The adherence to published guidelines for diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD) by primary care pediatricians (PDs) and family practice physicians (FPs), particularly those in rural areas, has not been well documented. This study examined survey responses from PDs and FPs who serve southern Appalachia (northeast Tennessee, southwest Virginia and Kentucky, and western North Carolina) regarding key practice parameters in line with the current American Academy of Pediatrics guidelines. Results showed that both PDs and FPs reported adhering to most of the diagnosis and treatment guidelines. PDs were more likely than FPs to report using both parent and teacher input in diagnosis and reported prescribing different medications for ADHD to some degree. Both practice areas reported ongoing access to continuing medical education, which is a means to enhancing care of ADHD patients. Implications for primary care are given with attention to the limited availability of PDs in rural areas and future areas of research in rural mental healthcare are suggested.

The effects of sertraline and methylphenidate on attention and behavior in children with attention deficit hyperactivity disorder were compared. Thirty-two children were randomly assigned to treatment with methylphenidate 20 mg per day, sertraline 50 mg per day, or a waiting list control group. Baseline testing included the Wechsler Intelligence Scale for Children, Children's Depression Inventory, Conners Parent and Teacher Rating Scales (CPRS and CTRS), Gordon Diagnostic System (GDS), and the Test of Variables of Attention (TOV A). After at least 2 weeks of medication the CPRS, CTRS, GDS, and TOVA were repeated. Analyses ofthe data using repeated measures ANOVAs revealed no significant main effects of treatment group on any of the primary outcome variables. However, several significant interaction effects of treatment group and trial period were noted. Children given methylphenidate showed significant improvement on measures of both attention and impulsivity/hyperactivity. Children in the sertraline group improved significantly on subscale 3 ofthe CPRS which measures impulsivity/hyperactivity, and showed a trend toward improvement in attention. Children in the control group did not improve significantly on measures of attention or impulsivity/hyperactivity. Both medications were well tolerated. These results suggest that methylphenidate is a more effective medication for ADHD than sertraline. However, the trend toward improvement with sertraline suggests that further clinical trials are warranted.

With this study, we have chosen to continue our B-essay about dual-diagnosis.In the essay we have done some research on how this target group feels about the treatment from the dependent unit, psychiatry unit, social services unit and the housing environment. We wanted to know about the feelings because during the B-essay we found out that individuals whit the dual-diagnosis is skipped between different caregivers. We used a qualitative method with six interviews from two different housings in south of Sweden. The information we got we used in our result and analysis part, where we found out that the caretaker’s thought the treatment were fine and that it was the surroundings they found the most fault with.

Impulsivity is a hallmark of two of the three DSM-IV ADHD subtypes and is associated with myriad adverse outcomes. Limited research, however, is available concerning the mechanisms and processes that contribute to impulsive responding by children with ADHD. The current study tested predictions from two competing models of ADHD – working memory (WM) and behavioral inhibition (BI) – to examine the extent to which ADHD-related impulsive responding was attributable to model-specific mechanisms and processes. Children with ADHD (n = 21) and typically developing children (n = 20) completed laboratory tasks that provided WM (domaingeneral central executive [CE], phonological/visuospatial storage/rehearsal) and BI indices (stopsignal reaction time [SSRT], stop-signal delay, mean reaction time). These indices were examined as potential mediators of ADHD-related impulsive responding on two diverse laboratory tasks used commonly to assess impulsive responding (CPT: continuous performance test; VMTS: visual match-to-sample). Bias-corrected, bootstrapped mediation analyses revealed that CE processes significantly attenuated between-group impulsivity differences, such that the initial large-magnitude impulsivity differences were no longer significant on either task after accounting for ADHD-related CE deficits. In contrast, SSRT partially mediated ADHD-related impulsive responding on the CPT but not VMTS. This partial attenuation was no longer significant after accounting for shared variance between CE and SSRT; CE continued to attenuate the ADHD-impulsivity relationship after accounting for SSRT. These findings add to the growing literature implicating CE deficits in core ADHD behavioral and functional impairments, and suggest that cognitive interventions targeting CE rather than storage/rehearsal or BI processes may hold greater promise for alleviating ADHD-related impairments

Hyperactivity is currently considered a core and ubiquitous feature of attention-deficit/hyperactivity disorder (ADHD); however, an alternative model challenges this premise and hypothesizes a functional relationship between working memory (WM) and activity level. The current study investigated whether children s activity level is functionally related to WM demands associated with the domain-general central executive and subsidiary storage/rehearsal components using tasks based on Baddeley s (2007) WM model. Activity level was objectively measured 16 times per second using wrist- and ankle-worn actigraphs while 23 boys between 8 and 12 years of age completed control tasks and visuospatial/phonological WM tasks of increasing memory demands. All children exhibited significantly higher activity rates under all WM relative to control conditions, and children with ADHD (n=12) moved significantly more than typically developing children (n=11) under all conditions. Activity level in all children was associated with central executive but not storage/rehearsal functioning, and higher activity rates exhibited by children with ADHD under control conditions were fully attenuated by removing variance directly related to central executive processes.

Attention-deficit/hyperactivity disorder (ADHD) is highly comorbid with substance use disorders, particularly cocaine. Preclinical studies using the well-validated Spontaneously Hypertensive Rat (SHR) model of ADHD suggest that adolescent treatment with the stimulant methylphenidate increases cocaine abuse risk in adulthood, highlighting the need to identify alternative medications for teenagers with ADHD. Experiments 1-4 tested the hypothesis that atomoxetine, a non-stimulant that improves prefrontal cortex functioning in adolescent SHR, would not increase cocaine abuse risk. The speed to acquire cocaine self-administration, the efficacy and motivating influence of cocaine reinforcement, and reactivity to cocaine cues in adulthood following discontinuation of adolescent atomoxetine treatment were examined in male SHR and two genetic control strains: inbred Wistar-Kyoto (WKY) and outbred Wistar (WIS). Because atomoxetine is not always as clinically efficacious as methylphenidate, Experiments 5-9 tested the hypothesis that an alternative stimulant, d-amphetamine, would improve cognitive performance in adolescent SHR during a strategy set-shifting task and not increase cocaine abuse risk in adult SHR after adolescent d-amphetamine was discontinued. Across experiments, adult SHR acquired cocaine self-administration faster than control strains and also were more sensitive to cocaine’s reinforcing and motivating influence and more reactive to cocaine cues. As hypothesized, adolescent atomoxetine did not increase any measure of cocaine abuse risk in adult SHR and modestly reduced SHR’s reactivity to cocaine cues. In WKY control, however, adolescent atomoxetine accelerated acquisition of cocaine self-administration. d-Amphetamine improved set-shifting deficits in adolescent SHR, demonstrating pro-cognitive effects as hypothesized. When self-administration was acquired, cocaine intake was lower in adult SHR that received adolescent d-amphetamine compared to vehicle-treated SHR, consistent with the hypothesis. Adolescent d-amphetamine slowed acquisition and reduced the efficacy and motivating influence of cocaine reinforcement in WIS control, but accelerated acquisition in WKY control. Collectively, these results highlight the heuristic value of SHR in evaluating comorbid ADHD and cocaine abuse risk, and suggest that atomoxetine and d-amphetamine may be safer medications than methylphenidate for teenagers with ADHD. However, findings in control strains emphasize the need for accurate ADHD diagnosis, as the long-term consequences of treatment could be favorable (d-amphetamine in WIS) or unfavorable (atomoxetine and d-amphetamine in WKY) in misdiagnosed individuals.

Attention reorienting is crucial to human survival in a constantly changing environment. In order to react and respond to novel and potentially threatening stimuli in the environment, we have to first reorient our attention to the stimuli themselves. While numerous studies in the past have attempted to uncover the principles of how our brain processes new stimuli and reorients our attention, they typically employed standardized paradigms such as an oddball or a cueing paradigm that do not represent how humans actually reorient attention in the real world. This dissertation seeks to directly address this issue by investigating the brain dynamics underlying attention reorienting in an immersive and naturalistic environment. We employ a virtual reality (VR)-based target detection paradigm that closely mimics how human would reorient their attention in real-world situations. During the experiments, subjects are instructed to reorient their attention between a primary visual task (driving simulation) and a secondary visual task (target detection) while their electroencephalography (EEG), eyetracking and behavioral inputs are being recorded. Each set of experiments and subsequent data analysis methods are tailored to answer different questions based on the three specific aims of this dissertation (1) how do eye movements affect attention reorienting signals? (2) how do we integrate the information obtained from the neural and ocular signals to decode reorienting? and (3) what is the relationship between attention reorienting and the arousal system? We found that while eye movements result in greater temporal variation of neural signals associated with attention reorienting, namely the P300 signal, time-locking the event-related potentials (ERPs) to image onset or saccade intersection still results in the best overall performance in classifying target vs. distractor stimuli. Similarly to eye movements, we also found that allowing for head movements results in greater temporal variations of both the neural (P300) and pupil-linked attention reorienting signals. However, by combining the EEG, pupil dilation and dwell time signals, a multi-modal hybrid classifier we developed using the hierarchical discriminant component analysis (HDCA) was able to capture and integrate the neural and ocular attention reorienting signals with similar performance both in the condition with and without head movements. In addition, the hybrid classifier outperformed single-modality classifiers (EEG-only, pupil dilation-only and dwell time-only) in all comparisons. Lastly, we reported a close-knit relationship between pupil-linked arousal and network-level EEG dynamics underlying attention reorienting. We observed improvements in overall performance as pupil-linked arousal increased. We also observed increased oscillatory activity across multiple frequency bands in regions associated with the dorsal and ventral attention networks as pupil-linked arousal increased. Additionally, we found a decrease in functional connectivity across nodes in the salience network and the ventral attention network as pupil-linked arousal increased. The findings of this dissertation have the potential to serve as the basis for the development of the next generation of non-invasive brain-computer interfaces (BCIs) that can function in real-world environments. Furthermore, these findings may also serve to help physicians and neuroscientists better understand the neurophysiology underlying attention-related disorders including attention-deficit disorder (ADD) or attention-deficit/hyperactivity disorder (ADHD).

The purpose of this study was to determine if attention-deficit/hyperactivity disorder (ADHD) subtypes (predominantly hyperactive/impulsive, ADHD-HI; predominantly inattentive, ADHD-IA; combined, ADHD-C) exhibit distinct neuropsychological profiles, using the Attention and Executive Function subtests of the Developmental Neuropsychological Assessment, (NEPSY) and the omission and commission scores obtained on the Conners' Continuous Performance Test-II (CPT-II), a test that assesses attention processes. The sample was selected using archival data collected in a neurodevelopmental clinic over the past decade and consisted of 138 children between the ages of 6 and 12 years old. Using the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) criteria, the children were placed in either the ADHD-HI (n = 40), ADHD-IA (n = 35), or ADHD-C (n = 36) group, or a symptom free comparison group (n = 27). It was hypothesized that children with elevations on the impulsivity/ hyperactivity (ADHD-HI and ADHD-C) scale would be impaired on measures of inhibition and those with elevations on the inattention scale (ADHD-IA and ADHD-C) would be impaired on tests of attention, vigilance, and other executive functions. A one-way multivariate analyses of variance (MANOVA) was conducted (Group X Task), with significant results for overall main effect for group on the 7 dependent variables post hoc tests using the Tukey's honestly significant difference (HSD) revealed the following: the ADHD-HI group scored significantly lower on tests that require behavioral inhibition processes (Knock and Tap, Statue and CPT-Commission errors). The ADHD-IA group scored significantly lower on tests of problem-solving and planning (Tower) but not on tests of attention as was expected. The ADHD-C group scored significantly lower on tests of inhibition, attention, and other executive functions (Auditory Attention Response Set, Visual Attention, Tower, Knock and Tap, Statue, and CPT-Omission and CPT-Commission errors). Overall results suggest that the NEPSY Attention and Executive Function subtests are able to differentiate ADHD subtypes. Recommendations for future research are discussed.

Bakgrund: Attention deficit/hyperactivity disorder (ADHD) hos barn är en av världens vanligaste neuropsykiatriska funktionsnedsättningar (NPF). Många människor har förutfattade meningar angående vad ADHD är, men att få lära sig och förstå hur det är att vara förälder till ett barn med ADHD och förstå vad dessa föräldrar går igenom varje dag, finns det inte tillräckligt mycket forskning om. Syfte: Att beskriva föräldrarnas upplevelse av att vara förälder till ett barn med ADHD. Metod: En litteraturstudie med kvalitativ design. För att få fram det kvalitativa materialet till studien användes tre databaser, PubMed, Cinahl och PsychInfo. En litteraturstudie med en kvalitativ innehållsanalys med induktiv ansats valdes för att kunna fördjupa sig i upplevelsen från ett inifrånperspektiv från föräldrar till barn med ADHD och deras vardag. Under innehållsanalysen användes ett manifest förhållningssätt för att analysera de utvalda artiklarna innehåll. Innehållsanalysen utfördes genom att de utvalda artiklarna lästes igenom och sedan extraherades textenheter, som är meningar, stycken eller citat som har relevans för det utvalda syftet. Efter kondensering och kategorisering av textenheter resulterade i fyra kategorier. Resultat: De fyra kategorierna som framkom i analysen var; Att hantera och uppleva stress i vardagslivet, Att känna press och krav från skolan, Att känna brist på stöd och resurser och Att bli socialt isolerad och stigmatiserad. I helhet kunde de ses i denna litteraturstudie att den generella upplevelsen av att vara förälder till ett barn med ADHD var den konstanta stressen. Stressen över deras framtid, stress för att de inte ska klara av skolan, stress över att de inte kommer ha några vänner och stressen över att inte veta när nästa utbrott kommer ske. Det som även kunde ses var att föräldrarna inte bara blev påverkade av barnets sjukdom, men även att syskonen påverkades. Slutsats: Att leva med ett barn som har ADHD resulterar i stor stress hos föräldrarna. Barnets beteende påverkar familjen i och utanför hemmet, samt hur skola och samhället uppfattar dem som familj och som föräldrar. Nyckelord: ADHD, Attention deficit/hyperactivity disorder, parents, lived experience, nursing, stress.

ADHD är en vanligt förekommande neuropsykiatrisk funktionsnedsättning som kan leda till stigmatisering på arbetsplatsen. Syftet med föreliggande studie var att genom en kvalitativ intervjustudie studera hur en grupp personer med ADHD upplever denna stigmatisering på arbetsplatsen utifrån ett inifrånperspektiv. Studien syftade även till att undersöka vilka faktorer i arbetslivet som kan vara faciliterande och hindrande för personer med ADHD. Tio personer med ADHD intervjuades med hjälp av en semistrukturerad intervjuguide. Intervjuerna analyserades därefter utifrån ett hermeneutiskt synsätt. Analysen resulterade i fem teman; Upplevelser av och förhållningssätt till sin ADHD diagnos på arbetsplatsen, Identitet och självbild på arbetsplatsen, Deltagarnas uppfattning av allmänhetens uppfattning- stigmatisering, Öppet eller dolt stigma och Faciliterande och hindrande faktorer i arbetsmiljön. Deltagarna hade både individuella och gemensamma upplevelser av stigmatisering på arbetsplatsen kopplat till ADHD. I intervjuerna framkommer bland annat en önskan om ökad kunskap och förståelse, och det framkommer en oro bland deltagarna över hur diagnosen ska tas emot av andra. Det fanns en koppling mellan att vilja berätta om sin diagnos och tilliten till den man ska berätta det för. Deltagarna önskar också stöd kring rutiner och arbetsmiljö för att kunna vara så effektiva som möjligt.  Studier som undersöker ADHD hos vuxna är få och denna studie bidrar till att öka kunskapen kring gruppen.