Jeffery N. Epstein

Cincinnati Children's Hospital Medical Center

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Co-Authors

Leanne Tamm

Cincinnati Children's Hospital Medical Center

Joshua M. Langberg

Rutgers, The State University of New Jersey

Stephen P. Becker

Cincinnati Children's Hospital Medical Center

Stephen P. Hinshaw

University of California, San Francisco

James M. Swanson

University of California, Irvine

William B. Brinkman

Cincinnati Children's Hospital Medical Center

L. Eugene Arnold

The Ohio State University

Brooke S. G. Molina

University of Pittsburgh

Lily Hechtman

Montreal Children's Hospital

James Peugh

Cincinnati Children's Hospital Medical Center

Cooperative Institutions

Cincinnati Children's Hospital Medical Center

156

Radboud University Nijmegen

139

Amsterdam UMC Location VUmc

134

Radboud University Medical Center

125

Sunovion (United States)

121

University of Cincinnati

111

University of Cincinnati Medical Center

Harvard University

University of Southern California

University of California, Irvine

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Racial differences on the Conners Teacher Rating Scale.

Journal of Abnormal Child Psychology (1998)

Jeffery N. Epstein John S. March C. Keith Conners Don L. Jackson

10.1023/a:1022617821422

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Citations (111)

Frontostriatal Connectivity and Its Role in Cognitive Control in Parent-Child Dyads With ADHD

American Journal of Psychiatry (2007)

B.J. Casey Jeffery N. Epstein Jason Buhle Conor Liston Matthew C. Davidson

Objective: Many studies have linked the structure and function of frontostriatal circuitry to cognitive control deficits in attention deficit hyperactivity disorder (ADHD). Few studies have examined the role of white matter tracts between these structures or the extent to which white matter tract myelination and regularity correlate in family members with the disorder. Method: Functional imaging maps from a go/nogo task were used to identify portions of the ventral prefrontal cortex and striatum involved in suppressing an inappropriate action (i.e., cognitive control) in 30 parent-child dyads (N=60), including 20 dyads (N=40) with ADHD and 10 dyads (N=20) without ADHD. An automated fiber-tracking algorithm was used to delineate white matter fibers adjacent to these functionally defined regions based on diffusion tensor images. Fractional anisotropy, an index of white matter tract myelination and regularity derived from diffusion tensor images, was calculated to characterize the associations between white matter tracts and function. Results: Fractional anisotropy in right prefrontal fiber tracts correlated with both functional activity in the inferior frontal gyrus and caudate nucleus and performance of a go/nogo task in parent-child dyads with ADHD, even after controlling for age. Prefrontal fiber tract measures were tightly associated between ADHD parents and their children. Conclusions: Collectively, these findings support previous studies suggesting heritability of frontostriatal structures among individuals with ADHD and suggest disruption in frontostriatal white matter tracts as one possible pathway to the disorder.

Inferior frontal gyrus

Caudate nucleus

Cognitive flexibility

Middle frontal gyrus

10.1176/appi.ajp.2007.06101754

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Citations (259)

Organizational-skills interventions in the treatment of ADHD

Expert Review of Neurotherapeutics (2008)

Joshua M. Langberg Jeffery N. Epstein Amanda J. Graham

Children with attention-deficit/hyperactivity disorder (ADHD) often experience problems with temporal and materials organization. These difficulties remain prominent throughout development. For children, organizational problems are most apparent in the school setting and result in impairments such as lost and forgotten homework assignments and inadequate planning for tests. Temporal aspects of organization tend to be most salient for adults with ADHD and manifest as procrastination and missed appointments and deadlines. Skills and strategy training interventions have been developed to address the organizational problems of children and adults with ADHD. Patients are taught systems for managing their time and materials more effectively. Contingency management is often used in conjunction with organizational skills training to promote the use of organizational skills and their generalization. Organizational skills interventions have been evaluated as standalone interventions and part of multicomponent interventions for children, adolescents and adults with ADHD. These interventions are associated with significant improvements in the organization of materials, homework management, time management and planning. There is also some evidence to suggest that organizational improvements lead to reductions in ADHD symptoms and gains in academic functioning. Additional research using randomized controlled research designs and long-term follow-up evaluation is necessary before organizational interventions may be considered established evidence-based interventions for patients with ADHD.

Procrastination

Contingency management

Contingency

10.1586/14737175.8.10.1549

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Citations (74)

Neuroanatomical Abnormalities in Adolescents With Attention-Deficit/Hyperactivity Disorder

Journal of the American Academy of Child & Adolescent Psychiatry (2008)

Amy Garrett Lauren Penniman Jeffery N. Epstein B. J. Casey Stephen P. Hinshaw

Frontal lobe

Caudate nucleus

10.1097/chi.0b013e318185d285

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Citations (37)

Extended Visual Glances Away from the Roadway are Associated with ADHD- and Texting-Related Driving Performance Deficits in Adolescents

Journal of Abnormal Child Psychology (2014)

Kathleen M. Kingery Megan E. Narad Annie A. Garner Tanya N. Antonini Leanne Tamm

Distracted driving

10.1007/s10802-014-9954-x

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Citations (33)

Continuous Performance Test Results of Adults with Attention Deficit Hyperactivity Disorder

The Clinical Neuropsychologist (1998)

Jeffery N. Epstein C. Keith Conners Gill Sitarenios Drew Erhardt

Abstract Although Attention Deficit Hyperactivity Disorder (ADHD) is well established as a diagnosis in childhood, the diagnosis in adults remains controversial. The present study compared the Continuous Performance Test (CPT) performance of 60 clinic-referred adults with current ADHD symptomatology to normal subjects. Adults with current ADHD symptoms were found to make more errors of omission and commission than did normal adults. The signal detection theory variable, d', indicated that patients with ADHD were less sensitive to stimulus features than were normals. Using several CPT measures to predict group status, the CPT appeared to be of moderate clinical utility. These CPT results lend convergent validity to similar results in child populations and help to establish ADHD as a valid disorder of adulthood.

Attention deficit disorder

Attention deficits

10.1076/clin.12.2.155.2000

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Citations (140)

Psychometric Validation of the Revised Child Anxiety and Depression Scales–Parent Version (RCADS-P) in Children Evaluated for ADHD

Assessment (2017)

Stephen P. Becker Dana N. Schindler Aaron M. Luebbe Leanne Tamm Jeffery N. Epstein

Children with attention-deficit/hyperactivity disorder (ADHD) frequently experience comorbid internalizing symptoms. The Revised Child Anxiety and Depression Scales–Parent Version (RCADS-P) is a frequently used measure of anxiety and depression in children, though its psychometric properties remain unexamined in children referred for ADHD specifically. The present study evaluated the RCADS-P in 372 children (age 7-12 years; 68% male) referred for evaluation at an ADHD specialty clinic (89% met criteria for ADHD). In addition to the RCADS-P, parents completed the Vanderbilt ADHD Diagnostic Rating Scale and Child Behavior Checklist and were administered the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children semistructured diagnostic interview. Teacher ratings were available for approximately half of the sample. Factor structure, reliability, convergent/discriminant validity, and sensitivity/specificity were examined. Results supported the six-factor structure of the RCADS-P. The RCADS-P demonstrated adequate internal consistency as well as convergent and discriminant validity with other parent ratings and, to a somewhat lesser extent, teacher ratings. Children with an internalizing diagnosis had higher RCADS-P scores than children without an internalizing diagnosis. Finally, the RCADS-P had good-to-excellent diagnostic efficiency, and a total sum score of 25 had excellent sensitivity and fair specificity. Findings provide psychometric support for the RCADS-P in children with ADHD.

Discriminant validity

Convergent validity

Depression

Child psychopathology

Child Behavior Checklist

10.1177/1073191117735886

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Citations (11)

Academic Skills Groups for Middle School Children With ADHD in the Outpatient Mental Health Setting: An Open Trial

Journal of Attention Disorders (2015)

Heather A. Ciesielski Leanne Tamm Aaron J. Vaughn Jessica E. M. Cyran Jeffery N. Epstein

Objective: To conduct an open trial assessing the initial efficacy of an intervention focusing on increasing skills related to academic performance (planning, organization, studying, and homework behaviors) for middle school children diagnosed with ADHD. The intervention is modeled on evidence-based interventions but designed for administration in the outpatient setting. Method: Parents and their children diagnosed with ADHD attended seven weekly group sessions targeting academic, organizational, and homework skills. Parents completed the Homework Problem Checklist and Impairment Rating Scale pre- and post-treatment. Results: Following intervention, significant improvements in homework completion and management, as well as reductions in academic impairment and improvements in parent confidence and family relations, were reported. Conclusion: Despite limitations including small sample size and lack of a control group, our results demonstrate initial efficacy of an academic skills intervention designed for use in the outpatient setting with middle school children diagnosed with ADHD on clinically relevant outcome measures.

Open label

10.1177/1087054715584055

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Citations (9)

Psychometric Properties of an Adult ADHD Diagnostic Interview

Journal of Attention Disorders (2006)

Jeffery N. Epstein Scott H. Kollins

Although research has been conducted to support the psychometric properties of rating scales used to assess ADHD in adults, little work has been published examining semi-structured interviews to assess ADHD in adults. The present study examined the test-retest reliability and concurrent validity of the Conners Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) in a sample (N = 30) of patients referred to an outpatient clinic. Kappa statistics for individual symptoms of inattention and hyperactivity-impulsivity were in the fair to good range for current report and retrospective childhood report. Kappa values for overall diagnosis, which included all DSM-IV symptoms, were fair for both current (adult) ADHD diagnosis (kappa = .67) and childhood report (kappa = .69). Concurrent validity was demonstrated for adult hyperactive-impulsive symptoms and child inattentive symptoms. The findings are discussed in the context of overall issues pertaining to adult ADHD assessment.

10.1177/1087054705283575

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Citations (101)

Improving Attention-Deficit/Hyperactivity Disorder Treatment Outcomes Through Use of a Collaborative Consultation Treatment Service by Community-Based Pediatricians

Archives of Pediatrics and Adolescent Medicine (2007)

Jeffery N. Epstein David L. Rabiner Diane E. Johnson David P. Fitzgerald Allan K. Chrisman

Objective

To test whether adoption of a collaborative consultative service model results in improved patient outcomes.

Design

Twelve pediatric practices were randomly assigned to receive access to collaborative consultative services or to a control group.

Setting

Community-based pediatric offices.

Participants

Fifty-two pediatricians and their 377 patients with attention-deficit/hyperactivity disorder (ADHD).

Intervention

A collaborative consultative service promoting the use of titration trials and periodic monitoring during medication maintenance.

Main Outcome Measure

Physician practice behaviors and child ADHD symptomatology.

Results

Using self-report of pediatricians, the collaborative consultative service increased the use of evidence-based practices by pediatricians, but no difference in children's ADHD symptomatology was observed between the groups. However, many pediatricians did not fully use the collaborative consultative services. Those children who actually received collaborative consultative services showed significant behavioral improvement compared with children not receiving these services.

Conclusions

When actually implemented by pediatricians, the collaborative consultative service appears to be an effective method for facilitating evidence-based treatment procedures for ADHD and use of these procedures appear to improve children's outcomes. Barriers to implementation of collaborative consultative service in pediatric practice need to be further understood.

Collaborative Care

10.1001/archpedi.161.9.835

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Citations (63)