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Open Access Publications from the University of California

Scholarly Works (16 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2016)

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with childhood onset that confers greater risk for many negative outcomes including future psychopathology, increased risk for substance abuse, poor self-esteem, and poor social functioning. Identification of targeted treatment approaches requires not only accurate measurement of the construct under study, but also an analytic method that can appropriately identify the effect of treatment, while accounting for the noise of measurement error. This study aimed to address the evident gap in our ability to predict an individual’s response to treatment by first identifying a best-fitting model for ADHD symptoms and then using this best fitting model to estimate treatment effect with increased precision.

A sample of 1,612 children and adolescents ages 6 to 17 was used to test the best-fitting model for ADHD. Results from the confirmatory model suggest that a modified bifactor model had better fit (BIC = 47902.44, M2(1346) = 2944.68, RMSEA = .03) compared to the unidimensional and correlated factor models and best minimized mean dimension differences across gender and age. In this modified bifactor model, impulsivity items loaded only on the primary dimension, while inattention and hyperactivity items loaded on both the primary dimension and two separate specific dimensions.

In the analysis of treatment effect, two randomized controlled clinical trials of pharmacotherapy for children and adolescents with ADHD were evaluated; DMPH compared to DMPH + guanfacine and atomoxetine compared to placebo. Item parameters generated in study one were used to estimate the treatment models. In the IRT analyses, atomoxetine produced significant reductions in the inattention and the general dimension, however there was more variability in children’s response to atomoxetine as measured by the general dimension. When comparing DMPH and combination treatment, combination treatment was superior in the treatment of the general dimension. Examining variability in average scores provided by the IRT analysis, it appeared that combination treatment was more effective in consistently reducing symptoms across children on the inattention dimension, while DMPH was more effective in consistently reducing symptoms across children on the general dimension. Therefore, creating conditionally independent dimensions clearly allowed for more precise modeling of treatment effect. The field of psychiatry, and more broadly treatment research, could benefit substantially from continued use of IRT models.

    Cover page: Applications of Item Response Theory to Clinical ADHD Research: Analysis of the Hierarchical Structure of ADHD Symptoms and Increased Precision of Treatment Effect Estimation
    • Thesis
    • Peer Reviewed
    UCLA Electronic Theses and Dissertations (2013)

    Attention and working memory, two constructs that affect youth who have ADHD and anxiety, are essential in establishing automaticity and success in academic achievement. Using data from a large study involving 502 children and adolescents (332 diagnosed with ADHD, 145 diagnosed with anxiety disorder, and 126 diagnosed with neither), ages 7 to 15 years, this paper applies structural equation modeling to test the sequential relationship between the latent constructs of attention, working memory, and academic achievement, and the effects of symptoms of ADHD and anxiety on each construct, and also to assess consistency in measurement techniques of each underlying construct. The study establishes that the structural equation model created to replicate a theory of automaticity fit the data from this sample well, and there was significant sequential prediction between attention, working memory, and academic achievement. In addition, better performance on measures of attention and working memory predicts higher academic achievement, as relative weaknesses in academic achievement seen in children and adolescents with ADHD can be explained largely by deficits in attention and working memory. Anxiety symptoms were unrelated to attention, working memory, and academic achievement, when controlling for ADHD. However, a significant negative correlation between harm avoidance, a trait of anxiety, and ADHD symptoms suggest that it may be of value to explore the theoretical underpinnings of the relationship between harm avoidance, ADHD, and academic achievement.

      Cover page: Effects of Attention-Deficit/Hyperactivity Disorder and Anxiety on Attention, Working Memory, and Academic Achievement in Children and Adolescents: A Structural Equation Modeling Approach
      • Article
      • Peer Reviewed
      UCLA Previously Published Works (2024)
      BACKGROUND: There are an increasing number of English Learners (EL) served in schools, including children with Autism Spectrum Disorder (ASD). However, little is known about students who receive school-based services as EL and under autism eligibility. PURPOSE & METHODS: The present study aimed to examine the sociodemographic characteristics, time to English Language Proficient status by survival analysis, and predictors of English fluency utilizing a logistic regression for dually identified EL and autism eligible students in a large urban school district during the 2011-2019 academic school years. RESULTS: Overall, dually identified students (N = 849) educated in segregated settings (N = 372) became English proficient at lower rates and at older ages than students included in general education (N = 477). CONCLUSION: Students placed in segregated special education classrooms were significantly less likely to achieve English Language Proficient classification. The present study begins to illustrate the time to English proficiency of dually identified students and the potential impact it has on their educational opportunities.
        Cover page: Dual Identification: Trajectories to English Proficiency for English Learners with Autism Spectrum Disorder.
        • Article
        • Peer Reviewed
        UCLA Previously Published Works (2022)
        This study examines autistic and non-autistic college students' experiences of discrimination and harassment and identifies protective and risk factors. A nationwide survey was used to match autistic students (N = 290) and non-autistic students (N = 290) on co-occurring diagnoses and demographic characteristics. Multiple regression and interaction analysis revealed that faculty support was protective against discrimination and harassment regardless of autism status. Habits of mind was particularly protective for autistic students against harassment. Any student who engaged in school-facilitated events was more likely to experience discrimination and harassment, but the risk was heightened for autistic students. Findings highlight the importance of faculty support in fostering positive interpersonal experiences on campus, and demonstrate the need to address deeper college campus issues with respect to neurodiversity.
          Cover page: Discrimination and Harassment Experiences of Autistic College Students and Their Neurotypical Peers: Risk and Protective Factors
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2015)

          Background

          This study examined the potential feasibility and utility of trigeminal nerve stimulation (TNS) for attention-deficit/hyperactivity disorder (ADHD) in youth.

          Methods

          Twenty-four participants ages 7-14 with ADHD enrolled in an 8-week open trial of TNS administered nightly during sleep, and were assessed weekly with parent- and physician-completed measures of ADHD symptoms and executive functioning as well as measures of treatment compliance, adverse events, and side effects. Computerized tests of cognitive functioning were administered at baseline and weeks 4 and 8.

          Results

          Significant improvements were seen on the ADHD-IV Rating Scale (P < .0001) and parent-completed Conners Global Index (P < .0001), as well as the majority of scales on the parent-completed Behavior Rating Inventory of Executive Functioning (BRIEF). Improvements were also noted on the computerized Attention Network Task (ANT) Incongruent Reaction Time (P = .006), suggesting that TNS has positive effects on response inhibition.

          Conclusions

          TNS therapy for youth with ADHD appears to be both feasible and without significant risk. Subjective improvements on rating scales and laboratory measures of cognition suggest a potential role for TNS in treating ADHD that merits further investigation. Future research in anticipation of designing definitive controlled efficacy trials should evaluate time to onset of TNS response and durability of treatment effects following TNS discontinuation, as well as validate an effective active sham comparator suitable for blinded studies.
            Creative Commons 'BY-NC' version 4.0 license
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2018)
            Predictors of math achievement in attention-deficit/hyperactivity disorder (ADHD) are not well-known. To address this gap in the literature, we examined individual differences in neurocognitive functioning domains on math computation in a cross-sectional sample of youth with ADHD. Gender and anxiety symptoms were explored as potential moderators. The sample consisted of 281 youth (aged 8-15 years) diagnosed with ADHD. Neurocognitive tasks assessed auditory-verbal working memory, visuospatial working memory, and processing speed. Auditory-verbal working memory speed significantly predicted math computation. A three-way interaction revealed that at low levels of anxious perfectionism, slower processing speed predicted poorer math computation for boys compared to girls. These findings indicate the uniquely predictive values of auditory-verbal working memory and processing speed on math computation, and their differential moderation. These findings provide preliminary support that gender and anxious perfectionism may influence the relationship between neurocognitive functioning and academic achievement.
              Cover page: The Effect of Neurocognitive Function on Math Computation in Pediatric ADHD: Moderating Influences of Anxious Perfectionism and Gender
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2018)
              Deficits in social communication are a core feature of autism spectrum disorder (ASD), yet significant social problems have been observed in youth with many neurodevelopmental disorders. In this preliminary investigation, we aimed to explore whether domains of social reciprocity (i.e., social communication, social cognition, social awareness, social motivation, and restricted and repetitive behaviors) represent transdiagnostic traits. These domains were compared across youth ages 7-17 with obsessive-compulsive disorder (OCD; N = 32), tic disorders (TD; N = 20), severe mood dysregulation (N = 33) and autism spectrum disorder (N = 35). While the ASD group was rated by parents as exhibiting the greatest social reciprocity deficits across domains, a high proportion of youth with severe mood dysregulation also exhibited pronounced deficits in social communication, cognition, and awareness. The ASD and severe mood dysregulation groups demonstrated comparable scores on the social awareness domain. In contrast, social motivation and restricted and repetitive behaviors did not appear to be transdiagnostic domains in severe mood dysregulation, OCD, or TD groups. The present work provides preliminary support that social awareness, and to a lesser extent social communication and cognition, may represent features of social reciprocity that are transdiagnostic across ASD and severe mood dysregulation.
                Cover page: Are the components of social reciprocity transdiagnostic across pediatric neurodevelopmental disorders? Evidence for common and disorder-specific social impairments
                • Article
                • Peer Reviewed
                UCLA Previously Published Works (2013)

                Objective

                The Child Behavior Checklist-Dysregulation Profile (CBCL/DP) identifies youth at increased risk for significant psychopathology. Although the genetic architecture and several biological correlates of the CBCL/DP have been described, little work has elucidated its underlying neurobiology. We examined the potential utility of electroencephalography (EEG), along with behavioral and cognitive assessments, in differentiating individuals based on the CBCL/DP.

                Method

                Participants aged 7 to 14 years of age were categorized into 3 age- and sex-matched groups based on clinical assessment and CBCL/DP: typically developing controls without attention-deficit/hyperactivity disorder (ADHD) (n = 38), individuals with ADHD without the CBCL/DP (ADHD/DP-) (n = 38), and individuals with the CBCL/DP (CBCL/DP+) (n = 38). Groups were compared with EEG and measures of clinical phenomenology and cognition.

                Results

                ADHD/DP- and CBCL/DP+ groups had increased inattention, but the CBCL/DP+ group had increased hyperactive/impulsive symptoms, disruptive behavior, mood, and anxiety comorbidities compared with the group with ADHD alone. Cognitive profiles suggested that ADHD/DP-participants had fast impulsive responses, whereas CBCL/DP+ participants were slow and inattentive. On EEG, CBCL/DP+ had a distinct profile of attenuated δ-band and elevated α-band spectral power in the central and parietal regions compared to ADHD/DP- and controls. The low-δ/high-α profile was correlated with measures of emotion and behavior problems and not with inattentive symptomatology or cognitive measures. There were no EEG differences between the ADHD/DP- and control groups.

                Conclusions

                An EEG/cognitive profile suggests a distinct pattern of underlying neural dysfunction with the CBCL/DP that might ultimately serve as a biosignature. Further work is required to identify potential relationships with clinically defined psychiatric disorders, particularly those of dysregulated mood.
                  Cover page: A Potential Electroencephalography and Cognitive Biosignature for the Child Behavior Checklist–Dysregulation Profile
                  • Article
                  • Peer Reviewed
                  UCLA Previously Published Works (2022)
                  BACKGROUND: Cognitive control processes are implicated in the behavioral treatment of Tourettes disorder (TD). However, the influence of these processes on treatment outcomes has received minimal attention. This study examined whether cognitive control processes and/or tic suppression predicted reductions in tic severity and treatment response to behavior therapy. METHOD: Fifty-three youth with TD or a pervasive tic disorder participated in a randomized wait list-controlled trial of behavior therapy. Following a baseline assessment to evaluate psychiatric diagnoses, tic severity, and cognitive control processes (e.g., response selection, inhibition, and suppression), youth were randomly assigned to receive eight sessions of behavior therapy (n = 23) or a wait list of equal duration (n = 28). Youth receiving immediate treatment completed a post-treatment assessment to determine improvement in tic severity. Meanwhile, youth in the wait list condition completed another assessment to re-evaluate tic severity and cognitive control processes, and subsequently received 8 sessions of behavior therapy followed by a post-treatment assessment to determine improvement. RESULTS: A multiple linear regression model found that pretreatment inhibition/switching on the Delis-Kaplan Executive Function System Color-Word Interference Test predicted reductions in tic severity after behavior therapy (β = -.36, t = -2.35, p = .025, ƞ2  = .15). However, other cognitive control processes and tic suppression did not predict treatment response and/or reductions in tic severity. Small nonsignificant effects were observed in cognitive control processes after behavior therapy. CONCLUSION: Cognitive control processes may influence tic severity reductions in behavior therapy. Notably, even when other cognitive control processes are impaired and youth are initially unable to voluntarily suppress their tics, youth with TD can still benefit from behavior therapy. Findings offer implications for clinical practice and research for TD.
                    Cover page: Cognitive control processes in behavior therapy for youth with Tourettes disorder.
                    • Article
                    • Peer Reviewed
                    UCLA Previously Published Works (2019)

                    Objective

                    Trigeminal nerve stimulation (TNS), a minimal-risk noninvasive neuromodulation method, showed potential benefits for attention-deficit/hyperactivity disorder (ADHD) in an unblinded open study. The present blinded sham-controlled trial was conducted to assess the efficacy and safety of TNS for ADHD and potential changes in brain spectral power using resting-state quantitative electroencephalography.

                    Method

                    Sixty-two children 8 to 12 years old, with full-scale IQ of at least 85 and Schedule for Affective Disorders and Schizophrenia-diagnosed ADHD, were randomized to 4 weeks of nightly treatment with active or sham TNS, followed by 1 week without intervention. Assessments included weekly clinician-administered ADHD Rating Scales (ADHD-RS) and Clinical Global Impression (CGI) scales and quantitative electroencephalography at baseline and week 4.

                    Results

                    ADHD-RS total scores showed significant group-by-time interactions (F1,228 = 8.12, p = .005; week 4 Cohen d = 0.5). CGI-Improvement scores also favored active treatment (χ21,168 = 8.75, p = .003; number needed to treat = 3). Resting-state quantitative electroencephalography showed increased spectral power in the right frontal and frontal midline frequency bands with active TNS. Neither group had clinically meaningful adverse events.

                    Conclusion

                    This study demonstrates TNS efficacy for ADHD in a blinded sham-controlled trial, with estimated treatment effect size similar to non-stimulants. TNS is well tolerated and has minimal risk. Additional research should examine treatment response durability and potential impact on brain development with sustained use.

                    Clinical trial registration information

                    Trigeminal Nerve Stimulation for ADHD; http://clinicaltrials.gov/; NCT02155608.
                      Cover page: Double-Blind, Sham-Controlled, Pilot Study of Trigeminal Nerve Stimulation for Attention-Deficit/Hyperactivity Disorder
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