Attention-deficit hyperactivity and conduct disorder: Comorbidity and implications for treatment.

The distinguishing and overlapping features of attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD) are discussed. Conclusions regarding comorbidity, treatment efficacy, and long-term outcome can be influenced by several factors, including diagnostic procedures and sample characteristics. The need to distinguish between referred and nonreferred samples is particularly crucial when considering treatment and comorbidity issues. The efficacy of psychosocial and pharmacological treatments in ADHD and CD children is reviewed as are the few studies of psychostimulant medication in comorbid youngsters. Suggestions regarding treatment planning and recommendations for treatment and research are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention-deficit hyperactivity disorder and communication disorders. Issues and clinical practices

Attention-deficit hyperactivity disorder (ADHD) is reviewed from the perspective of speech-language pathology, and various characteristics of the communicative process that co-occur with ADHD are presented. Incorporating Barkley's "inhibition model" with a systems theory approach and a functionality component, implications for service delivery and intervention are discussed. Five specific types of interventions are presented to encourage collaboration.     

Attention-deficit/hyperactivity disorder and conduct disorder symptomatology in adolescents with alcohol use disorder.

This study tested the hypothesis that attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) comorbidity is associated with substance use and deviance severity in 395 adolescents with alcohol use disorder. Thirty percent of the adolescents had high ADHD symptom counts, and 73% had 3 or more CD symptoms. ADHD-CD was associated with nonalcohol substance use disorder, drinking levels, and CD severity, but in general substance use was not uniquely elevated or problematic among the comorbid cases. In general, CD and CD severity were more important. The findings did not differ between boys and girls, revealing that in a treatment sample of adolescents, ADHD-CD comorbidity may need to be assessed and treated, but it is not broadly indicative of severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dual diagnosis of attention-deficit/hyperactivity disorder and substance abuse: case reports and literature review

BACKGROUND: It is now recognized that attention-deficit/hyperactivity disorder (ADHD) may persist into adulthood. A number of studies have found an association between ADHD and substance abuse. This article describes three adult patients with both ADHD and substance abuse who were treated successfully with psychostimulants. A review of the relevant literature is included. METHOD: The patients were drawn from a university-based referral center for adults with ADHD. Evaluations for ADHD and substance abuse were completed. Medical therapy and follow-up were completed by the first author. RESULTS: All of the patients responded to psychostimulants and have remained abstinent from alcohol and other drugs for the past 2 to 3 years. CONCLUSION: This case series and review of the literature suggest that specific treatment for ADHD with psychostimulants is feasible in patients who also have substance abuse. Future studies should evaluate the prevalence of this "dual diagnosis" and the efficacy of differing management strategies.     

Cocaine abuse and attention-deficit hyperactivity disorder: Implications of adult symptomatology.

Forty-three men between the ages of 18 and 48, in treatment for cocaine abuse or dependence, were evaluated for history of childhood attention-deficit hyperactivity disorder (ADHD) and adult symptoms (residual state). Participants completed a quantitative cocaine history and an interview designed to explore subjective cocaine experience. High ADHD scores were significantly correlated with high gram use of cocaine, r(41)?=?.37, p?r(41)?=?–.62, p?r(41)?=?.42, p?r(41)?=?.31, p?r(41)?=?.32, p?     

Group treatment for substance abuse in schizophrenia

OBJECTIVES: A review of the relevant research suggests a need to develop an appropriate, effective, and replicable treatment to help individuals with schizophrenia and substance abuse problems. This pilot study describes a biweekly group specifically designed to help the individual with both schizophrenia and substance abuse. The components of the group were support, psychoeducation, and skills training. Attention was also paid to the stage of recovery. METHOD: Eighteen subjects attended the group and were assessed pregroup. Thirteen subjects completed a 1-year follow-up, and 5 subjects were assessed between 3 and 6 months. RESULTS: At the follow-up assessment, 8 subjects (44%) were abstinent. CONCLUSIONS: This type of treatment appears to be effective for reducing substance abuse in this population.     

Handwriting in assessing treatment for substance abuse

Analysis of Mathematics and Language Arts scores for 11,438 fourth- and 8,972 seventh-grade students in compensatory education programs on the performance assessments for the Iowa Test of Basic Skills indicated the students performed poorly, particularly in mathematics.     

Comorbidity of schizophrenia and substance abuse: Implications for treatment.

The problem of substance abuse disorders in schizophrenia patients is reviewed, including the prevalence of comorbid disorders, assessment, hypothesized mechanisms underlying abuse, and the clinical effects of abuse on the course of illness and cognitive functioning. The principles of treatment for dual-diagnosis schizophrenia patients are outlined, and the limitations of existing interventions are noted. Gaps in current knowledge about the impact of substance abuse on schizophrenia and its treatment are identified, and suggestions are made regarding promising avenues of research in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multimodal treatment package for substance abuse treatment programs.

Describes a multimodal treatment design for a short-term, residential, hospital-based program for drug abusers. Each patient is expected to attend all program services with the intent that one or several will provide the corrective emotional experience facilitating change. Services included medical care, individual counseling/psychotherapy, group counseling, health education seminars, milieu/recreational therapy, Narcotics Anonymous meetings, linkage with aftercare components, and ancillary services (vocational rehabilitation, court liaison, and 90-day follow-up). Psychology interns and students are utilized. Results of internal follow-up show that 40% of Ss admitted over 3 yrs stated they were drug-free at 90 days and 1.5 yrs. (3 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention-deficit/hyperactivity disorder symptoms in preschool children: Examining psychometric properties using item response theory.

Clear and empirically supported diagnostic symptoms are important for proper diagnosis and treatment of psychological disorders. Unfortunately, the symptoms of many disorders presented in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000) lack sufficient psychometric evaluation. In this study, an item response theory (IRT) analysis was applied to ratings of the 18 attention-deficit/hyperactivity disorder (ADHD) symptoms in 268 preschool children. Children (55% boys, 45% girls) in this sample ranged in age from 37 to 74 months; 80.4% were identified as African American, 15.1% as Caucasian, and 4.5% as other ethnicity. Dichotomous and polytomous scoring methods for rating ADHD symptoms were compared and psychometric properties of these symptoms were calculated. Symptom-level analyses revealed that, in general, the current symptoms provided useful information in diagnosing ADHD in preschool children; however, several symptoms provided redundant information and should be examined further. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent substance abuse treatment outcome: The role of substance abuse problem severity, psychosocial, and treatment factors.

A structural equation model incorporating substance abuse problem severity, psychosocial risk and protection, and treatment variables examined adolescent drug abuse treatment outcome pathways across 6- and 12-month follow-up points. Findings on resiliency factors and an empirical method adapted from previous research were used to select and assign 10 psychosocial factors to either a multiple protective factor index or a risk factor index. Gender, substance abuse problem severity, treatment modality, treatment length, and aftercare participation were also examined as outcome predictors. The findings suggest that treatment intensity decisions may be better informed by pretreatment psychosocial risk level rather than by substance abuse problem severity. The present study also suggests that drug-abusing adolescents who receive sufficiently long treatment, participate in aftercare, and possess at least 1 individual or interpersonal protective factor during their recovery process have the best chance to maintain gains made during treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention-deficit hyperactivity disorder: a category or a continuum? Genetic analysis of a large-scale twin study

The improvement of preoperative imaging techniques gets hepatic surgery easier making it more safer and effective. The authors describe the most common hepatic pathologies, benign and malignant, pointing out for each one the principal diagnostic appearances achievable with, the several techniques and, collating these last between them, they optimize the diagnostic-curative pathways for several pathologies. Beyond allowing the diagnosis of the lesion's nature, an important role of the imaging modalities is also to evaluate the resectability of single lesion, weighing up its exact location and the impact on the vascular system esteeming, finally, the volume of remnant liver in case of larger resections. The intra- and extrahepatic, preoperative staging, of the varied hepatic lesions, primitive and secondary, performed comparing the most modern diagnostics techniques, results to be dramatically important arterial portography during, CT (CTAP), contrast-enhanced helical CT, MR imaging. For each patient it's possible to plan the most adequate treatment to his pathology.     

Twelve-step and cognitive-behavioral treatment for substance abuse: A comparison of treatment effectiveness.

The comparative effectiveness of 12-step and cognitive-behavioral (C-B) models of substance abuse treatment was examined among 3,018 patients from 15 programs at the US Department of Veterans Affairs Medical Centers. Across program types, participants showed significant improvements in functioning from treatment admission to a 1-year follow-up. Although 12-step patients were somewhat more likely to be abstinent at the 1-year follow-up, 12-step, C-B, and combined 12-Step–C-B treatment programs were equally effective in reducing substance use and improving most other areas of functioning. The finding of equal effectiveness was consistency over several treatment subgroups: Patients attending the "purest" 12-step and C-B treatment programs, and patients who had received the "full dose" of treatment. Also, patients with only substance abuse diagnoses, those with concomitant psychiatric diagnoses, and patients who were mandated to treatment showed similar improvement at the 1-year follow-up, regardless of type of treatment received. These data provide important new evidence supporting the effectiveness of 12-step treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Antisocial personality disorder, conduct disorder, and substance abuse in schizophrenia.

The validity of subtypes based on antisocial personality disorder (APD) or childhood conduct disorder without adult APD (CD only) in patients with schizophrenia (or schizoaffective disorder) and a substance use disorder (abuse or dependence) was examined. APD patients scored lower on personality measures related to socialization and higher on antisocial bebavior, psychopathy, and aggression. APD patients also reported higher rates of aggression and legal problems. APD, and to a lesser extent CD only, was associated with more severe psychiatric symptoms, an earlier age of onset of substance abuse, more severe symptoms of substance abuse, and a stronger family history of substance abuse and psychiatric hospitalization. The findings suggest that schizophrenia patients with APD represent a high-risk subgroup vulnerable to more severe substance abuse, psychiatric impairment, aggression, and legal problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost-effectiveness of inpatient substance abuse treatment

OBJECTIVE: To identify the characteristics of cost-effective inpatient substance abuse treatment programs. DATA SOURCES/STUDY SETTING: A survey of program directors and cost and discharge data for study of 38,863 patients treated in 98 Veterans Affairs treatment programs. STUDY DESIGN: We used random-effects regression to find the effect of program and patient characteristics on cost and readmission rates. A treatment was defined as successful if the patient was not readmitted for psychiatric or substance abuse care within six months. PRINCIPAL FINDINGS: Treatment was more expensive when the program was smaller, or had a longer intended length of stay (LOS) or a higher ratio of staff to patients. Readmission was less likely when the program was smaller or had longer intended LOS; the staff to patient ratio had no significant effect. The average treatment cost $3,754 with a 75.0% chance of being effective, a cost-effectiveness ratio of $5,007 per treatment success. A 28-day treatment program was $860 more costly and 3.3% more effective than a 21-day program, an incremental cost-effectiveness of $26,450 per treatment success. Patient characteristics did not affect readmission rates in the same way they affected costs. Patients with a history of prior treatment were more likely to be readmitted but their subsequent stays were less costly. CONCLUSIONS: A 21-day limit on intended LOS would increase the cost-effectiveness of treatment programs. Consolidation of small programs would reduce cost, but would also reduce access to treatment. Reduction of the staff to patient ratio would increase the cost-effectiveness of the most intensively staffed programs.     

Attention-deficit/hyperactivity disorder: relations between prevalence rate and school district size, diagnostic method, and referral process

To study whether prevalence rates of Attention-Deficit/Hyperactivity Disorder (ADHD) are related to size of school district, diagnostic method, and referral process, the ADHD Survey was mailed to all 311 superintendents of school districts in a midsouthern state; 128 (41.1%) were returned. Analysis showed no significant relationships; however, the low return rate suggests replication in other regions is necessary.