Showing papers in "Journal of Attention Disorders in 2007"
TL;DR: Improved identification of ADHD in adult and female patients has contributed to rapid growth in ADHD medication use, and treatment prevalence increased rapidly for adults than for children, more rapidly for women than for men, and more rapid for girls than for boys.
Abstract: Objective: This study examines demographic trends in the use of medications to treat ADHD in adult and pediatric populations. Method: Using pharmacy claims data for a large population of commercially insured Americans, the study measures ADHD treatment prevalence and drug use from 2000 to 2005. Results: In 2005, 4.4% of children (ages 0 to 19) and 0.8% of adults (ages 20 and older) used ADHD medications. Treatment rates were higher in boys (6.1%) than in girls (2.6%), but the rates for men and women were approximately equal (0.8%). During the period of the study, treatment prevalence increased rapidly (11.8% per year) for the population as a whole. Treatment rates grew more rapidly for adults than for children, more rapidly for women than for men, and more rapidly for girls than for boys. Conclusion: Improved identification of ADHD in adult and female patients has contributed to rapid growth in ADHD medication use. (J. of Att. Dis. 2007; 10(4) 335-342)
245 citations
TL;DR: The validity and clinical usefulness of the Behavior Rating Inventory of Executive Function, a behavior rating scale designed to assess dimensions of EF, are evaluated, indicating low interrater reliability but acceptable convergent validity.
Abstract: Objective: Current theories hypothesize that deficits in executive functioning (EF) are responsible for the symptoms of ADHD and that specific patterns of EF deficits may be associated with different subtypes of ADHD. The present study evaluates the validity and clinical usefulness of the Behavior Rating Inventory of Executive Function, a behavior rating scale designed to assess dimensions of EF. Method: Participants include 70 boys and girls between the ages of 5 and 13 referred to a university-based clinic for assessment of ADHD. Results: Results indicate low interrater reliability but acceptable convergent validity. Conclusion: Parent report on the Behavior Regulation scale differentiates the ADHD—Combined Type group from the ADHD—Inattentive Type and non-ADHD groups, and the Metacognitive Index differentiates both ADHD subtypes from the non-ADHD group, thus supporting the clinical utility of this measure in a clinic-referred sample. (J. of Att. Dis. 2007; 10(4) 381-389)
191 citations
TL;DR: There does not appear to be sufficient justification for the conclusion that ADHD is systematically overdiagnosed, and this conclusion is generally not reflected in public perceptions or media coverage of ADHD.
Abstract: Objective: According to the DSM-IV TR, approximately 3 to 7% of school-age children meet the criteria for ADHD. However, there is a common conception that ADHD is overdiagnosed. The purpose of this article is to evaluate the evidence for and against overdiagnosis. Method: Recent prevalence studies and research on factors affecting diagnostic accuracy were reviewed. For ADHD to be overdiagnosed, the rate of false positives (i.e., children inappropriately diagnosed with ADHD) must substantially exceed the number of false negatives (children with ADHD who are not identified or diagnosed). Results and Conclusion: Based on the review of prevalence studies and research on the diagnostic process, there does not appear to be sufficient justification for the conclusion that ADHD is systematically overdiagnosed. Yet, this conclusion is generally not reflected in public perceptions or media coverage of ADHD. Potential explanations for the persistence of the belief in the overdiagnosis of ADHD are offered. (J. of Att...
171 citations
TL;DR: Findings provide evidence of ADHD-related impairment in adult relationships, further differentiate the principal ADHD subtypes, and extend the RS literature to this clinical population.
Abstract: Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) has been consistently linked to social maladjustment. This study investigated whether elevated rejection sensitivity (RS) could contribute to the relational problems that adults with ADHD encounter. Method: Undergraduate men in ADHD-Combined Type (ADHD-C; n = 31), ADHD-Primarily Inattentive Type (ADHD-IA; n = 22), and nondiagnosed control (NC; n = 25) groups completed questionnaires concerning RS, relational history, current relationships, and self-esteem. Results: The hypothesis that those with ADHD would have elevated RS (versus NC peers) was not supported. However, low RS predicted divergent outcomes across groups. Furthermore, ADHD-IA men reported more negative relational outcomes than their ADHD-C peers, although both groups reported lower general self-esteem than controls. Conclusion: Perhaps the positive illusory bias associated with childhood ADHD could buffer RS development. Findings provide evidence of ADHD-related impairment in adult relationships, further differentiate the principal ADHD subtypes, and extend the RS literature to this clinical population.
99 citations
TL;DR: It is indicated that increasing helping and rule- following behaviors may improve peer functioning of children with ADHD in similar settings.
Abstract: Objective: Children with ADHD experience peer problems that may place them at risk for adverse outcomes. Using a short-term longitudinal design, this study links specific behaviors to peer functioning in groups of previously unfamiliar children with ADHD. Method: The participants were 268 children with ADHD who took part in an intensive summer treatment program. The program used a comprehensive behavioral point system that yielded observational data for 12 behavioral categories. These behavioral categories were used to predict peer acceptance, rejection, and liking assessed at three times during the program. Results: Following activity rules, helping, whining, and attention emerged as best predictors of initial peer status. Subsequent helping behaviors and activity rule following predicted changes in peer status, but their contributions were small. Conclusion: The results indicate that increasing helping and rule- following behaviors may improve peer functioning of children with ADHD in similar settings. ...
98 citations
TL;DR: In this article, the authors compare psychiatric comorbidity between the three symptom subtypes of Attention-Deficit/Hyperactivity Disorder (ADHD), Inattentive (I), Hyperactive-Impulsive (H), and Combined (C).
Abstract: Objective: To compare psychiatric comorbidity between the three symptom subtypes of Attention-Deficit/Hyperactivity Disorder (ADHD), Inattentive (I), Hyperactive-Impulsive (H), and Combined (C), in...
97 citations
TL;DR: The Conner’s Continuous Performance Test reliably differentiated between individuals with ADHD and both normal college students and individuals with psychiatric diagnoses but not persons with learning/cognitive disorders.
Abstract: Objective/Method: The Conner’s Continuous Performance Test (CPT) was administered to four groups of adult college students who self-referred for comprehensive psychoeducational evaluation and received either no diagnosis (n = 30) or a diagnosis of ADHD (n = 26), a psychiatric disorder (n = 17), or various cognitive deficits (n = 22).Results: The groups did not differ with respect to age, sex, race, or IQ. Although the ADHD group made more CPT errors of omission, had longer response times, and showed greater variability in responding than the other three groups, these differences did not reach statistical significance when analyzed parametrically using standard scores. But when the pattern of scores across the groups was analyzed nonparametrically, significant and interpretable results emerged.Conclusion: The CPT reliably differentiated between individuals with ADHD and both normal college students and individuals with psychiatric diagnoses but not persons with learning/cognitive disorders.
94 citations
TL;DR: Investigation of how the academic skills of children diagnosed with ADHD are perceived by teachers, parents, and the children themselves shows that for ADHD-diagnosed girls compared to other girls, both parents' and teachers' perceptions are substantially more negative.
Abstract: Objective: This study investigates how the academic skills of children diagnosed with ADHD are perceived by teachers, parents, and the children themselves. Method: The authors analyze data collected for third graders in spring 2002 in the nationally representative Early Childhood Longitudinal Survey. They use linear regressions to estimate independent associations between perceptions of academic abilities and parent-reported ADHD diagnoses, controlling for scores on standardized reading and math tests, assessments of externalizing behaviors, and other factors. Results: Results show that for ADHD-diagnosed girls compared to other girls, both parents’ and teachers’ perceptions are substantially more negative. For ADHD-diagnosed boys, the differentials are also negative but less pronounced. Self-perceptions are not significantly different by ADHD status, except for boys’ more negative self-perceptions related to math. Conclusion: Given the potentially damaging effects of these negative perceptions and expectations on self-esteem, motivation, and performance, efforts may be needed to bring perceptions of ADHD children more in line with the abilities they demonstrate on objective assessments. (J. of Att. Dis. 2007; 10(4) 390-397)
93 citations
TL;DR: It is concluded that a higher prevalence of ADHD exists in psychiatric nonpsychotic adult outpatients compared with nonclinical participants, and in the psychiatric adultOutpatients, females showed a higher likelihood of ADHD than males.
Abstract: Objective: The prevalence of ADHD in the general adult population has been estimated to be about 4.4%. However, few studies exist in which the prevalence of ADHD in psychiatric adult outpatient samples has been estimated. These studies suggest that the prevalence is higher than in the general population. The objective of this study is to estimate the prevalence of ADHD in a psychiatric nonpsychotic adult outpatient sample and to compare this data with the prevalence of a group of nonclinical participants. Method: The structured clinical interview Mini International Neuropsychiatric Interview (M.I.N.I.-Plus) was applied to 161 consecutive nonpsychotic psychiatric adult outpatients and to 149 healthy participants from the community. In addition, clinical rating scales were applied to measure the severity of general psychopathology such as mania, anxiety, depression, ADHD, and alcohol consumption in both groups. Results: The prevalence of ADHD in psychiatric nonpsychotic adult outpatients was 16.80% and 5.37...
92 citations
TL;DR: Abnormal brain function among adult ADHD participants was not limited to complex executive functions, and abnormal processing of numeric stimuli was indicated during both simple and complex cognitive operations.
Abstract: Objective: Executive dysfunction in ADHD is well supported. However, recent studies suggest that more fundamental impairments may be contributing. We assessed brain function in adults with ADHD during simple and complex forms of processing. Method: We used functional magnetic resonance imaging with forward and backward digit spans to investigate number repetitions and complex working memory function. If pathology is limited to higher cognitive operations, group differences should be confined to the backward condition. Results: During the forward digit span, ADHD participants exhibited greater activation of LH linguistic processing areas and increased activation of right frontal and parietal cortices. During the backward digit span, they exhibited greater activation of LH linguistic processing areas and failed to activate bilateral parietal regions important for the complex executive operations. Conclusion: Abnormal brain function among adult ADHD participants was not limited to complex executive functions...
91 citations
TL;DR: The absence of DSF suggests that previous reports of low parent-teacher agreement are likely to reflect a true state of affairs and that parent and teacher ratings can be compared.
Abstract: Objective: The aims of the study were to examine differential symptom functioning (DSF) and agreement across parent and teacher ratings for the DSM-IV ADHD inattention (IA) and hyperactivity/impulsivity (HI) symptoms, listed in the Disruptive Behavior Rating Scale (DBRS). Method: DSF was examined using a parametric technique involving ordinal logistic regression, and also a nonparametric technique known as kernel smoothing implemented in the program TestGraf. To accomplish the aims, Australian parents and teachers completed the DBRS for 213 children, between 6 and 11 years of age. Results: The results of both analytical procedures showed no DSF across all the IA and HI symptoms. Additional results indicated low parent-teacher agreement. Conclusion: The absence of DSF suggests that previous reports of low parent-teacher agreement are likely to reflect a true state of affairs and that parent and teacher ratings can be compared. In this context, the low parent-teacher agreement can be interpreted as indicati...
TL;DR: Although the Behavioral rating scales were successful at distinguishing clinical from nonclinical participants, their ability to distinguish among different clinical groups deserves further investigation.
Abstract: Objective: Behavioral rating scales are common instruments used in evaluations of ADHD and executive function. It is important to explore how different diagnostic groups perform on these measures, as this information can be used to provide criterion-related validity evidence for the measures. Method: Data from 92 children and adolescents were used to examine differences among participants in a No Diagnosis group, ADHD group, and Other Clinical group in terms of parent and teacher ratings on the Behavior Rating Inventory of Executive Function (BRIEF) and Conners' Rating Scales Revised—Short Form. Results: Participants in the ADHD and Other Clinical groups generally received similar scores on the scales, and both groups were generally rated higher in ADHD characteristics and executive dysfunction than were participants in the No Diagnosis group. Conclusion: Although the measures were successful at distinguishing clinical from nonclinical participants, their ability to distinguish among different clinical gr...
TL;DR: Older age, low starting dose, minority ethnic status, and fewer ADHD symptoms were associated with low adherence, and the results provide guidance to physicians seeking to identify those patients with ADHD most likely not be adherent to stimulant therapy.
Abstract: Objective: Treatment adherence is an important aspect of ADHD symptom management, but there are many factors that may influence adherence. Method: This analysis assessed adherence to OROS methylphenidate during a 1-year, open-label study in children. Adherence was defined as the number of days medication was taken divided by the number of days in the study and determined to be high if ≥75%. Possible clinical and demographic factors associated with adherence, including use of planned medication breaks, were assessed. Results: Mean adherence was 86.4%. It was 91.6% for the subgroup of patients who reported not taking planned medication breaks (n = 252) and 77.7% for the subgroup taking planned medication breaks (n = 155). Overall, 75% of patients showed high adherence. Older age, low starting dose, minority ethnic status, and fewer ADHD symptoms were associated with low adherence. Conclusion: Various factors were found to be associated with low adherence, and the results of this analysis provide guidance to...
TL;DR: Self-report of adherence to ADHD medications may be a useful and expedient way of assessing adherence, and that assessment and counseling about adherence may be an important part of treatment.
Abstract: Objective: One of the potential causes of residual symptoms of ADHD in adults can be difficulties with consistent adherence to medications.Method: This formative study examined self-reported medication adherence in adults with ADHD with clinically significant symptoms despite medication treatment.Results: Mean adherence for the two-week period prior to the assessment point was 86%, with 18% of the sample reporting less than 80% adherence, and 43% less than 90% adherence. Adherence correlated with ADHD symptoms but not anxiety or depression. Those with less than 80% adherence had higher ADHD severity compared to those whose adherence was at least 80%.Conclusion: These data suggest that self-report of adherence to ADHD medications may be a useful and expedient way of assessing adherence, and that assessment and counseling about adherence may be an important part of treatment. Future research using an objective indicator of adherence is needed to follow up on these findings.
TL;DR: Results suggest that self- and collateral reports of inattentive and hyperactive/impulsive symptoms are highly correlated, as are self-report measures and diagnostic interviews, and it was found that probands report more inATTentive symptoms than collaterals in both childhood and currently.
Abstract: Objective: Recent evidence suggests that ADHD persists into adulthood, but the best means of diagnosis and the concordance of measures used to diagnose adult ADHD are unknown.Method: The current st...
TL;DR: The ADHD groups report more depression and anxiety, greater childhood dissatisfaction, a more external locus of control and lower self-esteem, and being more likely to be classified with a maladaptive attributional style than controls.
Abstract: Objective: This study investigates attributional styles and psychosocial functioning of men and women with ADHD identified in adulthood to inform practice issues.Method: One hundred and eighty adults participate: 52 females with ADHD, 37 males with ADHD, 51 female controls, and 40 male controls are administered questionnaires broadly assessing attributional style and psychosocial functioning.Results: The ADHD groups report more depression and anxiety, greater childhood dissatisfaction, a more external locus of control and lower self-esteem, and being more likely to be classified with a maladaptive attributional style than controls. No specific gender differences are noted in the ADHD groups, although a few overall gender differences emerge, with males reporting lower self-esteem, a more external locus of control, and more dissatisfaction in childhood than females.Conclusion: Consistent with other research, ADHD participants, regardless of gender, are struggling significantly with psychosocial functioning.
TL;DR: Meta-analytic procedures are used to review the literature of combined treatments of psychosocial and pharmacological treatments for children diagnosed with ADHD and reveal large effect sizes for the core features of the disorder and the peripheral feature of social skills.
Abstract: Objective: Meta-analytic procedures are used to review the literature of combined treatments of psychosocial and pharmacological treatments for children diagnosed with ADHD.Method: Eight combined treatment studies meet specific inclusion and exclusion criteria regarding the core and peripheral features of the disorder.Results: The results of this study highlight the individual and average effect sizes within the categories of inattention, hyperactivity, impulsivity, social skills, and academics. These findings are compared with the effect sizes of meta-analytic findings previously reported in the pharmacological literature.Conclusion: The results reveal large effect sizes for the core features of the disorder and the peripheral feature of social skills. A small effect size is found for the peripheral feature of academics. Findings are discussed in light of the paucity of included studies focused on combined treatments for ADHD.
TL;DR: The relative contributions of measures of attention problems and hyperactivity to the prediction of college grade point average (GPA) were examined in a sample of 316 students enrolled in introductory psychology and sociology classes at a southeastern university.
Abstract: Objective: This study examined the relative contributions of measures of attention problems and hyperactivity to the prediction of college grade point average (GPA). Method: A sample of 316 student...
TL;DR: The ADHD Impact Module for Adults (AIM-A) as mentioned in this paper was developed to dimension quality of life for adults with attention-deficit/hyperactivity disorder (ADHD).
Abstract: Objective: To develop and evaluate a questionnaire, the ADHD Impact Module for Adults (AIM-A), to dimension quality of life for adults with attention-deficit/hyperactivity disorder (ADHD). Method: Six multi-item AIM scales were developed and evaluated in 317 participants enrolled in an open-label trial. Multitrait scaling analysis and correlations between the AIM-A and the ADHD Rating Scale were evaluated. Differences in scale scores based on severity (clinician rated), subtype, previous medication experience, and sensitivity to change were examined, and F statistics were compared for the AIM-A and the ADHD Rating Scale. Results: 100-80% scaling successes were observed for the AIM-A scales. Alpha coefficients were ≥.83. Significant correlations were observed (range: .494 to .200). The AIM-A discriminated based on severity, subtype, and medication experience (p ≤ .01) and was sensitive to change (n = 23, p ≤ .001). Conclusion: Psychometric findings are encouraging. Future efforts will examine validity and ...
TL;DR: A mixed pattern of results such that atomoxetine warrants further study for its effects on driving in this high-risk population of adults with ADHD are found.
Abstract: Objective: There is a high risk of vehicular crashes, traffic citations, and poorer driving performance in adults with ADHD. This pilot study examines the value of a new nonstimulant (atomoxetine) for improving the driving performance of adults with ADHD.Method: Atomoxetine (1.2 mg/kg daily for 3 weeks) and a placebo are studied on 18 adults with ADHD (M age = 37 years) using ratings of ADHD symptoms, impairment, and safe driving behavior; a virtual reality driving simulator; and ratings of simulator performance.Results: Atomoxetine improves self-ratings of ADHD symptoms, impairments, safe driving behavior, and simulator driving performance. No effects of atomoxetine are evident on others’ ratings of driving behavior or on the simulator. Practice effects on the simulator may have obscured those drug effects.Conclusion: The authors find a mixed pattern of results such that atomoxetine warrants further study for its effects on driving in this high-risk population.
TL;DR: Findings are consistent with the notion that an insular, dependent, and somewhat controlling family environment characterizes families of children with ADHD and comorbid childhood anxiety.
Abstract: Objective: To investigate the family environments of children in a community sample with ADHD and co-occurring anxiety.Method: Family Environment Scale, Behavioral Assessment System for Children, a...
TL;DR: Clinification of the neurological consequences of chronic AMPH treatment for ADHD is needed because more recent studies appear contradictory.
Abstract: Objective: A review of amphetamine treatment for attention-deficit/hyperactivity disorder (ADHD) was conducted, to obtain information on the long-term neurological consequences of this therapy. Met...
TL;DR: Children with VCFS+ADHD may have a different profile of ADHD symptoms and comorbidity when compared to children with idiopathic ADHD.
Abstract: Objective: Background: Children with velocardiofacial syndrome (VCFS), a contiguous deletion syndrome, have an increased prevalence of attention deficit/hyperactivity disorder (ADHD). Method: The authors compared youth with VCFS+ADHD (from the SUNY Upstate VCFS Research Program) to those with ADHD but not VCFS (from the Massachusetts General Hospital Longitudinal Family Studies of ADHD). Results: Children with VCFS+ADHD were more likely to be diagnosed with the inattentive subtype and differed from idiopathic ADHD in the frequency of several inattentive symptoms that appear linked to general cognitive functioning. After controlling for IQ differences, parents of children with VCFS+ADHD endorsed more thought and social problems on a rating checklist. Patterns of comorbidity also differed between the two groups of children with ADHD: Children with idiopathic ADHD had higher rates of comorbid major depression and disruptive behavior disorders. Conclusion: Children with VCFS+ADHD may have a different profile ...
TL;DR: Findings support the distinction between ADHD and ODD symptom presentations in adults, and the notion that the comorbid condition is a unique clinical entity, both of which are consistent with the child literature.
Abstract: Objective: To seek evidence for the validity of oppositional defiant disorder (ODD) as a behavioral syndrome in adults. Method: Two samples of adults, mental health outpatient clinic referrals (N = 490) and community controls (N = 900), completed a Diagnostic and Statistic Manual of Mental Disorders—referenced rating scale and a brief questionnaire (social, educational, occupational, and treatment variables). Participants were separated into four groups: ODD-only, ADHD-only, ODD+ADHD, and NONE. Results: In general, the three symptom groups were more severe than the NONE group; the ODD+ADHD and NONE groups were the most and least severe, respectively; and there were clear differences between the ODD-only and ADHD-only groups. The pattern of group differences was generally similar in both samples. Conclusion: Findings support the distinction between ADHD and ODD symptom presentations in adults, and the notion that the comorbid condition is a unique clinical entity, both of which are consistent with the chil...
TL;DR: Results support the growing evidence that CPTs currently provide only modest utility for discriminating performance in adults with and without ADHD, and recommend the future study of C PTs as a valid measure of ADHD performance and the potential utility of the flicker task.
Abstract: Objective: To examine the ability of the flicker task to demonstrate greater utility in discriminating performance in young adults with and without ADHD compared to the Conners' CPT (CCPT). Method: Flicker task and CCPT performance were compared between an ADHD (n = 28) and control (n = 30) group of college students. Results: This study replicated previous flicker task findings, providing support for using the flicker task to demonstrate the robust nature of change blindness. However, the flicker task did not demonstrate better discriminative utility than the CCPT. Task-dependent measures correlated with ADHD rating scale indices of inattention and hyperactivity/impulsivity, indicating that CPTs lack symptom domain specificity. Conclusion: Results support the growing evidence that CPTs currently provide only modest utility for discriminating performance in adults with and without ADHD. Recommendations are provided regarding the future study of CPTs as a valid measure of ADHD performance and the potential ...
TL;DR: The findings resolve a previous contradiction in the literature regarding the relationship between child depressive symptoms and parental perceptions of parent—child relationship quality.
Abstract: Objective/Method: Predictors of perceptions of parent—child relationship quality were examined for 175 children with ADHD, 119 comparison children, and parents of these children, drawn from the fol...
TL;DR: This study suggests that relative advantages of MAS-XR seen in the first 3 weeks are likely to be maintained in subsequent weeks, and treatment differences in each outcome measure at subsequent weeks are projected from generalized estimating equations to become greater with the duration of extension of the treatment regimen.
Abstract: Objective: Compare observed and forecasted efficacy of mixed amphetamine salts extended release (MAS-XR; Adderall) with atomoxetine (Strattera) in ADHD children. Method: The authors analyze data from a randomized, double-blind, multicenter, parallel-group, forced-dose-escalation laboratory school study of children ages 6 to 12 with ADHD combined or hyperactive/impulsive type. Primary efficacy measures are attention and deportment scores on the SKAMP behavioral rating scale, and secondary efficacy measures are academic performance scores from the PERMP test. Results: MAS-XR elicits greater improvements than atomoxetine in each domain within 3 weeks of treatment, including attention, number of math problems attempted and correct, and overall clinical functioning. Treatment differences in each outcome measure at subsequent weeks are projected from generalized estimating equations to become greater with the duration of extension of the treatment regimen. Conclusion: This study suggests that relative advantage...
TL;DR: During the past few months seventeen patients have been referred to the neuropsychiatric clinic for examination, because of marked behavior abnormalities, including marked sexual precocity was exhibited in two cases and the patient attempted to kill other members of his family in another case.
Abstract: In reviewing the enormous number of articles on all phases of acute epidemic encephalitis one cannot help being impressed by the lack of attention paid to children who have suffered from this disease. This is especially true of the important neuropsychiatric sequelae. Few articles deal exclusively with acute epidemic encephalitis in children. Happ and Blackfan,1Happ and Mason,2Grossman,3Leahly and Sands,4and recently Hohman5have written on this subject, the two last named having confined their remarks to the psychiatric manifestations of this interesting and protean disease. During the past few months seventeen patients have been referred to the neuropsychiatric clinic for examination, because of marked behavior abnormalities. Many of these patients were referred directly by the school authorities because they had been unmanageable and unable to progress in school. Frequently, they had disturbed the whole class, since they were very quarrelsome and impulsive
TL;DR: Grade repetition is a frequent complication in NF1 and correlates with inattention in individuals with this disease and mainly affected kindergarten and first-grade levels.
Abstract: Objective: The authors analyze the occurrence of grade repetition and inattention in children diagnosed with neurofibromatosis type 1 (NF1). Method: The participant group consisted of 310 patients with NF1 and a control group of 242 individuals. The number of grade repetitions for each participant during his or her time in elementary, middle, and high school was noted and the inattention score was calculated from the Barkley's ADHD Clinic Parent Interview form. Results: Fifty-three percent of NF1 patients versus 25% of the controls had increased grade repetition, P2 (1) = 27.41, p < .0001, and 67% of NF1 patients versus 14% of controls were found to be inattentive, 2 (1) = 27.41, p < .0001. Repetition mainly affected kindergarten and first-grade levels and the inattention score significantly correlated with grade repetition prevalence in NF1 patients (r2 = .7429, p < .0004). Conclusion: Grade repetition is a frequent complication in NF1 and correlates with inattention in individuals with this disease. (J....