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Attention-deficit hyperactivity disorder (ADHD) is typically characterized as a disorder of inattention and hyperactivity/impulsivity but there is increasing evidence of deficits in motivation. Using positron emission tomography (PET), we showed decreased function in the brain dopamine reward pathway in adults with ADHD, which, we hypothesized, could underlie the motivation deficits in this disorder. To evaluate this hypothesis, we performed secondary analyses to assess the correlation between the PET measures of dopamine D2/D3 receptor and dopamine transporter availability (obtained with [ 11 C]raclopride and [ 11 C]cocaine, respectively) in the dopamine reward pathway (midbrain and nucleus accumbens) and a surrogate measure of trait motivation (assessed using the Achievement scale on the Multidimensional Personality Questionnaire or MPQ) in 45 ADHD participants and 41 controls. The Achievement scale was lower in ADHD participants than in controls (11±5 vs 14±3, P <0.001) and was significantly correlated with D2/D3 receptors (accumbens: r =0.39, P <0.008; midbrain: r =0.41, P <0.005) and transporters (accumbens: r =0.35, P <0.02) in ADHD participants, but not in controls. ADHD participants also had lower values in the Constraint factor and higher values in the Negative Emotionality factor of the MPQ but did not differ in the Positive Emotionality factor—and none of these were correlated with the dopamine measures. In ADHD participants, scores in the Achievement scale were also negatively correlated with symptoms of inattention (CAARS A, E and SWAN I). These findings provide evidence that disruption of the dopamine reward pathway is associated with motivation deficits in ADHD adults, which may contribute to attention deficits and supports the use of therapeutic interventions to enhance motivation in ADHD.

Objective: To examine the associations between attention-deficit/hyperactivity disorder (ADHD) symptoms, obesity and hypertension in young adults in a large population-based cohort. Design, Setting and Participants: The study population consisted of 15 197 respondents from the National Longitudinal Study of Adolescent Health, a nationally representative sample of adolescents followed from 1995 to 2009 in the United States. Multinomial logistic and logistic models examined the odds of overweight, obesity and hypertension in adulthood in relation to retrospectively reported ADHD symptoms. Latent curve modeling was used to assess the association between symptoms and naturally occurring changes in body mass index (BMI) from adolescence to adulthood. Results: Linear association was identified between the number of inattentive (IN) and hyperactive/impulsive (HI) symptoms and waist circumference, BMI, diastolic blood pressure and systolic blood pressure (all P -values for trend <0.05). Controlling for demographic variables, physical activity, alcohol use, smoking and depressive symptoms, those with three or more HI or IN symptoms had the highest odds of obesity (HI 3+, odds ratio (OR)=1.50, 95% confidence interval (CI)=1.22−2.83; IN 3+, OR=1.21, 95% CI=1.02−1.44) compared with those with no HI or IN symptoms. HI symptoms at the 3+ level were significantly associated with a higher OR of hypertension (HI 3+, OR=1.24, 95% CI=1.01−1.51; HI continuous, OR=1.04, 95% CI=1.00−1.09), but associations were nonsignificant when models were adjusted for BMI. Latent growth modeling results indicated that compared with those reporting no HI or IN symptoms, those reporting 3 or more symptoms had higher initial levels of BMI during adolescence. Only HI symptoms were associated with change in BMI. Conclusion: Self-reported ADHD symptoms were associated with adult BMI and change in BMI from adolescence to adulthood, providing further evidence of a link between ADHD symptoms and obesity.

Introduction: Initial reactions to cigarettes predict later regular smoking. Symptoms of attention deficit hyperactivity disorder (ADHD) have also been shown to increase smoking risk and may moderate the relationship between genotype and smoking. We conducted an exploratory study to assess whether ADHD symptoms interact with genetic variation to predict self-reported initial reactions to smoking. Methods: Participants were a subsample of 1,900 unrelated individuals with genotype data drawn from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of adolescents followed from 1995 to 2002. Linear regression was used to examine relationships among self-reported ADHD symptoms, genotype, and self-reported initial reactions to cigarettes (index scores reflecting pleasant and unpleasant reactions). Results: Polymorphisms in the DRD2 gene, SLC6A4 gene, and among males, the MAOA gene interacted with retrospective reports of ADHD symptoms in predicting pleasant initial reaction to cigarettes. Polymorphisms in the CYP2A6 gene and, among females, the MAOA gene interacted with retrospective reports of ADHD symptoms in predicting unpleasant initial reaction to cigarettes. No main effect for any of these polymorphisms was observed nor were any interactions with DRD4 and DAT genes. Conclusions: These findings suggest that genotypes associated with monoamine neurotransmission interact with ADHD symptoms to influence initial reactions to cigarette smoking. Given that an initial pleasant reaction to cigarettes increases risk for lifetime smoking, these results add to a growing body of literature that suggests that ADHD symptoms increase risk for smoking and should be accounted for in genetic studies of smoking.

Abstract Introduction Polysomnography (PSG) is the gold-standard objective sleep assessment. However, particularly in pediatric samples, PSG is associated with sleep disturbances resulting from discomfort in the lab environment, a difficulty further amplified in youth with behavioral disorders such as ADHD. Ambulatory PSG records sleep at home, reduces lab-related sleep disturbances, and is acceptable to typically-developing children, and thus, may be a useful tool for sleep studies with ADHD youth. This study is the first to examine the feasibility and tolerability of ambulatory PSG with an ADHD sample. Initial data loss observed during the study (pulled wires) led to a solution (taping wires to the recorder). A crossover study examining data collected prior and subsequent to tape use investigated the effectiveness of this solution for increasing feasibility of ambulatory PSG with ADHD adolescents. Methods Twenty-two adolescents (aged 13–17; 13 ADHD, 9 Healthy Controls) participated in three nights of ambulatory PSG (Philips Alice PDx Portable Sleep System). Monitors were attached by a trained technician and participants subsequently slept at home and removed monitors each morning. Scored sleep studies assessed completeness of PSG data. The clinician-administered At-Home PSG Tolerability Rating Scale [Lunsford-Avery & Krystal] assessed the comfort of the system, system-related sleep disturbances, and overall study satisfaction. Results Data collection improved following use of tape (n = 11; 94% nights successfully collected) compared to use without tape (n = 11; 70%) at the trend level (p = .08). On average, adolescents indicated mild discomfort, minimal sleep disruptions, and overall satisfaction with the system. Groups did not differ in their ratings of the acceptability/tolerability of ambulatory PSG (p’s > .10). Conclusion Ambulatory PSG is a feasible and acceptable method for collecting sleep data in adolescents with ADHD. However, ADHD symptoms (e.g., fidgeting) resulted in a risk for data loss (e.g., pulled wires). Taping wires to the recording box eliminated data loss. This modification should be implemented when using ambulatory PSG with this population. Support (If Any) This work was supported by NIMH K23 MH108704 (Dr. Lunsford-Avery).

Abstract Introduction Executive functioning (EF) deficits are a key feature of ADHD, and sleep disturbances may be an important contributor. Specifically, disturbed sleep is prevalent in ADHD and similar EF deficits are observed in ADHD and sleep disorders. Associations between disrupted sleep and EF in ADHD are poorly understood, particularly during adolescence. This study is among the first to examine relationships between sleep and EF using polysomnography (PSG) among adolescents across the ADHD symptom continuum. Methods In this ongoing study, 42 adolescents aged 13 to 17 (mean age = 14.86, 20 females) completed 3 nights of at-home PSG recording (total sleep time; TST) and self-reports of sleep quality, daytime sleepiness, and chronotype. Seventeen had ADHD and 25 were healthy controls (HC). Participants and parents also completed a measure of EF (BRIEF-2; global and behavioral, emotional, and cognitive subscales). Linear regressions controlling for age and sex evaluated associations between sleep and EF. Results Self-reported poorer sleep quality and greater daytime sleepiness and eveningness tendency (p’s<.05), but not TST, were associated with poorer self-reported global EF among adolescents. Shorter TST and greater eveningness were correlated with poorer parent-reported global EF (p’s<.05). Follow up analyses examine differential relationships between sleep and behavioral, emotional, and cognitive domains of EF and between ADHD and HC groups. Conclusion This study is among the first to examine relationships between sleep and EF across the ADHD continuum in an adolescent-specific sample using PSG. Objectively-measured TST as well as subjective measures of sleep were associated with poorer EF in adolescents across the ADHD continuum. Prevention/intervention strategies focused on sleep may support EF among adolescents, and future studies should examine this possibility. In addition, given variability in EF among individuals with ADHD, future studies should investigate whether sleep disturbances identify a phenotypic subgroup within ADHD at risk for EF deficits. Support This work was supported by NIMH K23 MH108704 (Dr. Lunsford-Avery)

Introduction: Smokers with attention deficit hyperactivity disorder (ADHD) have greater difficulty quitting than those without ADHD, but preliminary data (McClernon, Kollins, Lutz, Fitzgerald, Murray, Redman, et al., 2008) suggest equivalent severity of withdrawal symptoms following brief abstinence. The objective of this study was to characterize the differential effects of intermediate term smoking abstinence on self-reported withdrawal and ADHD symptoms in adult smokers with and without ADHD. Methods: Forty adult (50% female), nontreatment seeking moderate-to-heavy smokers with and without ADHD were enrolled in a 12-day quit study in which monetary incentives were provided for maintaining biologically verified abstinence. Self-reported withdrawal, mood, and ADHD symptoms were measured pre- and post-quitting. Results: ADHD and controls did not vary on smoking or demographic variables. Significant Group × Session interactions were observed across a broad range of withdrawal symptoms and were generally characterized by greater withdrawal severity among ADHD smokers, particularly during the first 5 days of abstinence. In addition, Group × Sex × Session interactions were observed for craving, somatic symptoms, negative affect, and habit withdrawal; these interactions were driven by greater withdrawal severity among females with ADHD. Group × Session interactions were not observed for ADHD symptom scales. Conclusions: The results of this study suggest that smokers with ADHD, and ADHD females in particular, experience greater withdrawal severity during early abstinence-independent of effects on ADHD symptoms. Whereas additional research is needed to pinpoint mechanisms, our findings suggest that smoking cessation interventions targeted at smokers with ADHD should address their more severe withdrawal symptoms following quitting.

Smokers with attention-deficit/hyperactivity disorder (ADHD) differ from smokers without ADHD across a range of smoking outcomes (e.g., higher prevalence rates of smoking, faster progression to regular smoking, and greater difficulty quitting). Moreover, ADHD as a disorder has been characterized by deficits in fundamental motivational processes. To date, few studies have examined how motivation for smoking might differ between nicotine-dependent individuals with and without ADHD. The goal of this study was to assess whether specific smoking motivation factors differentiate smokers with and without ADHD as measured by an empirically derived self-report measure of smoking motivations. Smokers with (n = 61) and without (n = 89) ADHD participated in a range of laboratory and clinical studies that included the Wisconsin Inventory of Smoking Dependence Motives (WISDM). A series of one-way analysis of covariances statistically controlling for age and race indicated that smokers with ADHD scored higher on the following WISDM subscales than their non-ADHD peers: automaticity, loss of control, cognitive enhancement, cue exposure, and negative reinforcement. Smokers in the non-ADHD group yielded higher scores on the social- environmental goads WISDM subscale. No group by gender interactions emerged. Cigarette smokers with ADHD report different motives for smoking than smokers without ADHD. Clarifying the role of these motivational factors has implications for smoking prevention and treatment.

Smoking prevalence among individuals with posttraumatic stress disorder (PTSD) is elevated relative to non-PTSD smokers, and there is evidence to suggest that affect regulation may be a motivation for smoking among those with this disorder. Previous studies have also indicated that (a) PTSD is frequently comorbid with attention-deficit/hyperactivity disorder (ADHD), (b) individuals with ADHD smoke at significantly higher rates than the general population, (c) subclinical ADHD symptoms are a risk factor for smoking, and (d) affect regulation is a motivation for smoking in ADHD. The goal of this study was to assess the degree to which ADHD symptoms were uniquely associated with smoking-related affective functioning (SRAF) variables above and beyond the variance already explained by PTSD symptoms. Smokers with (n = 55) and without PTSD (n = 68) completed measures assessing PTSD symptoms, ADHD symptoms, and SRAF. The PTSD group endorsed significantly more severe levels of DSM-IV inattentive and hyperactive-impulsive ADHD symptoms. A series of hierarchical regressions among the entire sample indicated that, after accounting for PTSD symptoms, ADHD symptoms were associated with lower positive affect, higher negative affect, higher emotion dysregulation, higher anxiety sensitivity, and higher urges to smoke to increase positive affect. Taken together, these findings suggest that ADHD symptoms may increase affective dysregulation difficulties already faced by smokers, particularly those with PTSD, which may, in turn, confer increased risk for smoking relapse in those with higher levels of symptomatology of both disorders.

A study of the behavior of six attention-deficit hyperactivity disorder children and six comparison children on a computer task designed to present different parameters of reinforcement by using concurrent reinforcement schedules is presented.