV-1 and an overweight body mass were independently and additively associated with greater variability across trials in readiness potential amplitude and response accuracy. The analysis also showed that intra-task variability in the readiness potential, but not in response accuracy, was predictive of decrements in single and tandem leg balance and gait velocity. The present findings suggest that an elevated body mass is associated with, and may contribute to, problems in brain function and motor behavior experienced by patients in the current era. The findings recommend a careful consideration of the manner in which these problems are measured. When the problems are episodic and subtle, measures of central tendency may be less than ideal.

Challenges in the Detection of Working Memory and Attention Decrements among Overweight Adolescent Girls.

BACKGROUND: The present study is unique in employing unusually difficult attention and working memory tasks to reveal subtle cognitive decrements among overweight/obese adolescents. It evaluated novel measures of background electroencephalographic (EEG) activity during one of the tasks and tested correlations of these and other measures with psychological and psychiatric predictors of obesity maintenance or progression. METHODS: Working memory and sustained attention tasks were presented to 158 female adolescents who were rated on dichotomous (body mass index percentile <85 vs. ≥85) and continuous (triceps skinfold thickness) measures of adiposity. RESULTS: The results revealed a significant association between excess adiposity and performance errors during the working memory task. During the sustained attention task, overweight/obese adolescents exhibited more EEG frontal beta power as well as greater intraindividual variability in reaction time and beta power across task periods than their normal-weight peers. Secondary analyses showed that frontal beta power during the sustained attention task was positively correlated with anxiety, panic, borderline personality features, drug abuse, and loss of control over food intake. CONCLUSIONS: The findings suggest that working memory and sustained attention decrements do exist among overweight/obese adolescent girls. The reliable detection of the decrements may depend on the difficulty of the tasks as well as the manner in which performance and brain activity are measured. Future studies should examine the relevance of these decrements to dietary education efforts and treatment response.

Deficient Event-Related Theta Oscillations in Individuals at Risk for Alcoholism: A Study of Reward Processing and Impulsivity Features.

BACKGROUND: Individuals at high risk to develop alcoholism often manifest neurocognitive deficits as well as increased impulsivity. Event-related oscillations (EROs) have been used to effectively measure brain (dys)function during cognitive tasks in individuals with alcoholism and related disorders and in those at risk to develop these disorders. The current study examines ERO theta power during reward processing as well as impulsivity in adolescent and young adult subjects at high risk for alcoholism. METHODS: EROs were recorded during a monetary gambling task (MGT) in 12-25 years old participants (N = 1821; males = 48%) from high risk alcoholic families (HR, N = 1534) and comparison low risk community families (LR, N = 287) from the Collaborative Study on the Genetics of Alcoholism (COGA). Impulsivity scores and prevalence of externalizing diagnoses were also compared between LR and HR groups. RESULTS: HR offspring showed lower theta power and decreased current source density (CSD) activity than LR offspring during loss and gain conditions. Younger males had higher theta power than younger females in both groups, while the older HR females showed more theta power than older HR males. Younger subjects showed higher theta power than older subjects in each comparison. Differences in topography (i.e., frontalization) between groups were also observed. Further, HR subjects across gender had higher impulsivity scores and increased prevalence of externalizing disorders compared to LR subjects. CONCLUSIONS: As theta power during reward processing is found to be lower not only in alcoholics, but also in HR subjects, it is proposed that reduced reward-related theta power, in addition to impulsivity and externalizing features, may be related in a predisposition to develop alcoholism and related disorders.

Reward processing deficits and impulsivity in high-risk offspring of alcoholics: A study of event-related potentials during a monetary gambling task.

BACKGROUND: Individuals at high risk to develop alcoholism often manifest neurocognitive deficits as well as increased impulsivity. The goal of the present study is to elucidate reward processing deficits, externalizing disorders, and impulsivity as elicited by electrophysiological, clinical and behavioral measures in subjects at high risk for alcoholism from families densely affected by alcoholism in the context of brain maturation across age groups and gender. METHODS: Event-related potentials (ERPs) and current source density (CSD) during a monetary gambling task (MGT) were measured in 12-25 year old offspring (N=1864) of families in the Collaborative Study on the Genetics of Alcoholism (COGA) Prospective study; the high risk (HR, N=1569) subjects were from families densely affected with alcoholism and the low risk (LR, N=295) subjects were from community families. Externalizing disorders and impulsivity scores were also compared between LR and HR groups. RESULTS: HR offspring from older (16-25 years) male and younger (12-15 years) female subgroups showed lower P3 amplitude than LR subjects. The amplitude decrement was most prominent in HR males during the loss condition. Overall, P3 amplitude increase at anterior sites and decrease at posterior areas were seen in older compared to younger subjects, suggesting frontalization during brain maturation. The HR subgroups also exhibited hypofrontality manifested as weaker CSD activity during both loss and gain conditions at frontal regions. Further, the HR subjects had higher impulsivity scores and increased prevalence of externalizing disorders. P3 amplitudes during the gain condition were negatively correlated with impulsivity scores. CONCLUSIONS: Older male and younger female HR offspring, compared to their LR counterparts, manifested reward processing deficits as indexed by lower P3 amplitude and weaker CSD activity, along with higher prevalence of externalizing disorders and higher impulsivity scores. SIGNIFICANCE: Reward related P3 is a valuable measure reflecting neurocognitive dysfunction in subjects at risk for alcoholism, as well as to characterize reward processing and brain maturation across gender and age group.

Visual illusions and inattention: Their association with adiposity among adolescent girls.

The Delboeuf concentric circle illusion is frequently invoked as an explanation for the hypothesized association between dinner plate size and overeating. We examined its association with adiposity among 162 girls, aged 14-18 years. We also examined the association of adiposity with neural and behavioral responses during a separate visual discrimination task. The analysis showed that girls with a body mass index percentile ≥ 85, or with greater triceps skinfold thickness, exhibited less sensitivity to the Delboeuf illusion than girls with normal adiposity. The excess adiposity group also exhibited significantly smaller electroencephalographic responses and more errors during the separate visual discrimination task. In combination, the findings from the two tasks suggest that girls with an elevated body mass are less sensitive to visual cues in their environment. The implications of these findings for weight loss education should be considered.

Who gains? Genetic and neurophysiological correlates of BMI gain upon college entry in women.

The present investigation examined P3 event-related electroencephalographic potentials and a short and selected list of addiction-related candidate gene single nucleotide polymorphisms (SNPs) within 84 female students, aged 18-20 yrs. The students were assigned to groups defined by the presence versus absence of a positive body mass index (BMI) change from the pre-college physical exam to the current day. Analyses revealed significantly greater P3 latencies and reduced P3 amplitudes during a response inhibition task among students who exhibited a BMI gain. BMI gain was also significantly associated with a ANKK1 SNP previously implicated in substance dependence risk. In logistic regression analyses, P3 latencies at the frontal electrode and this ANKK1 genotype correctly classified 71.1% of the students into the BMI groups. The present findings suggest that heritable indicators of impaired response inhibition can differentiate students who may be on a path toward an overweight or obese body mass.

On the association of common and rare genetic variation influencing body mass index: a combined SNP and CNV analysis.

BACKGROUND: As the architecture of complex traits incorporates a widening spectrum of genetic variation, analyses integrating common and rare variation are needed. Body mass index (BMI) represents a model trait, since common variation shows robust association but accounts for a fraction of the heritability. A combined analysis of single nucleotide polymorphisms (SNP) and copy number variation (CNV) was performed using 1850 European and 498 African-Americans from the Study of Addiction: Genetics and Environment. Genetic risk sum scores (GRSS) were constructed using 32 BMI-validated SNPs and aggregate-risk methods were compared: count versus weighted and proxy versus imputation. RESULTS: The weighted SNP-GRSS constructed from imputed probabilities of risk alleles performed best and was highly associated with BMI (p=4.3×10(-16)) accounting for 3% of the phenotypic variance. In addition to BMI-validated SNPs, common and rare BMI/obesity-associated CNVs were identified from the literature. Of the 84 CNVs previously reported, only 21-kilobase deletions on 16p12.3 showed evidence for association with BMI (p=0.003, frequency=16.9%), with two CNVs nominally associated with class II obesity, 1p36.1 duplications (OR=3.1, p=0.009, frequency 1.2%) and 5q13.2 deletions (OR=1.5, p=0.048, frequency 7.7%). All other CNVs, individually and in aggregate, were not associated with BMI or obesity. The combined model, including covariates, SNP-GRSS, and 16p12.3 deletion accounted for 11.5% of phenotypic variance in BMI (3.2% from genetic effects). Models significantly predicted obesity classification with maximum discriminative ability for morbid-obesity (p=3.15×10(-18)). CONCLUSION: Results show that incorporating validated effect sizes and allelic probabilities improve prediction algorithms. Although rare-CNVs did not account for significant phenotypic variation, results provide a framework for integrated analyses.

Neural and genetic correlates of binge drinking among college women.

Ninety-seven female students were assigned to groups consisting of 55 infrequent and 42 frequent binge drinkers. The groups were compared on self-report measures of impulsivity, sensation seeking, and alexithymia, as well as several measures relevant to neural and genetic mechanisms, such as brain activation during a time estimation task and selected genotypes. Analyses of stimulus-locked brain activity revealed a slow cortical potential over the right parietal cortex during time estimation that was more negative among frequent binge drinkers. This group also showed a greater prevalence of a CHRM2 genotype previously associated with substance dependence and Major Depressive Disorder as well as a modest elevation on a non-planning impulsiveness scale. We conclude that the enhanced brain activation shown by binge drinkers compensates for an underlying deficit. That deficit may be reflected in poor planning skills and a genetic difference indicating increased risk for problems in later life.

Normalizing effects of EVP-6124, an α-7 nicotinic partial agonist, on event-related potentials and cognition: a proof of concept, randomized trial in patients with schizophrenia.

UNLABELLED: Cognitive impairment is a cause of significant disability in patients with schizophrenia. To date, no drug has been approved for this indication by the U.S. Food and Drug Administration. This article presents findings suggesting that a medication targeting the alpha-7 nicotinic acetylcholine receptor (α7 nAChR) might meet this need. This single-center, randomized, parallel-group, double-blind,placebo-controlled study examined 21 medically stable patients with schizophrenia or schizoaffective disorder treated with second generation antipsychotics. Patients were treated with a daily dose of either 0.3 mg (n=8) or 1.0 mg (n=9) of EVP-6124, an α7 nAChR partial agonist, or placebo (n=4). Treatment continued for 21 days while patients continued their usual antipsychotic medication: aripiprazole (10-30 mg/day), olanzapine (10-20 mg/day), paliperidone (3-12 mg/day), or risperidone (2-16 mg/day). Cognitive test performance, eventrelated electroencephalographic (EEG) potentials, clinical symptoms, laboratory values, and clinical side effects were measured. EVP-6124 was well tolerated and showed positive, and in some cases, dose-dependent effects on several EEG responses, especially the Mismatch Negativity and P300 potentials. Positive effects were also found in performance on cognitive tests that measured non-verbal learning, memory, and executive function. This study is an example of the type of early proof of concept trial that is done to enable drug developers to evaluate whether to continue research on an agent. Based on the promising findings in this study, larger phase II studies were initiated to further test the pro-cognitive effects of EVP-6124 in patients with chronic schizophrenia. CLINICAL TRIALS REGISTRATION: Safety, Tolerability, and Pharmacokinetic Study of EVP-6124 in Patients with Schizophrenia, NCT01556763 http://clinicaltrials.gov/ct2/show/NCT01556763?term=NCT01556763&rank=1.

Default mode network activity and white matter integrity in healthy middle-aged ApoE4 carriers.

Alzheimer's disease (AD) is most commonly detected during old age, but the underlying neuropathologic changes likely appear decades earlier, especially among patients possessing genetic risk factors, such as the isoform E4 of the apolipoprotein E (ApoE4). In this study, we used magnetic resonance imaging (MRI) to assess default mode network (DMN) connectivity in 22 ApoE4 non-carriers and 14 matched ApoE4 carriers as well as white matter fractional anisotropy (FA) in 15 ApoE4 non-carriers and 11 demographically matched ApoE4 carriers. Cognitive tests were also administered. All of the participants were middle-aged adults. The analysis revealed no cognitive or white matter FA differences between carriers and non-carriers. However, in DMN regions previously implicated in AD, we did detect decreased functional connectivity. Our findings suggest that functional MRI abnormalities may be detectable well before cognitive decline or white matter changes among individuals at increased genetic risk for AD.

GABRA2 genotype, impulsivity, and body mass.

BACKGROUND: The goal of this study was to test a hypothesis associating impulsivity with an elevated body mass index (BMI). METHODS: To this end, we examined associations of BMI with putative genetic, neurophysiological, psychiatric, and psychological indicators of impulsivity in 78 women and 74 men formerly dependent on alcohol or drugs. A second analysis was designed to test the replicability of the genetic findings in an independent sample of 109 women and 111 men with a similar history of substance dependence. RESULTS: The results of the first analysis showed that BMI was positively correlated with Total and Nonplanning Scale Scores on the Barratt Impulsiveness Scale and the number of childhood symptoms of Attention-Deficit/Hyperactivity Disorder in women. It was also positively correlated, in women, with a GABRA2 variant previously implicated as a risk factor for substance dependence and an objective electroencephalographic feature previously associated with GABRA2 and relapse risk. The second analysis confirmed that the correlation between BMI and the substance-dependence-associated GABRA2 genotype was reliable and sex-specific. CONCLUSIONS: We conclude that an elevated BMI is associated with genetic, neurophysiological, psychiatric, and psychological indicators of impulsivity. The sex difference may be explained by greater opportunities to eat and overeat, a preference for higher calorie foods, a longer duration of alcohol/drug abstinence, or previous pregnancies in women.

Attention deficit hyperactivity symptoms and risky sexual behavior in young adult women.

BACKGROUND: This study was undertaken to assess the association between adult attention deficit/hyperactivity disorder (ADHD) symptoms and high-risk sexual behavior. METHODS: This cross-sectional study interviewed 462 low-income women aged 18-30 years. We used the 18-item Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist to assess ADHD symptoms. Risky sexual behaviors included sex before 15 years of age, risky sex partners in lifetime, number of sex partners in the last 12 months, condom use in the last 12 months, alcohol use before sex in the last 12 months, traded sex in lifetime, and diagnosed with sexually transmitted infection (STI) in lifetime. RESULTS: Mean ADHD symptom score was 19.8 (SD±12.9), and summary index of all risky sexual behavior was 1.77 (SD±1.37). Using unadjusted odds ratios (OR), women who endorsed more ADHD symptoms reported engaging in more risky sexual behaviors of all types. However, when multivariable logistic regression was applied adjusting for various sociodemographic covariates, the adjusted ORs remained significant for having risky sex partners and having ≥3 sex partners in the prior 12 months. We observed some differences in risky sexual behavior between two domains of ADHD. CONCLUSIONS: The ADHD symptom score appears to be associated with some risky sexual behaviors and deserves further attention. A brief ADHD screening can identify this high-risk group for timely evaluation and safe sex counseling.